Aged-care homes’ drug use slammed as ‘elder abuse’

The Australian August 14, 2018:

Nearly two-thirds of Australian aged-care residents are every day given psychiatric drugs — many inappropriately prescribed — that cause deaths and strokes or are linked to falls and seizures.

The “horrifying” findings of a University of Tasmania study have prompted the Royal College of GPs to warn that aged-care homes can no longer be ­assumed to be safe places, and an expert to condemn ­resident-medicating practices as “elder abuse”.

Reporting on the first national audit of psychiatric medication prevalence in aged-care facilities, the study finds homes are beset by “high rates and inappropriate use”, that use of highly sedating antipsychotics and benzo­diazepines is “of major concern” and interventions are “urgently ­required”. The findings are likely to deepen turmoil over dysfunction and abuses exposed within Australia’s residential aged-care system, with experts saying the study numbers show “chemical restraint” — where sedation is used to control the behaviour of residents, particularly those with dementia — is “widespread”.

The federal government remains under pressure over a reform process to improve quality and safety in the sector sparked by the Oakden elderly abuse scandal in 2017.

The drug-use survey reveals more than 61 per cent of the 11,300 residents in 150 audited homes were found to be on daily doses of benzodiazepines, such as temaz­epam, so-called “tranquillising” antipsychotics, such as Risperdal, or antidepressants, many of which were also a sedative, such as Mirtazapine.

It said high drug use was ­occurring in spite of existing research evidence of only modest or no benefit for aged-care residents as well as the drugs’ “substantial adverse effects”, including deaths, stroke and heart problems, and links to increased rates of pneumonia, falls and seizures.

“Despite repeated warnings of limited effectiveness and significant risk associated with psychotropic medication … the residents of Australian aged-care homes continue to be prescribed (it in) excessive amounts,” lead author Juanita Westbury said. “As concerning … was high ‘as-needed’ prescribing where nursing staff decide when to medicate and which … is often used to sedate and control behaviour — in other words, as chemical restraint.”

Branding the survey findings “horrifying”, RACGP’s president, Bastian Seidel, said: “Medical sedation is a foul compromise for ­inadequate nursing care. People think they’re in a safe place in residential care and everything (will) be fine, but the reality is what’s being reflected in this research.”

Asked if he was saying aged-care homes could no longer be assumed to be safe places, Professor Seidel said: “That’s correct.”

Experts and peak clinical guidelines say antipsychotics should be used with people with dementia only exceptionally after psychological or person-centred approaches have failed.

Dr Westbury’s study concludes antipsychotics and benzodiazepines are being used to manage “common” behaviours such as wandering, agitation and calling out.

University of NSW conjoint professor of psychiatry Carmelle Peisah said the community should be “deeply disturbed to hear older people’s needs are not being met and they are instead being given psychotropic drugs … giving psychotropics without consent is elder abuse”.

Financial abuse: The hidden epidemic

Financial Standard – 7 August 2018

Australia’s Commonwealth Bank is extending its domestic and family violence support program due to customer need, with its helpline receiving about 90,000 calls in the first month.
Initially launched as a 12-month pilot in November 2017, the CBA Domestic and Family Violence Emergency Assistance Program will continue indefinitely as a result of the volume of customers requiring help.
In its first month, the program’s helpline received 87,000 calls with 6000 customers using the bank’s services to date. It is estimated up to 90 per cent of women affected by domestic and family violence are experiencing financial abuse.
The program offers access to independent specialist trauma counsellors, financial assistance, safe establishment of bank accounts and over the phone support to ensure appropriate communication with family and friends.
Of those helped so far, 95 per centare women, half of which are aged between 22 and 35 years of age. The majority of calls have been received from New South Wales, with Western Australia and Queensland close behind.
Describing financial abuse as a hidden epidemic, CBA is committing about $20 million in prevention and support initiatives, including training branch staff and financial counsellors in identifying and supporting potential victims.
While speaking at a forum hosted by Financial Standard and Challenger earlier this year, KJB Law senior solicitor Kerstin Glomb said financial abuse receives less attention and tends to go unchecked because perpetrators typically aren’t breaking the law.
“Illegal exploitations are easier to identify; fraud or theft can generally be found on paper,” she said.
CBA general manager of group customer relations Catherine Fitzpatrick said the response from customers shows the need is great, and it is essential government, community and corporates work together.
“We know that financial abuse can impact the long-term financial wellbeing of our customers, particularly women, and our focus on financial education and supporting our customers in crisis is one way we can help,” she said.
“Having help to access and manage your money gives people choices and, especially for those in violent relationships, can literally mean the difference between life and death.”
About 16 per cent of Australian women will experience financial abuse in their lifetime, ranging from controlling or restricting access to money to running up debt in a victim’s name.
In June, the Australian Banking Association, National Seniors, Council on the Ageing, Older Persons Action Network and the Financial Services Union joined forces to lobby Government to allow the safe reporting of suspected elder financial abuse by bank staff.
“Bank staff unfortunately all too often see people who are their customers being pressured to give access to their accounts, all too often see their accounts being drained by family members, by friends that they trust and care about,” ABA chief executive Anna Bligh said.

