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Half of our aged population use residential care - study

Fuseworks Media
Fuseworks Media

A new study has found that almost half of New Zealanders, aged 65 or older, move to live in residential care by the time they die.

"We investigated what proportion of the population move in to residential aged care (rest-homes, geriatric hospitals, and dementia care facilities) for late-life care," says study leader, Senior Research Fellow from the University of Auckland’s Freemasons Department of Geriatric Medicine, Ms Joanna Broad.

"We already knew that 38 percent of those aged 65-plus who die in New Zealand, do so in residential care and that this is higher than any other country in the world," she says. "We didn’t know the extent that people living in residential care die during a stay in acute hospitals, so we looked at four sources to estimate that. We found that was another nine percent."

"That adds to the 38 percent, making a total of 47 percent," says Dr Broad. "We know from our data that this is an under-estimate, so about half of all older New Zealanders will move into care at some stage of their lives."

"That contrasts greatly with the estimate of five to six percent of people aged 65-plus living in care at any one time, in NZ and in other countries," she says. "We think this will be of interest to people and their families planning their retirement, and to health service providers, government agencies, organisations supporting older people, and to insurance companies."

"Given an ageing population and increasing longevity, we think it is important to understand this dynamic," says study co-author, Professor Toni Ashton from the University’s School of Population Health.

"Although residential aged care beds outnumber acute hospital beds by more than three times and it is well recognised that population ageing will bring major challenges, the residential aged care sector remains largely invisible, with residents not included in many population surveys and reports at a population level," she says.

"Beyond the continued surveillance of mortality and other dynamic indicators there is a need to monitor residential aged care use, to understand better the pressures that lead to residential aged care entry and the determinants of length of stay," says Professor Ashton.

"To avert large increases in demand for residential aged care, alternatives are needed," she says.

"Public debate and research is required - for example, to determine if entry to residential aged care may be avoided or delayed for people with high dependency, without reducing quality of life," says co-author Professor Martin Connolly.

"Such initiatives may improve management of chronic diseases, reduce falls, facilitate transitions back into the community after discharge, provide day-care for people with dementia or other needs, and enable shared or sheltered accommodation," he says.

Research to investigate risk factors for entry to residential aged care in a variety of populations may

contribute to a better understanding of the reasons for high levels of use of residential aged care and facilitate reassessment of evidence-based alternatives, she says.

"This is the first known original study of lifetime use of residential aged care for New Zealand and it confirms that the residential aged care model of late-life care remains common, in spite of efforts to improve support to older people in the community" says Ms Broad.

"We have shown that in New Zealand and many other countries it has become the norm by about the age of 85 years"After the age of 85, more than 58 percent of men and 70 percent of women move into care at some time."

The method used in this study - using recent summaries of place of death in conjunction with estimates of in-hospital deaths of residential aged care residents - is simpler and requires less complex data and analyses than other methods used for estimating lifetime risk.

"Given that the only prior New Zealand estimate was 20 to 30 percent, these results provided significant new information, " she says. "Late-life care services have evolved and will continue to do so."

"High usage of residential aged care indicates a demand and/or need for such services, a lack of appropriate alternatives and/or use of these alternatives, and emphasises the need for utilisationinformation," says Ms Broad.

"Monitoring residential aged care use is necessary for informed debate about late-life care in general, including palliative care provision in residential aged care, use of hospital by residential aged care residents and to inform planning and provision of care for older people."

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