Ageing Population and Associated Needs

Executive Summary

Introduction

Ageing

Demographic Profile of Older People Living in the CAHML Region

South Australia

ProfileofOlderPeopleLivinginCAHML

SummaryofPopulation Characteristics

The Health Profile and Service Utilisation of Older CAHML Residents

ChronicDisease

Impact of Dementia and Osteoporosis

Dementia

DementiainCAHMLRegion

Osteoporosis

OsteoporosisandFalls

FallPreventionStrategies

SummaryofHealthProfile

Aged Care Services

AgedCareServiceUtilisation acrossCAHML

Community-basedAgedCare

RespiteCare

Consumer-directedCare

Summary and Conclusion

PotentialAreasforAction

Prevention,DetectionandEarly InterventionthroughPrimaryCare

SupportOlderPeopletobe ActiveandHealthy

ContributetoBuildingHealthy SocialandPhysicalEnvironments forOlderPeople

ChronicDiseaseManagement

HealthLiteracy-aKey DeterminantofHealth

ClientCentredCare-improved Pathways

References

Contents

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Central Adelaide and Hills Medicare Local coordinates and delivers primary health care, on the lands and seas of the traditional custodians, the Kaurna and Peramangk people. We recognise them as the traditional custodians, and respect that Aboriginal and Torres Strait Islander people represent the continuum of the world’s longest living culture, and that these historical relationships are enduring.

CentralAdelaideandHillsMedicareLocal-AgeingPopulationandAssociatedNeeds CentralAdelaideandHillsMedicareLocal-AgeingPopulationandAssociatedNeeds 32

CentralAdelaideandHillsMedicareLocal(CAHML)hasidentifiedhealthyageingandagedcareservicesaspriorityhealthplanningissues,giventheregionhasoneofAustralia’soldestageprofiles.ThismonographprovidesamoredetailedanalysisoftheageingissuesfacingtheCentralAdelaideandHillspopulationintheshortandmediumterm,andsuggestskeyareasoffocusforCAHML’sconsideration.

Thenumberofpeople65yearsandoverwithin CAHMLisprojectedtoincreaseupuntil2030, mirroringpopulationchangesacrossSouthAustraliaandAustralia.CAHMLalreadyhasthesecondhighestnumbernationallyofpeopleaged85+yearsofallMedicareLocals.ForCAHMLitwillbeachallengetooptimiseopportunitiesandreducethreatstotheindependenceofolderpeopleastheirfunctionalcapacitydeclinesdueto1)increasingprevalenceofchronicdisease2)cognitivedysfunction,3)increasedriskofinjuryasresultoffalls,and4)generalinfirmity.Thesefactorsalsolimitolderpeople’saccesstosocialnetworks,whichcanincreasesocialisolation.

Somekeyfindingsfromthemonographinclude:

• Projectedincreaseinthe65+yearoldpopulationinCAHMLwithoverseasbornelderlypopulation(manywithlimitedEnglish)increasingatarategreaterthanAustralianbornpeople.

• Addressingsocialdeterminantsofhealthbypromotinghealthierageingoptionsandhealthliteracyforpeopleintheearlystagesoftheageingprocess,usingculturallyappropriatestrategiesandresourcesforthediversepopulationswithinCAHML.

• FindingoutmoreabouttheneedsofthoseolderpeoplefromculturallydiversecommunitieswhoarereportedaspresentingathospitalEmergencyDepartmentswithmultipleissuesandcomplexcircumstances,wherelanguageisamajorbarrier.

• ForAboriginalandTorresStraitIslanderpeopleinCAHML,theevidenceindicatesthatageingrelatedissuesmaysurfaceatyoungeragesthantherestofthepopulation,andthatAboriginalandTorresStraitIslanderfamiliesandcommunitiesexperienceadditionalbarrierstohealthcomparedwiththenon-Aboriginalpopulation.

• Supportingcomprehensivestrategiesthatleadtoearlydetectionandearlyinterventionforthespectrumofconditionsrelatedtoageing,byincreasingtheuptakeofhealthassessmentsandsupportingoptimalmanagementinprimarycare.

• Managementofchronicmulti-morbidities(andpoly-pharmacy)andtheiracuteexacerbationswitheffectiveintegrationandcoordinationbetweenacutecareandprimarycareusingregionallytailoredapproachesandpathways.

Executive Summary

54 Central Adelaide and Hills Medicare Local - Ageing Population and Associated Needs Central Adelaide and Hills Medicare Local - Ageing Population and Associated Needs

Population ageing is a success story for public

health policies as well as social

and economic development.[1]

SouthAustralia’spopulationisageingrapidly.Thispresentsanunprecedentedchallengeforgovernments,healthsystemsandcommunitiesalikeasitimpactsontheeconomicandsocialprospectsoftheState.TheseimpactswillneedtobemanagedandwillinvolvealllevelsofgovernmentifthebestoutcomesforolderSouthAustraliansandtheeconomicandsocialprosperityoftheStateareto bedeliveredandmaintained.

Healthsystemcostsareescalatingatanalarmingratewithageingofthepopulationidentifiedasacontributingfactor,alongwithincreasingprevalenceofchronicdiseaseandthecostassociatedwithmedicalandtechnologicaladvancesinhealthcare.Forexample,researchundertakenbytheAIHWintoosteoporosisanddementia,highlighttheincreasingsocialandeconomicimpactsofprovidinghealthcareforageingpopulations,especiallyinthecontextofreducedavailabilityofinformalcaregivers.[2,3]

MedicareLocals,attheinterfacebetweenthefederalgovernment,stategovernmentandlocalgovernment,arewellpositionedtotakealeadershiproleinthedevelopmentofcoordinatedresponsestothechangingpopulationprofilewithintheirregions.

Thesocietalimplicationsofanageingpopulationaremultidimensionalandcomplex,anditisbeyondthescopeofthismonographtoprovideafullanalysisofthisphenomenon.However,fourkeyquestionshavebeenusedtoframethescopeofthismonograph.

Key Questions

1. What is the demographic profile and service

utilisation of the older population living within

CAHML region?

2. What are the key health issues experienced

by the older population within CAHML and

which of these could be better managed in

primary health care?

3. What aged care services are older people in

CAHML receiving and who is providing them?

4. Where are the primary care service gaps

for older people in CAHML?

ThepurposeofthisreportistooutlinetheimplicationsofpopulationageingintheCAHMLregionandtheimpactsonthehealthandagedcaresectorifcurrentandprojectedtrendscontinue.

Ageing

Society’sviewsaboutwhatitmeanstoagearechanging.Inthepast,oldagewasrecognisedandwidelyacceptedasthetimeofdeclineandlossinphysicalabilityandmentalcapacities,leadingtoincreasingdependencyonfamily,careservicesandsociety.Advancesinmedicineandpopulationhealthhaveresultedinincreasedlifeexpectancy,andcompressionofage-relatedmorbidity,withmanypeoplelivinglongerandhealthierlives.However,theageingprocessvariesgreatlyandhowoneagesisdeterminednotonlybyindividualgenetics,butalsobylifeexperiencesandopportunities;thedeterminantsofageing.

TheWorldHealthOrganisationhasdescribedarangeofinterconnectedsocio-economic,biological,behaviouralandculturalfactorsthatshapetheageingprocess.[4]Importantly,itchallengesthenotionthatageinghastobeatimeofrapiddeclineandfunctionalloss.Itsuggeststhattheageingprocesscanbeinfluencedbygovernmentandcommunityinitiativesthatoptimiseopportunitiesandsupportolderindividualsandcommunitiestoremain activeandwell.

Introduction

“Healthy older persons remain a resource to their families, communities and economies”[4]


FunctionalcapacitypeaksinearlyadulthoodandthereafterdeclinesasindicatedinFigure1.Therate ofdeclinecanvarydependingonlifecircumstancesandopportunities.[5]

Increasingprevalenceofchronicdisease,increasestheriskofearlierdeclineinfunctionalcapacity,whichlimitsindependence,andincreasesneedforhealthcareandsupportservices.

The Demographic Profile of Older People

“The ageing of the South Australian population is

one of the most significant challenges facing the

State during the next three decades, but it also

represents an important opportunity”. [6]

NB: South Australian data has been included to provide additional information and context, as a number of important indicators are not available at the Medicare Local or local government level.

South Australia

SouthAustraliahasarelativelyoldpopulation,comparedwiththerestofmainlandAustralia,andthepopulationisageingrapidly.Thispatternisexpectedtocontinueuntilatleast2051.AnumberoffactorsaredrivingtheageingofSouthAustralia’spopulation:

• Increasinglifeexpectancy;Sincethepostwarperiod,anextra13yearshasbeenaddedtotheaveragelifespanofSouthAustralianwomenandmorethan12yearsforSouthAustralianmen.

• Reducedfertility;Womenonaverageare havingslightlylessthantwochildren.

• Immigration;Immigrantsfromthepost waryearshaveagedinplace.

