Older people, defined as those aged 65 years and over, make up 17% of the NSW population. The majority of older people in NSW live in the community, with 4.4% living in residential aged care facilities (RACF)This factsheet provides information from the Lumos data asset, which combines data from general practices (GPs) with data from other NSW Health services. This factsheet presents analyses over a five-year period from 1 July 2016 to 30 June 2021 about how aged care facility residents use health services compared to older people living in the community. The aim is to gain a better understanding about healthcare needs among older people to inform health services management and planning.
Among older people identified in Lumos data as living in residential aged care facilities, 4 in 10 are aged over 85 years, compared to 1 in 10 aged over 85 years among older people living in the community.
Aged care facility residents use hospitals and ambulances more often than older people living in the community.
Over a 5-year period, older people who were aged care facility residents were more likely to use an ambulance or go to hospital compared to older people living in the community.
Across all age groups, older people who were aged care facility residents had on average:
Unplanned hospitalisation due to mental health disorders is more common among older people living in residential care than for those living in the community.
The top reasons for unplanned hospitalisations - accounting for nearly 60% of admissions - were similar among older people living in the community and those living in residential aged care facilities (RACF), although there were slight differences in ranking.
An important exception to this is admissions for mental health disorders, primarily dementia. Mental health disorder is the fifth ranked reason for an unplanned admission among those living in RACF, accounting for 7% of admissions among aged care facility residents. Among older people living in the community, mental health disorder ranked considerably lower, accounting for only 2.5% of admissions. This is consistent with Australian population data reporting that RACF patients are older and more likely to be living with dementia than those in community settings.
Aged care facility residents use primary care more often than other older people living in the community.
Over the period July 2016 – June 2021, older people in the Lumos cohort visited GPs on average nine times per year. The average annual number of GP visits increased with age, with those aged 85 years and over visiting their GP an average of 15 times per year.
Compared to older people living in the community, aged care facility residents saw a GP much more often – almost half saw a GP more than 16 times per year, compared to less than a quarter of older people in the community.
For all age groups, there was a dip in average annual GP visits around 2019-20, which corresponds to COVID-19 lockdowns, with these rates having returned to pre-pandemic levels in 2020-21.
The Royal Commission into Aged Care Quality and Safety released its findings in February 2021, highlighting critical issues faced by older people, particularly those in residential aged care facilities (RACF).
To support reforms it is important to understand how older people living in RACFs are using health care in NSW and how this compares with other older people in the community. While few RACF residents can be reliably identified in acute care data – such as hospital or ambulance records – GP billing records include items that are exclusive to RACF residents which provide greater population coverage. By bringing together GP and acute care data, Lumos makes it possible to identify residents of aged care facilities and to compare their need for acute health services with older people living in the community.
The Lumos Program links records from participating NSW general practices (GPs) to records held by NSW Health such as hospital admissions, emergency department and outpatient visits, and mortality. This factsheet provides information about care received in acute and primary care by older persons (65+) that is available in the Lumos data asset.
4,367,763 people were included in the Lumos cohort extracted in October 2021, representing 53% of the NSW population.
286,739 people were included in the analysis. These comprised those aged 65 years and over at their first GP encounter between 1 July 2016 and 30 June 2021 and who also had five or more encounters at a Lumos participating practice during that period. Their GP records were linked to hospital, emergency department and ambulance data over the same timeframe.
RACF status was flagged by the presence of RACF-specific MBS items in the GP billing records, supplemented with flags in the acute care data indicating either that the facility was an RACF or that there was referral from/discharge to an RACF. RACF status was assigned to persons who were flagged as having lived in an RACF at any point from 1 July 2016 to 30 June 2021.2 In all, 11,582 people (4%) included in the analysis were flagged as having lived in an RACF during the study period.
Rates were calculated as the number of events in each age group in each financial year, summed from 1 July 2016 to 30 June 2021, divided by the number of person-years5 in each age group in each financial year, summed from 1 July 2016 to 30 June 2021.
