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Palliative Care has become widely recognised as one of the most vital disciplines in Australian health, with our ageing population and increasingly effective medical treatments bringing about longer and longer final care stages of life.

Palliative care can be an awkward subject to broach – it is difficult to talk about death. However, given our ageing population and our rising rates of chronic and complex disease, including increasing instances of multiple morbidities, these discussions have never been more important and following the discussion, we must meet the growing need for carers with palliative care skills.
 

The release of the Guidelines for a Palliative Approach in Residential Aged Care(APRAC) and the Guidelines for a Palliative Approach for Aged Care in the Community Setting (COMPAC) were a significant advance in recognising and responding to changing population demography in Australia.  They aimed to support the provision of palliative care for older people living in the community or in residential aged care by identifying and evaluating the evidence for care to promote quality of life for older Australians who have a life-limiting illness or who are becoming progressively frailer during old age. The two sets of guidelines were important landmarks nationally and internationally. 
 

During National Palliative Care Week, the University of Technology Sydney (UTS) hosted a forum on dementia care planning facilitated by the Director of The Centre for Cardiovascular and Chronic Care, Faculty of Health, Professor Jane Phillips. Imelda Gilmore, an Alzheimer’s Australia NSW Dementia Advocate and wife of a person with dementia, opened the forum by highlighting the importance of “getting the word out to have conversations about end of life early on”. A recurring theme at the forum was the need for care decisions to be person-centred and focused on what the person with dementia would have wanted were they able to speak for themselves, rather than the wishes of surrogate decision-makers. Lynn Chenoweth (Professor of Nursing at the Centre for Healthy Brain Ageing, The University of New South Wales) defined person-centredness as respecting the person with dementia’s “values, beliefs, history, likes and dislikes … all of the things that make them unique”.

There is no doubt that nurses are fundamental to health care. There are over 350,000 nurses currently practising in Australia. They are the largest single health profession in Australia. But more importantly, they are most often the face of care to the person needing care. And this is particularly important to remember when thinking about the care needs of an older person who may be the last stage of their life.

Many older people spend some or all of the last year of their life at home. Some will move to residential aged care or will already be in an aged care facility. Others will live with families or friends. Some may spend time in a hospital. Nearly all will be involved with a GP and with their Practice Nurses. So not only are nurses critical in enabling good care for older Australians coming to the end of their life, they will be providing this care in many different settings.

We all know that the population is ageing; and the figures forecasted are significant with around 15% (3.6 million people) older than 65 years in 2016 (Australian Bureau of Statistics (ABS), 2013). These figures will continue to soar, and by 2031 it is estimated 19% (5.7 million) of the population will be older than 65 years (ABS, 2013).

In 2015 it was reported that 75% of people aged 65 and over who died in Australia used an aged care service in the 12 months before their death, and 60% were an aged care client at the time of their death (AIHW, 2015).  These figures alone point out the obvious key role the aged care sector plays in ensuring a person’s quality of life reaches its maximum potential as they approach the end of their lives, and inherent within that is the role aged care plays in ensuring a good death.