• Interstatemigration;SouthAustralialosesmoreyoungpeopletointerstatemigrationthanitreceives.[7]

Ageingofthepopulationhasbeenoccurringforsometime.Between1911and2006,thepercentageofpeopleaged65plusyearsincreasedfrom4.6%to15.4%andthischangeisprojectedtoescalateto23.9%by2031.Figure2onpage9demonstratesasimilarpatternoverashortertimeperiod.[7]

Table 1: Age and Sex Profile of Older Population by Age Groups [9]

Age Males Australia Females Australia Males SA Females SA

65-74years 49.0% 51.0% 48.1% 51.9%

75-84years 44.9% 55.1% 44.6% 55.4%

85plusyears 34.6% 65.4% 34.1% 65.9%

Table 2: Proportion of Older Population who Live Alone [9]

Age Australia SA

65-74years 20.7% 21.9%

75-84years 31.9% 34.0%

85plusyears 48.0% 53.8%

Total Aged population (65+) 23.7% 29.7%

Overall,SouthAustraliahasaslightlyhigherthanaverageproportionofitsolderpopulationwholivealone(29.7%).Itissignificantthatoverathirdofthe

75-84yearagegroup(34%)andoverhalf(53.8%)ofthe 85plusagegroupinSAlivealone.

Figure 2: South Australia Growth of the Population by Age, 1991 to 2031

1991 2011 2031

66% 66% 60%

13% 16%23%

21%

0-14

15-64

65+

18%

17%

Source: ABS Estimated Resident Population Dada and Projections of 2008


Figure 1: Maintaining Functional Capacity

over the Life Course

Early Life

Growthanddevelopment

Adult Life

Maintaininghighestpossibleleveloffunction

Older Age

Maintainingindependenceandpreventingdisability

Rehabilitationandensuringthequalityoflife

Range of function in individuals

Disability threshold*

Age

Fu

nc

tio

na

l Ca

pa

cit

y

Source: Kalache and

Kickbusch, 1997

Whencomparedtothenationalaverage,SouthAustraliahasahigherproportionofpeopleinthe“olderold”agegroups75-84and85yearsplus,andhasalowerproportionofpeopleinthe“youngerold”agegroupsof65-74years.Theincreaseinnumbersofover85yearoldsisexpectedtopeakaround2015andnotslowuntilabout2020.[8]

AddedtothispictureistheadditionalchallengesfacedbyAboriginalAustraliansastheyage.CurrentAustralianguidelinessuggestthatageingissuesbegintosurfacewithintheAboriginalpopulationfromtheageof50onwards.Only3.5%oftheSouthAustralianAboriginalpopulationareovertheageof65years.[7]

ThegenderdistributionoftheolderpopulationinSAislargelyinlinewithnationaltrends.Withalargerproportionoffemalesintheolderpopulationacrossallagegroups(bothAustraliaandSA).Thisisparticularlyevidentinthe85yearsplusagegroup.

Central Adelaide and Hills Medicare Local - Ageing Population and Associated Needs Central Adelaide and Hills Medicare Local - Ageing Population and Associated Needs 98

Profile of Older People Living in CAHML

TheCAHMLregionisamixtureofinnermetropolitansuburbs,andhillstownshipsandcommunities.ManyofthesecommunitieswereestablishedearlyinAdelaide’sdevelopment,havestronglocalhistoriesandsettlementpatterns,andnowtendtohavehigherproportionsofolderresidents.

Incontrast,MountBarkerhasexperiencedrecentsignificantgrowth.Asaresultofrecentlandreleasesandsubdivisions,andduetohousingavailabilityandaffordabilityithastendedtoattractyoungerfamiliestothearea,resultinginthiscommunityhavingayoungerageprofile.Thesehistoricaldifferencesinfluencethedistributionofolderpeopleacrosstheregion.

ThepopulationchangeoccurringacrossAustralia andSouthAustraliaismirroredintheCAHMLregion.Ashighlightedinthefiguresonpage9,theproportionofpeoplelivingintheregion65yearsplusand85yearsplusisprojectedtoincreaseandtheproportionofpeopleofworkingagedecline.

ConsistentwiththeAustralianandSouthAustralianpopulationprofiledocumentedinTable2,CAHMLhasmoreolderfemalesthanmalesineachagegroupandhasahigherproportionofolderfemalesinallthreeagegroupswhencomparedtotheAustralianandSouthAustralianpopulation.(Table4)

Figures3and4showprojectedincreasesinthenumberofolderpeoplelivingwithinCAHMLboundariesresultingin65plusyearoldsmakingupagrowingpercentageoftheoverallCAHMLpopulation.

Thisgrowthandthedifferentgenderprofilescanbetrackedfromasearlyas2015.Thenumberssuggestthatabout10,000females85yearsandolder,comparedwithonlyabout6,000males85yearspluswillbelivinginCAHML.By2020theincreaseinnumbersover85ismoresignificant.


Figure 3: Current (2011) and Projected Population

Numbers in CAHML 2015 [10]

Male - CAHML (current)

Male - CAHML (current)

Female - CAHML (current)

Female - CAHML (current)

Male - CAHML (projected)

Male - CAHML (projected)

Female - CAHML (projected)

Female - CAHML (projected)

10

0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84

85+

0 2 4 6 82468 10

0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84

85+

10 0 2 4 6 82468 10

Figure 4: Current (2011) and Projected Population

Numbers in CAHML 2020 [10]

Per cent

Per cent

Table 3: Age and Sex Profile of Older

CAHML Population by Age Groups [9]

AgeMales

CAHMLFemales CAHML

65-74years 47.5% 52.5%

75-84years 42.9% 57.1%

85plusyears 31.7% 68.3%

In2011therewere83,119peoplelivinginCAHMLagedover65yearscomprising16.84%ofthepopulationandplacingCAHML19thwhencomparedwithotherMedicareLocals.TheinnermetropolitanandwesternsuburbsofCAHMLcontainthelargestnumbersofolderpeopleinthegreatermetropolitanAdelaidearea.

Figure5showsthegeographicdistributionofolderpeople65yearsplusacrosstheCAHMLregionisnoteven,withsignificantlymoreolderpeoplelivinginthewesternsuburbsandintheinnernortheasternsuburbs.

In2011therewere14,473people85yearsandolderlivinginCAHMLmakingup2.93%ofthetotalCAHMLpopulation.CAHMLranks2ndoutofallMedicareLocalsfortheproportionofolderoldpeoplelivingwithinitsborders.

Figure 5: Number of Older People 65 Plus Years Living in CAHML [10]

Number of People 65+

5,320 to 6,530

4,420 to 5,320

3,830 to 4,420

2,600 to 3,830

870 to 2,600

Figure 6: Number of Older People 85 Plus Years Living in CAHML [10]


1,000 to 1,120

780 to 1,000

700 to 780

500 to 700

60 to 500

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Cultural Diversity

TherearepocketsofcommunitiesfromculturallydiversebackgroundslivingthroughouttheCAHMLregionandmanyofthesecommunitiescontainsubstantialnumbersofpeopleaged65+.

Traditionally,countriessignificantlyrepresentedintheseregionshaveincludedtheUnitedKingdom,India,Italy,Vietnam,China,Greece,Philippines,Malaysia,Afghanistan,Serbia,Poland,GermanyandNewZealand.MorerecentlytherehasbeenachangingprofileofnewarrivalswithemergingcommunitiesfromAfricaandtheMiddle-EastasaresultofAustralia’shumanitarianprogram.Theseemergingcommunitiestendtoincludemoreyoungpeopleand/orfamilies, andfewerolderpeople.[11]

Datatooutlinetheculturalbackgroundsofpeopleaged65yearspluswithintheCAHMLregionisnotavailableatthesmallarealevel,althoughitisreasonabletopredictsimilarpatternstoSouthAustralia,withhigherproportionsofpeopleborninNorthWesternEurope,SouthernandSouthEasternEuropelivingintheCAHMLregion.

CAHMLalsoincludessignificantnumbersofolderpeoplefromtheVietnamesecommunity.AnecdotalevidencefromhealthprofessionalsfromtheQueenElizabethHospitalinthewesternsuburbofWoodvilleindicatesthatolderpeoplefromculturallydiversebackgroundsarefrequentvisitorstotheemergencydepartment,oftenpresentingwithcomplexsocialandhealthissues,whicharecompoundedbyculturalandlanguagebarriers.EvidencesuggeststheVietnamesecommunitywhichresidesinlargenumbersinthenorthwestandnorthregionsofCAHMLisalsoageingrapidly.WhilelittleisknownaboutthespecifichealthandsupportneedsoftheolderVietnamesecommunity itisreasonabletoassumethatlanguageislikelyto beabarrier.

Within the CAHML CALD community there are substantial numbers of people aged 65+ years.


