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Keep elderly out of aged care for better mental health, royal commission hears

Improving oral and mental health will save the government and taxpayers millions of dollars and importantly drastically improve the lives of people in the aged care system, the aged care royal commission has been told.

The commission resumed after a break due to the ongoing pandemic and the hearing will focus on the intersection between the mental, oral and dental, and allied health care needs of older people.

On day 80 of proceedings, the commission heard that 49 per cent of people in residential aged care had a diagnosis of depression and people would be better off not entering the residential system at all.

Geriatric psychiatrist Stephen Macfarlane says 50 per cent will have dementia while 20 per cent of people are likely to also have an undiagnosed case of the illness.

Macfarlane, the chief clinician for Dementia Australia, recommended increasing the aged pension to ward off the risk factors for mental illness and other cognitive issues.

“Older people are subject to greater degrees of economic hardship, social isolation, loneliness, access to transport and public transport, all of which could be addressed by an improvement to the aged care pension.”

About 20 per cent of dementia cases are preventable with simple lifestyle changes, he said.

“I think we need to get to – improving prevention and improving the range of generic supports that we provide to old people – older persons, to prevent them getting into aged care in the first place, where these problems are endemic.

“I think if you keep people at home and healthy and not suffering from conditions that require entry to aged care, that’s a large part of the solution, in my book.

“If you decrease the number of people who ultimately are going to require services for aged care and dementia-specific behaviour management, that eases the burden on services.”

A witness told the Melbourne-based hearing dealing with her mother’s mental health providers had been a traumatic experience.

Staff at the 83-year-old’s high-care facility did not believe family members when they said her behavioural changes were down to depression.

“The staff assume just because mum is in her 80s and frail that she has dementia,” Ms UX said.

“There should be something for the older generation to tell them ‘you’ve been strong all your life and soldiered on but it’s OK to talk about mental health’.”

Clinical geropsychologist Alison Argo told the inquiry staff in residential homes lacked the training to identify mental illnesses.

Insufficient funding meant only people with severe conditions were receiving public treatment.

“We have a saying, you know, unless they’re actively suicidal, or actively psychotic, you’ve got no chance of getting your referral through,” Dr Argo said.

She called for a long-term educational plan to increase the number of clinicians with experience in geriatric health and for multidisciplinary teams to be placed within facilities.

Mental health can’t be addressed in isolation of physical and cognitive needs, she added.

The commission heard that the dental health program Senior Smiles, developed by the University of Newcastle, could save state governments hundreds of millions of dollars by placing qualified oral health professionals into health care facilities to monitor the dental hygiene of residents.

Janet Wallace, who heads the university’s school of health sciences, says Senior Smiles has also led to better nutrition, lower risk of pneumonia, decreased GP visits and fewer avoidable hospital visits.

“A cost and benefit analysis shows that if it was rolled out across NSW the social and health benefits would equate to $143.5 million,” Dr Wallace told the inquiry.

She called for Commonwealth funding for the preventative program, which is currently reliant on a philanthropic grant set to expire by years’ end.

The Melbourne based hearing continues until Friday July 17.  

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