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Better off at home
Keep elderly out of aged
care for better mental health,
royal commission hears.
Conor Burke
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 focused 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 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 dementiaspecific
behaviour management, that
eases the burden on services.”
“
If you keep people
at home and
healthy … that’s
a large part of
the solution.
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. ■
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