Older People

Determinants of enablement are personal attributes, background and environmental factors that affect how well a person can look after their health. They can have a greater influence on older people due to the cumulative impact of advantage or disadvantage over a lifetime.⁹

The health services that people use are also affected by where they live, their finances, cultural needs and beliefs, and past experience with health professionals and the health system. Beliefs about their role in their healthcare is shaped and reinforced by factors such as:

• gender
• family background
• education level
• culture
• life experiences.

When working with older people, you may need to focus more on working with these factors to build enablement, rather than changing them. But that does not mean that older people cannot change their attitudes, learn new things or become more confident in managing their health. Many older people are just as adaptable as young people with the right support.

It is not up to me to make decisions about my health – that is my doctor’s job.

I would never question the doctor or nurse, it is disrespectful.

Back in the day you just did what the doctor told you, but now we are a team.

I am too old to learn all this new stuff; I wish they would stop pushing it on me.

All this new technology is marvellous, we have got this whizz-bang device at home now that lets me measure all my vitals myself and send them off for checking.

I used to think seeing a shrink means you are weak, but since I finally went to one I feel strong and in control.

Positive stereotypes

Negative stereotypes about ageing and older people can have a negative impact on their health, including reduced physical and mental functioning, increased cardiovascular stress, increased risk of disability and reduced longevity.^{6 10 11} Research shows that generalisations like ‘old people are forgetful’ can actually lead to reduced memory performance.

On the other hand, pointing out positive stereotypes and the benefits of ageing can have a positive impact on the health of older people. When older people have a positive perception of ageing, they have improved physical functioning.^{6 10}

Cultural needs

Over a third of Australians aged 65 and over were born overseas, with the majority from non-English speaking countries in Europe and Asia.¹ Older people from culturally and linguistically diverse (CALD) backgrounds often face additional barriers to accessing healthcare.

• Financial: older people from CALD backgrounds often have a lower socioeconomic status than other Australians.
• Language: 65 per cent of Australians speak English poorly or not at all.
• Cultural: different cultural practices or norms mean people can feel uncomfortable or misunderstood in a health setting.¹

Older people may also have diverse cultural and immigration experiences that impact their world view, and affect their confidence, motivation and ability to care for their own health. This can include traumatic experiences such as genocide and war, or being a refugee or part of the Stolen Generations.

Spiritual needs

Older Australians are more likely to have religious beliefs than younger Australians, which can influence their healthcare needs and choices. In 2016, over 70% of Australians over 65 identified as Christian and 3% dentified as another religion.¹²

Mental health needs

Men aged over 85 have the highest suicide rate in Australia, with men who live alone most at risk.¹³ The onset on mental illness is rare in older people, but many experience psychological distress during times of significant change, which can affect their life and impact their ability to manage their own health.¹⁴

These may include:

• redundancy or retirement
• changes to health and abilities
• loss of independence
• death of a spouse
• changes to living arrangements
• increased social isolation.

Older people often believe they need to handle the distress themselves rather than get help. People who are prepared to get help may prefer medication to talking therapies. Overall, they use mental health services half as much as younger people, but prescription medications for mental health twice as much.⁴

To improve mental health in older people

• Find out what is going on in their life and if they are dealing with a change that could affect their mental health.
• Ask about their psychological wellbeing as part of your routine practice, to normalise the issue.
• Recognise that older people may be resistant to ask for help, due to their age or cultural beliefs.
• Promote positive coping behaviours.
• Encourage them to keep mentally active by reading, doing puzzles, learning new skills or doing further education.
• Recommend peer support and encourage them to maintain social connections by volunteering or joining a club, sports team or community group, and arranging regular meetings with friends.
• Recommend or refer mental health services for them and their family, such as a psychiatrist, psychologist or specialist mental health services for older people.
• Review the NSW Mental Health Commission’s Living Well in Later Life: a statement of principles.¹⁵

We need to move away from doing things ‘for’ older people to doing things ‘with’ older people.

Mental Health Commission of NSW, Living Well in Later Life: The Case for Change¹⁶

The strategies in this guide can all be applied to working with older people, as well as families, carers and guardians. It is important to personalise your approach, as different techniques will suit different people.

Families, carers and guardians

Good communication with families, carers and guardians becomes increasingly important as people age, particularly if the older person’s physical or mental abilities are affected. The people in their life can directly influence their enablement, through shared decision making and practical or emotional support.

Comorbidity and aging

Older people often have more than one risk factor or chronic disease, so lifestyle changes that benefit their overall health are important. They may also need to address problems that are affecting their social and psychological wellbeing.

Approaches such as health coaching can provide older people with the skills they need to improve their overall health and wellbeing.¹⁷

They may also benefit from working with health professionals who can provide behaviour change advice and motivation, such as:

• dieticians
• physiotherapists
• exercise psychologists
• psychologists
• practice nurses.

Older people and their families may benefit from learning about polypharmacy (taking five or more medications) to help them understand their medications and risks. This knowledge makes them more likely to take their medications as prescribed and communicate with health professionals about the different medications, drugs and supplements they take.

Health literacy

Health literacy is an important part of consumer enablement at any age. You can support health literacy in older people by using techniques such as teach-back, encouraging them to ask questions, and providing information that is easy to read and understand.

Motivational interviewing

Most people know what they should do to be healthier, such as eating healthy foods and exercising regularly, but they struggle with the motivation to change. They may also have trouble incorporating healthy habits into their life. Motivational interviewing can strengthen the motivation and commitment of older people to create and maintain positive behaviours.

Peer support

Organised and informal peer support with people with a similar condition or experience can significantly improve enablement in older people, increasing their health literacy and supporting their emotional wellbeing. Peer support provides social, emotional and practical benefits that give older people the skills and confidence to manage their health.

Healthcare technology

Try not to assume that older people cannot use technology. Many have used computers throughout their working lives and are likely to own a smartphone. Even if they have limited experience using technology, they can usually learn new skills when encouraged and supported by healthcare professionals.

Technology such as videoconference consultations and remote monitoring can be excellent options for older people, especially if access is difficult because of where they live, physical disability or if they no longer drive. The technology in healthcare section of this guide provides more information that may be useful.