Adelaide aged care residents ‘drugged and restrained’

Nine.com.au News
Staff at an Adelaide nursing home will be retrained after it was discovered they were drugging and physically restraining elderly residents.
North Eastern Community Nursing Home lost federal subsidies for six months after an audit revealed staff were not using appropriate behavioural management strategies, administering proper wound care or meeting standards of cleanliness, Adelaide Now reports.
The Australian Aged Car Quality Agency found the Campbelltown nursing home did not meet six of the 44 expected outcomes during an audit between June 12 and 25, putting residents’ wellbeing, health and safety at an “immediate and severe” risk.
According to the report, incidents involving bed rail and pelvic restraints likely caused harm to residents.
“Management was unable to demonstrate the needs of care recipients with challenging behaviours are managed effectively,’’ the report reads.
“Clinical staff are using chemical and physical restraint interventions instead of consistently trialling alternative behavioural management strategies.”
NECHN chief executive officer said the Board of the Hospital are meeting shortly to discuss the findings.
The Department of Health imposed sanctions – including the requirement of appointing an adviser to ensure standards are met – on June 24.
The home will continue to be monitored in unannounced visits.
This comes months after the horrific level of elder abuse and neglect at Oakden Older Persons Mental Health Facility in Adelaide was described as “a shameful chapter in South Australia’s history”.
Elderly, frail patients were left “with faeces in their hair” and “deliberately allowed to fall” by staff who referred to them as “a group of mindless children”, a damning report by the Independent Commissioner Against Corruption found.
© Nine Digital Pty Ltd 2018

How to stop elder financial abuse in your family

The rise of the “inheritance impatience syndrome” seems to be impacting how some adult children act as their parent’s attorney.

With the increasing proportion of people aged 65 and over, the problem of elder financial abuse is a growing concern.

While the full extent in Australia is unknown, conservative estimates suggest at least 10% of older Australians suffer from financial abuse each year. The surprising factor is that their adult children are most likely the perpetrators.

If an older person needs some cash and can’t get out to a bank, why wouldn’t they just give their ATM card to their son or daughter and ask them to make a withdrawal on their behalf? Or if they need some shopping, they think it natural to give some money to a son or daughter and ask them to pick up a few extra groceries.

While most of us have the moral compass to know that taking out extra cash or adding a few of our own groceries to the list without either asking or paying for it ourselves is akin to stealing, there are many elder law specialists who know that these and other (much bolder) acts of elder financial abuse are being carried out by some of the most trusted individuals and organisations.

Property is being transferred from a parent to a child on a promise that mum or dad will live in the house and be properly cared for. Bank accounts are being fleeced of thousands of dollars as trusted people with access – legally or otherwise – help themselves. Parents are being moved into aged care on the understanding that family will continue to care for them financially.

Because of the hidden nature of the problem, very few cases are reported. Often the truth is not revealed until relationships break down or death.

