Do Indigenous Australians age prematurely? The implications of life expectancy and health conditions of older Indigenous people for health and aged care policy

Abstract

Objective. To assess whether Indigenous Australians age prematurely compared with other Australians, as implied by Australian Government aged care policy, which uses age 50 years and over for population-based planning for Indigenous people compared with 70 years for non-indigenous people. Methods. Cross-sectional analysis of aged care assessment, hospital and health survey data comparing Indigenous and non-indigenous age-specific prevalence of health conditions. Analysis of life tables for Indigenous and non-indigenous populations comparing life expectancy at different ages. Results. At age 63 for women and age 65 for men, Indigenous people had the same life expectancy as non-indigenous people at age 70. There is no consistent pattern of a 20-year lead in age-specific prevalence of age-associated conditions for Indigenous compared with other Australians. There is high prevalence from middle-age onwards of some conditions, particularly diabetes (type unspecified), but there is little or no lead for others. Conclusion. The idea that Indigenous people age prematurely is not well supported by this study of a series of discrete conditions. The current focus and type of services provided by the aged care sector may not be the best way to respond to the excessive burden of chronic disease and disability of middle-aged Indigenous people. What is known about the topic? The empirical basis for the Australian Government’s use of age 50 for Indigenous aged care planning, compared to age 70 for the non-indigenous population, is not well established. It is not clear whether Indigenous people’s poorer health outcomes and lower life expectancy are associated with premature ageing. What does this paper add? This paper compares Indigenous and non-indigenous life expectancy and prevalence of health conditions. Only some conditions associated with ageing appear to affect Indigenous people earlier than other Australians. The proposition of premature ageing based on this explanatory framework is uncertain. The estimated gap between Indigenous and non-indigenous life expectancy in later life is ~6 years. What are the implications for practitioners? The current rationale for using a lower Indigenous planning age is problematic; however, further research is required to assess the effectiveness of this policy measure. The much higher prevalence of preventable chronic conditions among Indigenous Australians in middle-age groups is clear. The ‘early ageing’ frame can imply irremediable disability and disease. The aged care sector may be filling gaps in other services. The community care services for this group require a more tailored approach than simply lowering the planning age for aged care services.