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Umbrella Aged Care
← Palliative and end-of-life care

Evidence and sources

Every empirical claim in this section is tied to a named source. This is the full list of 41 trials, systematic reviews, guidelines and Australian regulatory documents, with the topic pages that rely on each one.

How these sources are used

Interventions are graded on randomised trial evidence for the outcome that matters: symptoms, comfort, whether wishes are followed, family wellbeing, hospital transfer or survival. Trials in residential care are preferred. Many palliative care trials were done in hospices, palliative care units or outpatients, and that is stated where the finding is described.

Observational studies, post hoc analyses and non-randomised studies are labelled as such. Where no randomised trial exists, as for tube feeding in advanced dementia, the topic is described but not graded.

Legal statements come from state health departments, End of Life Law in Australia and an aged care legal fact sheet, and each names the state it applies to. Laws, regulatory requirements and service contact details are correct as at the review date below and change. Confirm the current position against the primary source before relying on them.

Last full evidence review: October 2026.

Sources

  1. 1

    Palliative Care Australia. Understanding palliative care. (Accessed October 2026.) View source

    Cited in: What palliative care means in residential aged care

  2. 2

    Australian Institute of Health and Welfare. Palliative care services in Australia: palliative care for people living in residential aged care. (2021–22 data, appraisal under the Aged Care Funding Instrument; section last updated May 2023.) View source

    Cited in: What palliative care means in residential aged care Recognising that someone may be in the last year or months of life Hospital transfer at the end of life

  3. 3

    Australian Government Department of Health, Disability and Ageing. Strengthened Aged Care Quality Standards (November 2025; implemented 1 November 2025). Outcome 5.7 Palliative care and end-of-life care, Actions 5.7.1 to 5.7.4. View source

    Cited in: What palliative care means in residential aged care Advance care planning and goals of care Recognising that someone may be in the last year or months of life Hospital transfer at the end of life Eating and drinking at the end of life Common symptoms and how they are managed in the facility The last days: what families can expect Grief, family and staff support Palliative care: a guide for facility leadership

  4. 4

    Detering KM, Hancock AD, Reade MC, Silvester W. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ. 2010;340:c1345. (Single centre, Melbourne university hospital; 309 medical inpatients aged 80 or more.) View source

    Cited in: Advance care planning and goals of care

  5. 5

    Detering KM, Buck K, Ruseckaite R, et al. Prevalence and correlates of advance care directives among older Australians accessing health and residential aged care services: multicentre audit study. BMJ Open. 2019;9:e025255. (Health record audit; 1,208 people in 26 residential aged care facilities.) View source

    Cited in: What palliative care means in residential aged care

  6. 6

    Molloy DW, Guyatt GH, Russo R, et al. Systematic implementation of an advance directive program in nursing homes: a randomized controlled trial. JAMA. 2000;283:1437–44. (Six Ontario nursing homes, pair-matched, one home per pair randomised.) View source

    Cited in: Advance care planning and goals of care Hospital transfer at the end of life Palliative care: a guide for facility leadership

  7. 7

    Mitchell SL, Volandes AE, Gutman R, et al. Advance care planning video intervention among long-stay nursing home residents: a pragmatic cluster randomized clinical trial (PROVEN). JAMA Intern Med. 2020;180:1070–8. (360 US nursing homes.) View source

    Cited in: Advance care planning and goals of care Hospital transfer at the end of life Palliative care: a guide for facility leadership

  8. 8

    End of Life Law for Clinicians / End of Life Law in Australia, Australian Centre for Health Law Research, Queensland University of Technology. Advance directives: Queensland. (Accessed October 2026; page undated.) View source

    Cited in: Advance care planning and goals of care Eating and drinking at the end of life Palliative care: a guide for facility leadership

  9. 9

    End of Life Law in Australia, Queensland University of Technology. Stopping treatment, adults: Queensland. (Accessed October 2026; page undated.) View source

    Cited in: Advance care planning and goals of care

  10. 10

    Queensland Health. Queensland advance care planning documents: summary. Version 2.0, January 2025. View source

    Cited in: Advance care planning and goals of care

  11. 11

    NSW Health. Advance care planning. (Current as at 26 August 2025.) View source

    Cited in: Advance care planning and goals of care Palliative care: a guide for facility leadership

  12. 12

    End of Life Law in Australia, Queensland University of Technology. Stopping treatment, adults: New South Wales. (Accessed October 2026; page undated.) View source