Briony Dow of the National Ageing Research Institute and the University of Melbourne says that when adult children abuse their parents, feelings of parental love and responsibility coupled with shame and guilt for having “failed” as a parent often stop the parent from seeking help and protecting themselves. Few parents would want to report their son or daughter to the police.

Power of attorney challenge

Brian Herd, a Brisbane lawyer with CRH Law who specialises in elder abuse cases, believes the under-reporting of elder financial abuse is made worse (and even legitimised) through the appointment of the power of attorney.

By appointing an adult child as power of attorney (thereby giving them the authority to act for you in specified or all legal or financial matters), money withdrawals or property transfers by that person can be lawful.

People in these situations can be the victim of abuse, and they can also be the victim of undue influence where they end up making decisions to satisfy their children.

Enduring powers of attorney, which take effect once a person loses capacity, are the “wild west” says Herd.

An individual acting as the enduring power of attorney is under no obligation to report to anyone or tell anyone what he or she is up to.

Jessica Barker, a solicitor with Elringtons Lawyers says it is often where parents appoint their children to be their attorney and/or guardian that there is confusion around whether an attorney is acting in the parent’s best interest – despite there being clear guidelines available.

Barker was recently contacted by an adult child attorney saying: “I’ve got power of attorney for mum and my sisters are telling me I should put mum’s house into us kids’ name because she doesn’t need it anymore. Is that right?”

Unfortunately, the rise of the “inheritance impatience syndrome” seems to be increasing the confusion that some adult children are experiencing about how best to act as their parent’s attorney, she says.

A common situation for a solicitor is to be called into a hospital to see someone who is on their deathbed and asked to draw up a power of attorney document so their financial affairs can be managed while they are bedridden and beyond.

There is often some urgency in these situations and a whole lot of issues need addressing – such as whether an attorney has previously been appointed, whether the person has capacity and ability to understand the nature of the document, the person’s relationship with their chosen attorney(s), advising on the person’s rights and responsibilities and the risks involved in making the appointment.

Aged care rush

There is similar pressure when someone needs to go into residential aged care. Power of attorney documents are often downloaded hurriedly from the internet or arranged through solicitors, only to create further issues down the track.

At the very least, once it has your signature on it, this important document provides that nominated person with instant access to your bank accounts. The enduring power of attorney document also hands over the “power” for them to sell your house or shares or any other assets.

Of course, the widespread use of electronic banking means the signatures may never be seen.

Trusted professional third parties – including banks, financial institutions and real estate agents – may unwittingly assist a perpetrator of elder financial abuse.

It is in their best interest to establish clear guidelines around the detection of financial abuse and what to do about it – as many have already done.

The SMSF Association (with 47% of its members aged 60 or older) supports a recommendation from the Australian Law Reform Commission to change the superannuation laws to ensure that trustees plan for the loss of capacity to an SMSF trustee as part of the fund’s investment strategy and that the Australian Tax Office is told when an individual becomes an SMSF trustee through an enduring power of attorney.

Herd says an increasing number of aged care facilities are presenting to a tribunal on behalf of residents to revoke a power of attorney following concerns about whose interests are being served through action taken by adult children.

What to do

The issue of where to report suspected abuse is another grey area.

If a person has lost capacity and you suspect abuse, then the relevant public guardian in your state or territory may be able to step in. You could go to the police but they could easily dismiss it as a family or civil matter.

A third option is to apply to the relevant tribunal in your jurisdiction to have an attorney sacked.

Jessica Latimer, a principal lawyer and elder law specialist with Slater and Gordon Lawyers, says that while criminalising an abuse offence through the introduction of an elder abuse act may make it easier to prosecute someone, currently the legal system is able to respond and help older people recover financial losses.

As well as mediation there are state and territory property laws, power of attorney acts, claims for breach of fiduciary duties and breach of contract claims, which can all help.

Obviously, it is far better to protect someone at the front end than chase down the perpetrators at the back end through a court.

Which brings us back to relying on the good nature of human beings and trust. If it looks like a rat and smells like a rat – it probably is a rat!

