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4102.0 - Australian Social Trends, 2006  
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Contents >> Health >> Older people in cared accommodation

Older people in cared accommodation

In 2003, 167,000 people aged 60 years and over lived in cared accommodation. The main health condition of almost a third of these people was Alzheimer's disease or other dementia.

Residential aged care assists older people who cannot continue to live at home due to disability or age-related frailty. Since the mid 1980s there has been a strong policy of reform of aged care, to assist older people's desire to 'age in place'. The number of residential aged care places per 1,000 people aged 70 years and over decreased after 1985, while community-based care of various kinds was developed and expanded. Current arrangements stem from the Aged Care Act 1997 which restructured the residential aged care system. Further changes followed from the Review of Pricing Arrangements for Residential Aged Care in 2004.(EndNote 1) This process of reform, and other factors such as population ageing, means that people in aged care are likely to be an older and frailer group than in the past. This article examines the current characteristics of people aged 60 years and over in cared accommodation and compares them with other people of this age.

Data sources and definitions

This article draws on data from the ABS 1998 and 2003 Surveys of Disability, Ageing and Carers. As part of these surveys, data was collected about the characteristics of a sample of people in cared accommodation, via a questionnaire filled in by staff of these establishments.

Older people in this article are those aged 60 years and over.

Cared accommodation in the Survey of Disability Ageing and Carers comprises health establishments such as hospitals, nursing homes, aged care hostels, hostels for people with disabilities and some cared components of retirement villages. People living in cared accommodation are those who had been or were expected to be in cared accommodation for three months or more.

Households in the Survey of Disability Ageing and Carers refers to all living arrangements other than cared accommodation, and includes people living alone or with others, in private dwellings or non-private dwellings such as boarding houses, staff quarters or religious institutions.


USE OF CARED ACCOMMODATION

There were 167,000 people aged 60 years and over in cared accommodation in 2003 or 5% of the population of that age. The median age of older people in cared accommodation was 85 years. The use of cared accommodation was concentrated in the oldest age groups. Only 1% of people aged 60–74 years were living in cared accommodation, increasing to 7% of those aged 75–84 years and 31% of those aged 85 years and over.

Women made up 72% of all older people in cared accommodation. Their median age was 86 years, compared with a median of 82 years for men. A greater proportion of older women than older men were in cared accommodation (7% compared with 3%). In the age group 60–74 years about 1% of both women and men were in cared accommodation, but there were differences in the older age groups. Women aged 75–84 years were considerably more likely than men of this age to be in cared accommodation (8% compared with 5%) and there was also a difference among people aged 85 years and over (35% of women and 22% of men were in cared accommodation).

Women's longer average life expectancy may influence their use of cared accommodation. The oldest age groups include more women than men. The more severe levels of disability are more prevalent among very old women than among the smaller number of men who survive to the oldest age groups. Women are more likely than men to outlive a partner, and very old people with disability living alone are less likely to continue at home than people living with partners (EndNote 2)(see Australian Social Trends 2005, Older people with disabilities, pp. 74–78 and Carers, pp. 39–43).

People with more severe disability are of special interest when examining the use of care. In 2003, 37% of older people with a profound limitation and 6% of older people with a severe limitation were in cared accommodation.

The proportion of older people living in cared accommodation in 2003 was lower than in 1998, when 6% of those aged 60 years and over were living in cared accommodation (171,000 people). For those older people with a profound core activity limitation the decrease in the proportion in cared accommodation was from 41% to 37%, and the decrease for those aged 85 years and over was from 36% to 31%.

Over the same period, the proportion of older people living in a household who received some kind of formal care increased, from 20% to 22%. This represents older people, with or without a disability, who received care which would have ranged from help with one task such as home maintenance to more intensive help with personal activities like walking or dressing.

PROPORTION(A) OF OLDER PEOPLE IN CARED ACCOMMODATION — 2003
GRAPH: PROPORTION(A) OF OLDER PEOPLE IN CARED ACCOMMODATION — 2003


PROPORTION OF OLDER PEOPLE IN CARED ACCOMMODATION(A) — 1998 AND 2003

1998
2003
%
%

Aged 60 years or more
5.7
5.0
Aged 60–74 years
1.3
1.0
Aged 75–84 years
8.3
6.6
Aged 85 years or more
36.3
30.7
Male
3.7
3.1
Female
7.3
6.6
Profound
core activity limitation
41.0
37.0
Severe
core activity limitation
9.0
6.3
Any reported disability
11.0
9.5

(a) Older people in cared accommodation as a proportion of all older people with that characteristic. All data are on a crude basis.

