Older people flown to hospital for preventable illness

A recent Royal Flying Doctor Service (RFDS) research report has looked into how to make healthy ageing in the bush possible and to prevent extended hospital stays through improving provision of  country health services.

Sharon Bell is 65 years old, and lives with her husband, Daryl, on Dulkaninna cattle station, 80 kilometres north of Marree in Far North South Australia. The family's remote cattle station is a four and half hour drive from the nearest hospital.

Four generations of the Bell family have benefitted from the RFDS's regular clinic visits and primary health services.

Sharon watched her father-in-law George Bell remain on the station until he died just shy of his 87th birthday.

"He had a range of issues, which could have made it impossible for him to live up here.

"But it was a team effort between the Royal Flying Doctor Service, a nurse in Marree, and the family that made it possible for him to stay. He didn't want to live anywhere else, he wouldn't have gone to an aged care facility, he wasn't going to leave the station."

After experiencing a stroke three years ago, Sharon herself now relies on the consistent primary care provided by the RFDS and their numerous bush-tailored solutions.

"I had to go to Adelaide — the RFDS probably saved my life", she said.

"I had a few months in Adelaide and since returning, I've had to learn to walk again and get my arm working again; there's been ongoing contact with the RFDS through that.

She uses the RFDS's telehealth service to access physiotherapists in Adelaide.

"I would not have been able to come home, or progressed without them", Sharon said. "I see myself on the station for the foreseeable future — with the support we get, we are very lucky, it would be different without the services."

The RFDS health service to the Bell family on their remote South Australian property is an example of how healthy ageing can be supported for our older country residents. Each year thousands of Australians aged over 65 who live in remote areas are flown by RFDS aeromedical teams to hospitals with illnesses that could have been prevented through increased country health services.  

The RFDS study of 23,377 older remote residents transferred by air to hospital found injury and heart and digestive illness triggered preventable hospital stays.

The Australian population is ageing. In 2018, people aged 65 years and over made up 15.6 per cent of Australia’s population. This is projected to increase to 22 per cent in 2061 and to 25 per cent in 2101. As people live longer, the prevalence of chronic diseases increases, resulting in increased utilisation of health services by older Australians.

The report found that the Barkly and Alice Springs regions in the Northern Territory, the Kimberley in Western Australia, and Bourke to Coonamble in western New South Wales had the highest preventable heart conditions.

Hospitalisation of remote stroke patients was found to be 1.5 times higher than for city residents, but less than 8 per cent of the nation’s stroke rehabilitation services are rurally based.

RFDS Chief Executive Dr Martin Laverty said, “The population of remote Australia is getting older, but the nation is yet to work out how to support people to age and stay in the bush. Neurological conditions of ageing - dementia and Alzheimer’s - will significantly increase within the bush in a decade. Without new investment, existing country services won’t cope.”

The RFDS report examined reasons for RFDS transfer by air of people aged over 65 and reasons for attendance at RFDS country health clinics and found that:

•    rates of all cancers are higher in rural and remote areas than in cities, but country areas lack reasonable access to oncology, haematology and palliative care;

•    falls by older people are a key reason for RFDS transfers, but there are too few country physiotherapists and occupational therapists to provide injury rehabilitation;

•    an absence of aged care services in remote areas correlates with an increase in transfer by air of older remote residents for preventable hospital stays.

The RFDS report calls for expanded cancer care in rural and remote areas, together with increased cardiac and injury rehabilitation, and expanded dementia and aged care services – basing its recommendations on success stories like the Bell family in South Australia.

“Ageing of the remote population is occurring faster than in other areas. The current Royal Commission into Aged Care Quality and Safety needs to consider remote needs”, Martin said.

The report, Healthy ageing in rural and remote Australia: challenges to consider, can be accessed on the RFDS website.

The Royal Flying Doctor Service is principal sponsor of the 15th National Rural Health Conference.