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Methods for mental health analysis

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Defining the cohort

Included in this report were all people who accessed home care packages and/or permanent residential aged care from 1 July 2017 to 30 June 2022. People who did not receive any of these services but did receive other types of aged care (e.g. home support, transition care packages, respite care) are outside the scope of this project and were excluded from these analyses.

People who entered one of these care types prior to 1 July 2017 are also excluded from this analysis.

Mental health conditions

In reporting on the prevalence of mental health conditions based on available information in assessment forms , the cohort was divided based on the first entry to each care type during the study period - home care packages and permanent residential aged care.

Defining the cohort in this way means that a person may have used more than one care type over the study period, and if so is included in more than one group of reported proportions. This ensures that the reported proportions are reflective of all people entering each service type during the study period.

Data from aged care eligibility assessments were taken from the aged care assessment that occurred closest to the date of entry to that care type (before or after entry date). For people entering permanent residential aged care, data were also taken from the first ACFI available in the study period.

The data therefore provide information on the of mental health conditions at the time of assessment only, as a proxy measure of mental health at the time of entry to care. People can experience an extended elapsed time between an aged care eligibility assessment and entry to care. As such, mental health captured at the time of assessment may have changed at the time of care entry.

The assessed prevalence of mental health conditions was calculated as the proportion (in percentage) of individuals accessing the included aged care services who had a recorded mental health disorder in their assessment data. The denominator was all eligible cohort members during the study period. Mental health conditions are reported by pooling all conditions, and separated by specific conditions where possible.

People living in permanent residential aged care were considered to have a mental health condition if one of the eligible conditions was recorded in their aged care eligibility assessment or in their ACFI.

Depression in people entering permanent residential aged care

The proportion of people entering permanent residential aged care recorded with symptoms of depression on the Cornell Scale for Depression in Dementia was calculated. Categories were defined according to the pre-determined categories used in the ACFI:

  • ‘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).
Death by suicide

Deaths by suicide were categorised by the type of aged care service that was being accessed at the time of death. Categories were mutually exclusive, such that each person that died by suicide was categorised only into the service they were using at the time of death (i.e. the last service they used).

Age-specific crude suicide rates were calculated using the total number of people using each service type in the financial year as the denominator. To allow for comparison with other populations, age-standardised suicide rates were also calculated using direct standardisation against the Estimated Resident Population (ERP) of Australia at 30 June 2001 from the 2001 Census.

Because of their very small numbers, causing instability of rates and risk for identification, people aged under 65 years using aged care services were excluded from this analysis. Age groups are combined to protect confidentiality in the case of small numbers (defined here as n<3).