 

This article was originally published by the Australian Financial Review on 28 March 2018. It represents the views of the author only and does not necessarily reflect the views of AMP. Bina Brown is a director of aged care solutions company Third Age Matters.

 

 

‘Senior Sitter’ ad sparks call for better vetting of aged care workers to reduce elder abuse

A Gold Coast solicitor is calling for Australia to introduce a coordinated system for screening people who work in the aged care sector, similar to the Working With Children Checks (WWCC) performed nation-wide that vets people wanting to work with children and young people.

Christine Smyth, who specialises in laws affecting the elderly, said a recent advertisement in a Gold Coast newsletter highlighted a gap in protection for older Australians.

The advertiser, described as a retired registered nurse, offered to mind seniors in clients’ homes on a freelance basis for $12 per hour, plus a one-off payment of $8 for petrol.

Ms Smyth said she was sceptical about the advertisement.

“It should raise a great deal of questions about what care is available for vulnerable elderly people,” she said.

“How do we monitor freelancers — people who would individually come into our homes and offer their services?

Ms Smyth also questioned the safety of elderly people who could be placed into the care of unvetted individuals.

“You don’t have the luxury of having someone else always in the home when the aged carer … is there,” she said.

“It is placing the responsibility on the people who are using those individualised services to check and to check thoroughly.”

Not a fail-proof system

Ms Smyth said she believed the blue card screening system that Queensland uses for its WWCC is a valuable tool and a similar system could be adapted to screen aged care workers.

She said a vetting process would help guard against elder abuse, but agreed it would not be fail-proof.

“No blue card is ever going to stop elder abuse,” she said.

“It does not stop child abuse but it does put a hurdle in the way.

“It puts a barrier, it provides some degree of comfort that the person who holds the blue card has gone through a checking mechanism.”

Multi-purpose card to protect the vulnerable

The chief executive of Council of the Aging (COTA) Australia, Ian Yates, said the organisation had not heard a lot about freelance aged care workers in the sector.

Mr Yates said it is not illegal for individuals to offer to mind people in private homes for a fee but he warned against the practice, and could see merit in a card that could testify to a worker’s credentials.

“We are strong supporters of the development of a vulnerable person’s card so that anyone working with people who might be older or frailer, children or people with a disability … that they all have a common card,” Mr Yates said.

He said COTA welcomed an additional 20,000 home care packages and the single quality framework that the Federal Government had established for the sector.

“It’s a step in the direction of extending the quality standards that have traditionally applied in residential home care into the home care space, but there are risks and they have to be looked to and prevented,” Mr Yates said.

A spokesperson for the Aged Care Minister, Ken Wyatt, said the safety of older Australians is paramount but the Review of National Aged Care Quality Practices did not recommend a blue card screening system for the sector.

The spokesperson said workers in home and residential services funded by the Federal Government are required to undergo police and background checks.

Palliative care resources ‘distressingly low’ in Canberra

By Katie Burgess– Canberra Times

13 July 2018 — 6:19am

Staff at Canberra’s Clare Holland House are under pressure to push dying patients in and out as quickly as possible, while dealing with bottlenecks in referrals.

Canberra Hospital’s palliative care service is also stretched, with a distressingly low number of specialists, a parliamentary inquiry has heard.

Doctors, former politicians and peak health bodies appeared before an ACT Legislative Committee examining the end-of-life choices available to dying Canberrans on Thursday.

While the inquiry has dwelt on the ACT’s inability to legalise voluntary assisted dying due to Commonwealth restrictions, it has also heard evidence of shortcomings in the territory’s palliative care system.

The Canberra Hospital’s director of palliative medicine, Dr Michael Chapman, was called to give evidence again, this time in a personal capacity.

Dr Chapman restated there were just four full-time palliative medicine specialists in the ACT, a number he described as insufficient and “arguably less than half” what was needed, given the hospital looked after the wider Canberra region.

He also said his personal belief was the number of trained palliative nurses – rather than nurses who happened to work in palliative care – was insufficient, as too was the number of allied health staff in the sector.

“Our pressing priority to provide end-of-life choices in the ACT requires people to have real access to quality palliative care which is currently not always the case for many and not always the case when we need it. People often receive too little or too late or no services at all,” Dr Chapman said.

