AUSTRALIANS LIVING IN RESIDENTIAL AGED CARE


INTRODUCTION

Older people make up a growing proportion of Australia’s population. The number of people aged 65 years and over has increased from one in every seven people in 2011 (14%), to nearly one in every six people (16%) in 2016¹, and it is predicted to increase to almost one in five by 2031². Australia’s growing ageing population presents a challenge to service provision, particularly in the aged care sector. While increasing numbers of people are receiving care at home³, ensuring that adequate and sustainable residential care is available to those who need it is an important national policy priority as our older population continues to grow.


RESIDENTIAL CARE

The 2015 ABS Survey of Disability, Ageing and Carers (SDAC) found that there were 201,900 people living in residential care. In the SDAC, residential care includes hospitals, nursing homes, aged care hostels, cared components of retirement villages, psychiatric institutions, and other 'homes', such as group homes for people with disability.

Consistent with Australia’s ageing population, the number of people living in residential care has increased since 2009 (from 163,500 people to 201,900 people). As expected, a larger proportion of older Australians were living in residential care compared with those in the younger age groups.



While most people in residential care were in a nursing home or accommodation for the aged (92.8% or 187,300 people), such as aged care hostels and cared components of retirement villages, a small proportion were in another ‘home’ (3.8%), or in hospital (3.4%). For the purpose of this publication, the remainder of the analysis will be limited to residents of residential aged care which includes people living in nursing homes, aged care hostels and those who received care within retirement villages. Residential care populations are summarised in the Residential Care Conceptual Framework, below.

Residential Care Conceptual Framework, 2015



RESIDENTIAL AGED CARE

Age and sex

In 2015, of the 187,300 people living in residential aged care, over two-thirds (68.1%) were women. This in part reflects the fact that on average, Australian women live longer (84.5 years) than men (80.5 years)⁴.

Most people (95.4%) living in residential aged care were aged 65 years or more, though the split across age groups differed for men and women, with women living in residential aged care tending to be older than men. Around two-thirds (65.6%) of all women living in residential aged care were over the age of 85 years (compared with 45.0% of all men), whilst, proportionally, there were more men than women living in residential aged care in all other age groups.



Disability

In the SDAC, disability is any limitation, restriction or impairment which restricts everyday activities and has lasted, or is likely to last, for at least six months. A more detailed description of disability is provided in the Glossary. Nearly all people living in residential aged care in 2015 had some type of disability (96.5%). Of those with disability, most had a profound or severe disability (96.9% of men and 98.1% of women).

Disability group

Disabilities can be broadly grouped depending on whether they relate to functioning of the mind or the senses, or to anatomy or physiology, and people may have one or more disabilities from different disability groups. For more information about disability groups, refer to the Glossary.

In 2015, most people living in residential aged care with disability had a physical restriction (88.5%), such as chronic pain or incomplete use of arms or legs, with many also having a psychosocial restriction (73.1%), including memory problems and social or behavioural difficulties.

There was some variability among men and women living in residential aged care in terms of their disability types. Men living in residential aged care were more likely to have had a stroke, head injury or acquired brain injury (28.8%) compared with women (17.8%). Men were also more likely to have a sensory or speech disability (67.2%) compared with women (61.4%).

Long-term health conditions

A long-term health condition is a disease or disorder that has lasted, or is likely to last, for six months or more. As people age, their physical and mental functioning can deteriorate, and they may become susceptible to age-related conditions. A long-term health condition may or may not cause disability, dependent on whether it causes limitation, restriction or impairment which restricts everyday activities.

As people age, their physical and mental functioning can deteriorate, and they may become susceptible to age-related conditions. Almost all (99.7%) people living in residential aged care in 2015 had at least one long-term health condition, ranging from skin conditions such as eczema to conditions such as osteoporosis. Over half (54.7%) of people living in residential aged care had 5-8 long-term health conditions, while one in five (20.8%) had nine or more conditions. There was very little variation between men and women living in residential aged care in terms of their number of long-term health conditions.



