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A growing and ageing population

Australia’s population is a growing and ageing population. This growing and ageing population is one of Australia’s health priorities because with a growing and ageing population comes an increase in disease burden and health care demand.

Australia’s growing and ageing population is a product of increased life expectancy, and decreased birth rates. The increasing survival rates for chronic diseases means that the elderly population have greater prevalence of major diseases, such as: cancer, cardiovascular disease, diabetes, and musculoskeletal disorders, as well as suffering greater levels of disability.

As the growing and raging population increase the population living with chronic disease and disability, they also increase the demand for health services, which causes workforce shortages and a greater need for carers and volunteers.

Healthy Ageing

Healthy ageing is a process that includes various behaviour and choices that affect health, such as regular physical activity, good dietary choices, regular family contact and social activities, as well as resilience to life’s circumstances. The goal of healthy ageing is to enable the elderly to maintain their health into old age, which allows them to contribute to the workforce longer, and engage in society better. This increases economic growth, but also decreases the use of health services by the elderly, who are the largest users of the health care system. Many people believe poor health comes with age, but this is not the case. Many chronic diseases and some disability are preventable and are not inevitable with aging. Healthy ageing involves people reducing their risk factors for disease, and preventing the progression of the disease after its onset and reducing morbidity and mortality. Encouraging health across the lifespan will help improve the health of future generation, if they may healthy choices to prevent risk factors. Another aspect of healthy ageing, is using broader strategies to improve the management of chronic diseases and multi-morbidity, which will help enable healthy ageing.

As the government seeks to promote healthy ageing it aims to:

prevent disease,
reduce illness and illness periods,
maintain economic contributions, and
maintain social participation

These goals are achieved by helping people to make good healthy choices and develop healthy behaviours throughout each stage of life. Ultimately healthy ageing improves Quality Of Life (QOL) and decreases Disability Adjusted Life Years (DALYs) which are used to measure disease burden.

Health care professionals, who provide advice about lifestyle, managing disease, and avoiding complications, enable healthy ageing. Other programs aim to improve balance in order to avoid falls and fractures in the elderly. Many elderly desire to remain in their own home as long as possible, which requires independence and/or health and social services in the community. People who live in accessible homes and take responsibility for their situation have a better sense of wellbeing and independence.

Better health is associated with employment, thus healthy ageing can bring health gains and increase their work and community activity, which improves wellbeing. There is currently an increasing trend for the elderly to stay in employment beyond the retirement age. Many older unemployed people, however, believe they are seen as too old by employers and do not actively seek work, even though they want employment.

Increased population living with chronic disease and disability

As Australia’s population continues to age, there is an increased population living with chronic disease and disability. This is because chronic disease and disability are more prevalent in the elderly. This is especially the case as survival rates from many chronic diseases increases, resulting in decreased quality of living and independence.

Chronic disease is the greatest issue for Australia’s health and has a large burden on the population. Diseases such as cancer, diabetes, cardiovascular disease, cerebrovascular disease and respiratory disease and mental health issues continue to impact Australian society and can lead to debilitating conditions. For example, a person who survives a stroke may never walk again and may end up in a nursing home for the rest of their life.

With rising survival rates from cancers, cardiovascular disease and other major diseases, prevalence of people living with chronic disease and disability is rising and increases the population of the elderly.

The more common chronic disease and disability amongst the elderly include:

53% of the have a disability
49% have arthritis
38% have high blood pressure
35% have hearing loss
Over 1 in 5 (22%) have cardiovascular disease
15% have diabetes
7% have cancer
20% have vision problems, and
93% of people with dementia are elderly

With an increased population living with chronic disease and disability, comes an increase in health care expenditure and the need for aged care facilities.