Source: ABS 1998 and 2003 Surveys of Disability, Ageing and Carers.


LIMITATIONS AND NEED FOR ASSISTANCE WITH EVERYDAY ACTIVITIES

The great majority of older people in cared accommodation in 2003 had either a profound (85%) or severe (10%) core activity limitation. That is, they needed assistance with at least one personal activity (such as walking or dressing), or could not undertake an activity at all, or had difficulty communicating. Those 5% of older people in cared accommodation who did not have a profound or severe core activity limitation mainly comprised people with a less severe disability and those with a long term health condition, without disability.

Specific personal activities, such as getting out of a bed or a chair, walking up stairs or showering, can be grouped into activity areas, such as mobility or self care. A majority of older people in cared accommodation needed assistance with: self care (91%), mobility (87%), oral communication (63%), health care (95%) and emotion and cognition (85%). (The latter refers to needing assistance in areas such as maintaining relationships, understanding others or dealing with emotion). More than half of older people in cared accommodation needed help with all five of these areas (55%) and a further 26% needed assistance with four areas.

Among people in cared accommodation, there was not a great deal of variation in the need for assistance by age group. The area showing the greatest difference was mobility: 81% of those aged 60–74 years needed assistance with this area, increasing to 89% of those aged 85 years and over.

Most older people in cared accommodation used an aid of some kind (92%). The most common were aids that assisted people to move around their accommodation, used by 73%. Also common were aids used in showering or bathing (71%) and aids used in managing incontinence (57%). This high level of use of aids is consistent with the high levels of need for assistance reported for this group. In addition, aids tend to be routinely installed in cared accommodation (for example, showering aids) which seems likely to contribute to the high rates of use.

Number of residential places

Under the Aged Care Act (1997) the Australian Government subsidises residential aged care places and community care packages. Community care packages provide an older person at home with a level of care equivalent to residential care. A combined ratio of places and packages per 1,000 people aged 70 years and over is used in planning by the Department of Health and Ageing.

In 1985 there were 99 residential aged care places per 1,000 population aged 70 years and over 3 and this decreased to 89.2 by 1997 and then to a low of 82.2 in 2002. Recent increases have seen the first upward movement in the level of provision of residential aged care since 1985, to 84.2 in 2004.4 A new target of 108 places/packages per 1,000 people aged 70 years and over was set in 2004–05, 88 of which should be residential places.(EndNote 1)

AGED CARE PLACES AND PACKAGES

1997
2004
Places No.
139 058
156 580
ratio(a)
89.2
84.2
Packages(b)No.
6 124
29 923
ratio(a)
3.9
16.1
TotalNo.
145 182
186 503
ratio(a)
93.1
100.3


(a) Number of places and/or packages per 1,000 people aged 70 years and over.

(b) As well as Community Aged Care packages, 2004 data includes 860 Extended Aged Care at Home packages.

Source: Australian Institute of Health and Welfare 2005, Residential Aged Care in Australia 2003-2004: a statistical overview, Aged Care Statistics Series no. 20, (AIHW Cat. No. AGE43), AIHW, Canberra.


...COMPARED WITH THOSE AT HOME

As might be expected, this level of limitation and need for assistance contrasted with that of older people living in households, who were on average a much younger group (a median age in whole years of 70 years). The need for assistance of older people living in households ranged from 1% who needed assistance with oral communication to 17% who needed assistance with health care. Further, while 82% of older people in cared accommodation needed assistance with at least four of the five activity areas, this was observed for just 2% of older people in households. Consistent with these results, 8% of older people in households were considered to have a profound core activity limitation (compared with 85% of those in cared accommodation) and 7% to have a severe core activity limitation (compared with 10% of those in cared accommodation).

In each age group, much lower levels of need for assistance were reported for those living in households compared with those living in cared accommodation.


OLDER PEOPLE IN CARED ACCOMMODATION: USE OF AIDS — 2003

GRAPH: OLDER PEOPLE IN CARED ACCOMMODATION: USE OF AIDS — 2003



Disability

Disability as defined in the ABS 2003 Survey of Disability, Ageing and Carers refers to a limitation, restriction or impairment, which has lasted, or is likely to last, for at least six months. This definition is consistent with the International Classification of Functioning, Disability and Health, which defines disability as an umbrella term for impairments, activity limitations and participation restrictions.

