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What is available in aged care data about mental health?

There are several sources of information that can be used to examine the mental health of people using aged care services, including aged care assessments, death records, medication data, and information from hospitalisations.

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Aged care assessments

People seeking to access aged care services undergo assessments to determine their eligibility to receive Australian Government-subsidised aged care services, including permanent residential aged care and home care packages. Assessments are conducted by Aged Care Assessment Teams which operate in all states and territories. These assessments are completed using the National Screening and Assessment Form.

People accessing residential aged care also participate in an assessment to determine their funding needs. Until 30 September 2022, this assessment was completed using the Aged Care Funding Instrument (ACFI).  

Included in both assessments are items identifying diagnosed mental health conditions and measures of psychological wellbeing.

Indicators of Mental wellbeing in aged care assessments

Supplementary Assessment Tools in the National Screening and Assessment Form

Comprehensive assessment for aged care eligibility, using the National Screening and Assessment Form, includes Supplementary Assessment Tools that assessors can choose to complete during their assessment.

These tools include two validated scales of mental wellbeing:

  • Geriatric Depression Scale: a 15-item measure of depressive symptoms in which the person records whether they have experienced specified symptoms of depression over the past week (e.g. ‘Do you feel that your life is empty?’). Scores are summed and a score >5 is indicative of depression (Sheikh and Yesavage, 1986).
  • Kessler-10: a 10-item measure of psychological distress in which a person indicates how often they experienced symptoms of distress over the past four weeks (e.g. ‘In the past four weeks, about how often did you feel tired out for no good reason?’) on a scale from ‘None of the time’ (1) to ‘All of the time’ (5). Scores are summed, with higher scores indicating higher distress (Kessler et al., 2003).

The Supplementary Assessment Tools also include five binary (i.e. yes/no) items regarding the presence or absence of loneliness, social isolation, insomnia, nervousness/depression, and anxiety.

However, these tools are rarely completed during assessments in practice. Figure 1 demonstrates the very low rates of completion of these tools each year.

Given the very low completion rates for these tools, valid and reliable information on prevalence of mental wellbeing in the whole aged care user (e.g. home care, residential aged care) population cannot be drawn from them. As such, reporting on these tools is not included in this report.

Cornell Scale for Depression in Dementia in the Aged Care Funding Instrument

For people in permanent residential aged care, the ACFI included a slightly modified version of the Cornell Scale for Depression in Dementia, a measure of depressive symptoms completed by both the resident (if possible) and by an informant (carer, staff member) (Alexopoulos et al., 1988).

The Cornell Scale for Depression in Dementia tool used in the ACFI consists of 19 questions covering five areas: mood-related signs, behavioural disturbance, physical signs, cyclic functions, and ideation disturbance. It is designed to be administered by a clinician.

The Cornell Scale for Depression in Dementia is scored on a 38-point scale with a score of 0–8 indicating minimal or no symptoms of depression. In the ACFI, scores are categorised:

  • ‘minimal or no symptoms of depression’ (less than 9),
  • ‘mild symptoms of depression’ (9–13),
  • ‘moderate symptoms of depression’ (14–18) and
  • ‘major symptoms of depression’ (19–38).

There are important limitations of Cornell Scale for Depression in Dementia used in the ACFI, described below in the ‘Notes on data quality’ section.

Indicators of mental health conditions in aged care assessments

Mental health conditions can be identified in aged care assessments where they are recorded in the list of a person’s health conditions. In aged care eligibility assessments, assessors record any major diseases or disorders that have an impact on the person’s need for assistance. Assessors also record a ‘primary health condition’ considered to be the primary influence on the person’s care needs. Assessors may record different primary health conditions on different assessments, depending on the person’s needs at the time. More information about these records can be found in the <<Technical Notes>>.

In ACFI, assessors record up to three major diseases or disorders that have an impact on the person’s need for assistance (with an emphasis on conditions that will most affect funding needs).

Codes used to identify mental health conditions are displayed in the <<Technical Notes>>.

There are important strengths and limitations of these data sources, described in the ‘Notes on data quality’ section below.

Death by suicide and ‘deaths of despair’

When data about aged care service users is linked to the National Death Index, deaths due to suicide can be identified. The date and causes of death are provided to the National Death Index from state and territory Registrars of Births, Deaths and Marriages, the National Coronial Information System, and the Australian Bureau of Statistics.

Deaths due to suicide can be identified where the primary cause of death (as derived by the Australian Bureau of Statistics from death certificates) was in the International Classification of Disease and Related Health Problems – Tenth Revision (ICD-10) range X60-X84, Y87.0 (injury, poisoning, and certain other consequences of other external causes). These criteria have been previously defined by the AIHW Suicide and Self Harm Monitoring Unit (Australian Institute of Health and Welfare, 2024). 

In addition, so called ‘deaths of despair’ can be identified as one proxy measure of deaths related to mental illbeing and self-neglect. Case and Deaton (2015, 2017, 2020) use the term ‘deaths of despair’ to describe a cluster of causes of death including suicide (X60-X84, Y87.0), drug and alcohol poisonings (both accidental and undetermined intent; X40-45, Y10-15, Y45, Y47, Y49) and deaths due to chronic liver diseases and cirrhosis (K70, K73-74). Data available in the AIHW Suicide and Self-Harm Monitoring System shows the rates of so-called ‘deaths of despair’ in the general Australian population.

There are important strengths and limitations of these data sources, described in the ‘Notes on data quality’ section below.

Other potential data sources

When data about aged care service users is linked to other administrative data sources it is possible to report on the rate of hospitalisations, emergency department presentations, and ambulance attendances for self-injury. The AIHW Suicide and Self-Harm Monitoring System provides data about these events for the Australian population. These events can provide information about the mental wellbeing of people while they are using aged care services. Hospitalisation, emergency department, and ambulance data were not available for the current analysis. Self-injury (that did not result in death) of aged care services users is not described in this report.

Medication data can also be used to indicate mental health needs, particularly psychotropic medication use. The AIHW publishes data elsewhere about use of these medications in the Australian population. However, medication data were not available for this analysis and are not described in this report.

Finally, quarterly reporting for the National Mandatory Residential Aged Care Quality Indicator program is a requirement for all Government-subsidised residential aged care facilities in Australia. Since April 2023, the program has included a ‘Quality of Life’ indicator in which providers must administer the Quality of Life – Aged Care Consumers tool (Hutchinson et al., 2021) with each resident (or their proxy) every three months. Results are published on the GEN Aged Care website. The most recent quarterly report indicates that 72.5% of people living in residential aged care report a ‘Good’ or ‘Excellent’ quality of life.