“This isn’t a unique issue in the ACT and … I think also it’s important to recognise that this isn’t an issue that’s being ignored in the ACT, nor that there haven’t been steps to try and meet it.”

Catholic Health Australia chief executive Suzanne Greenwood described the number of specialist palliative care physicians as “distressingly low”.

She appeared with the manager of Clare Holland House, Jane Etchells, who said while the biggest gaps in palliative care remained in the aged care and community sectors, the hospice was under pressure.

“The fact of the matter is we have 19 beds, we are under the restrictions of activity-based funding so we can’t have people that come to Clare Holland House that stay for months and months and months,” she said.

“We have to use our admission criteria to say either ‘this person has a high symptom burden and they need to come over because they need our expertise’ or ‘this person is reaching the last two to three weeks of their life and they can’t be managed at home’ and so they need to come to Clare Holland House.”

Ms Etchells said the average length of stay at Clare Holland House was 11.7 days, although it could range from just hours to 12 months.

“With an activity-based funding model the pressure is very much to keep the length of stay as short as possible …  because that’s what makes the health system money and so therefore the pressure is on us to make sure we are constantly talking to people about what we do if you stabilise, if you’re in here, you’ve come in with acute symptoms and those symptoms stabilise where will the next place be?” she said.

“Because being stable in Clare Holland House is not going to be, unless someone has clearly reached the end of life, being stable in Clare Holland House is not what the government wants. They want us to have throughput.”

Ms Etchells also said for a long time, Canberra Hospital made many of its referrals on a Friday afternoon, which made it difficult to admit patients as Clare Holland medical staff worked 8am to 5pm Monday to Friday.

“Obviously it’s a significant cost burden to bring someone in on-call so we try not to do that and we don’t have a multidisciplinary team on staff 24 hours a day either so if someone comes over from another hospital and requires some counselling from a social worker or a lot of care from pastoral care and they come in after-hours we can’t give them the best service,” Ms Etchells said.

Dr Chapman acknowledged that had been a problem in the past, but extra government funding had meant extended hours for consultants to assess and refer palliative care patients.

He said while the service could be improved by even more funding for the consultancy team, a palliative care ward could help dying patients who were too acute to be referred to Clare Holland House a better quality of life in their final days.

“Unfortunately, my personal impression of palliative care services in Canberra Hospital is they’re stretched, they’re under pressure and some kind of additional resourcing for those services is quite sorely needed,” Dr Chapman said.

The inquiry continues.

 

 

 

 

 

 

Dealing with elder abuse a regular event

“Every one of us has to deal with elder abuse regularly”: Kay Patterson speaks to 30 Mornington Peninsula village managers 

Published on July 10, 2018, The Weekly Source

Last Friday morning we joined the Hon. Dr Kay Patterson AO, the Age Discrimination Commissioner, who travelled down to Mornington for the quarterly 8am meeting of local retirement village managers.

Held at Chas Jacobsen’s new Village Glen Aged Care Residences Mornington, Kay spent two hours discussing many forms of elder abuse with an emphasis on children of retirement village and aged care residents.

Managers present confirmed that for many, observing and being drawn into residents being placed under duress by their children particularly seeking financial gain is a monthly occurrence.

Gadens lawyer Sabine Phillips said: “There would be nobody in this room that is not regularly confronted by elder abuse”. She pointed out that village and aged care managers do not have a legal position to act, making their role “difficult”.

Dr Patterson advised that staff need to be educated so they are not intimidated by the children.

She also advised that she had been “pounding the law society about educating people on their rights and responsibilities around powers of attorney” as well as enduring guardianships.

Banks want registration of power of attorney and she noted that in Queensland they can be suspended for up to three months to investigate abuse.

Another insight was that ACAT teams would like the right to see a person on their own for at least 30 minutes; often the children insist on joint meetings.

It was evident that there is little structure in place to support village and care managers in protecting residents from family elder abuse.