TheWesternregionoftheCAHMLhousesahighpercentageofoverseas-bornresidents:[11]

City of Pt Adelaide Enfield 30.4%

City of Charles Sturt 27.2%

City of West Torrens 29.3%

Themajority(59.3%)ofthe65pluspopulationwasborninAustralia.ThiswasslightlylowerforSAat58%.OveralltrendsaresimilarforbothAustraliaandSA.However,SAhasahigherproportionofoldermigrantsfromNorth-West,SouthernandEasternEurope;afifthborninNorth-WestEurope(20.1%)and11.6%bornin

SouthernandEasternEurope.In2006,SouthAustraliahad53%ofitsoverseasborn65pluspopulationfromnonEnglishspeakingbackgroundcountriesandthispopulationgroupisgrowingfasterwhencomparedwiththeAustralianbornelderlypopulation.[8]

Table 4: Country of Birth of Older Population 2011 Census [9]

Country Australia SA

Australia 59.3% 58.0%

Other-Oceania 1.7% 0.6%

North-WestEurope 14.3% 20.1%

SouthernandEasternEurope 10.1% 11.6%

NorthAfricaandMiddleEast 1.3% 0.5%

SouthEastAsia 1.7% 1.1%

NorthEastAsia 1.4% 0.4%

SouthernCentralAsia 1.1% 0.6%

America's 0.8% 0.4%

Sub-SaharanAfrica 0.7% 0.3%

Other 7.4% 6.4%

Total non-Australian Born (excluding those who did not indicate place of birth)

33.4% 35.6%

The CAHML region is a mixture of inner

metropolitan suburbs, and hills townships

and communities.


OlderpeoplelivingintheWesternandPortAdelaideregionaremorelikelytobereceivinganagedpensionthanthoseinEasternandHills.TheregionalsocontainssubpopulationsofolderpeoplefromnonEnglishspeakingbackgrounds.Finally,sizeablenumbersofthe85plusolderpopulationliveinthemoreaffluent(thoughsomemaybeassetrichbutincomepoor)innersuburbsoftheCityofUnley.TheselocationshavehigherSEIFAscoresindicatinglowlevelsofdisadvantagecomparedwithotherinnerurbanpartsoftheregionandolderpeopleinthiscommunityarelesslikelytoexperiencefinancialstressorhardship.

Summary of Population Characteristics

ThedemographicpictureofCAHML’solderpopulationfollowstheusualpatternfortheregion,withtheWesternandPortAdelaideareashavingthelargestnumbersofolderpeopleincludingtheveryold,withCampbelltownhavingthenexthighestnumbers.Theregioncontainsmorefemalesthanmalesintheolderagegroupswithmanywomenlikelytobelivingalone.

Financialsecurityisfundamentaltothewellbeingofallpeople;however,itisofparticularimportancetoolderpeople.Aspeopleageandarerestrictedintheirabilitytoengageinthepaidworkforcetheycanbecomevulnerable.WhileolderSouthAustraliansreporthigherlevelsofprosperityandlowerlevelsoffinancialstresswhencomparedwithotheragegroups,andareonaveragewealthierthanotherhouseholds,anumberofolderhouseholdsarevulnerabletofinancialstress.

Forexample,atthetimeofthe2006census(2011Censusdatanotyetavailable)76%ofSouthAustraliansaged65plushadincomesoflessthan$400perweek.[7]Anothermeasureofeconomicinsecurityistheproportionofpeoplewithinaregionwhoreceivegovernmentbenefitsandpensions,includingtheAgedpension.

Figure7indicateswherethegreatestnumbersofolderpeoplewhoareinreceiptofanagedpensionlivewithintheCAHMLregion.Themapfollowsalargelyexpectedpatternfortheregion,withthegreatestnumbersintheWestandNorthEastareas.

Aged Pensioners (Number)

4,280 to 4,590

3,650 to 4,280

2,830 to 3,650

1,880 to 2,830

580 to 1,880

Figure 7: Aged Pensioners Numbers [10]


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Thereisgreatdiversityinthehealthandwellbeingofolderpeople.Manyolderpeopleremainhealthywellintotheirseventiesandbeyond,whileothersexperienceincreasinglevelsofillhealthandfunctionaldeclineinearlieryears.Normalageinginvolvesgradualphysicalandmentalchangeswhichimpactonsight,hearing,memory,motorsensoryskills,mobilityandbalance.Ageingalsobringsincreasedriskofacuteandchronicdiseases.Therateofageingvariesbetweenindividualsandisinfluencedbygenetic,biological,behaviouralandenvironmentalfactors.Socioeconomicdisadvantageandassociatedenvironmentalfactorsareknowntoincreasetheincidenceofdiseaseanddisabilitylaterinlife.[8]

Asindividualsagechronicdiseasesbecometheleadingcausesofmorbidity,disabilityandmortality.Thesediseasessuchascancers,cardio-vascular,respiratoryandneurologicaldiseasesareessentiallydiseasesoflaterlife,althoughresearchisincreasinglyshowingthattheoriginsofchronicdiseasebegininchildhoodorevenearlier.Thisriskofdevelopingsignificantchronicdiseaseissubsequentlyshapedandmodifiedbyexposuretosocial,economicandenvironmentalfactorsacrossthelifecourse.Thesefactorsareusuallyreferredtoasthesocialdeterminantsofhealth(SDH).TheriskofdevelopingchronicdiseasescontinuestoincreaseasindividualsageandinadditiontotheimpactofSDH,behaviouralriskfactorssuchastobaccouse,physicalinactivity,andpoordiet,playasignificantroleinincreasinganindividual’sriskofdevelopingchronic

diseaseastheyage.Manychronicdiseasescanthereforepotentiallybepreventedordelayed.[5]

The75+healthchecksconductedingeneral practice[10]aredesignedtosupportolderpeopleandtheirfamiliestomaintaintheirhealthandindependencethroughidentificationofriskfactorsandearlysignsofdiseaseanddisabilityandtopreventdeteriorationandescalationofhealthconcernsthroughappropriatecare,treatmentandsupport.Ithelpstoestablishcarepathwaysandreferraltoappropriatecommunitysupportservices.

Figure8showsthenumberof75+Health AssessmentsconductedineachSLAoftheCAHMLregion.Thenumbersoftheseservicesareinfluenced byGPandpracticenurseavailability/capacity,and bypatientconsent.

Figure9showsthenumberofSouthAustralianmalesandfemalesthatwereaged75+thathadaHealthAssessmentdonefromJuly2012toJune2013.MorerecentdataisunavailableduethenewMedicareHealthAssessmentitemnumbers.UnfortunatelythisdataisunavailableattheMedicareLocallevel.

Aspeopleagetheyaremorelikelytoaccesshealthcare.Peopleaged65-75yearsaretwiceaslikelytobeadmittedtohospitalastherestofthepopulationandforthoseaged85plus,morethan5timesmorelikely tobeadmittedtohospital.[8]

Intheprimarycaresettingolderpeoplearepresentingwithawiderangeofhealthconditions.Tables5-7documenttherangeofchronicconditionsaffectingolderpeopleinCAHMLandhighlightsthatmanyolderpeoplehavemultiplechronicconditions(oftenreferredtoasmultiplemorbidity)whichcomplicatestheircareandimpactstheirqualityoflife.ThetableshavebeenbasedondatacollectedfromasampleofsixGPpracticesinthenorth-westoftheCAHMLregionovera15monthperiod.Table5comparestheGPpracticepopulationwiththeCAHMLpopulation.

Thenumberof75plushealthcheckslargelycorrespondswiththelocationoftheolderpopulation.Although,giventhattheregioncontains43,277peopleaged75plusyears,andonly7,805or18%ofthisgrouphada75plushealthcheck,thereisanopportunitytoincreasethenumberof75plushealthcheckscompletedintheregion.

