Transcript AGEING, WORK & HEALTH - Baptist Care Australia

Imagining Ageing and Aged Care
in 2030
Professor Colleen Cartwright
Principal Director
Cartwright Consulting Australia Pty ltd
[email protected]
Major Events in Australian History
– Timeline • 1890 – Bismarck sets retirement age at 65 (5% >65)
• 1909 – Australia introduces age pension – 65 (average life
expectancy around 50 years)
• 1940s – Unemployment & widow’s pension
• 1975 – Henderson poverty report (many older people were below
the poverty line)
• 1977 - Age as grounds for discrimination (NSW)
• 1996 – Workplace Relations Act – prohibiting termination of
employment on basis of age
• 2009 – New policy to lift pension age to 67 by 2023 (begins to rise
by 6 mths/2 yrs from 2017). Average life expectancy 84
• 2013/14 – Move to CDC Care; start of Aged Care Gateway;
proposed pension age to rise to 70
Demographic Trends: International
(U.N. World Population Prospects: 2006 Revision)
COUNTRY
65+
2005
2050
Australia*
13.1%
Canada*
2005
2050
24.3%
3.5%
9.3%
13.1%
25.7%
3.5%
10.0%
Europe (all)*
15.9%
27.6%
3.5%
9.6%
US*
12.3%
21.5%
3.5%
7.8%
China**
7.7%
23.7%
1.2%
7.3%
Indonesia**
5.5%
18.6%
0.6%
4.0%
Malaysia**
4.4%
16.3%
0.6%
4.0%
Singapore***
8.5%
32.8%
1.5%
14.8%
Greece #
18.3%
31.7%
3.5%
11.1%
Italy #
19.7%
32.6%
5.1%
13.3%
Japan #
19.7%
37.7%
4.8%
15.5%
* & # 65+ <x 2; 80+ <x 3;
80+
** 65+ x3-4; 80+ x6-8; *** 65+ x4; 80+ x10
Facts on Ageing
Ageing does not mean inevitable physical/mental decline
• The greatest decline in the human body occurs between
30-40 years of age
• While there will be an increase in chronic disease and numbers of
people with dementia, the majority of older people do not have
dementia:
– < 80 = approx. 12% (i.e. 88% do not have dementia);
– 80 - 89 = approx. 18% (i.e. 82% do not have dementia);
– 90 – 94 = approx. 33% (i.e. 67% do not have dementia).
– 95+ = 37.2% for males; 47.3% for females (still < 50%)
• Vast majority of older people live in their own homes. Around
7% of Australians 75+ live in nursing homes (i.e. 93% do not!).
Facts on Ageing
• Older people can learn, and retain, new skills – may
take a little longer but are more consistent afterwards
• Older workers benefit from continuous training and
retraining to the same extent as younger workers
• The impacts of predicted increases in health and aged
care costs as the population ages can be minimised by
reducing barriers for older people to continued
employment and access to mainstream services, and
in supporting older people to stay fit and healthy.
Older Workers
• (From 2005 UK study):
– Health and safety concerns not good excuse not to employ
older workers: “Older workers can have a more responsible
attitude to health and safety; show less absenteeism; show
more advanced functioning in some cognitive capacities; and
have more healthy lifestyles in some respects.”
– Many declines in health or cognitive, physical or sensory
functioning can be “minimised, prevented or overcome”.
– Employers who adopt flexible retirement practices that can
retain older workers longer will gain marketplace advantage
– Many older workers can match physical strength and
endurance, relevant to workplace, of younger co-workers –
fewer jobs today are physically demanding
Ageing: Current Developments
• People no longer consider themselves ‘old” at 65; many
people see the years from 65-80 (or beyond) as a time to
enjoy life in a way that they could not do before.
• Many older people are taking up sports, dancing, travel.
• Older people’s sexuality is (finally) being recognised and
taken into account, even in RACFs. No reason not to
stay sexually active until the end of life – all you need is
an interesting and interested partner!!
• Major development – Mapping the Humane Genome; this
is likely to produce many health benefits, as the “genetic
origins” of diseases are identified and treatments
developed.
Ageing: Current Developments - 2
• 7.30 Report, ABC TV, 28 May 2014: Australian researcher,
David Sinclair, a geneticist at Harvard Medical School, is working
“towards the miracle of an anti-ageing pill” which could reverse
the way our cells deteriorate, so we can live much longer and
healthier lives. “The discoveries have enormous implications for
treating diseases like diabetes and Alzheimer's … (and ) Cancer,
Parkinson's disease”.
• Dr Sinclair noted: “about 20 years ago there was a big discovery in
the field of ageing and that is that we have these genes that keep us
younger. We call these longevity genes. And what I've been doing
ever since is trying to figure out a way to make … a little pill that
we could take every day, to turn on those genes and make our
bodies fight against diseases and live a longer, healthier life.”
• His work has already been successful in reversing diabetes in mice.
(But: need to consider ethical issues raised by such ‘advances”)
Other Developments
• Prevention of dementia? Some research is showing that the
rate of dementia (as above) is slowing; ‘cure” may still be a
long way off (unless Dr Sinclair’s work proves to be the
solution), but recent increase in funding may provide better
support services. Advance Care Planning is vital for people
who have just been diagnosed with dementia.