    Cited in: Advance care planning and goals of care

  13. 13

    Downar J, Goldman R, Pinto R, Englesakis M, Adhikari NKJ. The “surprise question” for predicting death in seriously ill patients: a systematic review and meta-analysis. CMAJ. 2017;189:E484–93. (16 studies, 11,621 patients; most at moderate to high risk of bias.) View source

    Cited in: Recognising that someone may be in the last year or months of life

  14. 14

    Gozalo P, Teno JM, Mitchell SL, et al. End-of-life transitions among nursing home residents with cognitive issues. N Engl J Med. 2011;365:1212–21. (Observational; US Medicare data, 474,829 decedents, 2000–2007.) View source

    Cited in: Hospital transfer at the end of life

  15. 15

    Kane RL, Huckfeldt P, Tappen R, et al. Effects of an intervention to reduce hospitalizations from nursing homes: a randomized implementation trial of the INTERACT program. JAMA Intern Med. 2017;177:1257–64. (85 US nursing homes.) View source

    Cited in: Hospital transfer at the end of life Palliative care: a guide for facility leadership

  16. 16

    Forbat L, Liu WM, Koerner J, et al. Reducing time in acute hospitals: a stepped-wedge randomised control trial of a specialist palliative care intervention in residential care homes. Palliat Med. 2020;34:571–9. (1,700 residents in 12 Australian care homes.) View source

    Cited in: Hospital transfer at the end of life Palliative care: a guide for facility leadership

  17. 17

    Moyo P, Loomer L, Teno JM, et al. Effect of a video-assisted advance care planning intervention on end-of-life health care transitions among long-stay nursing home residents. J Am Med Dir Assoc. 2022;23:394–8. (Post hoc analysis of the PROVEN trial.) View source

    Cited in: Advance care planning and goals of care Hospital transfer at the end of life

  18. 18

    Davies N, Barrado-Martín Y, Vickerstaff V, et al. Enteral tube feeding for people with severe dementia. Cochrane Database Syst Rev. 2021;8:CD013503. (No randomised trials; 14 controlled non-randomised studies, all at high or very high risk of bias from confounding.) View source

    Cited in: Eating and drinking at the end of life

  19. 19

    Buchan EJ, Haywood A, Syrmis W, Good P. Medically assisted hydration for adults receiving palliative care. Cochrane Database Syst Rev. 2023;12:CD006273. (Four randomised trials, 422 participants, all with advanced cancer.) View source

    Cited in: Eating and drinking at the end of life

  20. 20

    Bruera E, Hui D, Dalal S, et al. Parenteral hydration in patients with advanced cancer: a multicenter, double-blind, placebo-controlled randomized trial. J Clin Oncol. 2013;31:111–8. (129 patients from six hospices.) View source

    Cited in: Eating and drinking at the end of life

  21. 21

    Agar MR, Lawlor PG, Quinn S, et al. Efficacy of oral risperidone, haloperidol, or placebo for symptoms of delirium among patients in palliative care: a randomized clinical trial. JAMA Intern Med. 2017;177:34–42. (247 participants, 11 Australian inpatient hospice or hospital palliative care services; 88% had cancer.) View source

    Cited in: Common symptoms and how they are managed in the facility

  22. 22

    van Esch HJ, van Zuylen L, Geijteman ECT, et al. Effect of prophylactic subcutaneous scopolamine butylbromide on death rattle in patients at the end of life: the SILENCE randomized clinical trial. JAMA. 2021;326:1268–76. (157 patients analysed, six Dutch hospices. Scopolamine butylbromide is called hyoscine butylbromide in Australia.) View source

    Cited in: Common symptoms and how they are managed in the facility The last days: what families can expect

  23. 23

    Abernethy AP, McDonald CF, Frith PA, et al. Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial. Lancet. 2010;376:784–93. (239 outpatients in Australia, the USA and the UK.) View source

    Cited in: Common symptoms and how they are managed in the facility

  24. 24

    Abernethy AP, Currow DC, Frith P, et al. Randomised, double blind, placebo controlled crossover trial of sustained release morphine for the management of refractory dyspnoea. BMJ. 2003;327:523–8. (48 participants, South Australian outpatient clinics; mostly COPD.) View source

    Cited in: Common symptoms and how they are managed in the facility

  25. 25

    Currow D, Louw S, McCloud P, et al. Regular, sustained-release morphine for chronic breathlessness: a multicentre, double-blind, randomised, placebo-controlled trial. Thorax. 2020;75:50–6. (284 participants, 14 Australian services.) View source

