Models of care for palliative care in residential aged care facilities: a scoping review

As the number of older people living in residential aged care facilities continues to rise, it is essential that facilities can provide high quality palliative care. However, unmet palliative care needs in residential aged care facilities are leading to inadequate end-of-life care and causing poor outcomes for older people. Various models of care are being implemented to try and address this challenge. This review aims to synthesise existing models of palliative care delivery in the residential aged care sector, to understand how best to provide palliative care in this setting.

A search of three databases (OVID Medline, Psych Info and CINAHL) between January 2009 to June 2024 found 1585 sources and 30 met the inclusion criteria of describing and/or evaluating a model of care for delivering palliative care services to people over the age of 65 years old in the residential aged care sector. Data was extracted related to model characteristics, evidence-basis, implementation factors, and evaluation outcomes.

The review identified 23 unique models of care. The models were categorised based on the principal service provider. Care was delivered either internally by the residential aged care facility (n = 14), or externally by community-based (n = 5) or hospital-based (n = 4) services. Models were developed using a range of methodologies, including based on literature, consensus-building techniques and establishing expert working groups. Services had been implemented in a range of different contexts, including metropolitan and rural settings and face-to-face or via telehealth. The evaluated models did not provide high-quality evidence of improved clinical outcomes.

There are a range of evidence-based models of care that describe comprehensive palliative care service delivery in residential aged care facilities. They have been implemented in various contexts. No model has demonstrated a high quality of evidence that it improves outcomes. Future work is needed to know how best to provide palliative care to RACF residents. This future work should be grounded in implementation science.