Table 5: Sentinel Practice population compared with CAHML population

Total Population Total Population 65+Percentage of

Population 65+

Sentinel Practices

patient population45,946 10,641 23%

CAHML population 493,523 83,119 17%

Annual 75+ Health Checks

501 to 540

412 to 501

259 to 412

139 to 259

35 to 139

Figure 8: Medicare 75 Plus Health Check 2009-2010 [10]

If ageing is to be a positive experience, longer life must be accompanied by continuing opportunities for health, participation and security. [5]


0

2000

4000

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701 703 705 707

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10000

12000

14000

16000

Males

Females

Figure 9: SA Health Assessments - 75+ Year Olds

MBS Item Number

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Table 6: Sentinel Practices Multi-morbidity Matrix (percentages)

Diab

etes

Asth

ma

Hypertension

MentalH

ealth

COPD

CHD

Stroke

CRD/I

Osteopo

rosis

Dementia

Oseoarth

ritis

Diabetes 100.0% 10.5% 71.8% 20.9% 7.7% 26.5% 8.6% 5.8% 22.1% 3.7% 38.4%

Asthma 100.0% 62.9% 25.0% 18.2% 22.0% 6.5% 3.4% 32.8% 2.7% 49.2%

Hypertension 100.0% 20.5% 6.9% 28.6% 8.6% 4.7% 25.7% 3.8% 38.4%

MentalHealth 100.0% 7.6% 20.3% 9.2% 1.4% 31.6% 6.0% 44.3%

COPD 100.0% 37.2% 8.7% 5.0% 33.1% 5.3% 10.7%

CHD 100.0% 36.2% 7.7% 24.9% 5.5% 38.1%

Stroke 100.0% 7.3% 29.9% 8.3% 41.3%

CRD/I 100.0% 27.3% 5.4% 43.9%

Osteoporosis 100.0% 5.1% 45.4%

Dementia 100.0% 39.6%

Osteoarthritis 100.0%

Table 7: CAHML Multi-morbidity Matrix (numbers)

Diab

etes

Asth

ma

Hypertension

MentalH

ealth

COPD

CHD

Stroke

CRD/I

Osteopo

rosis

Dementia

Oseoarth

ritis

Diabetes 28,669 3,008 20,580 5,994 2,213 7,583 2,460 1,665 6,348 1,074 10,999

Asthma 10,011 6,294 2,503 1,826 2,202 655 344 3,287 269 4,930

Hypertension 63,632 13,019 4,393 18,196 5,457 2,975 16,370 2,417 24,426

MentalHealth 20,183 1,536 4,092 1,848 279 6,370 1,203 8,937

COPD 7,497 2,793 655 376 2,481 397 801

CHD 20,688 7,497 1,590 5,145 1,128 7,873

Stroke 7,497 548 2,245 623 3,094

CRD/I 3,813 1,042 204 1,676

Osteoporosis 26,048 1,321 11,816

Dementia 3,770 1493

Osteoarthritis 36,682

Incontrasttopracticedata,theconditionswhichpresentandrequireadmissiontohospitalcovera muchmorediversesetofconditions.Inpartthisis duetothemannerinwhichthedataiscollected andcategorised.

Forexample,Figure10onpage20highlightsaseriesofacuteandchronicconditionswhichrequiredinpatientadmissionforolderCAHMLresidents75+butareclassified(accordingtoanationallyagreedclassificationsystem)as“potentiallypreventable”, iftimelyandappropriateinterventionwasprovidedwithinthecommunity.Itisofnotethatthese conditionsarenotspecifictoolderpeopleand mayoccurthroughoutanindividual'slife.


Table6identifiesthepercentageofthepatientpopulationwithinthesepracticesthatpresentedwithoneormorechroniccondition.Thesepercentageshavethenbeenextrapolatedtotheentire65pluspopulationoftheCAHMLregion,toindicatethepotentialnumberofolderpeoplelivingwithintheCAHMLregionwith

oneorseveraloftheseconditions(seeTable7).Itisacknowledgedthatthenumberspresentedarelikelytoover-estimateprevalenceastheoriginaldatawasderivedfromGPpracticeslocatedinsub-regionsofCAHMLwherethepopulationhaspoorerhealthprofilecomparedwiththerestoftheregion.


Chronic Disease

Theageingofourpopulationhasplayedakeyrole intheriseinprevalenceofchronicdisease.Inthe 2001NationalHealthSurvey99%ofallpeople aged65yearsandover,reportedhavingatleastonelong-termcondition(withmorethan80percentofpeopleinthisagegroupreportedhavingthreeor morelong-termconditions).[29]

Theunderlyingcausesandriskfactorsforchronicdiseasecanbegininchildhoodbutmostoftenbecomeapparentinearlytomidadulthoodandthereforeactiontoaddressthedevelopmentandearlytreatment ofchronicdiseaseshouldoccurwellbeforeoldage.


This section of the population health report

examines the impact of dementia and osteoporosis

in more detail. These two conditions have been

selected as they occur mostly in older age groups,

affect large numbers of people, have a significant

impact on the health and aged care systems, are

amenable to early diagnosis and intervention and

if left untreated result in high hospital and

healthcare costs.

Optimal management of dementia and osteoporosis

in the primary care setting can enhance the quality

of life and independence of the patient, as well as

reduce the likelihood of distressing and expensive

hospital admission.

Dementia

Dementiaisadegenerativediseasethathasaprofoundimpactonindividualsandcommunities,aswellassignificanthealthservicedeliveryandcostimplications.Itisnotonediseasebutatermcoveringarangeofconditionscharacterisedbyimpairmentsofbrainfunction,suchaslanguage,memoryloss,perception,personalityandcognitiveskills.[12]Dementiacanleadtodeclineinintellect,rationality,socialskillsandnormalemotionalreactions.ThemostcommontypeofdementiaisAlzheimersdisease,whichaccountsforaround50%ofalldementia.[13]

Thetypeandseverityofsymptomswillvarydependingonthetypeofdementiaandstageofthecondition. Apersonwithearlydementiamayonlyhaveoneortwomildsymptoms,whichhaveminimalimpactontheirdailylife,whileapersoninlatestagesofdementiawillpresentwithmanysymptomsandislikelytorequire24hourcare.Theriskofdevelopingdementiaincreaseswithage.

Thereisnodefinitiveclinicaltesttodiagnosedementingillnesses.Thewords“probable”or“possible”areusuallyattachedtotheirclinicaldiagnosis.Absolutediagnosisrequirestissueexaminationonbiopsyoratautopsy.

Yet,aswithanydisease,earlydetectioniscriticaltomanagement.

Differingformsofdementia—Alzheimerdisease,dementiawithLewybodies,fronto-temporallobedementia,andothers—aswellasprodromalsyndromesofmildcognitiveimpairmentmustbedistinguished fromeachotherandfromotherneurologicalconditions.

Anticipatingandrespondingtothechangingneedsofpeoplewhoexperiencedeterioratingbrainfunctionasaresultofdementiapresentsacontinuingchallengeforthehealthandagedcaresystem.[8] It is also worth notingthatdementiahasrecentlybeenincludedastheninthNationalHealthPriority.SouthAustralia’sDementiaActionPlan2009-2012[18]predictsthatby2016,dementiawillbethemajorcauseofdisabilityforAustralians,overtakingcardiovasculardisease,canceranddepression.SouthAustraliaisthesecondfastestageingstateinAustraliaafterTasmania,andtheprevalenceofdementiaisexpectedtorisealongsidetheprogressiveincreaseofpeopleovertheageof65.

TheprojectednumbersofpeoplelivingwithdementiainSouthAustraliaare:

• 2010-21,760

• 2020-28,000

• 2030-36,770

Other Vaccine

Influenza/Pneumonia

Rheumatic Heart Disease

Iron Deficiency Anaemia

Hypertension

Diabetes Complications

Chronic Obstructive Pulmonary Disease

Congestive Cardiac Failure

Asthma

Angina

Pyelonephritis

Perforated/Bleeding Ulcer

Gangrene

Ear Nose Throat

Dental

Dehydration/Gastroenteritis

Convulsions/Epilepsy

Cellulitis

Figure 10: Potentially Preventable Admissions

85+ 85+ 85+

Vaccine preventableSeparations

0 50 100 150 200 250 300 350 400

Chronic

Number of Admissions

Acute

75-84 75-84 75-84



Dementia in CAHML Region

ArecentreportfromDeloitteAccessEconomicsonDementiaAcrossAustralia,[14]projecteddementiaprevalenceratesin2012forSouthAustralianfederalgovernmentelectorates.Figure11showstheFederalElectoralboundariesforAdelaideandcomparesthemwiththeCAHMLregion.

• Hindmarshwith3003people

• Sturtwith2671people

• Boothbywith2611people

ThereportfoundthreeSouthAustralianelectorates(Hindmarsh,SturtandBoothby)hadthehighestnumbersofpeoplewithdementiainthewholeofAustralia,withHindmarshandSturtfallinginsidetheboundariesoftheCAHMLregion.ThethreeremainingfederalelectorateswithinCAHML;Adelaide,MayoandPortAdelaidealsowereprojectedtohavehighnumbersofpeoplewithdementia,asoutlinedinTable8.

Table8onthepreviouspagehighlightsoneofthecurrentandfuturechallengesfortheCAHMLregion, asitprojectsagrowthinthenumberofpeoplelivingwithdementiawithintheCAHMLregionwillincrease bybetween60-70%by2030.

AnearlierreportfromAccessEconomics(2006),indicatedthattheincidenceandprevalenceofdementiaisalsopredictedtoriseamongculturallydiversecommunities.TheproportionofAustraliansfromculturallydiversebackgroundshasbeengrowingatafasterratethantheAustralianbornpopulation,

[16]howevertheyaremorelikelytobeunder-referredtoagedcareservicesandtolooktotheirfamiliesandfriendsfirstforsupport.[17]

Today,thereisnocurefordementia.Asthecausesofthediseasecommencelongbeforethefirstsignsofdementiaappear,preventionoffersthebesthopeforreducingtheimpactofthediseaseonindividualsandsociety.Thereisagrowingbodyofevidencethatreducingbehaviouralandcardiovascularriskfactorsacrossthelifecoursemayreducedementiarisk.