Core-activity limitation refers to a limitation in the core-activities of self care, communication or mobility. Levels of severity of these limitations are: profound, severe, moderate, mild.

People with a profound core-activity limitation always need help or supervision with self care, communication or mobility, or are unable to perform these tasks themselves. People with severe core-activity limitations sometimes need help with self care, communication or mobility, have difficulty understanding or being understood by friends or family, or can communicate more easily using sign language or other non-spoken forms of communication.

Health conditions

Long term health condition is a condition that has lasted or is likely to last 6 months or more; or a disease, disorder or event (e.g. stroke, poisoning, accident etc.) which produces an impairment or restriction that has lasted or is likely to last 6 months or more. Conditions are coded to a classification based on the International Classification of Diseases, version 10 (ICD–10).

Main health condition is the long term condition causing the most problems. Where only one long-term condition is reported, this is the main condition.


DISABILITY GROUPS

Consistent with the tendency to need assistance across a range of areas, older people in cared accommodation tended to have limitations in several broad areas of functioning. For example, a person might have both physical and psychological disabilities. Among the 97% of people in cared accommodation who had a disability, physical disabilities were the most common (91%), followed by sensory or speech disabilities (72%), intellectual disabilities (60%), psychological disabilities (57%), and disabilities related to head injury, stroke or brain damage (31%). It can be seen from the high proportions across the groups that many older people in cared accommodation did have more than one broad type of disability. For almost half (49%) of older people in cared accommodation the disability that caused the most problems was psychological while for 42% it was physical.

Compared with people in cared accommodation, a much lower proportion of older people in households had a disability (49%) and the balance was weighted more towards physical disabilities and sensory or speech disabilities. Of the 49% of older people in households who had a disability, 78% had a physical disability and 41% had sensory or speech disabilities, while intellectual disabilities (5%), psychological disabilities (7%) and disabilities relating to head injury, stroke or brain damage (7%) were less common.

OLDER PEOPLE: NEED FOR ASSISTANCE — 2003

In cared accommodation
In households

%
%

Need for assistance
Self care
90.5
7.7
Mobility
86.9
12.3
Oral communication
62.6
1.3
Health care
95.3
17.1
Emotion and cognition
84.7
5.9
Needed assistance with at least
four of the above activity areas
81.7
2.2
Had a profound core activity limitation(a)
84.5
7.6
Had a severe core activity limitation(b)
9.6
7.5
Total persons ('000)
167.4
3 350.2

(a) Always needed assistance with at least one of: mobility, self care, communication.

(b) Sometimes needed assistance with at least one of: mobility, self care, communication.

Source: ABS 2003 Survey of Disability, Ageing and Carers.


HEALTH CONDITIONS

Disability is generally related to long term conditions, although the effects of conditions vary from person to person, and the interaction of multiple conditions may have an important influence on how much disability a person experiences. Older people in cared accommodation tended to have multiple long term conditions: 74% had four or more and less than 1% had none. This compared with 27% of older people in households who had four or more long term conditions and 17% who had none.

The conditions reported ranged from eyesight problems correctable by glasses to dementia. Therefore information was sought on which condition caused most problems. The medical condition most commonly reported as the one that caused most problems for older people in cared accommodation was Alzheimer's disease and other dementia (32%). In total, Alzheimer's disease and dementia together with other mental and behavioural disorders were reported as the main condition for 42% of people in cared accommodation. After mental and behavioural disorders, circulatory system conditions (17%) was the second most common main condition group, with stroke as the largest component (10%). The third largest group was conditions of the musculoskeletal system (14%) with arthritis as the largest component (10%).

Among the 2.6 million older people in households who reported having at least one long term condition, the main condition was most often physical. Diseases of the musculoskeletal system and connective tissue were the most common main condition group (35%), with arthritis (17%) and back problems (10%) predominating within this group. This was followed by diseases of the circulatory system (22%) with hypertension as the most common main condition (12%) and diseases of the endocrine system (8%) with diabetes as the most common main condition (5%). Mental or behavioural conditions were reported as a main condition by only 4%.


PEOPLE WITH A PROFOUND DISABILITY LIVING IN HOUSEHOLDS

Compared with the 95% of older people who lived in households, the 5% of older people in cared accommodation were an older and more frail group. But were there people in households with a similar disability and health profile? As 85% of people in cared accommodation have a profound core activity limitation, one comparison might be to people with this limitation aged 60 years and over living at home. There were 241,000 such people in 2003, 1.7 times the 141,000 older people with a profound limitation living in cared accommodation.

