There are many programs and services available to support the health of older Australians. Health services include those provided by medical practitioners, specialists and other health professionals in hospitals and clinics. Older people’s access to these services may vary according to where they live, their access to transport, their health and cultural background, as well as socioeconomic factors (AIHW 2020e; van Gaans and Dent 2018).
Cancer screening programs are an important component of health service use. In Australia, there are three national screening programs:
- BreastScreen Australia
- National Bowel Cancer Screening Program (NBCSP)
- National Cervical Screening Program (NCSP).
These programs test for signs of cancer or pre-cancerous conditions in populations without obvious symptoms. They target specific populations and/or age groups where evidence shows screening to be most effective. Cancer screening is not included in this page; for more information on cancer screening in Australia, see Cancer screening.
Throughout this page, ‘older people’ refers to people aged 65 and over. Where this definition does not apply, the age group in focus is specified. The Older Aboriginal and Torres Strait Islander people feature article defines older people as aged 50 and over. This definition does not apply to this page, with Indigenous Australians aged 50–64 not included in the information presented.
General practitioners
General practitioners (GPs) are part of the front line of Australia’s health care system. GPs treat a broad range of health issues and are often the first point of contact many people have with the health system. They can be critical in reducing the number of potentially avoidable hospital visits and improving the health of the population (AIHW 2020k).
Most older Australians see a GP. The 2019–20 Australian Bureau of Statistics (ABS) Patient Experience Survey estimated that, in 2019–20, 3.7 million older people (aged 65 and over) saw a GP at least once (95% of all older people). Over half (58%) of these older people were aged 65–74. An estimated 8 in 10 (80%) people aged 15–64 saw a GP at least once (ABS 2020).
In 2019–20, there were 43 million Medicare claims for unreferred GP attendances for people aged 65 and over – 30% of the total 141 million claims for unreferred GP attendances.
Unreferred GP usage was greater for those of older ages. The rates of service use per 100,000 population were:
- 1.5 million by people aged 85 and over
- 1.1 million by those aged 75–84
- 0.8 million by those aged 65–74.
In comparison, the service use for those aged 45–54 was 0.5 million per 100,000 (Services Australia 2021).
ABS data for 2018–19 show that the majority of older people self-reported that they had acceptable waiting times to get an appointment with a GP. For those accessing GP services in the last 12 months, this included:
- 86% of those aged 65–74
- 90% of those aged 75–84
- 89% of those aged 85 and over (AIHW 2020k).
GP visits during COVID-19
During the coronavirus disease 2019 (COVID-19) pandemic, the Australian Government expanded Medicare-subsidised telehealth (telephone and videoconference) services for all Australians and increased Practice Incentive Payments. The new Medicare Benefits Schedule (MBS) items allowed Australians to access essential primary health services, such as GP visits from home, to limit the potential exposure of patients, practice staff and medical practitioners to the virus (AIHW 2020b).
Specialists
Specialists provide diagnostic and treatment services in a specific area of medicine, generally for a particular disease or body system. They also support patients in managing health conditions. Commonly referred specialties across all age groups include: dermatology, cardiology, gynaecology, neurology, oncology and rheumatology.
Medicare-subsidised specialist consultations
There were 14.6 million specialist attendances processed through Medicare in 2019–20 for people aged 65 and over. Almost 1 in 2 specialist attendance claims (46%) were for these older people (Services Australia 2021).
Older people received more Medicare-subsidised specialist consultations outside hospital than younger people. In 2017–18, a higher percentage of older people had at least one Medicare-subsidised referred specialist consultation outside hospital (64% compared with 26% of those under 65) (AIHW 2020g).
Estimates from the 2019–20 ABS Patient Experience Survey showed that older people (aged 65 and over) are more likely to see a medical specialist than younger people. In 2019–20, people aged 85 and over were more than twice as likely to have seen a medical specialist in the last 12 months as those aged 15–24 (59% compared with 20%, respectively) (ABS 2020).
Older people who report seeing a medical specialist, across both age and sex comprised:
- 57% of men and 53% of women aged 65–74
- 61% of men and 61% of women aged 75–84
- 61% of men and 58% of women aged 85 and over (ABS 2020).
Older people were less likely to delay seeing or to not see a medical specialist compared with younger people – 1 in 10 people aged 65 and over (11%) compared with 1 in 4 people aged 15–24 (27%).
Most older people reported that a medical specialist:
- always listened carefully to them (85%)
- always showed them respect (88%)
- always spent enough time with them (86%) (ABS 2020).
Allied health services include those delivered by audiologists, chiropractors, diabetes educators, dietitians, exercise physiologists, occupational therapists, optometrists, orthoptists, osteopaths, physiotherapists, podiatrists, psychologists, social workers and speech pathologists.
Overall, older people (aged 65 and over) use allied health services more than younger people. In 2018–19, 65% of Australians aged 65–79 and 72% of people aged 80 and over received an allied health service, whereas 32% of Australians aged 64 or under received a service (AIHW 2020g). For more information on older Australians’ health, see Health – selected conditions.
There were around 10 million non-admitted patient service events provided to people aged 65 and over in 2019–20; that is, allied health services provided to public patients in public hospital outpatient clinics. While people aged 65 and over accounted for 16% of the total population, they represented 34% of these non-admitted patient service events (AIHW 2020i).
For more information, see Medicare-subsidised GP, allied health and specialist health care across local areas: 2013–14 to 2017–18.