Moderate alcohol consumption is associated with lower risk, but comes with a warning- alcohol consumption can cause other health problemsTable 8: Projections for Dementia by Federal Electorates within CAHML Region [14]

Federal

Electoral Division2012 2013 2014 2015 2016 2020 2030

Adelaide 2,464 2,512 2,564 2,623 2,689 2,947 3,960

Hindmarsh 3,003 3,074 3,127 3,182 3,243 3,453 4,259

Mayo 2,082 2,201 2,324 2,453 2,577 3,102 4,746

PortAdelaide 2,245 2,316 2,389 2,454 2,524 2,822 3,771

Sturt 2,671 2,754 2,850 2,937 3,024 3,370 4,429

Table 9: Risk Factors for Developing Cognitive Decline and Dementia

Health or lifestyle factor Risk for cognitive decline and dementia

BrainMentalActivity

Highermentalstimulationthrougheducation,occupationorleisureisassociatedwithlowerrisk.

SocialActivity Highersocialinteractioninlatelifeisassociatedwithlowerrisk.

BodyDiet

Findingsforindividualnutrientsareinconsistent.Higherintakesoffruitsandvegetablesandfishseemtobeassociatedwithlowerrisk.

PhysicalActivity Regularphysicalexerciseatallagesisassociatedwithlowerrisk.

Heart

BloodPressure Untreatedmidlifehighbloodpressureisassociatedwithincreasedrisk.

Cholesterol Untreatedmidlifehighcholesterolisassociatedwithincreasedrisk.

DiabetesType2 Diabetesisassociatedwithincreasedrisk.

Smoking Currentsmokingisassociatedwithincreasedrisk,formersmokingisnot.

Weight Midlifeobesityandunderweightareassociatedwithincreasedrisk.

Actionontheaboveriskfactorsisthoughttonotonlyreducetheriskofdevelopingthecondition,butisalsoconsideredeffectiveinmanagingthecondition,incombinationwithappropriatetreatmentplans,oncedementiahasbeendiagnosed.

Thereisemergingevidencethatmanypreventivestrategies(asoutlinedabove)mayhelptoslowthecognitivedeclineinpeoplediagnosedwithdementia.


Figure 11: Federal Electoral Boundaries Compared with

CAHML Region Borders

Mayo

Port AdelaideSturt

Hindmarsh

Adelaide

Boothby

Figure11comparesthefederalelectoralboundarieswiththebordersoftheCAHMLregion.FiveFederalElectoratesfallwithinCAHMLtheseincludePortAdelaide,Adelaide,Hindmarsh,SturtandMayo.WhilethereisnodirectmatchbetweenCAHMLboundariesandtheFederalElectorates,theoverlapofelectorateboundariesmakesthisinformationrelevanttoCAHML.


Screeningcanassistwithearlydiagnosisofdementia,andstrategiescanbeputinplacetominimisetheimpactofsymptomsfromanearlystage.Earlyinterventionsassiststhosediagnosedwithdementiaandtheirfamiliestoforwardplanforserviceprovision,andprepareadvancedcaredirectives.

TheAlzheimer’sAssociationreportsthat“Earlydiagnosiscanallowtheindividualtohaveanactiveroleindecisionmakingandplanningforthefuturewhilefamiliescaneducatethemselvesaboutthediseaseandlearneffectivewaysofinteractingwiththepersonwithdementia”.Knowingthetypeandseverityofthepatient’sdementiaaidsprognosis,familycounselling,andtherapeuticintervention

Currentmedicaltherapiestreatsymptoms,butthegoalofmuchdementiaresearchistargetedtowarddisease-alteringdrugsthatcouldhaltdiseaseprogression.Theirdevelopmentrestsonunderstandingthemechanismsofthevariousdementias,onaccuratediagnosis,andonnon-invasivewaysofmonitoringoutcomesinclinicaltrials.Theeventualsuccessofexperimentaltherapiesrestsonearlydetection.[20]

Insummary,theevidencebasefordementiariskfactorsisgrowingandeffortstosupportpeoplecontrolexistingcardiovascularrisksandadopthealthylifestylesthroughoutlife,butinparticularinmidlifeandolderageareimportant.[19]

Osteoporosis

Osteoporosisisachronicconditionthatcausesthebonestobecomelessdense,andmorebrittle,andhencemorelikelytobreak(fracture)withminimaltrauma.Thesefracturesmostlyoccurinthehipsandthewristsbutcanoccurinthespine,armorpelvis.

Fromabouttheageof35individualsgraduallylosebonedensity,whichisanormalpartoftheageingprocess.However,forsomepeopleitcanleadtoosteoporosis(severebonedensityloss)andfractures.Theconditionaffects1.2millionAustraliansand6.3millionhaveabonedensitythatincreasestheirriskofdevelopingosteoporosisandpotentialfractures.Thenumberofosteoporosissufferersisexpectedtoincreaseto3millionby2021asthepopulationages.Forpeopleovertheageof60years,oneintwopost-menopausalwomenandoneinthreeoldermenwillsufferanosteoporosisrelatedfracture.Mortalityisincreasedafterallosteoporosisrelatedfractures,particularlyhipfractures.[21]

Osteoporosishasbeendescribedasachildhooddiseasewhichresultsinhealthimpactsinlaterlife.ChildhoodisacriticaltimetoestablishhealthyboneswhichisbestdonethroughadequatecalciumandVitaminDintake,andregularphysicalactivity.Thesethreefactorslaythefoundationforsoundbonedensitythroughoutadulthoodandoldage.Inordertooptimisebonehealthinthepopulationandminimisetheincidenceofpainfulandcostlyfragilityfracturesamongstolderpeople,alifelongapproachtobuildingandmaintaininghealthybonesinoldageisessential.

Thereareanumberoffactorsthatincreasetheriskofdevelopingosteoporosis,includingnon-modifiablefactors,suchasbeingfemale(womendevelopthinbonessoonerthanmen),menopause,age,certainmedicalconditions(egrenaldiseases),andageneticpredisposition.However,thereareanumberof readilymodifiableriskfactorsthatcanreducethe riskofosteoporosis.

Bonehealthisoftenoverlookedandassuchosteoporosisisoftennotdiagnoseduntilfractures duetominimaltraumaoccur.Althoughthediseaseoccursmainlyinpeopleaged55yearsandover(84.0%),osteoporosisisaconditionwithoutovertsymptomsandisknowntobeunder-diagnosed. ThefrailelderlyhavethehighestratesoffractureduetominimaltraumaandthoseinresidentialcaretypicallyhaveVitaminDdeficiencyandaninadequatecalciumintake,whichmeansthatthesepeoplehavethegreatestpotentialtobenefitfromincreasedintakeofdietarycalcium,VitaminDandincreasingphysicalactivity/resistancetraining.[21]

Osteoporosis and Falls

In2009,peopleover65yearsmadeup65.5%ofthepopulationhospitalisedforinjuriescausedbyfalls,and74.1%ofallhipfractures.[8]Fallspreventionstrategieswithinhealthservicesandtheagedcaresectorcanmakeanimportantcontributiontoprotectingthehealthoftheolderperson.Expandingthesestrategiestothebroadercommunityaspartofanapproachtocreatingagefriendlyenvironmentscouldpreventfallsinthecommunityandencourageolderpeopletowalkwithintheirlocalareas,therebyincreasingtheirstrengthandmobilityandreducingtheirriskoffallsandfractures.Thestrategieshighlighttheneedtobuildandmaintainpartnershipswitharangeofstakeholdersincludinglocalgovernment.

Early diagnosis can allow the individual to have an active role in decision making and planning for the future...

ModifiableriskfactorsforOsteoporosis:

• Lackofweight-bearingexercise.

• Poorcalciumintake.

• VitaminDdeficiency.

• Loworhighbodyweight.

• Cigarettesmoking.

• Excessivealcoholuse.



fallsriskbyusingsinglelensdistanceglassesinsteadofmultifocalswhengoingoutsideortoanunfamiliarenvironment.Thisadvicehowever,increasesfallsriskinlessactiveadults.Improvingspectacleprescriptionalonehasnotresultedinfallsprevention.Shortwaitingtimesforfirsteyecataractsurgeryisaneffectivefallsandfracturepreventionstrategy.

