Australian seniors’ need for age appropriate treatment services
Australia has a population of 2.8 million of people over age 65. Although not the first people that come to mind when the words ‘drug addict’ or ‘alcoholic’ are heard, nevertheless there are many people over 65 who have an addiction or other mental health problem. When they seek treatment they will find services that are designed for people their grandchildren’s age.
Overseas, particularly the USA and Canada, there are now services in operation that are designed specifically to meet the needs of the older health service consumer. But in England decisions about any medical treatment received in their public health service has been found to be based more on age than actual clinical need, with the unspoken viewpoint apparently in operation that the younger people are more deserving.
A UK Healthcare Commission report released in late March 2009 reports that government targets invariably put older people’s services on a lower priority, which combined with a chronic lack of resources means the needs of the elderly are not being addressed. The report went on to say that eliminating such discrimination in adult mental health services would require an additional 2 billion pounds annually, an increase in funding of 24%.
The concept of “Distributive justice” should determine how society’s resources are portioned out amongst the many deserving, and what is just with respect to the allocation of goods, including limited health care resources. Because any given society has a limited amount of resources the problem always arises as to how the goods will be divided. The common answer to this question is that every individual should receive a ‘fair share’, but this is not always easy in practice.
In the report “Older people’s mental health services: a national study” the UK Health Commission found that services for younger adults indirectly discriminated against older adults, even when in theory there was no obstruction to their access. They did this, for example, by providing services that were open to older people, but not sensitive to their age-related needs. In particular, many of their older patients had a complex mix of physical and mental health needs and often required more intensive support from social services.
There was no policy actually requiring age discrimination, but staff reported that in practice obtaining the full range of services was often not possible. There was both a reluctance to refer and to accept referrals. When queried this was blamed on workload capacity. However it was found there was no justification for this, and the way in which services were allocated appeared to be based on organisational, historic and cost reasons. Even when it was possible for older people to access services, there was a lack of evaluation to ensure that their needs were being addressed.
There are few, if any, age-appropriate mental health services in Australia for the elderly, which includes alcohol and other addictions (AOD). In 2008 Victoria funded research into examining what is being done in this regard overseas. The researcher, after touring Canada and USA age appropriate facilities, found that there was a general consensus that older people do better and receive better service from older adult specific treatment services.
Some of the specific recommendations for meeting older peoples’ needs included allowing more time for the treatment process because it takes longer for a response to treatment by the older adult. It has become apparent that older people need to take more breaks and go at a slower pace. Counselling sessions need to be shorter than for younger people and the groups smaller. Other problems arose, as well, like physical illness meaning that missed appointments were more likely. It was also noted that older adults’ brain function takes longer to return to normal after withdrawal.
With all of this evidence it is now clear that Australian mental health, alcohol and other addiction treatment services need to be tailored to the specific needs of older people, as well as funded appropriately, and we would encourage and support that development.
That said, it should also be kept in mind that all people over 65 are not alike, as seniors are not a one-size-fits-all group. Consider also the gender-based, cultural, ethnic, religious and language differences as well as the differences between 65 year olds and 95 year olds. It is a utopian health system that would be able to sensitively meet every person’s individual needs and this will never happen. But it is sensible and within society’s means to provide appropriate care for all its older members and is reasonable to expect.