Historical Trends and Future Projections of Demand for Permanent Residential Aged Care for Older People in Australia, 2008-2052.

OBJECTIVES: To examine the historical trends and predict the future rates and total volumes of permanent residential aged care (PRAC) service utilization in Australia. DESIGN: A population-based repeated cross-sectional and projection study of non-indigenous older people (≥65 years) accessing PRAC in Australia was conducted. SETTING AND PARTICIPANTS: Publicly available aged care admissions from the Australian Institute of Health and Welfare and population estimates from the Australian Bureau of Statistics were used. METHODS: Historical incidence rates (per 1000 people), incidence rate ratios (IRRs) and 95% CIs of PRAC admission from 2008-2009 to 2020-2021 were estimated using negative binomial regression models. The future incidence and prediction intervals (PIs) of PRAC admission between 2021-2022 and 2051-2052 were projected using a generalized additive model-negative binomial regression. All estimates were adjusted or standardized by sex and age. RESULTS: Between 2008-2009 and 2020-2021, the adjusted admission to PRAC decreased (from 23.6/1000 people to 15.7/1000 people with an IRR = 0.97/year, 95% CI 0.97-0.98). The projected PRAC admission rate will decrease to 12.1/1000 (95%PI 10.8-13.3) by 2037-2038 and 9.0/1000 (95%PI 7.6-10.4) by 2051-2052. The projected volume of PRAC admission will be 73,988 (95%PI 65,960-81,425) at its highest point in 2037-2038 and 64,579 (95%PI 54,258-74,543) in 2051-2052. CONCLUSIONS AND IMPLICATIONS: The utilization of PRAC has decreased in the past decade, and a predicted decrease in PRAC use in future years is estimated. However, the volume of PRAC utilization will still increase for the next 15 years (until 2037-2038) due to our increasingly older population. These findings can inform service planning of PRAC access in Australia.

Excess mortality in residents of aged care facilities during COVID-19 in Australia, 2019-22.

BACKGROUND: To date, the excess mortality experienced by residential aged care facility (RACF) residents related to COVID-19 has not been estimated in Australia. This study examined (i) the historical mortality trends (2008-09 to 2021-22) and (ii) the excess mortality (2019-20 to 2021-22) of Australian RACF residents. METHODS: A retrospective population-based study was conducted using the Australian Institute of Health and Welfare's GEN website data (publicly available aged care services information). Non-Aboriginal, older (≥65 years old) RACF residents between 2008-09 and 2021-22 were evaluated. The observed mortality rate was estimated from RACF exits compared with the RACF cohort yearly. Direct standardization was employed to estimate age-standardized mortality rates and 95% CIs. Excess mortality and 95% prediction intervals (PIs) for 2019-20 to 2021-22 were estimated using four negative binomial (NB) and NB generalized additive models and compared. RESULTS: The age-standardized mortality rate in 2018-19 was 23 061/100 000 residents (95% CI, 22 711-23 412). This rate remained similar in 2019-20 (23 023/100 000; 95% CI, 22 674-23 372), decreased in 2020-21 (22 559/100 000; 95% CI, 22 210-22 909) and increased in 2021-22 (24 885/100 000; 95% CI, 24 543-25 227). The mortality rate increase between 2020-21 and 2021-22 was observed in all age and sex groups. All models yielded excess mortality in 2021-22. Using the best-performing model (NB), the excess mortality for 2019-20 was -160 (95% PI, -418 to 98), -958 (95% PI, -1279 to -637) for 2020-21 and 4896 (95% PI, 4503-5288) for 2021-22. CONCLUSIONS: In 2021-22, RACF residents, who represented <1% of the population, experienced 21% of the Australian national excess mortality (4896/22 886). As Australia adjusts to COVID-19, RACF residents remain a population vulnerable to COVID-19.