Home Modification

Homesafetymodificationsinassociationwithtransfertrainingandeducationareeffectiveinhigh-riskpopulationssuchaspatientswithpoorvisionorthoserecentlyhospitalised.Thebenefitsaregreaterwhendeliveredaspartofamultifactorialstrategy.[22]

Summary of Health Profile

Preventingtheonsetofchronicconditionsandmanagingconditionsonceestablishedarekeystrategiestoimprovingthehealthofthepopulation.Inparticular,twoconditionscloselyassociatedwithpopulationageingarebecominganincreasingchallengeforSouthAustraliaandfortheCAHMLregion;dementiaandosteoporosis.Theriskfactors forbothconditionsareestablishedearly,diagnosisearlyinthedevelopmentofthediseaseisdifficult, andonceadvancedthediseaseand/oritsconsequencesaredebilitatingandlifelimiting,oftenleadingtohighlevelsofhealthinterventionandagedcaresupport.Bothconditionsareasymptomicintheirearlystagesofdevelopmentandsoscreeningbecomesanimportantstrategytoassistwithearlydiagnosisandtreatment.

Fall Prevention Strategies

Estimatesoftheannualprevalenceoffallsamongpeopleaged65andoverinSouthAustraliarangefrom27.3%to36.4%.OfmostrelevancetoCAHMListheestimategainedthroughtheNorthWestAdelaideHealthStudywhichpartlysourcessubjectsfromwithinthewesternpartoftheCAHMLregion.Thisstudyfoundthat33.9%ofpeople(allages)hadexperiencedafallinthepastyear.Ofthese,3.8%hadexperiencedafractureasaresultoffallinginthepastyear,and6.3%inthepast5years.Theprevalenceoffallsinpeopleage50andoverwasverysimilar(33.1%),buttheriskofsustainingafractureasaresultoffallingwassignificantlyhigherintheover50group(6.2%vs2.0%).

Themostcommonsiteoffractureresultingfromafallistothewrist(30%),withothercommonsitesincludingtheupperarm/shoulder(15%),ribs(15%),ankle(9%),hip(8%),andspine(7%).Approximately30%offracturesweresustainedatothersites. Fallscanalsoresultinbruising,sprainsandabrasions,andafearoffallingthatreducesconfidenceandrestrictsactivity.[30]

Fallsarenotinevitableandmanyolderpeople canbepreventedfromfalling.

Somefallpreventionstrategiesinclude:

Exercise Programs

Thelinkbetweenexerciseanddecreasedfallsinolderpeoplelivinginthecommunityiswell-established.Thereisalsogoodevidencethatdisabilitycanbereducedbywell-designedexerciseinthispopulation.

• Moderateorhighchallengetobalance (eg.taichi,OtagoExerciseProgram).

• 2hours/weekonanongoingbasis.

• Homeorgroupsetting.

• Optionalstrengthtraining:cognitive andfunctionalbenefits.

Vitamin D

ForolderadultsdeficientinVitaminD,supplementationcanbeaneffectiveandsimplestrategyforfractureprevention.VitaminDsupplementationcanreducefracturesby17%andhigherdosescanreducehipfractureriskby30%.

Reduced Benzodiazepine Use

Psychoactivemedicationsaretakenby22%ofcommunitydwellingolderpeopleandthereisstrongevidencetheyincreasetheriskoffalls.Psychoactivedrugwithdrawalcanreducefallsby66%.Almost1in5olderadultstakebenzodiazepineslongterm(>4.5years)despitealackofevidencesupportingefficacybeyondtheshortterm.Recentdataassociatestheuseofsuchsedativeswithhigherratesoffalls,fractures,deathandcancer.

Optimised Vision

Visualimpairmentisanindependentriskfactorforfallsandfractures.Multifocalspectaclesincreasefallsriskbydistortingthelowervisualfield.Adultswhoundertakeregularoutdooractivitycanreducetheir



The following supplements are also available

across all levels of Home Care Packages:

• DementiaandCognitionSupplement.

• Veterans’SupplementforpeoplewithamentalhealthconditionacceptedbytheDepartmentofVeterans’Affairsasassociatedwiththeveteran’sservice.

Recentchangestothefundingofagedcarehaveledtheresidentialcaresectortobegintomoveawayfromtheseparationofresidentialcareintolowcareandhighcarefacilities.

Residentialcarefacilitiesarealreadydealingwithincreasingnumbers,supportingolderpeoplewithcomplexhighcareneedssuchasdementiapatientsandtheveryfrailelderly,andthistrendisexpectedtoescalateinthenearfuture.

Typesofservicesprovidedare:

Personal Care

Suchashelpwithshowering,dressing,mobility,mealpreparationandeating, andfittingsensorycommunicationaids.

Support services

Suchashelpwithlaundry,housecleaning,gardening,basichomemaintenance,homemodifications(relatedtocareneeds),andtransporttohelpdoshopping,visitthe doctororattendsocialactivities.

Clinical care

Nursing,alliedhealthandothertherapies.

Other services

Suchasremotemonitoringtechnology(whereappropriate)andassistivetechnology,includingdevicesthatassistmobility,communicationandpersonalsafetywheretheseservicesareidentifiedinthecareplan.

WiththerapidageingoftheSouthAustralianpopulation,anincreasingnumberofpeoplewillrequirecommunityandresidentialagedcareservices.Deliveringpersoncentredhealthcareforolderpeopleinvolvesmaximisingfunctionandindependencethroughaccesstoaflexiblerangeofgeneralpractice,primaryandacutehealthcareandagedcareservices.Akeydriverforthisincreaseddemandwillbetheincreasedprevalenceofdementiaandosteoporosisandtheassociatedneed ofhighlevelsofcareandsupport.

The federal government allocates funding, in the

form of Home Care packages, to the aged and

community sector to provide care and support to

older people whether living in the community or

in residential care. As of 1 August 2013 funding

is allocated at four levels: [23]

Home Care Level 1: to support people

with basic care needs.


with low level care needs.


with intermediate care needs.


with high care needs.

The frequency and intensity of care escalates as people move up through the home care packages.

Research and feedback consistently confirms that older people wish to stay in their homes as they age. [8]

Carefallsintothreekeycategorieswhich arebrieflydescribedbelow.

Informal Care

Informalcareisunpaidassistanceorsupportprovidedtopeoplewhosehealthrestrictstheirabilitytoundertakedailyactivities.Mostinformalcarersarefamilyorfriendsofthepersonreceivingcare.The2011Censusfound11.8%SouthAustraliansinthetwoweekspriortocensusnightprovidedinformalcaresuchasassistingfamilymembersorothersduetoadisability,longtermillnessorproblemsrelatedtooldage.Theageingpopulationandchangingsocialconstructswillprofoundlyaffectthesupplyofinformalcare.Forexample,increasingfemaleworkforceparticipation,increasingdivorceandsmallerfamilysizewillreducethepool ofinformalcarers.

Community Care

Communityagedcarereferstoformalservicesusuallyprovidedinthecarerecipient’shome.Inmanyinstances, peoplelivinginthecommunityand receivingcommunityagedcarealso relyonaninformalcarer.

Residential Care

Residentialcareisprovidedatanagedcarefacilitybyapaidformalcarer.Itisforpeopleforwhomcommunitycareisnotdesirable orfeasible,oftenbecausethehealthcare needsarehighandaccesstoinformal caresupportislimited.

Aged Care Services


Aged Care Service Utilisation across CAHML

TheolderpopulationlivingwithintheCAHMLregionisdiverseandthereforeitislikelythattheagedcareneedsofthispopulationarealsodiverse.ThedistributionofresidentialagedcarefacilitiesismappedinFigure12andidentifiesthattherearereasonablenumbersofagedcarefacilitiesintheEastandWestoftheregionwithsmallernumbersintheHillsandintheCBD.Residentialagedcarefacilities(RACF)aredistributedacrosstheregionalthoughnotevenly,withsomepartsofCAHMLhavinghighnumbersofolderpeople,butfewornoresidentialagedcarefacilities.Thismeansthatasignificantnumberofpeopleneed tomoveoutoftheircommunitytoresidentialaged caredislocatingthemfromtheircommunity,family andfriends,unlesssuitablecommunitybased optionsareavailable.

Forpeoplefromculturallyandlinguisticallydiverse(CALD)backgroundsfindingsuitableagedcareservicescanbechallenging.BarrierssuchasalackofEnglishlanguageskills,socialisolation,insensitivityfromserviceproviderstopeople’sculturalneeds,andlackoftransportcanallresultinolderpeoplefromculturallydiversebackgroundsfailingtouseagedcareservices.However,withintheCAHMLregiontherearealargenumberofRACFfacilitieswithintheregion(infactthemajorityoffacilitiesinSA)thatspecificallycaterforpeoplefromculturallyandlinguisticallydiverse(CALD)backgrounds,whichisnotsurprisinggiventheculturallydiversemakeupoftheCAHMLpopulation. AnumberofRACFswithintheregionofferpriorityaccesstoindividualsfromculturallyandlinguisticallydiversebackgrounds.[25]

OtherformalagedcareserviceswithintheregionaredescribedinTable11,startingwiththosewhoreceiveHomeandCommunityCare(HACC)packages.InformationfromthePHIDUSocialHealthAtlasMedicareLocalwebsitesuggeststhatmanyolderpeoplewithintheCAHMLregionwhoareinreceiptofaHACCpackagearelivingaloneandprobablyagedbetween65yearsand84years.Thelownumbersofolderindigenousclientsreceivingformalagedcareisevident.