Dr Patterson recommended a Commonwealth Bank booklet on elder abuse titled ‘Savvy and Safe’. You can download it HERE.

No excuse for elder abuse – Queensland police

This year the Queensland Police Service is determined to get the message out that there’s no excuse for elder abuse.

Elder abuse is any act within a relationship of trust which results in harm to an older person.

Elder abuse can take various forms such as physical, psychological or emotional, sexual and financial abuse.  It can also be the result of intentional or unintentional neglect.

Using the funds of an elderly parent without their knowledge, such as skimming their pension or taking their key card, is elder abuse. So is intimidating an elderly person into signing legal documents to hand over assets or make new wills. Someone neglecting the care of an elderly person they’re responsible for is elder abuse, and can have devastating effects on health and wellbeing.

Sadly, it is most often close family members who are the abusers. This can mean older people are less willing to tell someone, or we are reluctant to identify this behaviour in others, and it stays hidden.

It’s vital to start a conversation and recognise these different forms of abuse so we can effectively combat it as a community.

Visit the Department of Communities, Disability Services and Seniors website for more information.

They provide resources to help you see whether a situation might be abusive, and will give you the tools you need to identify, support and report.

If you are concerned about someone, you can contact the Elder Abuse Helpline (1300 651 192) for free, confidential advice and support.

In an emergency always call Triple Zero (000).

For free legal and support services, contact your local Seniors Legal and Support Service:

  • Brisbane: (07) 3214 6333
  • Cairns: 1800 062 608 or 07 4031 7179
  • Hervey Bay: (07) 4124 6863
  • Toowoomba: (07) 4616 9700
  • Townsville: (07) 4721 5511

Call 1300 063 232 for support and advice services located in Gladstone, Gold Coast, Mackay, Rockhampton and Sunshine Coast.

Space hero sues children for elder abuse

APOLLO 11 moonwalker Buzz Aldrin is suing two of his children and a former business manager, accusing them of misusing his credit cards, transferring money from an account and slandering him by saying he has dementia.

Aldrin’s lawsuit filed earlier this month in a Florida state court came a week after his children, Andrew and Janice, filed a petition claiming their father was suffering from memory loss, delusions, paranoia and confusion. They asked for the court to name them his legal guardians, saying Aldrin was associating with new friends who were trying to alienate Aldrin from his family and that he had been spending his assets at “an alarming rate”.

Court-appointed mental health experts planned to evaluate Aldrin in Florida on Tuesday and Wednesday.

In April, the 88-year-old Aldrin underwent his own evaluation conducted by a geriatric psychiatrist at UCLA, who said Aldrin scored “superior to normal” for his age on tests.

“I also believe that he is perfectly capable of providing for his physical health needs, food, clothing and shelter, and is substantially able to manage his finances and resist fraud and undue influence,” said Dr James Spar in a letter to Aldrin’s lawyer.

In Aldrin’s lawsuit, the former astronaut asked a judge to remove Andrew Aldrin from control of his financial affairs, social media accounts and several non-profit and business enterprises. Andrew Aldrin had been a trustee of his father’s trust.

Buzz Aldrin said in the complaint that despite revoking the power of attorney he had given his son, Andrew Aldrin continued making financial decisions for him.

“Specifically, defendant Andrew Aldrin, as trustee, does not inform plaintiff of pending or future business transactions, removes large sums of monies from plaintiff’s accounts, and continues to represent plaintiff in business and social capacities despite plaintiff’s repeated requests for such representations to be terminated,” the lawsuit said.

Aldrin accused his daughter, Janice, in the lawsuit of not acting in his financial interests and conspiracy, and he accused his former manager, Christina Korp, of fraud, exploitation of the elderly and unjust enrichment. Also named in the lawsuit are several businesses and foundations run by the family.

Aldrin’s oldest son, James, isn’t involved in the legal fight.

In a statement, Andrew and Janice Aldrin said they’re saddened by the “unjustifiable” lawsuit.

“If nothing else, our family is resilient and our ability to work together to solve problems and accomplish great things is strong,” the Aldrin children said. “We love and respect our father very much and remain hopeful that we can rise above this situation and recover the strong relationship that built this foundation in the first place.”

