This article is part of our series on older people’s health. It looks at the changes and processes that occur in our body as we age, the conditions we’re more likely to suffer from and what we can do to prevent them.
As our population ages and life expectancy increases, the need for comprehensive health and care services for older people becomes greater. Older people access health services across lots of different settings, but the ability for different services to share patient information is poor, and the opportunity to shift the costs from state and federal systems provides disincentives for them to coordinate services.
By 2031, almost one in five people will be aged 65 and over. If the system does not change by then, poorly equipped and uncoordinated services will fail our most vulnerable. Health carers need to be trained in dealing with the issues of the ageing population, and we need to be able to identify appropriate models of care that reflect the whole person’s needs.
Training for GPs
Older people use GPs more than younger people, so primary care is often their first point of contact. But there is little recognition of the care and training needed for GPs to tackle complex health and social concerns, including for people with dementia. Timely and accurate diagnosis of dementia allows the person to make choices while they are still able. This requires the GP to differentiate the normal signs of ageing from dementia and recognise the importance of early diagnosis.
One financial incentive to encourage GPs to engage with patients is the “75+ health assessments”. First introduced in 1999, these assessments are designed to identify risk factors and plan interventions. However, uptake has been low, with only one in five eligible people taking part.
Restructuring primary care from “Divisions of General Practice” in the 90s, to “Medicare Locals” in 2011 and now “Primary Health Networks” has meant aged care initiatives are in a mess. Aged care is one of the six priority areas for primary health networks but each network can still tackle the issue in their own way, resulting in no overall state or national approach.
Hospital admissions for those aged 85 and over have risen rapidly compared to overall admissions. This group of older Australians, while representing only 2% of the population, accounted for 7% of all hospital admissions and 13% of days spent in hospital. As the baby boomers age and this number doubles by 2031, hospitals will struggle.
More people die in hospitals than any other setting in Australia, so they need to acknowledge the role they have in providing acute and palliative care for older people. Often care for older people in hospital means fast-tracking them through the emergency department and if possible returning them home (including residential care) without admission.
Hospital staff need training in palliative care and dementia. Specialised medical, nursing and allied health positions (such as physiotherapists and occupational therapists) in geriatrics and dementia fall well short of what is required to keep pace with demand. For example, aggression from someone with dementia who is not able to talk may be due to pain, and clinicians need to know how to identify and treat the problem.
Aged care services
Aged care services are provided to over a million people in their homes. The Aged Care Reform agenda is a ten-year program that sets out ways to improve services, recognise the role of carers and provide better information about services.
Unlike GPs and hospitals, increased numbers of aged care places subsidised by the government has helped aged care services to prepare for the increased demand posed by an ageing population. However, dementia projections remain a challenge.
Currently, care for most older people with advanced dementia occurs in residential aged care, settings in which care of the dying is becoming core business.
Recent government initiatives such as the Palliative Approach Toolkit and Decision Assist have provided resources and education to meet the growing demands of palliative and end of life care for older people.
Another option to residential aged care, the Home Care Packages Program, enables the person to remain at home. Continued growth of this program under the aged care reform agenda with support for individuals with complex care needs will add pressure on GPs to identify and treat conditions that untreated would result in hospital admissions.
Like residential aged care, home care packages rely heavily on a workforce with limited formal qualification and no regulation. While in residential aged care, unregulated workers are more likely to be supervised, and home care workers may deliver care with limited direct supervision of a regulated worker.
With the demand for the aged care workforce nearly tripling, the need for an appropriately skilled and regulated workforce is needed. We still don’t know how this can be done, or how to make sure workers are properly trained.
The baby boomers now needing more care expect a flexible and tailored approach to their needs. At present, the primary, acute and aged care workforce may not be adequately prepared to meet these expectations.
Read other articles in the series here.
Authors: Deborah Parker, Professor of Nursing Aged Care (Dementia), University of Technology Sydney