Compared with people in cared accommodation with a profound core activity limitation, these people were on average younger, with a median age of 79 years compared with 85 years. Although both groups included more women than men, this was less pronounced among people in households than among people in cared accommodation (66% in households were female compared with 72% in cared accommodation). Those in households included a greater proportion of married people (43% compared with 18%). As well as demographic differences, there were differences in the disability and health profiles of the two groups which indicate what types and levels of disability may trigger entry to cared accommodation.

Almost all people with a profound core activity limitation had a physical disability regardless of where they lived (96% of those in households and 94% of those in cared accommodation). Sensory or speech disabilities were also relatively common (46% of those in households and 74% of those in cared accommodation). However, older people in households with a profound core activity limitation were much less likely than people with a profound disability in cared accommodation to have a disability which was intellectual (14% compared with 65%) or psychological (19% compared with 62%).

The proportion of people with a profound core activity limitation living in households who needed assistance ranged from 12% for oral communication to 91% for mobility. This compared with very high levels of need across all five activity areas for people with profound core activity limitation in cared accommodation, from 70% for oral communication to over 90% for each of the other activity groups. Further, at a finer level of detail, differences are apparent even in the more comparable areas. For example, in respect of self care activities, the greater contrasts between the two groups of people was in the need for assistance with fundamental activities such as eating (22% of people in households, 76% of those in cared accommodation) or toileting (16% compared with 79%). There was less difference in the need for assistance with more advanced self-care tasks such as showering (44% compared with 97%) or dressing (46% compared with 95%).

People with a profound core activity limitation living in households were less likely than people with such limitations in cared accommodation to have a mental or behavioural disorder as their main condition (10% compared with 45%). Diseases of the musculoskeletal system (33%) and diseases of the circulatory system (19%) were the leading main conditions among those in households.

These survey results are broadly consistent with administrative data from aged care assessment teams. These show that people were more likely to be assessed as needing residential care if they: had dementia; were assessed as dependent in the areas of mobility, continence or orientation (awareness of surroundings); or were in hospital at the time of assessment.(EndNote 3)


OLDER PEOPLE WITH PROFOUND CORE ACTIVITY LIMITATION(A): BROAD DISABILITY GROUPS BY LIVING ARRANGEMENT — 2003

GRAPH: OLDER PEOPLE WITH PROFOUND CORE ACTIVITY LIMITATION(A): BROAD DISABILITY GROUPS BY LIVING ARRANGEMENT — 2003



OLDER PEOPLE WITH PROFOUND CORE ACTIVITY LIMITATIONS(A): NEED FOR ASSISTANCE — 2003

In households
In cared accommodation

Selected characteristics
%
%

Needed assistance with personal activity areas
Mobility(b)
91.1
94.9
Getting around away from home
86.4
86.1
Moving about the home
34.8
83.5
Self care
61.1
98.6
Dressing
46.0
97.0
Going to the toilet
15.8
84.9
Oral communication
12.0
70.3
Health care
79.4
99.5
Emotion and cognition
33.8
90.1
Needed assistance with more than three of the above five personal activity areas
22.3
91.2
Mental or behavioural condition was main condition
9.7
45.2
Total persons ('000)
141.5
240.8

(a) Always needed assistance with at least one of: mobility, self care, communication.

Source: ABS 2003 Survey of Disability, Ageing and Carers.


ENDNOTES

    1. Australian Institute of Health and Welfare 2005, Australia's Welfare 2005 (AIHW Cat. No. AUS65), Canberra, AIHW and also see earlier editions of this biennial report.
    2. Gibson, D. and Liu, Z 1999 'Do families matter?' Family Matters, No 52 ,Autumn 1999, Australian Institute of Family Studies, Melbourne.
    3. Australian Institute of Health and Welfare 1997, Australia's Welfare 1997 (AIHW Cat. No. AUS65), Canberra, AIHW.
    4. Australian Institute of Health and Welfare 2005, Residential Aged Care in Australia 2003-2004: a statistical overview, (Aged Care Statistics Series no. 20. (AIHW Cat. No. AGE43), AIHW, Canberra.
    5. Lincoln Gerontology Centre 2004, Aged Care Assessment Program national minimum data set report July 2002June 2003, viewed 15 April
    2006,<
    http://www.health.gov.au/internet/wcms/publishing.nsf/Content/ageing-reports-acapmds.htm>.

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