The notion of walking backwards into the future describes the value we can derive from remembering and understanding our past, in order to best prepare for a better tomorrow. We can’t do this without properly caring for our elders.
The high prevalence and early onset of chronic diseases such as heart, kidney and lung disease and diabetes in Aboriginal and Torres Strait Islander people is well documented. Aboriginal Australians and Torres Strait Islanders can show common signs of age-related diseases as young as their mid-40s and are more likely than non-Indigenous Australians to face premature death.
But Aboriginal and Torres Strait Islander people do not age at an accelerated rate per se. Rather, they face a greater burden of conditions at an earlier age that lead to the premature onset of complications typically seen with ageing in non-Indigenous Australians.
The ultimate aim of addressing the marked health disparity between Indigenous and non-Indigenous Australians should be the pursuit of an equivalent life expectancy of non-Indigenous Australians into their 80s.
The challenges of health-care delivery in remote communities can be significant. Faced with a plethora of health issues, the health workforce may have little awareness of how lifestyle factors such as alcohol, smoking and trauma can influence and accelerate conditions and complications normally seen in much older non-Indigenous Australians.
This lack of recognition can mean Indigenous Australians are less likely to seek medical help and health providers are less able to recognise the development of these complications in a relatively young population.
When problems are recognised, health providers may have a different understanding of disease and impairment compared with the patient, and may have difficulty recognising a culturally appropriate response to illness.
A lack of aged care-specific services in remote Australia often means locals face long travel times for medical care. And the clinician may not even speak the patient’s language, understand the nuances of their culture or even have an expert understanding of aged and disability care.
While Australia’s aged care workforce is growing, specialists remain principally confined to large urban centres on the eastern and southern coasts. In Alice Springs, for example, there are currently no resident aged care or rehabilitation specialists, despite a large Aboriginal Australian population and a significant burden of disability related to the premature onset of age-related diseases.
In view of economic, social and environmental disadvantage and varying access to services, families play an important role as the ultimate “safety net”. Nonetheless, even strong families and communities can find it difficult to provide ongoing support for people who struggle to meet their own day-to-day needs.
The issue of “carer burnout” can be multiplied in communities where resource are scarce and the burden of disease is high; carers have limited capacity to shoulder additional responsibilities. This is complicated by the issues of “granny burnout”, where many of the elderly that require care are key carers themselves.
Like many health challenges, the answer lies first in effective primary prevention strategies to drive behavioural change earlier in life and prepare people for better ageing.
Second, there needs to be high-quality, culturally appropriate, sustainable and accessible aged care and disability services in our remote centres as well as cities and large regional centres, where more than half of Aboriginal and Torres Strait Islander people live.
The ultimate aim, however, must be for all health services to reflect the aspirations of local residents. In the case of aged-care services for Indigenous Australians, this includes close involvement with, and leadership by, Aboriginal and Torres Strait Islander community-controlled health services.
The aged and health-care workforce must also represent Aboriginal and Torres Strait Islander people at all levels. This not only ensures a culturally relevant service, it also facilitates the development of sustainable remote communities through job opportunities and economic activity in areas of traditionally high unemployment.
Importantly, any system must be structured to recognise the value of caregivers and to ensure appropriate support and training for those who seek it.
Of course, such a scenario cannot be achieved immediately. The limited formal educational attainment of many Indigenous Australians, particularly those in remote communities, means additional training to meet aged care needs will still require investment in the foundations of literacy and numeracy.
While the provision of a suitable, locally led aged care workforce, particularly in remote Australia, is still some time away, the unique Indigenous population pyramid, with a large proportion of young people, suggests that it is eminently achievable.
Any new initiatives must also be combined with further roll-out of other remote health strategies. These include a boost to the number skilled primary health providers in remote communities, telehealth, and aged-care and disability-relevant specialist outreach to ensure services can be delivered in the communities where people live.
This approach, while costly, ensures that Aboriginal and Torres Strait people are able to maintain their familial links and continue to fulfil the important elder role that is so valued in the community.
There must be ongoing investment and innovation to facilitate the delivery of specialised age care and disability services now, while we prepare Aboriginal and Torres Strait Islander children to provide future care. That way we can continue to walk backwards into the future, knowing that there are healthy elders whose knowledge will help to lay the path we cannot see.
This is an edited version of an article that appears in the latest issue of Perspectives, an opinion-led journal published by Baker IDI Heart and Diabetes Institute.