Table 9: Persons Receiving HACC [10]

HACC Packages CAHML 2010/2011

LivingAlone 11,492

ClientswithCarer 7,087

IndigenousClients 354

Non-EnglishSpeakingClients 5,903

Total Clients 29,018

Aged Care Services

RACF High Care Beds

RACF Low Care

19 - 37

38 - 45

46 - 50

60 - 87

88 - 161

Persons 65 or over

20% - 21.8%

15.9% - 19.9%

14.9% - 15.8%

12.4% - 14.8%

10.2% - 12.3%

SA SLA Region

Number of People 65+Specific Ethnic Group

5,320 to 6,530

4,420 to 5,320

3,830 to 4,420

2,600 to 3,830

870 to 2,600

Figure 12: Persons Aged 65+ and Aged Care Facilities Figure 13: Persons Aged 65+ and Aged Care Facilities with Ethnic Speciality

Serbian, Polish & Eastern European Greek

Russian Estonian, Latvian, Lithuanian

Polish Croatian & Ukrainian

Italian Belarusian, Croatian & Ukrainian

Hungarian ATSI, Cambodian, Chinese, Maltese, Filipino, Spanish & Vietnamese

3

1

2

4

5

9

8

7

6

10

11

12 13

14

15

16

18

17 1920

21

22

3

1

2

4

5

9

8

7

6

10

11

12 13

14

15

16

18

1719

20

2122

25

24

26

23

21


Community-based Aged Care

AccesstotherangeofcommunityagedcarepackagesisthenextlevelofcareavailableforolderpeoplewithintheCAHMLregion.

Table11,providesasnapshotofwhereagenciesthathavebeenallocatedfundingtoprovidecommunitycarepackagesarelocatedacrosstheAdelaideregion.

Asagedcareprovidersdecidewhoandwheretodeliverservices,itispossiblethatasmallnumberofcommunitycarepackagesincludedinTable9reflectthatsomeofthesehavebeenprovidedtopeopleoutsideofCAHMLboundaries.Despitethis,theinformationishelpfulasitprovidesanindicationofwherethegreatestnumbersofolderpeopleareaccessingsupporttoageinplace.

ItwouldbeworthwhilecollectingadditionaldetailsaboutwhoreceivesthecommunitycarepackagesandfurtheranalysingthisinformationasitcouldbearichsourceofinformationforplanningpopulationbasedserviceswithinCAHML.Howeverthiswillrequireworkwiththeagenciesthatareprovidingthosepackagestogainmoreinformationaboutthefollowing:

• Postcodes where packages are delivered.

• Profile of people receiving packages (ie age,

ethnic background, language group).

• Specific services delivered under the packages.

• Carer status.

Thiscanpotentiallyidentifywhichpopulationsandcommunitiesarenotyetaccessingservicesorthosethatareover-represented,andthisinformationcanbeusedtoinformprimarycareresponses(targetedhealthliteracy,sentinelGPpracticedevelopment,andreducehospitaladmissions).

Table 11: 2012-2013 Aged Care Approvals Round Home Care Package Allocations [26]

Region Level 1 Level 2 Level 3 Level 4 Total

Hills,Mallee&Southern 18 26 13 10 67

AllMetroRegions 9 14 7 5 35

MetroEast 27 40 20 14 101

MetroNorth 27 40 20 14 101

MetroSouth 27 40 20 14 101

MetroWest 19 20 13 14 66

Aged Care Services

Thereareanumberofdifferenttypesof respite.Somecommontypesinclude:[27]

In home

Asupportworkerlooksaftertheperson inthehome.

Facility or residential based

Apersonstaysforashortperiodinacarefacilitylikeanagedcarehomeorsupportedaccommodation.

Community based

Thepersonjoinsadayprogramatanadult daycentre,neighbourhoodhouseorcommunityhealthcentre.

Alternative family care

Familyandfriendsmaybeabletohelpwithcaringresponsibilitieswhiletheusualcarertakesabreak.

Recreation based

Thecarerandthepersonbeingcaredforcanjoinorganisedrecreation,socialorleisureactivitieseithertogetherorseparately.

Equipment

Tosupportoreasethecarer’srole.

Emergency respite

Availableifthecarerneedstodealwithsuddenillness,accidents,familytroubles oremergencies.

Respite Care

Residential/respitecareprovidesashorttermalternativetocommunitycareandisfrequentlyaccessedwhentheinformalcaresupportisnotavailableduetoillhealth,otherurgentcommitments ortimeforthecarertohaveabreakfromthecaringroletobeabletorestandrecuperate.

RespiteservicesareoftenattachedtoresidentialagedcarefacilitiesandFigure14showsthelocationofrespitecareservicescomparedwithwheretheolderpopulation65plusliveacrosstheCAHMLregion.

Figure 14: Respite facilities located within

CAHML boundaries


5,320 to 6,530

4,420 to 5,320

3,830 to 4,420

2,600 to 3,830

870 to 2,600

Respite Facility


Consumer-directed Care

Theageingofthepopulationandimpactof specificconditionssuchasdementia,osteoporosisandchronicdiseasewillseedemandforaged careservicessignificantlyincrease.Thisdemandwillnotbeuniformwithcareneedschangingasthepopulationagesandastheproportionof agedcarerecipientswithcomplexhighcare needsincreases.

Therewillbegreaterdemandformorechoicewithinandacrossthecommunityandresidentialcaretomeetindividualpreferences.Currentlyadequateandappropriateprovisionofagedcareiscomplicatedbyindividualpreferencesinthetypeandqualityofcare.Evenpeoplewiththesame

conditionmayhavedifferentpreferencesforthetypeofcaretheywantandhowtheywouldliketheircaredelivered.Therecentmovetoconsumerdirectedcare,whereagedcarerecipientscanuseallocatedfundsorbenefitstopurchaseservicesandequipmentfromwithintheformalagedcaresectororoutsideoftheformalagedcaresystem,islikelytochangethewaycommunityagedcareservicesareprovided.

Itistooearlytodeterminetheeffectivenessofconsumerdirectedcarefunding,althoughitisexpectedtoincreasetheflexibilityofexistingfundingpackagesandincreaseavailabilityofservices,suchasrespitewithinthecurrent agedcaresystem.[24]

Aged Care Services Summary and Conclusion

The CAHML region has an older population profile,

includes sizable pockets of older people from

cultural and linguistically diverse backgrounds

and it is expected that the ageing population will

grow significantly in the immediate future.

The health status of this population is challenged

by a range of chronic conditions leading to

morbidity, mortality and disability. The impact of

chronic conditions such as chronic obstructive

pulmonary disease and diabetes are evident earlier

in life and so is the focus of CAHML’s work across

the community.

Currently dementia is a significant issue for older

people in the region, as is osteoporosis and the

risk of falls and fractures due to minimal trauma.

The population is accessing a range of GP,

community and residential aged care services and

while there appears to be reasonable coverage of

all service types, it is anticipated that the region

has significant unmet needs. Anecdotal evidence

further supports this view.

It is difficult to pinpoint exactly where the greatest

service gaps exist, although access to timely and

appropriate levels of community and health care

that is designed to support people to remain

in their home as they age is very likely to be

under resourced.

Potential Areas for Action

Intheearlyphaseoftheageingprocess,asolderageapproaches,a‘windowofopportunity’ispresenttobuildhealthliteracyandreinforcethefoundationsofhealthylifestylesthroughpositivesocialandphysicalenvironmentsthatsupportandencouragepositivebehaviouralchoices.Advancingagethenoffersopportunitiestoenhancefunction,minimisedeclineandimprovemostoftheestablisheddiseaseorimpairment.

Prevention, Detection and Early Intervention through Primary Care

Primarycareservicesareintheprimepositiontopromoteopportunitiesforolderpeopletomaintainandenhancetheirwellbeingandindependencethrough;

• Increasedfocusonhealthyphysicalandmentalactivity,mobilityandstrengthprograms.

• Accesstoannualhealthchecksincluding physicalactivity,nutrition,mentalandoralhealth,sight,hearing,mobilityreviewsandmedicationchecksandfollowups(e.g.annualMedicare75 plushealthcheck).

• Targetedsmokingcessationandalcoholharmreductionprograms.

• Promotingvaccinationagainstinfluenzaandotherinfectiousdiseases.

• IncreasingscreeningandearlydiagnosisofdementiaandosteoporosisegbonedensityandVitaminDscreeningforatriskindividuals.

• IncludingmoreaccurateandcompleteMBScodingoftheseconditionsandrelatedco-morbidities.

Generalpracticeasthefocalpointofhealthcareforolderpeopleprovidesamajoraccesspointtothehealth,communityandagedcaresystems.

