Looking after the mental health and wellbeing of older Australians and those who care for them

Below is an excerpt from an article by Vidthyany Ananthapavan and Dr Thripura Hariharan. To read the full article please visit.

The transformation of Australia’s aged care system will continue to gather pace in 2023. However, the pressure on those who look after older Australians, including family members, carers, and the aged care workforce, has never been greater. The mental health and well-being of older Australians is also often overlooked.

As we head into another year of reforms across the sector, we reflect on the opportunity for the aged care and mental health sectors – policymakers, service providers, and peak bodies – to bridge the gap from policy to practice.

In recent years, the aged care sector has endeavoured to improve the quality and safety of care provided to older Australians, following the recommendations of the Royal Commission into Aged Care Quality and Safety and the Australian Government’s response to this.

However, the mental health and well-being of many older Australians, particularly those who live alone or in residential aged care, have deteriorated due to greater isolation and loneliness. In June 2019, approximately 87% of aged care residents were experiencing at least one mental health or behavioural condition, and 49% were experiencing depression. This was exacerbated by the COVID-19 pandemic, which continues to threaten the safety of older Australians and limits their ability to establish and maintain social connections. Older people have experienced dramatic increases in anxiety, worry, and psychological distress as a result of the pandemic. Despite this, their uptake of government-subsidized mental health services remains lower than the general population’s.

To improve the quality of life for older Australians, we must consider alternative models of care that engage and stimulate each person, to minimize cognitive decline and help them establish and maintain social connections. Momentum is building on this front, with some institutions leading the change. For example, the University of Wollongong is developing Australia’s first ‘Intergenerational University Community,’ where older Australians live on campus and enjoy the benefits of living, learning, working, and growing alongside university students and preschoolers.

Similarly, some Australian providers have opened residential aged care homes to students, including Calvary Health Care with its Outside In program, which saw occupational therapy students living and volunteering on-site. In Sydney, Neuroscience Research Australia is testing the feasibility and practicability of structured intergenerational programs that bring together preschool children and older Australians for physical and social activities.

Governments also emphasize the importance of improving the mental health and well-being of older Australians. Recently, the Australian Department of Health and Aged Care added quality-of-life and consumer-experience measures to clinical indicators in the National Aged Care Mandatory Quality Indicator Program (QI Program). From April 2023, residential aged care services will report on these each quarter. The measures will amplify the voices of older Australians and shift the focus from quality and safety of care to quality of life. Additionally, the proposed Support at Home Program, to be implemented from mid-2024, expands the list of service categories for those living at home, to improve their independence and social connections.

Although these actions represent a shift in the right direction, their siloed implementation can lead to inequitable results across the country. We need a national framework for nationally consistent improvement to mental health and well-being across the entire aged care continuum, from independent living to home and community care, to residential care.

Such a framework should recognise barriers to accessibility and uptake of mental health services: cognitive impairment and dementia, poor digital literacy and digital exclusion, the stigma around mental ill-health, and cultural and linguistic factors. Additionally, demographic factors such as gender and socioeconomic status must be considered. While the framework should clearly state the strategic priorities, it should also permit flexible implementation, encouraging innovative design and delivery of initiatives.