As the baby boomers approach older age, the number of Australians aged over 65 is projected to rise from around 14% to 24% by 2056. Given that not even a massive influx of immigrants would reverse this trend, who will look after this rising ageing population?
Many are currently housed in residential aged care facilities where families assume they are getting appropriate care. But our studies suggest that while their physical needs are being attended to, their psychological needs are being overlooked.
Depression occurs at a high rate among the elderly when compared to the general population. We have found that within some aged care facilities, up to 40% of residents experience significant levels of depression. This is far higher than the national average of 4% for men and 7% for women. The elderly are also over-represented in suicide statistics.
But why? Clearly, old age represents a period of life where losses – physical, financial, personal - are cumulative and frequent. But mood need not be one of them; depression isn’t an inevitable part of ageing.
Physical illness increases the risk of depression in the elderly. [Cerebrovascular disease](http://circ.ahajournals.org/content/111/3/250.full.pdf+html](http://circ.ahajournals.org/content/111/3/250.full.pdf+html) (conditions that affect the circulation of blood to the brain), for example, increase with age, as blood vessels become obstructed and less elastic. This can compromise blood flow to the brain and therefore affect brain function, and consequently, mood.
Cancer, thyroid disease, vitamin deficiencies, infection and major illness also predispose the elderly to depression. And researchers are investigating whether depression might cause cardiovascular disease, through chronic stress and hormone release.
Another problem is that staff of aged care residences are not trained to detect mental illness; training instead focuses on detecting physical illness. Nor do the busy schedules of registered nurses and personal care attendants allow time to conduct detailed or subtle investigations into the mental health of residents.
Depression is hard to spot. And the elderly – sometimes feeling ashamed, or not wanting to be a burden – stoically suffer in silence. This reduces their quality of life and tends to shorten lifespan. The reduced willingness to eat or exercise, for example, exacerbates physical illness and makes treatment harder when it is eventually commenced.
As if that was not enough, many residents also have Alzheimer’s disease. This can lead to aggressive outbursts and verbal agitation often only controlled with high doses of medication, something which is potentially life-shortening. As our research has shown, this can lead to staff burn-out and a high turnover.
So what can be done?
Firstly, the problem needs to be acknowledged. The 2005 Dementia Initiative to support people with dementia and their carers through education, funding, home care and training made a start in this process. A further $177 million was allocated for the 2010-11 period, along with $60 million for the 2012-2013.
But more still needs to be done at the coalface. The biggest area for improvement is staff training. And a number of options are available. Our research team, for instance, has developed in-house training for staff – both nurses and personal care attendants – in the detection and management of depression, as well as the management of the challenging behaviours associated with dementia.
We have shown that among those with depression and the so-called “challenging behaviours” of Alzheimer’s disease, training of staff to detect and refer resident depression results in better outcomes for residents and happier staff.
The use of mental health “champions” also helps. This is where staff are selected to champion the cause of detecting depression among residents and referring sufferers to appropriate treatment. This has been shown to improve outcomes internationally.
One significant hurdle can be getting management on board. Changes to staff routines, arranging diagnostic assessments and treatments all takes time and, ultimately, money.
But happier residents and happier staff means happier families and a better bottom line. While the training and shifts in staff routines will initially cost the aged care centres money, if families see happier loved-ones, it’s likely to improve the reputation and popularity of those centres.
It’s often said that a measure of a civilisation is how it treats its weakest members. We should work towards ensuring that Australia treats its people with care and respect – irrespective of age.