Health status and healthcare trends of individuals accessing Australian aged care programmes over a decade: the Registry of Senior Australians historical cohort

Abstract

Background: Understanding the health profile, service and medicine use of Australians in the aged care sector will help inform appropriate service provision for our ageing population.

Aims: To examine the 2006-2015 trends in (i) comorbidities and frailty of individuals accessing aged care, and (ii) health services, medicine use and mortality after entry into long-term care.

Methods: Cross-sectional and population-based trend analyses were conducted using the Registry of Senior Australians.

Results: From 2006 to 2015, 509 944 individuals accessed permanent residential care, 206 394 home care, 283 014 respite and 124 943 transition care. Over this time, the proportion of individuals accessing permanent residential care with high frailty scores (≥0.3) increased (19.7-49.7%), as did the proportion with 5-9 comorbidities (46.4-54.5%), with similar trends observed for those accessing other services. The median number of medicines dispensed in the year after entering permanent residential care increased from 9 (interquartile range (IQR) 6-12) to 10 (IQR 7-14), while remaining stable in home care (2006: 9, IQR 5-12, 2015: 9, IQR 6-13). Short-term (within 100 days) mortality in those accessing permanent care was higher in 2006 (15.6%, 95% CI 15.2-16.0) than 2015 (14.6%, 95% CI 14.3-14.9). Longer term (101-1095 days, 2006: 44.3%, 95% CI 43.7-45.0, 2015: 46.4%, 95% CI 45.8-46.9) mortality was higher in 2015 compared to 2006. Mortality in individuals accessing home care did not change.

Conclusion: The health of older Australians accessing aged care programmes has declined while frailty increased, with an increasing use of medicine and worse long-term mortality in some. Funding and care models need to adapt to this changing profile.

Keywords: comorbidity; cost of illness; frailty; health services for the aged; mortality.

Figure 1

Ten most prevalent health conditions and trends in individuals entering permanent residential care. (), Anticoagulants; (), antiplatelets; (), chronic airways disease; (), congestive heart failure; (), depression; (), gastro‐oesophageal reflux disease; (), hyperlipidaemia; (), hypertension; (), ischaemic heart disease: hypertension; (), pain.

Figure 2

Ten most commonly used healthcare services by individuals in the first year after entering permanent residential care, age and sex adjusted prevalence. Does not include ‘General practitioner attendances to which no other item applies’, which >96.6% of the cohort has every year. (), Optometrical services; (), urgent attendance after hours; (), health assessments; (), GP and multidisciplinary care plans; (), medication management reviews; (), GP after hours attendances; (), cardiovascular diagnostic procedures; (), diagnostic radiology; (), allied health services; (), surgical operations.

Figure 3

Ten most commonly dispensed medicines for individuals in the first year after entering permanent residential care, age and sex adjusted prevalence. (), Paracetamol; (), furosemide; (), acetylsalicylic acid; (), cefalexin; (), macrogol; (), temazepam; (), oxycodone; (), pantoprazole; (), atorvastatin; (), risperidone.