• Robots and assistive devices are being developed at a rapid
rate – watch this space!
• Pressure for individuals to take more responsibility for their
health, self-monitoring; people will need to learn much
more about their health conditions and what they can do to
manage them. Home telehealth will play a major role in
this.
How will People Self-Monitor?
• Advance Care Planning & increased use of technology –
gives control back to older person, fits well with CDC.
• Recent NBN projects – older people now can learn to use
telehealth equipment
• In 30 years time, people who are 75+ will be much more
computer-literate and very familiar and comfortable with
technology. They will now how to source information
about their health/illness – this may be challenging for
health-care providers.
• They will also be used to social media in all it’s forms,
which should allow improved health education
• Risk: increased social isolation, including from poor
mobility and lack of public transport, especially in rural
areas – technology is not the same as human contact.
Paradigm Shift: Maintenance to Reablement
• Old Paradigm
• New Paradigm
• “We will fix your knee”
• Deficit or problem-based
assessment
• Maintenance support
• “What are your goals?”
• Strengths-based assessment
• Service provision to
substitute for loss of function
• Assumption of ongoing
service on entry
• Standard service provision
• Care and service plans per
program
• Capacity building resilience
support
• Goal oriented care planning
• Potential for episodic
support
• Individually tailored
• Integrated care plan per
person across programs/
services
What will Aged Care be like in 30 Years?
• While it is predicted that most aged care will be delivered in the
community, there is a decreasing number of informal carers
available.
• It’s possible that people will only go into residential care at the
very end stage of life, when care needs exceed care available in the
community and death is approaching.
• That will almost certainly require an increase in the provision of
palliative care in RACFs – which, in turn, will require well-trained
and qualified staff.
• Increased use of telehealth/technology in both community care and
RACF; in some services now, staff providing care in the
community have a ‘virtual office’ and only go routinely to main
office once a month.
• But technology may be the “easy” policy option; a frail older
person at home still needs to see a real person from time to time
Impact of Technology on Ageing/Aged Care
• Technology can assist older people to stay at home
– Prof Len Gray, PA Hospital, conducts geriatric assessment,
consultations in rural Qld “on-line”
• high acceptance by older people
• increases access for very frail older people
• reduces carer stress, cost for travel & accommodation
• no need to take time off work to take older person to doctor
– Smart Houses
• Can use privacy-protecting devices (not cameras), e.g. heat
and motion sensitive (how long has person been in toilet?);
• Safety devices – monitor water flow, gas use; closed-circuit
TV allows person to see who is at the door and can push
button to allow entry
• Caring for person with dementia who wanders: mat beside bed
Impact of Technology on Ageing/Aged Care -2
• Telehealth projects: BCS
– Randomised controlled trial, investigating use of
telehealth monitors, telecare pendants for frail older
people discharged from acute care into Transition Care
and at risk of going to residential care;
– Telehealth monitor checks BP, pulse, weight, oxygen
sat. Daily readings: outside parameters set by GP,
triggers alert to Data Control Centre, Fax sent to alert
GP
– High client satisfaction (especially from carers):
Comment from GP: “The telehealth monitor may well
have prevented (his patient) from having a stroke”.
Good Design of RACFs
• In The Netherlands, villages are now being designed
specifically for people with dementia, where they can live,
shop, cook safely.
• Even wanderers are safe – village is built so perimeter is secure
but inside allows people to walk around gardens and go to
shops, hairdresser – looks like “normal” village.
• RACFs will need to “engage” with their local communities –
medical and allied health providers: education providers –
schools/TAFE/universities (encourage research to identify
gaps).
• Many will become teaching facilities, not just for nurses/ allied
health students but for students in accounting, engineering,
design, hospitality, music, drama
Personally Controlled Electronic
Health Records
• PCEHRs have had some teething problems but $$ has been
allocated in the recent budget to get them working well.
• The previous government allocated $800,000 to get
Advance Care Plans onto the PCEHR. This should help to
ensure that people’s wishes are known and that the level of
unwanted/unwarranted treatment that is given to terminally
ill older people reduces considerably.
• When the PCEHRs are working well, each doctor should be
able to see what others have prescribed – there should be
many fewer iatrogenic problems (such as confusion and
delirium) for older people from over-medication
We need a Crystal Ball!
• There is confusion now, especially in relation to the
changing political landscape. It is not easy to see what
lies ahead.
• Consumer demands will change – but possibly will only
be met if the consumer can afford to pay for what they
want – there is a risk we will end up with a two-tiered
system of care (while we already have that to some
extent, the divide could become much wider)
• A big challenge – a well-trained and remunerated agedcare workforce. Unless we get some wage parity
between acute and residential/community care we will
not have the workforce we need to provide good care.
Interactive Session
• What changes do you see coming?
• What will care in the community look like in 30 years?
• What will residential care look like in 30 years?
• What are the challenges/risks?
• What are the exciting possibilities?
Healthy Ageing: Healthy Dying
• An ageing world population brings many
challenges – including the imperative to
protect our most vulnerable older people
• When older people not only live well but also
die well, we can claim success!
Thank You
ASLaRC’s website: http://aslarc.scu.edu.au
(Click on Advance Care Planning on left-hand panel)
Acknowledgements
• My thanks to Annie Banbury & Prof
Lynne Parkinson for discussion and ideas
in preparation of this presentation