They said they would have no further comment.

Aldrin was a member of the Apollo 11 crew which landed the first two humans on the moon. Aldrin joined Neil Armstrong on the lunar surface in July 1969. Earlier this month, Aldrin was at the White House for President Donald Trump’s announcement directing the Pentagon to create the “Space Force” as a new military branch.

 

 

 

Early heart checks prevent coronaries and stroke in Indigenous Australians

Most heart attacks and strokes can be prevented with appropriate treatment. Yet heart disease, including heart attacks, causes 13 per cent of deaths among Australia’s Aboriginal and Torres Strait Islander peoples and is a major contributor to the gap in life expectancy with non-Indigenous Australians.
New findings from a study published in the Medical Journal of Australia show vast room for improvement in heart health among Aboriginal and Torres Strait Islander peoples.
Who is at risk?
This new research found 10 per cent of Aboriginal and Torres Strait Islander people aged 35-74 years old have heart disease (compared to 9 per cent aged 45-74 in the general population). Another 16 per cent are at high risk of getting heart disease (compared to 11 per cent aged 45-74 in the general population), defined in Australia as a greater than 15 per cent chance of getting heart disease in the next five years.
A heart check involves calculating how likely a person is to develop heart disease over a specific time period (five years in Australia). This involves gathering information from multiple factors including a person’s age, sex, smoking status, whether they have diabetes and their blood pressure and cholesterol levels.
Australia’s national guidelines recommend all Aboriginal and Torres Strait Islander peoples aged 35-74 have a heart check. But this new research found the “high risk” category starts much earlier than this.
Around 1.1 per cent of Aboriginal and Torres Strait Islander 18-24 year olds and 4.7 per cent of 25-34 year olds were at high risk of heart disease. This is around the same as the proportion of non-Indigenous Australians aged 45-54 who are at high risk.
Heart disease risk can be lowered through lifestyle changes, including giving up smoking, losing weight and exercising more, as well as using medications that lower blood pressure and cholesterol levels. Generally, all people who have heart disease and those at high risk should be prescribed preventative medications.
Yet this latest evidence shows only 53 per cent of Aboriginal and Torres Strait Islander peoples with existing heart disease and 42 per cent of those at high risk were using cholesterol-lowering medications. We don’t know the exact reasons for this. It could be due to a number of things including people not getting a heart check in the first place, and not continuing to use medications when they have been prescribed.
We don’t know the exact number of Aboriginal and Torres Strait Islander people receiving a heart check, but we do know overall numbers are low and it varies by region. Estimates among Aboriginal and Torres Strait Islander people with diabetes found rates of heart checks ranged from about 3% of people in participating health centres in Queensland, South Australia and Western Australia to around 56% in the Northern Territory.
This highlights the huge potential to prevent future heart attack and stroke in these communities by improving treatment in people at high risk.
What can we do?
These findings highlight multiple actions that can be taken to improve heart disease prevention. First, this new evidence suggests the age to start doing heart checks should be lowered in Australian guidelines. This decision would need to be jointly undertaken with Aboriginal and Torres Strait Islander communities.
GPs and nurses should be proactive in identifying Aboriginal and Torres Strait Islander patients, providing heart and overall health checks, and following up with patients.
The Northern Territory is a good example. There, the number of Aboriginal and Torres Strait Islander peoples receiving a heart check more than doubled after improvements in reporting, monitoring and follow-up. Improving the rate of health checks for adolescents and young adults is particularly important so discussions and treatment decisions can take place early.
Programs aimed at prevention should also be co-designed with Aboriginal and Torres Strait Islander peoples, taking into account social and cultural barriers that impact access and ongoing treatment.
The good news is, we know heart attacks and strokes can be prevented and we have effective treatments to achieve this. Within Aboriginal and Torres Strait Islander communities there is huge potential to prevent heart attacks and stroke.
Many people don’t receive a heart check and could be at high risk without knowing it. Prevention starts with getting a heart check and continuing to use any medications prescribed to you by your doctor to lower your risk.