Abstract：
OBJECTIVE: Population-based data on the required needs for palliative care in residential aged care have been highlighted as a key information gap. This study aimed to provide a comprehensive estimate of palliative care needs among Australia\'s residential aged care population using a validated algorithm based on causes of death.
METHODS: A population-based retrospective cohort study was conducted using data from the Registry of Senior Australians of non-Indigenous residents of residential aged care services in New South Wales, Victoria, and South Australia aged older than 65 years, who died between 2016 and 2017 (n = 71,677). An internationally validated algorithm was used to estimate and characterise potential palliative care needs based on causes of death. This estimate was compared to palliative care needs identified from funding-based care needs assessment data.
RESULTS: Ninety two per cent (n = 65,949) were estimated to have had potential palliative care needs prior to their death. Of these, 19% (n = 12,467) were assigned an end-of-life trajectory related to cancer, 61% (n = 40,511) to organ failure and 20% (n = 12,971) to frailty and dementia. By comparison, only 6% (n = 4430) of residents were assessed as needing palliative care by the funding-based care needs assessment.
CONCLUSIONS: Over 90% of individuals dying in residential aged care may have benefited from a palliative approach to care. This need is substantially underestimated by the funding-based care needs assessment, which utilises a narrow definition of palliative care when death is imminent. There is a clear imperative to distinguish between palliative and end-of-life care needs within residential aged care to ensure appropriate and equitable access to palliative care.
METHODS: A population-based retrospective cohort study was conducted using data from the Registry of Senior Australians of non-Indigenous residents of residential aged care services in New South Wales, Victoria, and South Australia aged older than 65 years, who died between 2016 and 2017 (n = 71,677). An internationally validated algorithm was used to estimate and characterise potential palliative care needs based on causes of death. This estimate was compared to palliative care needs identified from funding-based care needs assessment data.
RESULTS: Ninety two per cent (n = 65,949) were estimated to have had potential palliative care needs prior to their death. Of these, 19% (n = 12,467) were assigned an end-of-life trajectory related to cancer, 61% (n = 40,511) to organ failure and 20% (n = 12,971) to frailty and dementia. By comparison, only 6% (n = 4430) of residents were assessed as needing palliative care by the funding-based care needs assessment.
CONCLUSIONS: Over 90% of individuals dying in residential aged care may have benefited from a palliative approach to care. This need is substantially underestimated by the funding-based care needs assessment, which utilises a narrow definition of palliative care when death is imminent. There is a clear imperative to distinguish between palliative and end-of-life care needs within residential aged care to ensure appropriate and equitable access to palliative care.
摘要：
目的：以人口为基础的老年护理姑息治疗所需需求的数据已被强调为一个关键的信息差距。本研究旨在使用基于死亡原因的有效算法，对澳大利亚居民老年护理人群的姑息治疗需求进行全面评估。
方法：一项基于人群的回顾性队列研究是使用来自新南威尔士州非土著居民老年人登记处的数据进行的。维多利亚,以及65岁以上的南澳大利亚,他在2016年至2017年之间去世（n=71,677）。一种经过国际验证的算法用于根据死亡原因估计和表征潜在的姑息治疗需求。将此估计值与从基于资金的护理需求评估数据中确定的姑息治疗需求进行比较。
结果：估计有92%（n=65,949）的人在死亡之前有潜在的姑息治疗需求。其中,19%(n=12,467)被分配了与癌症相关的生命终点轨迹，61％（n=40,511）患有器官衰竭，20％（n=12,971）患有虚弱和痴呆。相比之下,只有6%(n=4430)的居民通过基于资金的护理需求评估被评估为需要姑息治疗.
结论：超过90％的死于老年护理的人可能受益于姑息治疗方法。基于资金的护理需求评估大大低估了这种需求，它利用了临死时姑息治疗的狭义定义。显然，必须在老年居民护理中区分姑息治疗和临终关怀需求，以确保适当和公平地获得姑息治疗。
方法：一项基于人群的回顾性队列研究是使用来自新南威尔士州非土著居民老年人登记处的数据进行的。维多利亚,以及65岁以上的南澳大利亚,他在2016年至2017年之间去世（n=71,677）。一种经过国际验证的算法用于根据死亡原因估计和表征潜在的姑息治疗需求。将此估计值与从基于资金的护理需求评估数据中确定的姑息治疗需求进行比较。
结果：估计有92%（n=65,949）的人在死亡之前有潜在的姑息治疗需求。其中,19%(n=12,467)被分配了与癌症相关的生命终点轨迹，61％（n=40,511）患有器官衰竭，20％（n=12,971）患有虚弱和痴呆。相比之下,只有6%(n=4430)的居民通过基于资金的护理需求评估被评估为需要姑息治疗.
结论：超过90％的死于老年护理的人可能受益于姑息治疗方法。基于资金的护理需求评估大大低估了这种需求，它利用了临死时姑息治疗的狭义定义。显然，必须在老年居民护理中区分姑息治疗和临终关怀需求，以确保适当和公平地获得姑息治疗。