Assess the impact of a growing and ageing population on:

The health system and services

A growing and ageing population increases the demand for health services and creates workforce shortages in the health service as an increase in the workforce would be required. There is concern that the ageing population will increase public spending on health and place an unsustainable strain on the health system trying to serve the increasing cliental. This concern comes because an increase in age is associated with an increase in health conditions and disability making the elderly high users of health services. Currently there is an increase in the people living past 85 who suffer from diseases such as arthritis, dementia and cancer, while the generation moving into the 65+ age group have larger levels of lifestyle diseases such as diabetes. The resulting challenges focus on how the health system and its workforce will manage the health needs of the ageing population, particularly the increasing impact of chronic disease. The elderly visit health professionals more frequently than younger people, with 98% of the elderly (90% under 65) consulting a health professional in the last year. In particular, the elderly have much higher rates of specialist consultation; with 57% of the elderly using a specialist in the last year, compared to 28% of people under 65, and hospitalisation (20% compared to 11%).

In the last 10 years the number of people living in aged care facilities has risen by 20%. This reflects the growing and ageing population as well as the increase in government-subsidised residential places. Aged care caries a high burden on the health system with all of their residents having chronic disease or illness that increased the demand for health services. Many who live in these facilities (52%) also have symptoms of depression.

Health service workforce

The increase in aged care facilities also require an increase in workforce training in aged care and issues surrounding chronic diseases and disability. An ageing population requires an adequate health workforce. This relates to not only the number in the workforce, but their distribution and skills as well. Of particular concern is the increased demand for workforce in the aged care sector and specialists.

One way to address this growing demand for health services and workforce shortages is to focus on efficient coordination of care. The elderly have higher rates of multiple diseases and disability and coordinated care and a focus on safe use of medication would decrease the demand for health services and workforce shortages. Such a focus would reduce duplication of tests, medicating and medical records. Further efficiency might be achieved through greater interaction with aged care services, with focus on both the care and the setting in which it is provided. Of particular interest is the interaction between the hospitals and the aged care system. With 1 in 4 aged care residents visiting hospital a year accounting for approximately 9% of hospitalisations.

In 2012 the Australian government introduced the Living Longer, Living Better aged care reform package, which aims to address the attraction, retention, remuneration, education, training and career development of aged care workers, in order to address workforce shortages.

Carers of the elderly

A growing and ageing population, with the increase in chronic disease and disability require an increase in carers and volunteers. A carer is someone who provides assistance in a formal paid (64% of people receiving care use this) or informal unpaid role (83% of people receiving care use this) for someone due to illness, disease or disability. Care for the elderly needs to be varied in its approach in order to meet the demands. Aged care can be provided through community aged care or residential aged care. Care provided often includes daily activities such as bathing, cooking, home upkeep, and administering medications. Most informal unpaid carers are family members, particularly children or a spouse. These family members often decrease their workload in order to provide care to their loved ones. Many carers come from charities, religious institutions, or the government. There are currently three types of community care:

community aged care packages – provide low-level care giving basic support and assistance with daily activities.
Extended aged care at home – providing a higher level of care than the community aged care package above.
Extended aged care at home dementia – catering for the more complex needs of those with dementia.

Often people begin with informal community care and progress to using formal community care before transferring into residential aged care, such as a nursing home or hostel.

There is some positive news here though, as 31% of the elderly participate in voluntary work as carers, child minders and volunteers. The elderly provide support for relatives and friends who are aged, sick, or living with a disability. They also provide regular care for their grandchildren aged under 12, with this number rising.

Volunteer organisations

Numerous volunteers complement the care provided through the community services workforce. Volunteering is unpaid wilful help given as time, service or skill to a formal organisation. Formal groups include social groups such as sport or recreation groups, religious groups or heritage groups, as well as civic participation, which relates to unions, professional associations or political parties. Volunteers often cook, drive, do housework, visiting, or help the elderly shop. Volunteer organisations include: Anglicare, Alzheimer’s Australia NSW, ARV (Anglican Retirement Villages), Your Aged Care at Home Ltd, Independent Community Living Australia, and Nursing on Wheels (see www.volunteer.com.au for other organisations). Rates of volunteers had increased between 1995 and 2010, but from 2010-2014 the rate of volunteers fell from 36% to 31% of people 18 and over. This falling rate needs to be turned around if Australia is going to appropriately care for the needs of our growing and ageing population.

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