Ageing policy ignores the majority of older people

By  Don Edgar  and  Patricia Edgar

Sep 3, 2024

'Old' is defined by the Australian Bureau of Statistics as any person over the age of 65. This is a wildly outdated notion given our longer life expectancy and the fact that most of us will live many years beyond that arbitrary date in active service to the community.

We know little about this cohort, numbering 4.38 million, yet aged care policies are based on alarmist assumptions that they will all need, and want, either a nursing home bed or an aged care package. We need a radical rethink about life after 65 to ensure better informed policy, more effective use of resources and inter-generational, community-wide supports for the aged.

Of those currently aged over 65, only 250,000, fewer than 6%, are in residential aged care or receiving home-based care packages. Population projections suggest that number will grow to 20.7% in 2066. But from what we now know about the system that is currently on offer, we think not. The Royal Commission on Aged Care painted a damning picture of a failing system; elder abuse, poor nutrition in aged-care homes, lack of qualified care workers, a huge shortage and long delays in obtaining a home-based aged care "package".

In fact, the large majority of the over 65s are managing in ways not yet known in any systematic study of "older" people. We need to know how they are managing, to learn from their experiences, to make better policies for the future, so there is a better use of resources for the community as a whole. And is there a dark world to be discovered where people are not managing at all?

From available relevant data we know the following.

Fifteen percent are still working in paid jobs, (19% of men). Thirty-seven percent were born overseas, with many speaking languages other than English and coming from cultures where perceptions of the old can be very different. Some are from cultures where respect and family responsibilities to ageing parents are the norm.

One in every four live in a private dwelling, with 92% of older couples owning their own home. Twenty-six percent of them have one or more spare bedrooms; 33% are widowed (10% of men) with household competencies much lower for men living alone.

Health problems vary widely in this age group. The most common and disabling disease of the over-65s is arthritis (8.5%), followed by asthma (8.1%), diabetes (5.6%) heart disease (3.9%) and cancer (2.9%), One in twelve lives with dementia, rising to 33% of those over 85. Many report more than one long-term health condition. However, the majority of those labelled "old" remain sufficiently fit to contribute much to younger families and the wider community. Thirteen percent of them provide help to a person with a disability and 13% to  22% provide child-care to their extended family. Voluntary community service activities also continue well into the later years (28% of those over 70 are involved).

We know from Time Use surveys that older people spend more time watching TV and less time using digital devices. That will change as digital natives join the elderly. Meanwhile, the viewing and listening options for this older audience are limited. They are not regarded as an audience worth pursuing in programming, even by the ABC. This group averages the same 1.4 hours per day as younger people on exercise, sports and walking, but close to 70% do little or no outdoor activity, a vital contributor to health and well-being. This inactive lifestyle needs addressing for all age groups.

Overall, life satisfaction varies little by age group, but is higher for those over 70. Forty-two percent of "the old" still have face-to-face contact with family or friends and 93% say they can expect support in times of crisis.

Not much of the data available paints a picture of "dependency" or cause for alarm, but we need to break down the so-called "old" age group and look at those over 75 years and over 80 years separately to refine any sensible policy on ageing in Australia.

We need to ask what the over-65s actually want for their later years. What are their concerns? Would, or could, they share their homes with a young person in exchange for practical help with cooking, shopping and getting to appointments? Can they rely on family members or friends for support? Would they tolerate an unfamiliar "carer" coming into their homes, or being segregated in aged care accommodation?

How age-friendly is their neighbourhood? Are there parks to walk in? Are there safe paths to walk on - traffic and obstacle-free? Are there benches to sit on when tired of walking? Trees for shade in summer? A mix of young and old? Are houses and apartments being designed to suit older people's physical capacities? Are local bus services linked to adequate shops and medical services? Are there community services that welcome volunteer participation? Are there schools and child-care centres willing to arrange inter-generational activities? Are the banks and other online facilities willing and planning to assist older, less digitally savvy, people in ways that don't exclude or intimidate them? Are current programs and services sensitive to different ethnicities?

We need answers to such questions from all levels of government before assuming the four million-plus Australians who are not using current aged-care accommodation or services will want to use them in the future or would prefer to take care of themselves.

But first we must cease the relentless political and media beat-up about the coming crisis in aged care and start looking for a cohesive way forward. We will all grow old in increasing numbers. This system we have is failing the older age group by segregating and stigmatising, not respecting and listening to those who wish to grow old in an age-friendly community, without formal care. Eighty-eight thousand people in Japan, which has the world's oldest society, will die alone in their houses this year. It is a symptom of a society where the community no longer cares for its aged and no longer look out for one another. Australia is capable of a better way.