    Cited in: Common symptoms and how they are managed in the facility

  26. 26

    Ekström M, Ferreira D, Chang S, et al. Effect of regular, low-dose, extended-release morphine on chronic breathlessness in chronic obstructive pulmonary disease: the BEAMS randomized clinical trial. JAMA. 2022;328:2022–32. (160 participants, 20 Australian centres.) View source

    Cited in: Common symptoms and how they are managed in the facility

  27. 27

    End of Life Law in Australia, Queensland University of Technology. Palliative care: the law on medication to relieve pain and symptoms (doctrine of double effect; Criminal Code (Qld) s 282A). (Accessed October 2026; page undated.) View source

    Cited in: Common symptoms and how they are managed in the facility

  28. 28

    Queensland Health. Care plan for the dying person: family and carer distress in the last days of life (fact sheet). (Undated; cites 2024 guidance.) View source

    Cited in: Common symptoms and how they are managed in the facility The last days: what families can expect

  29. 29

    ACT Government. When someone is dying. (Last updated 16 December 2025.) View source

    Cited in: Eating and drinking at the end of life The last days: what families can expect

  30. 30

    Hui D, dos Santos R, Chisholm G, et al. Clinical signs of impending death in cancer patients. Oncologist. 2014;19:681–7. (Prospective cohort; 357 patients with advanced cancer in two acute palliative care units.) View source

    Cited in: The last days: what families can expect

  31. 31

    Lundorff M, Holmgren H, Zachariae R, Farver-Vestergaard I, O’Connor M. Prevalence of prolonged grief disorder in adult bereavement: a systematic review and meta-analysis. J Affect Disord. 2017;212:138–49. (14 studies of non-violent bereavement.) View source

    Cited in: Grief, family and staff support

  32. 32

    van Riesenbeck I, Boerner K, Barooah A, Burack OR. Preparedness for resident death in long-term care: the experience of front-line staff. J Pain Symptom Manage. 2015;50:9–16. (Observational; interviews with 140 nursing assistants in US long-term care.) View source

    Cited in: Grief, family and staff support Palliative care: a guide for facility leadership

  33. 33

    Palliative Care Australia. Understanding grief. (Accessed October 2026; lists national support services.) View source

    Cited in: Grief, family and staff support

  34. 34

    Queensland Health. Voluntary assisted dying: the eligibility criteria. (Last updated 12 May 2023.) View source

    Cited in: Voluntary assisted dying in Queensland and New South Wales: the facts

  35. 35

    Queensland Health. Voluntary assisted dying: the process. (Last updated 12 May 2023.) View source

    Cited in: Voluntary assisted dying in Queensland and New South Wales: the facts

  36. 36

    Queensland Health. Voluntary assisted dying: legal obligations for all medical practitioners. (Last updated 9 December 2022.) View source

    Cited in: Voluntary assisted dying in Queensland and New South Wales: the facts

  37. 37

    Queensland Health. Implementation of voluntary assisted dying (overview, Queensland Voluntary Assisted Dying Support Service contact details). (Last updated 12 May 2023.) View source

    Cited in: Voluntary assisted dying in Queensland and New South Wales: the facts

  38. 38

    NSW Health. What is voluntary assisted dying and who is eligible? (Last updated 28 November 2023.) View source

    Cited in: Voluntary assisted dying in Queensland and New South Wales: the facts

  39. 39

    NSW Health. Voluntary assisted dying: an overview. (Current as at 5 June 2023.) View source

    Cited in: Voluntary assisted dying in Queensland and New South Wales: the facts

  40. 40

    NSW Health. Voluntary assisted dying: obligations of healthcare workers. (Last updated 28 November 2023.) View source

    Cited in: Voluntary assisted dying in Queensland and New South Wales: the facts

  41. 41

    End of Life Directions for Aged Care (ELDAC). Voluntary assisted dying in aged care: residential facilities in South Australia, Queensland, New South Wales and the Australian Capital Territory (fact sheet). Current at November 2025. View source

    Cited in: Voluntary assisted dying in Queensland and New South Wales: the facts Palliative care: a guide for facility leadership

Listing a source is not an endorsement of every conclusion its authors draw, and summarising a trial in one sentence necessarily loses detail. Where a finding matters to a decision, read the original.

Written by Dr Josh Hatch, FRACGP. This page is general information reflecting his reading of these sources, not individual medical advice.

This is general education, not a clinical protocol. The doctors who practise with Umbrella Aged Care are independent general practitioners, and each makes their own clinical decisions with the resident and family. Your GP’s advice for an individual may differ from what is written here. If it does, please ask them to talk it through with you.

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