Population and policy context - Care of older people toolkit
In 2005, two thirds of older South Australians reported good, very good or excellent health and many healthy older people manage their own health and well beingiii. They use primary health care services, such as general practitioners with occasional use of hospital services for emergency or planned treatments including elective surgery.
However, as people age, they are more likely to access emergency and other hospital services. For example, people aged between 65 and 75 years are twice as likely to be admitted to hospital as the rest of the population, and those aged over 85 years are five times likely to be admitted to hospitaliv.
South Australia’s population aged over 65 years is increasing as a proportion of the total population and older people are now living longer than previous generations. This is due to a number of factors such as an increase in longevity due to, declines in mortality from disease, such as heart disease and stroke, public health initiatives including improved nutrition, and through advances in medical technology and levelling off of the birth rate.
A key challenge for the South Australian health system is to deliver high quality person-centred health care for older people that maintains or maximises a person’s independence and wellbeing through access to a flexible and timely range of general and specialist health services within an environment of increasing demand, workforce shortages and financial pressures.
Older Aboriginal and Torres Strait Islander People
The age structure of the total Australian population differs markedly from that of the Aboriginal and Torres Strait Islander population. Children represent a much greater proportion of the Aboriginal and Torres Strait Islander population and there are relatively few older people.
Projections for the Aboriginal and Torres Strait Islander population continue to raise concerns about the persistence of health inequalities. In 1996, 3% of Australian people were aged 65 years and over compared with 12% of the total Australian population . In 2006, the proportion of Indigenous people increased very slightly to 3.5% of the total Australian populationv, while the proportion of older people in the total Australian population is 13%vi.
Aboriginal and Torres Strait Islander people have poorer health status than non Aboriginal people. The reasons for this are complex, but represent a combination of general factors - such as the past injustices of dislocation and dispossession, education, employment, income and socioeconomic status - and factors more specific to the health sector. As the Australian health ministers noted in their introduction to the National Strategic Framework for Aboriginal and Torres Strait Islander Health 2003-2013, achievement of substantial improvements in Indigenous health will depend on long-term collaborative approaches involving Indigenous leaders and communities, the health and non-health sectors, and all levels of government.
Care of older Aboriginal and Torres Strait Islander people in hospital
Hospitals and health services which are culturally responsive are more likely to observe better health outcomes for their patients. Aboriginal and Torres Strait Islander people who feel supported and are respected tend to adhere to the requirements of their treatment and actively participate in their own treatment plan.
Hospitals and health services need to recognise and respond to the consequences of relocation for the purposes of treatment and care of illness for Aboriginal patients and their family members, including loss of social and cultural contacts and supports, the need for housing and transport assistance and the potential discontinuity of health care.
Coordinated, culturally appropriate services across a person’s health care journey - including primary health care and hospital care - will improve the patient journey for Aboriginal South Australians.
All health services must give consideration to the health literacy of Aboriginal older people and their families, the significance of belief systems to the older person’s experience of illness and subsequent provision of health care.
Significant issues might include cultural expectations about the meaning of having an illness, gender roles within the family for the patient and their carers, appropriate exercise and dietary regimes and the respective roles of the patient and clinician in managing illness.
Cultural issues are also important when considering using screening and assessment tools. Difficulty in translating the language and cultural appropriateness of tools can lead to problems in cross cultural validation of the screening instrument and cultural issues can impact on a person’s performance in an interview. Cultural differences can also complicate decisions about the management of a person’s health care needs.
Cultural and linguistic diversity in the older population
South Australia’s cultural and linguistically diverse (CALD) older population is growing between two and three times faster than the Australian born populationvii.
The Productivity Commission projects that the number of older Australians from non-English speaking backgrounds will increase by over 40 per cent between 2011 and 2026 and by 2026, 1 in 4 Australians aged over 80 will be from a non- English speaking backgroundviii.
Existing studies suggest there appears to be significant under utilisation of services by CALD older people. This pattern may be confounded by language barriers which prevent non-English speaking elderly from being aware of, or using, existing services. There may also be a greater tendency to rely on support from family among the major ethnic groups than is the case among other Australiansix.
All health services must give consideration to the health literacy of CALD older people and their families, the significance of cultural beliefs to the older person’s experience of illness and subsequent provision of health care. Significant issues might include cultural expectations about the meaning of having an illness, gender roles within the family for the patient and their carers, appropriate exercise and dietary regimes and the respective roles of the patient and clinician in managing illnessx.
Cultural issues are also important when considering using screening and assessment tools. Difficulty in translating the language and cultural appropriateness of tools can lead to problems in cross cultural validation of the screening instrument and cultural issues can impact on a person’s performance in an interview. Cultural differences can also complicate decisions about the management of a person’s health care needsxi.
Within Australia, the diversity of cultural groups, including Aboriginal and Torres Strait Islander groups, creates particular issues around the way in which culturally appropriate health care is provided. Recognition and respect of individual diversity and cultural and religious beliefs can facilitate the experience of older people from culturally and linguistically diverse backgroundsxii.
Policies and strategies
There are a number of policies and strategies on ageing and associated health and well being that set the context for this work. Links to some key documents are listed below.
South Australia – State Government
South Australia’s Strategic Plan – provides the overarching policy context for improving the life and wellbeing of South Australians.
SA Health Care Plan for South Australia 2007-2016 – outlines the strategies to improve our health system and provides direction for reforming health services.
Improving with Age – Our Ageing Plan for South Australia – is the State Government’s blueprint for its response to an increasingly ageing population.
Health Service Framework for Older People 2009-2016 – sets out the government’s directions for health services for older people now and into the future.
South Australia – SA Health and other
i Inouye, S., et al The Hospital Elder Life Program: A Model Of Care To Prevent Cognitive And Functional Decline In Older Hospitalized Patients, Journal American Geriatric Society 2000, 48, 1697-706
iv Government of South Australia (2007) South Australia’s Health Care Plan 2007-2016: The South Australian Governments plan for health care over the next 10 years, Government of South Australia: Adelaide
v Australian Bureau of Statistics (2000) Indigenous population. Canberra: Australian Bureau of Statistics
vii Hugo, G (1998) South Australia’s Ageing Population and its increasing Multicultural Nature. AGM, Multicultural Aged Care, Melbourne.
viii Productivity Commission Inquiry Report (2011) Caring for Older Australians, No. 53
ix Hugo, G.J. (1986). Australia’s Changing Population. Melbourne, Oxford University Press
x Clinical Epidemiology and Health Services Evaluation Unit (2004) Best Practice Approaches to minimise functional decline in the older person across the acute, sub-acute and residential aged care settings, AHMAC Care if Older Australian Working Groups Government of Australia