Advance care planning in Australia

Background Paper 5

Most older Australians are not set up to direct the way they are cared for in the event they become incapable of communicating as a result of accident, dementia, or illness. Information available to the Royal Commission into Aged Care Quality and Safety shows that even those aged 65-plus years are often ill-prepared, with only 3% having a statutory advance care directive in place.

The directives enable people to express how they want to be cared for, and that decisions and actions taken on their behalf are consistent with their goals, preferences and values, if they become incapable of making those decisions themselves.

Research on the uptake, benefits, issues and practices associated with advance care planning directives, as well as various arrangements in each state and territory, are briefly summarised in a background paper, Advance Care Planning in Australia, released today and available on the Royal Commission's website.

It says: "Advance care planning has been shown to reduce unnecessary transfers from a residential aged care facility to a hospital and decrease a person's level of worry and anxiety about their future.

"Advance care planning can also have benefits for the person's family, by improving the family's understanding of the person's wishes and reducing stress, anxiety and depression in the surviving family by helping them prepare for a death."

It also says that advance care planning may decrease depressive symptoms among those diagnosed with dementia and is particularly relevant for those approaching end-of-life.

"Advance care planning has been shown to positively influence quality end-of-life care, increase compliance with a person's preferences for their end-of-life care and increase the likelihood that a person will die in their preferred setting."

A lack of awareness and understanding about advance care planning is identified in the paper as one reason for low uptake of the directives, as is a general reluctance to discuss issues around cognitive deterioration, end-of-life and death.

"These can be very challenging conversations that require someone to engage with their own mortality and plan for worst case scenarios."

This paper is part of a series of background papers the Royal Commission will issue. Any views expressed in it are not necessarily the views of the Commissioners.

The Advance care planning in Australia: Background Paper 5 is now available on the website.

Published on 20 June 2019.

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