As for all Australians, older people may access mental health services through various pathways, including hospital, residential and community-based services, emergency departments, GPs, medical specialists and/or allied health professionals. Due to the diversity of mental health support services available, there is no single, overarching data collection that can be used to report on the mental health care being accessed by older Australians.
In 2019–20, 241,200 older people (aged 65 and over) accessed over 1.0 million Medicare-subsidised mental health-specific services. These services represented 8.3% of the total 12.4 million mental health-related services subsidised by Medicare in that year (AIHW 2021a). Compared with younger people, a relatively low percentage of older people received Medicare-subsidised mental health-specific services (Table 3D.1).
Table 3D.1: Australians accessing Medicare-subsidised mental health-specific services by age, 2019–20
|
Age group (years)
|
Number of services
|
Number of patients
|
Rate (% of the population)
|
|
18–24
|
1,641,488
|
361,634
|
15.3
|
|
25–34
|
2,497,812
|
553,374
|
14.5
|
|
35–44
|
2,224,281
|
483,525
|
14.1
|
|
45–54
|
1,906,883
|
403,860
|
12.5
|
|
55–64
|
1,429,588
|
294,977
|
10.0
|
|
65–74
|
714,261
|
157,596
|
6.8
|
|
75–84
|
261,029
|
65,965
|
5.2
|
|
85 and over
|
60,253
|
17,650
|
3.4
|
Note: In the last 12 months.
Source: AIHW 2021a.
Of the 241,200 older people accessing Medicare-subsidised mental health-specific services, most accessed these services provided by GPs (186,300 people). Psychiatrists were the next most common provider (50,900), followed by psychologists –other psychologist services (44,800) and clinical psychologist services (35,100) (AIHW 2021a). Note people can receive services from multiple providers but are counted only once in the total number of patients. As such, the total number of patients will not be a sum of the provider types.
Some older people (aged 65 and over) seeking help for their mental health are admitted for overnight care. In 2018–19, 54,300 older people had a separation from an overnight admitted mental health service. Most of these were without specialised psychiatric care (70%, 38,200). Over time, there has been an increase in the percentage of separations without specialised psychiatric care, particularly for people aged 85 and over (average annual change of 9.3% from 2008–09 to 2018–19). In contrast, separations with specialised psychiatric care for people aged 85 and over had an average annual decrease of 0.8% from 2008–09 to 2018–19 (AIHW 2021a).
For more details about older people with mental health conditions, see Health – selected conditions, and for more information on mental health services in general see Mental health services in Australia.
Dental services are provided to improve oral health and reduce disease. Dental services are commonly delivered by dental practitioners (such as dentists and dental surgeons). Services range from routine and preventive care to treatment of dental problems and emergencies. Services can be accessed privately or through public dental clinics or the Department of Veterans Affairs (based on eligibility). As more people are retaining more of their teeth into old age, this is also likely to increase older people’s need for dental services. For more about older Australians’ dental health, see Health – selected conditions.
According to the 2017–18 National Survey of Adult and Oral Health, almost 3 in 5 older people saw a dentist in the last 12 months (AIHW 2021b) (Table 3D.2).
Table 3D.2: Older Australians who saw a dentist by age and sex, 2017–18
|
|
55–74
|
75 and over
|
|
Males
|
57.4%
|
54.8%
|
|
Females
|
61.3%
|
56.9%
|
|
Total
|
59.4%
|
56.0%
|
Notes
- In the last 12 months.
- `Older Australians’ refers to people aged 55 and over.
According to the 2019–20 ABS Patient Experience Survey, over half of older Australians who visited a dental professional in the last 12 months had between 2 to 3 dental visits (52%), with 35% having one visit and 13% having 4 or more (ABS 2020).
Publicly funded dental care is targeted towards low-income groups, with aged pensioners and unemployed people eligible for services at minimal or no cost to the patient. Waiting times for services, and their availability, can be problematic and lead to poorer outcomes for people reliant on these services. According to the 2019–20 ABS Patient Experience Survey:
- 1 in 7 (14%) older people aged 65 and over received public dental care.
- 1 in 12 (8.3%) older people were placed on a public dentistry waiting list (ABS 2020).
The cost of dental services is often reported as a barrier to accessing services. In 2017–18, of people aged 75 and over:
- 22% avoided or delayed dental care due to cost.
- 18% reported they would have difficulty paying a $200 dental bill.
- 9.8% reported cost prevented dental treatment (AIHW 2021b).
For more information, such as to compare with younger age groups or explore financial barriers to dental care by selected characteristics, see Oral health and dental care use in Australia.
Emergency departments
Emergency departments (EDs) are an essential component of Australia’s health care system. Many of Australia’s public hospitals have purpose-built EDs, staffed 24 hours a day, providing care for patients who require urgent medical, surgical or other attention. Between February and June 2020, a number of travel, business, social interaction and border control restrictions were introduced to prevent and reduce the spread of COVID-19. A number of other changes during this time may have impacted ED health care, and the provision of health-care services more generally. Compared with 2018–19, ED presentations in 2019–20 decreased by 1.4% (AIHW 2020d).
In 2019–20, older people – who made up about 16% of the population – accounted for 22% (1.8 million ED presentations) of the 8.2 million ED presentations over the year. Across the older age groups, men had higher rates of presentation than women, with ED presentations per 1,000 population, respectively, of:
- 366.2 compared with 320.3 for those aged 65–74
- 589.8 compared with 516.1 for those aged 75–84
- 918.7 compared with 744.7 for those aged 85 and over (AIHW 2020d).
Taking account of the size of the population, presentations were highest for men and women aged 85 and over (Figure 3D.1).