Rural Health Issues - Ageing

The ageing of the Australian population is becoming an issue of increasing political and strategic importance. In addition to government concern with funding of aged care and health services, retirement income and intergenerational and workforce issues, there has also been an emphasis on promoting and encouraging healthy ageing (Byles et al. 2006:151). It is clear that the proportion of the Australian population aged over 65 years is increasing. It is predicted that in the year 2051 25% of the Australian population will be aged over 65 years (Byles et al. 2006:151). Of the 26.3% of Australia’s population living in regional and rural areas, approximately 16% are aged over 60 years, and this proportion is increasing (Brewster 2002:8). Schofield and Earnest (2006:507), suggest that the ageing of the population and advances in technologies will see significant shifts in the demand for health are impacting on all health programs including public hospital systems. Ageing of the health workforce is also likely to lead to a shortage of health professionals at the same time that demand for their services is increasing (Schofield & Earnest 2006:507).

Black et al. (2000:74) has noted that the trend towards both rationalisation and privatisation of health and other services in rural and remote communities has had a disproportionate effect on the elderly. Their lower incomes, restricted mobility and poorer health status make them more vulnerable in a context of reduced health services. Whilst it should be recognised that the ageing process is natural and should not be medicalised or assumed to be equated with illness, senility or dependence, shortages of GPs, nurses and allied health workers in rural and remote communities make access to health care services more difficult and expensive for older people in rural and remote areas than elsewhere. Added to this, is the non-existence of geriatric and psycho-geriatric services in many rural areas, the high cost or lack of public transport to regional medical centres, and the social isolation affecting rural older people, especially women. (Black 2000:74-75). This essay will discuss the issues associated with Australia’s ageing population in the context of rural health delivery, and the frameworks and strategies currently being implemented, or suggested to address these issues.

The experience of ageing is likely to vary greatly between people living in large capital cities such as Sydney and those living in rural parts of Australia where the nearest neighbour may be kilometres away and the nearest hospital is several hours drive (Byles et al. 2006:151).

Australia’s residential aged and community care system aims to maximise the independence and participation of older people, and to assist them and their families where necessary through practical support and care services. Healthier lifestyles, better coordinated health services, higher retirement incomes, more appropriate housing and transport and other improvements to social infrastructure have the capacity to keep older people healthier, independent and in their own homes for longer (Bishop 2000:18).

The Australian Government’s Department of Health and Ageing (2007: online) identify a number of challenges faced by rural health and aged care services including: declining or changing populations causing shifts to occur in the community's health and aged care needs; isolation, making it difficult to access a wide range of services; sustainability - being unable to support financially viable residential aged care facilities, resulting in the elderly having to leave their community; difficulty recruiting, retaining and training staff for the health and aged care services; and restrictions in coordinating service delivery because of traditional funding guidelines.

The ageing of the Australian population is more marked in country areas than in cities, compounded by the effects of internal migration. Young people leave the country to pursue work, study and other experiences while older people move to country and coastal areas to benefit from the positive aspects of country life (NRHA 2005:3). The ageing of the population has occurred within a context of enormous social and structural change. Some social changes, for example, changes to family structures and changing working patterns, can influence people’s care options should they become frail in old age, particularly as it affects informal care. Social change can also shape the expectations of coming cohorts of older people. (Bishop 2000:7).

Long-term health conditions are more common with increasing age. In 2005 nearly 100% of people aged 65 years or more reported at least one long-term health condition (ABS 2006 online). This means that an increase in chronic disease is likely with an increase in the proportion of older people in the population, which will result in increased demands for health and aged care services.

Brewster (2002:8) suggests that older people living in regional, rural and remote areas can justifiably claim that they are disadvantaged when it comes to accessing both those services to help them stay healthy and those to support them in times of sickness. The unequal distribution of aged care services and funding across geographical areas has been an area of policy concern for some decades (Gibson, Braun & Liu 2002:80). The number of hospital beds declines sharply as the distance increases from metropolitan areas, and the number of nursing home beds per 1000 population over 70 is less than average (Brewster 2002:8).

The ability of older people to remain independent within their communities depends upon the availability of infrastructure such as suitable accommodation and the social support provided by families and the community. (Bishop 2000:1) Older people in rural and remote communities face particular difficulties in accessing the services they need. The challenge is to achieve the right mix of health and aged care services in the community, so the older person does not need to move to a nursing home or hostel in another community, far from family and friends (Bishop 2000:29).

Geographic characteristics and social conditions in rural and remote areas often mean greater difficulty and costs in terms of providing aged care services. This, in turn, inevitably causes concern over spatial equity in the distribution of aged care services (Gibson, Braun & Liu 2002:80).

The shortage of residential aged care services limits the health system’s ability to function well. In rural and remote NSW hospitals are being used as substitute residential aged care services (NSW Health 2002:23). The NSW Ministerial Advisory Committee on Health Services in Smaller Towns Report to the NSW Minister for Health (2000: 21) suggests