There was, however, some variation in the types of long-term health conditions between men and women living in residential aged care. For example, women were more likely than men to have arthritis (58.1% compared with 44.1%), osteoporosis (24.6% compared with 9.4%) and/or phobic and anxiety disorders (21.2% compared with 12.0%). In contrast, men living in residential aged care were twice as likely as women to have had a head injury or acquired brain injury (13.0% compared with 6.4%) and were more likely to have had a stroke (25.8% of men compared with 19.0% of women). This may be a contributing factor to the higher proportion of men under the age of 65 years living in residential aged care (8.0% of all men living in aged care compared with 3.4% of women).



Dementia

Dementia (including Alzheimer’s disease) is a collection of numerous symptoms caused by disorders affecting the brain, leading to health complications and death⁵. In 2017, dementia was the leading cause of death for women and the third leading cause of death for men in Australia⁶. Understanding the characteristics of people with dementia is important to ensure that adequate and appropriate care is available as Australia’s older population grows.

According to the 2015 SDAC, almost half (49.9% or 93,400 people) of all people living in residential aged care had dementia (including Alzheimer’s disease). The proportion of people living in residential aged care with dementia increased with age, from almost one quarter of all men (24.4%) and women (24.2%) aged 50-64 years, to around half of those aged 85 years and over (49.8% of men and 53.6% of women).



Impairments experienced by people with dementia

An impairment is a problem with the body’s functioning or structure, including impairment of mood or emotion, impairments of speech, loss of sight or loss of a limb, disfigurement or deformity, hallucinations, loss of consciousness, and any other lack of function of body organs.

In 2015, among people living in residential aged care, those with dementia were twice as likely as those without dementia to have nine or more impairments (53.4% compared with 23.9%), suggesting that the care needs associated with dementia may be greater.



Use of aids and equipment

Certain aids and equipment can help those people with disability living in residential aged care with everyday activities such as dressing, eating and moving around, as well as assist with their health care needs. People living in residential aged care most commonly used aids and equipment to assist with showering or bathing (76.1% of all those living in residential aged care) and moving about their place of residence (75.2%).

Use of certain aids and equipment in residential aged care was more common among people with dementia. For example, people with dementia were more likely to use aids and equipment for activities such as managing incontinence (80.5% of those with dementia compared with 60.3% of those without dementia), toileting (69.1% compared with 57.0%) and eating (37.2% compared with 23.7%). However, those with dementia were less likely to use aids or equipment for communication (21.2% compared with 25.7% of those without dementia) and managing health conditions (39.1% compared with 42.9%).




LOOKING AHEAD

As people age, many will seek services that reflect and address their care needs. The preference of many older Australians to remain in their own home has led to an increasing focus on policies, programmes and services to improve the quality of home support and care in Australia ⁷. While a growing proportion of older Australians are accessing care services from their homes³, the increasing size of the ageing population, particularly those with dementia, means there is an ongoing need for residential aged care support. Understanding the characteristics of those who use residential aged care today can help in tailoring the services currently provided, and better prepare for the needs of the future.


ENDNOTES

1. ABS Census of Population and Housing, Reflecting Australia: Stories from the Census, Ageing Population, 2016
2. ABS Population Projections, Australia (cat. no. 3222.0), 2012 (base) to 2101
3. Australian Institute of Health and Welfare Admissions into Aged Care, 2017-18 (accessed 28 September 2018)
4. ABS Gender Indicators, Australia (cat. no. 4125.0), 2017
5. ABS Causes of Death, Australia: Dementia and death in Australia (cat. no. 3303.0), 2015
6. ABS Causes of Death, Australia: Australia’s leading causes of death (cat. no. 3303.0), 2017
7. Department of Health, Ageing and Aged care, Aged care reform (accessed 26 October 2018)