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Advances in Contemporary Aged Care
Retirement to End of Life
The most recent data shows that 25% of the Australian population is over 55 years of age. 13% of the population are already aged 65 years or older and by 2050 this will increase to over 25% of the population totaling 6.6 million people.
According to the Australian Institute of Health and Welfare, most Australians consider their health to be good; however, results from the 2004-05 ABS National Health Service indicate that 87% had at least one long-term health condition. Notably, the prevalence of these diseases increases with age. Estimates also show that there will be a substantial change in the structure of our population resulting in a more equal distribution across aged cohorts and between gender. Furthermore, the number of people over 80 years will double in the next 20 years and triple over the next 30 years to over 9% of the population.
In 2003, a survey showed that over 560,000 older Australians had a profound or severe limitation which represents 22% of that population. Among this group, arthritis was the most common health condition. Hearing disorders, hypertension, heart disease and stroke were also common among this group. For each of these conditions, its prevalence in the population combined with its likelihood of being associated with a profound limitation leads to a considerable burden on the community. In addition, the impact of aging is magnified in small country towns and they have significantly worse health status than their metropolitan counterparts. The exponential growth in the number of older people raises a range of social, economic, political and scientific questions about how best to manage the changing demographics and meet the needs of older people.
A fundamental problem in our knowledge about older people is that the maintenance of health and functioning in this population is largely unexplored both clinically and epidemiologically. Whilst chronic disease and disability are declining, chronic diseases change with advancing age. Conditions such as osteoarthritis lead to functional impairment and increased mortality risks through the effect of co-existing conditions such as gastrointestinal bleeding that may result from treatment for the primary condition, or make its treatment more problematic. The higher incidence of chronic disease, falls, and other health problems associated with aging, mean that elderly people are also at a greater risk of pain. Aging also heralds an increased incidence of cognitive impairment.
Essentially, older patients in the community, acute care and residential aged care have complex health needs that require highly skilled care. Older people requiring care are likely to have more than one diagnosis, requiring treatment for chronic illness and disability and they are likely to present to hospital with an acute episode of illness. Further, cognitive and sensory impairments and mental health problems pose challenges in terms of communication, health assessment, management and ongoing care. Transfer to a hospital may in itself be traumatic for an older person and contribute to their decline in functional status. Older patients may be living alone with little or no support and lack of social and family support pose challenges in terms of solving problems and discharge planning.
That the chronic and complex care needs of older people increase with age, coupled with the population trends for aging in the very old means that health care services are being challenged to provide better systems and models of care in order to ensure clinical safety, quality care and quality outcomes for older people. Nurses, as health care professionals across all of the sectors, are well placed to play key roles in rising to these challenges by showing leadership and working collaboratively with our medical and allied health colleagues.
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