In the 20th century, Australia, like many Western nations, witnessed dramatic changes in terms of life expectancy, what people died from, how they were cared for when they were dying, and how/where they died. A person who is 60-70 years old today has seen amazing improvements in the quality of healthcare and life expectancy. People are living longer than in any other period in human history. This is due to such things as the introduction of immunisation, antibiotics and advances in medical technology. Recent decades have also seen the introduction of aged care facilities to care for frail, older people who were previously cared for by their families at home. The support for people living with chronic disease has also been improved, through advancements in technology and improvements in the management of diseases.[1-2]
Australian Statistics:
- In 2022 there were 190,939 deaths in Australia. Around 75% of deaths are ‘expected’. [3]
- Life expectancy at birth was 81.2 years for males and 85.3 years for females in 2020-2022. Over the past decade, life expectancy increased by 1.3 years for males and 1.0 years for females.[4]
- Australia has the third-highest life expectancy in the world.[4]
- Life expectancy for Aboriginal and/or Torres Strait Islander people at all ages is lower than for non-Indigenous Australians. At birth, Aboriginal and Torres Strait Islander life expectancy is 71.9 years for males and 75.6 years for females.[5] Colonisation, discrimination and systemic racism are fundamental drivers of health and wellbeing outcomes for Aboriginal and Torres Strait Islander peoples. These issues are explored in greater depth in PCC4U Focus Topic 2.
The five leading causes of death in 2022 were responsible for one-third of deaths overall. These were ischaemic heart disease, dementia, COVID-19, cerebrovascular diseases and lung cancer. These data contrast with data from a century ago, where death in Australia was typically quite sudden and the leading causes were infections, accidents, childbirth.[3]
Expected deaths include those related to many of the life-limiting illnesses that are common causes of death in Australia. The term ‘life-limiting illness’ is used to describe a wide range of progressive and advanced conditions (eg, heart failure, renal failure, motor neurone disease, various cancers, chronic obstructive pulmonary disease etc) where it is expected that death will be a direct consequence of the specified illness. Many people living with these illnesses will benefit from the provision of palliative care.[6-7]
Where do people die?
2021-22 statistics show that of all the deaths in Australia:
- 51.0% occur in hospital or medical service
- 29.5% occur in the home
- 14.8% occur in residential aged care
- 4.8% are in other or unspecified locations [8]
What about palliative care?
Palliative care was developed in the 1960s, after it was recognised that the care provided to people with life-limiting illnesses needed to be improved.[9]
Currently in Australia, palliative care is provided in many healthcare settings, including specialist palliative care services, neonatal units, paediatric services, geriatric services, public and private hospitals, general practices, disability services and residential and community aged care services. It is important to note that identifying the provision of palliative care in health data collections and across all health settings is a key challenge. It is a current focus of improvement for national data management.[10]
In 2021-22 there were 94,800 palliative care-related hospitalisations; 40% of these were for a principal diagnosis of cancer and 67% ended in the person dying in hospital. Also in 2021-22, 14,500 people received services provided by palliative medicine specialists; 77% of these were aged 65 and over.[10] Many more people benefit from receiving a palliative approach to care that is provided by the non-specialist health workforce. This underscores the need for all healthcare providers – who encounter people affected by life-limiting illness in their day-to-day practice – to develop skills knowledge and confidence in providing a palliative approach to care.
Thinking Points
- Think about how death is depicted in the media. Consider television, movies, books and social media.
- Choose an example and describe:
- Who is dying? How old are they and what kind of background are they from?
- Where are they dying? Home, hospital or care facility?
- Why are they dying? What type of illness do they have and how long have they been unwell? Is dying sudden or gradual?
- Who is involved in the scene? Who is providing care – family, friends, health professionals?
- In what ways are media depictions similar or different to your own experiences or observations of where and how people die and how they react to death?
- Choose an example and describe:
- What historical events and developments have been most influential in shaping attitudes and beliefs about dying and death in developed societies in the 21st century? Consider:
- Scientific advances
- Information technology
- Health care developments, reforms and policy
- Demographic changes
- Consumerism
- Social media
- Mass deaths.
- Some commentators argue that modern Western society is ‘death denying’ or ‘death avoiding’. Provide at least two examples that would:
- Support this argument
- Contradict this argument.
In responding to this question, consider:
- Any personal experiences you have had in working with or caring for someone with a life-limiting illness
- Whether you are comfortable (or not) to talk about dying and death and why this is the case
- Your knowledge of how healthcare resources are allocated and what society prioritises
- How the media portray dying and death and healthcare in general.
- Life expectancy is determined by a range of factors (e.g. age, gender, health, lifestyle choices and where we live), which can be used to determine the average age at which we are likely to die. Access an online life expectancy calculator (provided by various organisations and life insurance providers) and consider your life expectancy.
- The Death Clock provides a simple calculation based on your answers to six questions.
References
- Strazzari, M., Ageing, Dying and Death in the Twenty-first Century, in Second Opinion. 2005, Oxford University Press. p. 244 – 264.
- Australian Bureau of Statistics, Changing Patterns of Mortality in Australia, 1968-2017. 2018, ABS: Canberra.
- Australian Bureau of Statistics, Causes of death, Australia, 2022
- Australian Bureau of Statistics, Life expectancy 2020-2022
- Australian Bureau of Statistics, Aboriginal and Torres Strait Islander Life Expectancy, 2020-2022
- Palliative Care Australia. 2018. National Palliative Care Standards. 5th Ed.
- Palliative Care Australia. 2018. Palliative Care Service Development Guidelines.
- Australian Bureau of Statistics. 2021, Classifying places of death in Australian Mortality Statistics
- Saunders, C. 2001, The evolution of palliative care. J R Soc Med. 94(9): 430–432.
- Australian Institute of Health and Welfare. 2023, Palliative care services in Australia