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Tuesday, December 5, 2023

End-of-life crisis looms for older Australians without planning

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A new national study has found that 70 per cent of Australians aged 65+ are sidestepping the opportunity to control their end-of-life care, with men less likely to plan than women.

For the 30 per cent of older Australians with some form of advance care planning (ACP) document in place, the majority of them are either incomplete, invalid or not legally binding.

This highlights a looming minefield of family conflict and confusion as a generation of baby boomers enter their twilight years and dementia now being the leading cause of death for Australians aged 85+.

Around a third of people will be unable to make their own end-of-life decisions. 

The government-funded study, led by Advance Care Planning Australia (ACPA), revealed that among the 30 per cent of older Australians with ACP documents, only 14 per cent of these were legally-binding advance care directives (ACDs) – considered to be the gold standard of ACP documents, which can only be completed by a person with decision-making capacity.

The majority of ACP documents that were found among older Australians were ‘advance care plans’, where preferences are reported by either family or healthcare professionals. These documents can be used to guide care but are not legally binding.

The study audited the health records of more than 4000 older people in hospitals, GP clinics and aged care facilities across Australia. The study also found that women were more likely to have an ACD, raising questions about what can be done to increase uptake among older Australian men, who are largely leaving their future care to chance or for others to decide for them.

“While ACP is by no means mandatory, we’re concerned for older people who expect to remain in control of their medical decisions as they age. If choice and control is important to you, advance care planning should be on your radar,” Linda Nolte, program director of ACPA, said.

“An important part of healthy ageing is making informed healthcare choices. We urge people to take active steps to control their future care and create a legally-binding ACD, while they still have decision-making capacity. 

“It means you’re more likely to get the care you want and avoid treatment you don’t want. It also relieves loved ones of the burden of making life-and-death decisions by guesswork.

“We also encourage people to ensure their ACD is coherent and properly dated, signed and witnessed. It may be the difference between whether your doctor follows your directive or not,” Nolte said.

Key advance care planning facts

  • Around 30% of people will not be able to make their own end-of-life medical decisions3.
  • Less than 15% of Australians aged 65 and over have an Advance Care Directive4
  • A third of Australians will die before the age of 755.
  • Most people die after a chronic illness, not a sudden event.
  • Research shows that advance care planning can reduce anxiety, depression and stress experienced by families and that they’re more likely to be satisfied with their loved one’s care.

About Advance Care Planning Australia

Advance Care Planning Australia (ACPA) is a national program funded by the Australian Government, Department of Health, enabling Australians to make the best choices for their life and health care.

ACPA increases advance care planning resources across health sectors and NGOs, improves workforce capability, produces information resources for diverse consumers and communities, and builds the evidence base.

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