From home life to institutional life

Moving house is recognised as one of life’s most stressful experiences. So it comes as no surprise that moving into residential aged care might be even more of a shock, particularly if the decision was made for you.

A move into residential care often comes in the wake of other accumulated losses – the loss of a spouse, of your independence, of your health – and the immense grief associated with this. To find yourself in an unfamiliar environment without the comfort of your own things or your own routine honed over many years; living with people who are neither friend or family – is not easy, even for the most resilient.

Add to this the now pervasive knowledge of how inadequate Australia’s aged care system is, illustrated by the too-common stories of neglect, and you can see why this move may be traumatic.

Considering this, it is not surprising that many people’s mental health plummets upon moving into aged care. Rates of depression have been found to be much higher for people living in residential aged care than those of the same age living at home. This was the case even prior to the strict isolation experienced by residents during the COVID-19 pandemic; since then, it can only be expected that feelings of depression, anxiety, despair, and stress will have skyrocketed in those hours spent alone. And yet, little is done to acknowledge or address this.

As arguments continue about whether residential care services should even have to provide 24/7 nursing staff, it is hard to imagine the Royal Commission into Aged Care recommendations to improve mental health treatment will be implemented very quickly.

Research shows that older people are open to counselling or cognitive behavioural therapies, but issues of resources, accessibility, and availability often mean medication is the only treatment offered. It is also commonly used to address challenging behaviours that might respond better to more time-intensive therapy. The Royal Commission found antipsychotic use in aged care homes was widespread and inappropriate with medications often being used as chemical restraint. Alarmingly, data revealed that half of the residents given antipsychotics had no psychosis diagnosed.

Over-medication and a lack of proper treatment for mental health are just two examples of the structural, funding and resourcing failures within the aged care system, which have resulted in an environment that can result in the abuse and neglect of older people. This no doubt compounds feelings of helplessness and hopelessness, which can have dire consequences.

Recent research in Australia suggests that suicide in residential aged care is of increasing concern. A study by Monash University’s Department of Forensic Medicine identified 141 deaths by suicide in Australian residential care facilities over a 12.5-year period. Half of the residents who died from suicide did so within 12 months of moving into aged care. In the wider community, the highest age-specific suicide rate for men is in those aged 85 and over.

A study by the Florey Institute of Neuroscience and Mental Health showed that there appears to be little to no age-related deterioration in cognitive function: “Normal ageing appears to be associated with some subtle changes in the speed of problem-solving and when learning new information, however, the accuracy of decisions does not deteriorate.”

Positive changes to the aged care system will only be embedded if underlying ageist beliefs are addressed. It is easy enough to call for respect and to rally against the marginalisation of older people and their needs while demanding an end to negative stereotyping and discrimination.

But what of the ageism we each carry internally? The feelings of not wanting to grow old, of being afraid of what lies ahead? The belief that it’s admirable to be stoic and ‘not make a fuss’. That when the time comes, we won’t be ‘choosing’ residential aged care. These unconscious biases and attitudes can influence decisions children make about their parents’ needs, how medical and healthcare practitioners treat older people, and how policymakers envisage systemic changes.

It is ageist to think that such immense upheaval as a move into aged care would not have a detrimental effect. A sense of security and safety will not always nullify feelings of despair, worry and anxiety, and it is ageist to think that these things matter any less for those who have lived a long life. We need to acknowledge the enormity of such a move and support a person to adjust to their new circumstance.

A system that does little to adequately prepare and support a person’s transition into aged care, (including, where necessary, by providing appropriate mental health services) is inherently ageist.

Many people have fulfilling and healthy lives in aged care homes: our challenge is to ensure that all people have this opportunity, by being provided with the care, respect and dignity that is their right.