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Senior attitudes

481848613A recent COTA survey takes on some of the assumptions about what older people want and underscores ways aged care can better serve the consumer. 

Seniors are probably happier than you think.

When COTA New South Wales investigated consumer attitudes within the ageing population with a survey, the results revealed that many of the nation’s elderly are happy with their current state of life.

COTA NSW CEO Ian Day says that whilst people working in hospitals and nursing homes often see older people who are ill and requiring care, many people over 50 and right up into their 80s are still getting out and about and enjoying a good quality of life

“The majority of older people are feeling pretty good about themselves,” Day says.

About 85 per cent of respondents to the survey, including 80 per cent of those aged 80 and over, were happy with their lives and rated their health and wellbeing as good, very good or excellent. However, the report does reveal some areas of concern, particularly in relation to healthcare.

In this issue of Aged Care Insite, we profile some of the findings of the report, look at areas that were considered lacking and explore some ways the healthcare system can meet the needs of the nation’s elderly.

GP access

About 15 per cent of respondents experienced difficulties getting to and from their GP. The main problems cited were a lack of parking and the time related to travel. Some practices lack easy access to public transport.

Professor Helen Edwards, from Queensland University of Technology’s faculty of health, says, “Ease of access is essential for older people, as many need to have regular follow-up visits for chronic conditions and ongoing monitoring.”

COTA suggests co-located services, better access to community transport and better co-ordinated public transport. Edwards agrees that all these aspects are important.

“Co-location of services is a good idea but there still needs to be good public transport or ease of parking,” she says. “Incorporation of GP practices in shopping centres [can be effective], as most shopping centres are well serviced by public transport and parking is usually more available.

Edwards says this can be further enhanced if other services such as pharmacies, pathology and X-ray facilities are also on site, making for a one-stop shop.

The study also found that GP continuity was of the highest importance for seniors. As Edwards explains, “It is important older people have someone who understands their often complex health status, without having to tell their story on repeated visits. This gives them a sense that someone does really understand their issues and genuinely wants to assist them. It should be an exception that an older person sees a different GP.”

Hospital

More than half of the survey’s respondents had been admitted to hospital in the last five years, and just under half rated having their diagnosis, treatment and care explained as the most important aspect of their hospital experience.

A third said being treated with respect and dignity was the most important factor during a hospital stay.

Edwards says these results are not unexpected. “Most people want good and clear explanations about their healthcare and to be treated with dignity and respect,” she says. “Older people are no different from other patients in this respect.”

Men and mental health

About 80 per cent of respondents say they would seek help if they were concerned about their mental health. Dr Wendy Li, lecturer from James Cook University department of psychology, says it’s encouraging to see that this many participants say they would seek help. “Mental health problems are under-identified by older people, and the stigma surrounding mental illness makes them reluctant to seek help,” Li says.

She says it’s important that elderly people access mental health services because there are many situations that “can result in isolation, loss of independence, loneliness and psychological distress in older people”. For example, they may lose their ability to live independently due to mobility, chronic pain, frailty or other problems, and require long-term care. They are also more likely to experience bereavement, a drop in socioeconomic status through retirement or a disability.

Unfortunately, the survey also found that the respondents who are most likely to need help are the least likely to seek it. Li says promotional campaigns for older people can help with this problem; for example, by encouraging an ‘It’s OK to seek help’ attitude towards mental health.

“Such health promotion will raise awareness and understanding of how and where to seek help, and encourage people to seek help,” she says.

Of those surveyed who said they either wouldn’t seek help or were unsure if they would, one quarter cited privacy as the main reason. Another third feared losing control of their lives.

Li says another factor that makes seniors reluctant to seek out services is the stigma that still surrounds mental illness. This is particularly true of men. She says men often seek help from informal supports instead of professional services, preferring to talk to friends and family about most mental health problems.

“The profound reluctance to be a mental health patient means people will put off seeing a doctor for months, years, or even [entirely], which in turn delays their recovery,” Li explains. “This reluctance is of particular concern [because] of the higher rate of completed suicides for males. Therefore, framing help-seeking as one of life’s tools, and a sign of strength rather than weakness, is essential.”

The study also found one other potential reason men are less likely to seek out mental health services – they are less likely than women to be sure about where they can access it.

Palliative care

Almost 20 per cent of survey respondents were caring for someone needing palliative care or had done so.

Margaret Brown, adjunct research fellow from the University of South Australia’s Hawke Research Institute, says whether the care is at home or in a hospital, nursing home or hospice, everyone is involved at some point in their life with caring for people dying, particularly as they get older.

She says more services are needed for those who are looking after people dying, including nursing services and general care.

“It’s very demanding for older couples,” Brown says. “We could improve that service because it’s cheaper in a monetary sense than actually paying for an acute hospital bed.”

The report also found that more than a quarter of those who know or knew someone receiving palliative care felt that it didn’t provide a comfortable end to the person’s life.

Brown says this needs to be looked into a little further. “We need to know where that palliative care was being given,” she says, adding that the availability of palliative care services in the home is limited.

End-of-life support

More than half of respondents said they would prefer to die at home with the right support. Unfortunately, this is becoming an increasingly rare reality.

“Fewer and fewer people are dying at home, more and more are dying in hospital settings,” Brown says, adding that everybody has the right to die at home with appropriate palliative care, if possible.

Respondents felt the same way: 3-in-4 believed people should have the legal right to control the circumstances and timing of their own death.

“That’s what people want but most people don’t achieve that and the main reason why … is because an increasing number of older people live alone and there is no one there to care for them,” Brown says. “From my own research, I could say that there are not services available to support older people [who want] to die at home.”

She explains that people often go downhill quite quickly and then may not receive the appropriate palliative care. “That frightens most older people, who would like to think ‘I’ve got some control over this’.”

She says older people often end up in the acute system and are kept alive when they tend to prefer for that not to happen. However, there are some standards being introduced that are aimed at improving end-of-life care.

“Rather than resuscitating and treating older people aggressively at the end of life, we’re trying to sort of turn that around a bit and say we need to recognise that people are coming towards their end of life and treat them with care and dignity and not necessarily acute treatment,” Brown says.

Fewer than 2-in-3 respondents had discussed their end-of-life wishes with anyone. Brown says these figures are a concern but aren’t surprising. In fact, she believes this is a relatively high proportion.

“This is not uncommon and it would perhaps suggest that what we need is not just more advertisements and information, but actually more support for people to have that conversation,” she says. “If you’re living alone, it’s often difficult to have that conversation with someone.”

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