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Rural end-of-life care in New Zealand, Australia and South East Asia

Rural end-of-life care in New Zealand, Australia and South East Asia. Rod MacLeod Department of General Practice and Primary Health Care University of Auckland and North Shore Hospice, Takapuna rd.macleod@auckland.ac.nz. The overall trends – not really different ‘down under’.

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Rural end-of-life care in New Zealand, Australia and South East Asia

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  1. Ruralend-of-life care in New Zealand, Australia and South East Asia Rod MacLeod Department of General Practice and Primary Health Care University of Auckland and North Shore Hospice, Takapuna rd.macleod@auckland.ac.nz

  2. The overall trends – not really different ‘down under’ An aging population Increasing life expectancy Rising numbers of the oldest old [Growing burden of non-communicable disease] Changing family structure Shifting patterns of work and retirement Evolving social insurance systems Department of State and the Department of Health and Human Services. 2007. Why Population Aging Matters: A Global Perspective . Washington DC: National Institutes of Health

  3. Asia Pacific Hospice Palliative Care Network • 600 services throughout the region • Vary from comprehensive urban programs to rudimentary rural ones • Over 1000 members from 29 countries • Split into 5 regions • East Asia; central Asia; south-east Asia; south Asia; Pacific www.aphn.org

  4. Malaysia • Perhaps up to 40% of deaths not registered in Malaysia • Penang General Hospital 1999-2001 • Place of death • Home 94 (60%) • Penang General Hospital 41 (26%) • Nursing homes 13 (8%) • Unknown 8 (5%)

  5. Malaysia • Penang Hospice at home 1992-2005 • Place of death • Home 1999 (79%) • Hospital 515 (20%) • Nursing homes 27 (1%)

  6. Michael Wright with Ednin Hamzah, Temsak Phungrassami and Agnes Bausa-ClaudioOxford University Press Hospice and Palliative Care in Southeast Asia

  7. Australia • Foreman LM, Hunt RW, Luke CG, Roder DM. Factors predictive of preferred place of death in the general population of South Australia. Palliative Medicine 2006; 20: 447-453 • 2652 respondents aged 15+ if dying of ‘a terminal illness such as cancer or emphysema’ • Predictors of preference of preferred home death include younger age, male, born in UK/Ireland or Italy/Greece, better physical health, poorer mental health

  8. Australia

  9. Australia Currow DC, Burns CM, Abernethy AP Place of death for people with noncancer and cancer illness in South Australia: a population-based survey. Journal of Palliative Care 2008; 24,3, 144-150 9,500 households – 31% had someone close die of a terminal illness in the preceding five years 62% of deceased had accessed palliative care Palliative care involvement did not reduce institutional deaths

  10. Australia

  11. Australia

  12. Australia McNamara B, Rosenwax L Factors affecting place of death in Western Australia Health & Place 2007; 356-367 • Almost half of Western Australians died in hospital • With increasing age there is a tendency to die in your place of residence • People accessing specialist palliative care had a seven times higher chance of dying in their usual place of residence

  13. Australia 26,882 people died in WA in 2.5 year study • 48.6% died in hospital • 35.8% died in place of residence (private 20.2%; RAC 15.6%) • 5.5% died in hospice • 6.3% died in some ‘other’ place McNamara B, Rosenwax L. Factors affecting place of death in Western Australia. Health & Place 2007; 356-367

  14. Hospice care in NZ

  15. Hospice care in NZ

  16. Palliative Care Partnership Stewart B, Allan S, Keane B et al (2006) Palliative Care Partnership: a successful model of primary/secondary integration New Zealand Medical Journal 119(1242) http://www.nzma.org.nz/journal/119-1242/2235/ McKinlay E, McBain L (2007) Evaluation of the Palliative Care Partnership: a New Zealand solution to the provision of integrated palliative care New Zealand Medical Journal 120(1263) http://www.nzma.org.nz/journal/120-1263/2745/

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