Is Australia prepared for its ageing population?

IN BRIEF:Emergency departments will increasingly struggle to cope with an influx of elderly patients, a new report has found.Experts say that older people are falling through the cracks at every level of the health and aged care systems.

Australians are living longer and the healthcare system is increasingly unable to cope, according to a new national report on the state of emergency departments (EDs).

The Australasian College of Emergency Medicine’s (ACEM) third annual report notes that while Australia’s ageing population is a “modern-day success story”, the nation is not sufficiently prepared for the influx of elderly people into EDs.

From 2019 to 2024, the number of older people attending EDs increased by 16 per cent, compared with a 4 per cent increase among younger people, with half of all elderly presentations to an ED resulting in a hospital admission.

The group also found disparities in hospital care requirements between groups of older people.

While all non-Indigenous people aged 65 years and over were significantly more likely than younger people to be classified in higher urgency categories, arrive by ambulance and be admitted into hospital, that also holds for Aboriginal and Torres Strait Islander people aged 50 years and over.

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ACEM president Dr Peter Allely said EDs were “far from ideal” environments to treat elderly patients, due to their “harsh lighting, loud noises and constant interruptions”.

“We see too many frail people made afraid, confused and unwell by an unfamiliar environment, far away from their loved ones, familiar faces, supports and home comforts.”

He said that, despite the “scale and predictability of demographic trends”, governments across Australia had done little to prepare for the “volume and complexity of care needs” for the ageing population.

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As a result, significant pressure was now being felt at “all levels” of the health system, including hospitals, primary and aged care facilities, and in-home support programs, he added.

ACEM is the organisation responsible for training emergency medicine specialists and setting standards for emergency care in Australia and New Zealand.

Across-the-board lack of preparedness

University of New South Wales professor in ageing health Lee-Fay Low agreed, saying she didn’t think Australia had been doing anything long-term to prepare the health system for Australia’s ageing population.

Similarly to Allely, Low said this lack of preparedness wasn’t unique to hospitals, but could also be seen in primary care clinics, aged care facilities, and even among families.

Low, who is also leader of the Ageing and Health Research Group at the University of Sydney, said the ongoing aged care crisis was affecting people’s ability to receive preventative care.

“Right now, because you have to wait for aged care, those things that might help might prevent you from going to emergency, like poor nutrition, ending up with an infection because your hygiene’s not looked after.”

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Even since the Royal Commission into Aged Care handed down its final report in 2021, lengthy waitlists for aged care providers have seen many people go without crucial care, Low said.

“After the Aged Care Royal Commission, the government released more home care packages, allowing people to age in place without going into nursing homes. But that waitlist is a year long again now.

“The problem is that with the aged care reforms, things are worse now … I mean, waiting a year is ridiculous.

“People living in their homes aren’t really getting that aged care in a timely way, and that precedes these emergency visits.”

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New health department data released yesterday found an average of 17 older Australians died while waiting to receive support at home care each day last year — an increase of more than a third on the previous year.

As of June 30, more than 106,000 Australians were on the official waiting list for a place in the Commonwealth-funded Support at Home program, while the ABC’s Four Corners reported in August that the true number of people waiting was almost 154,000.

‘Urgent action’ needed

Older Australians made up only 17 per cent of the population in 2024 but accounted for almost a quarter of all ED presentations.

The ACEM report said that, without “urgent action”, increased ED presentations by older people would disproportionately impact the healthcare system.

Using population growth modelling from the Australian Bureau of Statistics, the report projected a 177 per cent increase in total ED presentations between 2010 and 2050, noting projected increases of 242 per cent for people aged 65 to 84, and 411 per cent for people aged 85 and over.

ACEM is calling for federal, state and territory governments to urgently improve the quality of care older people receive across the health system, reduce ED demand, lift hospital capacity and provide sustainable hospital care for all Australians.

The government’s latest Intergenerational Report projected rapid population ageing and falling fertility rates would fundamentally reshape the economy and budget out to 2065–66. By 2030, nearly one in five Australians will be aged 65 and over.

“The ratio of working people to older people is going to change substantively,” Low said.

Allely warned that “Australia’s health system and its health workforce are just not equipped for this demographic change.”

More funding not the only remedy

Low said preparing for an ageing future required more than a funding boost.

“We always say we should have more funding, but I think where the funding is focused is important.”

She also said proper reform would also require “an adjustment in presumptions and expectations Australians have for care as they get older”.

“I think the presumption and the expectation in Australia is that when you get older, if you need care, you’ve paid taxes your whole life and the government will look after you. And that’s already untrue, right? Aged care doesn’t look after you straight away.”

Low said a “national conversation” was needed to identify where the responsibility for care lies — whether it is with the government, or a co-contribution arrangement through which “as part of saving for retirement and super, that we also put aside some money, if we need help and we can pay for care”.

Reforms also need to ensure the aged-care sector has a sufficient workforce, one-third of which is currently made up of migrants. Australia needs to reconsider decisions made around cutting migration, Low said.

She also suggested more families needed to start conversations about the “expectation that maybe mum and dad will need some help, and at that stage we might have to work less or chip in somehow to support the care”.

But beyond families, she said, “this is not a conversation that we’ve had nationally”.

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