Offering older Australians a dignified life in their twilight years is important to ensuring their mental resilience is protected.
One of the many key insights to emerge from the Royal Commission into Aged Care Quality and Safety was that older people have insufficient access to mental health support.
Approximately 3 in 5 aged-care residents have a mental health condition and they are four times more likely to experience mental ill-health compared to community-dwelling older adults.
These older Australians have lived long, rich and exciting lives, and they deserve a wide range of mental health support during the latter years of their lives to live with dignity and comfort.
The Australian Psychological Society's aim is to ensure all people, including the 178,000 older Australians living in permanent residential care, have equitable access to high-quality health and mental health care.
Mental health challenges in aged care
As well as having a higher propensity for ill-mental health more broadly, 50% of aged-care residents are reported to have depression and up to 60% experience clinically significant symptoms of anxiety that require treatment.
Suicide ideation is also four times higher in aged-care residents than in community-dwelling older adults, which is an alarming figure that requires urgent attention.
Unrecognised and poorly managed psychological distress and mental ill-health contribute to suffering, reduced quality of life and increased mortality risk for older people living in residential aged care. And there are ripple effects to this suffering.
Families and loved ones supporting older people with poorly managed mental ill-health can experience distress that impacts their own mental health and wellbeing. It can also lead to increased stress and burnout for aged-care workers, which in turn impacts care quality and staff retention in residential care facilities.
Barriers to providing adequate support
We know the aged-care industry is under a lot of pressure, despite the government's recent bid to attract more workers with a historic 15 per cent pay boost to award wages earlier this year.
A report from the National Skills Commission (NSC), released earlier this year, found that demand for care staff is likely to increase by 40% over the next four years. That would equate to 54,000 more aged-care roles and 50,000 nursing positions, both figures the NSC says are unlikely to be met with enough willing and working-age Australians.
This means there's likely to be continued pressure placed on this already scarcely resourced and over-stretched industry. And, despite the dedicated aged-care workers doing their best to meet the psychosocial needs of their residents, time-pressures could mean that many vulnerable Australians will fall through the cracks.
We also know that while aged-care facilities are required to ensure that residents have access to appropriate support and services for psychological wellbeing, they are not required or funded to provide psychological support, and only 14% directly employ psychologists.
There has, instead, been an over-reliance on pharmacological treatment. Over one third of older adults are prescribed psychotropic medications, such as antidepressants, antipsychotics and benzodiazepines, soon after entry into residential care. This is despite many older adults preferring a non-pharmacological approach to mental health issues.
The health risks of the overuse of psychotropic medications for older people include a greater risk of falls, higher mortality and adverse drug events related to polypharmacy.
Psychological support is also rarely accessed by older Australians in aged-care facilities – just 3% accessed government-funded support between 2012-2017, compared to 10% of the community-dwelling older population.
Contributing to this statistic is a history of Government exclusion of aged-care residents from the Medicare Benefits Schedule. Even with eligibility to Better Access expanded to include aged care residents from December 2020 to December 2022, as a temporary pandemic support measure, only a small number of Better Access services were provided to this cohort.
Long-term action is needed
Residential aged care can be a confronting experience for older people, as they find themselves in unfamiliar environments, often removed from their friends and family, and are required to adapt to a new shared-living arrangement.
On top of this, they also often grapple with issues such as poor health, frailty, loneliness, loss of independence and the impacts these factors can have on their sense of purpose and identity.
Psychological distress is, however, not inevitable in the transition to aged care. Older people can experience strong wellbeing and have a good quality of life in aged care with the right support and services to meet their specific physical, social-emotional and cultural needs.
To address psychological risk factors in older Australians, support needs to start from the top.
We need the government to advocate for, design and implement targeted legislation and policies that ensure aged-care residents have adequate access to allied health professionals, including psychologists.
We need to take a long-term view and equip our community with a range of skilled psychologists all across Australia, especially in rural and regional Australia where mental health support is scarce. This requires the government to fund more postgraduate psychology training programs, continuing professional development and incentives to increase the availability of the psychology workforce in residential aged-care settings.
We also need to see more research funded via scholarship programs to further grow the evidence base around health promotion approaches, psychological prevention programs and treatments in residential aged care settings.
There is also an urgent need to increase the diversity of the profession and grow the number of Aboriginal and Torres Strait Islander and culturally and linguistically diverse psychologists working in residential aged-care settings, in order to provide bespoke care that aligns with specific cultural needs of residents.
It's also critical that training, education and support programs are funded and offered to aged-care staff to help them to build their own mental health literacy and enable them to better identify and refer residents experiencing psychological distress or mental ill-health to a registered psychologist.
Support at every age
Research studies and evidence consistently demonstrate the efficacy of psychological therapies for older adults experiencing mild to moderate symptoms of mental ill-health when delivered by trained mental health practitioners such as psychologists.
Irrespective of how aged care residents access that psychological support, models and funding for psychological support must enable:
• Person-centred care, where all aged residents have access to holistic and individualised psychological support when they need it and how they want it.
• Collaborative and multidisciplinary care, where the psychologist is an integral member of the care team and is enabled to work closely with other health professionals, facility staff, the older person and their family to design and implement psychological support and services.
• Easily accessible care, with straightforward and timely referral pathways, assessment and access to appropriate preventive care or psychological support and treatment.
APS is already advocating for these initiatives, as they have been on our agenda for some time now. However, the last few years have made action in this space even more important.
The cumulative impacts of Covid-19, the cost-of-living crisis, natural disasters and psychology workforce shortages have profoundly impacted Australians across the country, especially in the aged-care sector. So we mustn't lose steam now. Access to mental health support should be a basic human right for every citizen, at all stages of life.