Who makes it out alive?

This article was updated on March 14, 2023. It discusses palliative care patients.

Dr Katrin Gerber on the impact of grief on the elderly.

What a great headline. Katrin Gerber has used it with the added thought – “Predicting survival to discharge of hospital patients referred to residential aged care.”

Dr Gerber and her team looked retrospectively over a two year period at the files of 71 patients leaving an acute hospital in Melbourne.

“Overall, 44 per cent of the 71 palliative care patients referred for residential aged care placement died before being discharged from hospital,” she points out.

Later in her discussion she says: “Many palliative care patients are commencing upon the taxing residential aged care placement pathway with questionable benefits to them, their families, and the healthcare system. The low rate of patients surviving to discharge may reflect gaps in the recognition of dying, amongst other system-specific challenges.”

Reading the abstract of Dr Gerber’s study conjures an image. Staff at the acute care hospital and the aged care facility have to liaise. Papers have to be signed, social workers checked in with. The staff at the aged care facility need to organise transport. They need to get a bed ready.

We see the elderly person’s family members making phone calls, packing another suitcase. Maybe there’ll even be lots of to-ing and fro-ing because the logistics haven’t quite worked out the way everyone thought they would. After all, such things rarely go exactly to plan with palliative care patients.

All these organisational efforts, all for a mistaken objective.

What if it’s a missed opportunity for a family network to be called, for particular individuals to make a last visit, for a minister of religion or spiritual counsellor to be brought in?

Maybe preparing for a bricks and mortar destination, along the street and past the next set of traffic lights, all provides a distraction – even a welcome one – for those in this family who don’t want to face the impending death.

But that means the dying person is cheated and the patient’s supporters focus in the wrong place, instead of being given permission to turn their undivided attention to the person themselves and the solemn business of their dying.

Yes, much more difficult than a transfer to an aged care facility. But not being prepared for the harder outcome won’t change it.

Dr Gerber points out in her conclusion that: “Prognostic tools can feasibly be completed with routinely collected hospital data and their use is indicated to support clinical decision-making and inform transfer decisions in acute settings.”

She expands with more practical details about how the truer outcome can be foreseen, even with the information that we already collect.

It’s a great piece of research showing how using the information we already have could help us reorganise and adjust our systems only a little bit, to make the death of palliative care patients after a hospital episode, so much better.

To read the abstract of Dr Gerber’s paper, go to:

From there the portal shows ways to reach and download the full article.

We’ve published items about Dr Katrin Gerber’s research before.

To see these, go to:

and also:

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