35Central Adelaide and Hills Medicare Local - Ageing Population and Associated NeedsCentralAdelaideandHillsMedicareLocal-AgeingPopulationandAssociatedNeeds34

Summary and Conclusion

Support Older People to be Active and Healthy

Creatingtheconditionsthatenableolderpeopletomakehealthychoiceswillbecomeincreasinglyimportantastheprevalenceofchronicdiseasecontinuestorise.

Thereissignificantopportunitytoreducethenegativeconsequencesofpoornutrition,obesity,smoking,alcoholandlackofphysicalexerciseinolderage,throughappropriatesocialandenvironmentsupportsandpromotionofhealthylifestylechoices.PromotionofthesetypesofstrategieswillreducetherateoffunctionaldeclineexperiencedbyolderpeoplelivingintheCAHMLregionandhelptomaintainhealth,wellbeingandindependence.

Primarycareserviceshaveakeyroleintheprovisionofhealthandlifestyleeducation,increasinghealthliteracy,illnessprevention,promotionofmobility,independenceandpositivelivingtosupportolderpeoplelivingsociallyconnectedlives.

Contribute to Building Healthy Social and Physical Environments for Older People

Thephysicalandsocialenvironmentplaysanimportantroleinsupportingolderpeopletomaintaintheirhealthandwellbeing.Inparticular,urbanenvironmentsclosetohomehavebeendemonstratedtoinfluencepeople’smentalhealthandlevelofphysicalactivity.

TheWorldHealthOrganizationhasadoptedTheAge-FriendlyEnvironmentsProgram.ThisProgramaimstocreatephysicalandsocialurbanenvironmentsthatpromotehealthyandactiveageingandalsoincludesafocusonfallsreductionstrategies.AnumberofSouthAustralianlocalcouncilshavebeguntoinvestigateadoptingthisapproachincludingtheCityofUnley.Theremaybeopportunitiesto:

• ExpandtheadoptionofAge-friendlyEnvironmentsproject,ascompletedbyCityofUnley,tootherlocalgovernmentareasacrosstheCAHMLregioninpartnershipwithlocalcouncils,inparticularCharlesSturt,PortAdelaideEnfieldandCampbelltown.

• EstablishpartnershipgroupstooverseeandsupporttheadoptionofAge-friendlyEnvironments.PartnerscouldincludelocalcouncilswithinCAHML,ActiveAgeingAustralia,CounciloftheAgeingandCarersSA.

Chronic Disease Management

Forthoseolderpeoplewhohavejustreceivedadiagnosisofachronichealthconditionandmaybeexperiencingtheearlystagesofthatillness,thegoalistoprovidetherightprogramsandservicesthatidentifyemerginghealthproblemsearlyandencouragethedevelopmentofeffectiveself-managementskills.Thebestplaceforthistotakeplaceisingeneralpracticeandotherprimarycaresettings.

Health Literacy - a Key Determinant of Health

Healthliteracyisanemergingtopicofinterestfor healthpractitionersandhealthsystems.Evidenceindicatesthatpeoplewhohavepoorhealthliteracyaremorelikelytoengageinunhealthybehaviours,makelessuseofpreventivehealthactivities,suchasscreening,havediminishedcapacitytomanagechronicdiseasesandpooradherencetomedication,whichresultsinincreasedhospitalisationandriskofdeath.

Healthliteracyaffectspeople’sabilitytolookaftertheirhealthateachlevelofthechronicdiseasecontinuum:prevention;earlyintervention;establisheddiseaseandcontrolleddisease.[26]

Peoplewithlimitedhealthliteracymostoftenhavelowerlevelsofeducationandincome,areolderadultsandaremigrants.ThepopulationoftheCAHMLregionincludesmanypeoplewithoneormoreofthesecharacteristics.

Potential strategies to make health literacy

a priority for CAHML:

• UndertakeahealthliteracysurveyfortheregionbasedupontheEuropeanhealthliteracysurvey.

• Developplainlanguageinitiativesforallcommunityengagementactivities.

Workwithprimarycareandagedcareproviderstoadopthealthliteracystrategieswiththeirclientsandthroughouttheorganisation.

Client Centred Care-improved Pathways

Inpartnershipwithkeystakeholdersfromtheaged careandprimarycaresector,thereexistsanopportunitytoredefineandredesignagedcarepathways,withaparticularfocusonthoseolderpeoplelivinginthecommunity,whoarenotreceivinganagedcarepackage,butwhosesupportandhealthneedsare notbeingmet.Potentialstrategiesforthisinclude:

• Workwithexistingagedcareandcommunityproviderstoidentifyopportunitiestoextendandbuilduponexistingservicesandprogramsto bettersupportolderpeoplelivinginthecommunity.

• Reinforcetheimportanceoftreatingolderpatientswithdignityandrespect,focusingonissuessuchaszerotoleranceforallformsofabuse,respectingpeoplesprivacyandlisteningtotheindividualneedsofolderpatients.ForexamplebuildonTheQueenElizabethHospitalDignityinCareprogram.

• UndertakequalitativeresearchtobetterunderstandthehealthandsupportneedsofolderpeoplelivingincommunityeitherintheirownhomesorinsupportedaccommodationintheCAHMLregion.

• Workwithgeneralpracticeandresidentialcarefacilitiestoimprovedataqualityandcareof olderpeoplethroughimproveduseofscreeningandattendanceatresidentialcarefacilitiesbygeneralpractitioners.


1. Brundtland DG - Director-General, World Health Organization. World Health Day – Active ageing makes the difference. April 1999

2. Dementia Care in Hospitals – Costs and Strategies. Australian Institute of Health and Welfare 2013

3. Economic Implications of an Ageing Australia. Australian Government Productivity Commission Research Report –March 2005

4. World Health Organization. Brasilia Declaration on Ageing, WHO July 1996

5. Active Ageing – A Policy Framework. A contribution of the World Health Organization to the Second United Nations World Assemby on Ageing, Madrid, Spain. April 2002

6. Ageing and Aged Care In Australia. Department of Health and Ageing. Australian Government. July 2008

7. State of Ageing in South Australia. Summary of a Report to the South Australian Office for the Ageing. Published October 2009 by the Department for Families and Communities Government of South Australia

8. Service Framework for Older People 2009–2016: Improving Health & Wellbeing Together. Department of Health, State-wide Service Strategy Division. Government of http://www.fightdementia.org.au/what-is-dementia.aspxSouth Australia 2009

9. Office for the Ageing – Australian Bureau of Statistics 2011 Census

10. PHIDU - Social Health Atlas of Australia: Medicare Locals, Published 2013

11. Census of Population and Housing 2011 – Australian Bureau of Statistics

12. Dementia in Australia - Australian Institute of Health and Welfare – September 2012

13. Department of Health and Ageing. http://www.health.gov.au/dementia accessed Aug 13

14. Dementia Across Australia: 2011-2050. Prepared by Deloitte Access Economics for Alzheimer’s Australia –September 2011

15. Alzheimer’s Association. http://www.fightdementia.org.au/what-is-dementia.aspx. Access Oct 13.

References

16. AIHW 2012. Dementia in Australia. Cat. no. AGE 70. Canberra: AIHW.

17. Australian Institute of Health and Welfare 2007. Australia’s welfare 2007. Cat. no. AUS 93. Canberra: AIHW.

18. South Australia’s Dementia Action Plan 2009-2012: Facing the Challenges Together. Government of South Australia – Office for the Ageing, Department for Families and Communities in Partnership with SA Health

19. Targeting Brain, Body and Heart for Cognitive Health and Dementia Prevention. Current Evidence and Future Directions. Alzheimer’s Australia. September 2012

20. Mayo Clinic Nuerosciences Update. Neurologic Surgery and Clinical Neurology News Vol 6, No 4, 2009

21. Building healthy bones through life. An evidence-informed strategy to prevent osteoporosis in Australia. The Medical Journal of Australia. February 2003

22. RACGP – Australian Family Physician – The Elderly December 2012 Vol 41 (12)

23. Department of Health and Ageing – Living Longer. Living Better. April 2012

24. Caring places: Planning for aged care and dementia 2010-2050. Volume 1. Report by Access Economics Pty Ltd for Alzheimer’s Australia. July 2010

25. Multicultural Aged Care – A guide to services for older people from culturally and linguistically diverse backgrounds, sixth edition, March 2012

26. Australian Government - Department of Health. 2012-13 Aged Care Approvals Round Home Care Package allocations

27. Carers SA - http://carers-sa.asn.au/respite/about-respite Accessed Oct 13

28. The solid Facts: Health Literacy. World Health Organization. Europe 2013.

29. Australian Bureau of Statistics 2001, National Health Survey: summary of results, cat. no. 3464.0

30. Gill T, Marin T, Laslett L, Kourbelis C, Taylor A. An Epidemiological Analysis of Falls Among South Australian Adults. Population Research and Outcome Studies Unit. SA Health, Adelaide. May 2009

WeacknowledgeHealthFirstNetwork™forcollatingthispopulationhealthinformationfortheregion.


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