1. An Ageing Australia: Implications for Health Expenditure and Private Health Insurance Allan McLean MD PhD FRACP MBA Issues Requested for Consideration The Biology of Ageing Consequences of Ageing and its Social Accompaniments Cause, Prevention and Cure of Disease Lessons for Health Insurers

2. The Dubbo Study and Life Outcomes for Older People Professor John McCallum and colleagues have made a major contribution through their studies of the Dubbo population. John McCallum, Leon Simons, Judith Simons, Paul Sadler and Joanne Wilson. The continuum of care for older people. Australian Health Review. 1995; 18:40-55

3. “Not Sick” “Sick” with Hospitalisation Population 2805 Not hospitalised N = 1261 45% Hospitalised N = 1544 55% Home N = 1208 95.8% Hostel N = 3 0.2% Nursing Home N = 1 0.08% Dead N = 34 2.7% Home N = 1293 84% Hostel N = 8 0.5% Nursing Home N = 46 3% Dead N = 197 13% Alive N = 5 63% Dead N = 3 37% Alive N = 24 52% Dead N = 22 48% Alive N = 1230 95% Dead N = 63 5% Lost to Follow-up N = 15 1.22% Patterns of service use in an elderly cohort over 50 months The Dubbo Study and Outcomes for Older People

4. Dubbo Study - Outcomes if Not Sick Not hospitalised N = 1261 45% Home N = 1208 95.8% Hostel N = 3 0.2% Nursing Home N = 1 0.08% Dead N = 34 2.7% Lost to Follow-up N = 15 1.22%

5. Dubbo Study - Outcomes if Sick and Hospitalised Hospitalised N = 1544 55% Home N = 1293 84% Hostel N = 8 0.5% Nursing Home N = 46 3% Dead N = 197 13%

6. Dubbo Study - Hostel and Nursing Home Outcomes Nursing Home N = 46 3% Alive N = 24 52% Dead* N = 22 48% Hostel N = 8 0.5% Alive N = 5 63% Dead N = 3 37% * - the valued outcome for a nursing home resident

7. “Not Sick” “Sick” with Hospitalisation Population 2805 Not hospitalised N = 1261 45% Hospitalised N = 1544 55% Home N = 1208 95.8% Hostel N = 3 0.2% Nursing Home N = 1 0.08% Dead N = 34 2.7% Home N = 1293 84% Hostel N = 8 0.5% Nursing Home N = 46 3% Dead N = 197 13% Alive N = 5 63% Dead N = 3 37% Alive N = 24 52% Dead N = 22 48% Alive N = 1230 95% Dead N = 63 5% Lost to Follow-up N = 15 1.22% Patterns of service use in an elderly cohort over 50 months The Dubbo Study and Outcomes for Older People

8. POPULATION CHANGE (GROWTH RATE) BY AGE GROUP, ACT AND AUSTRALIA 1998/99

10. Productivity in Australian Health Care Services Source – IBISWorld Top 1000 Enterprises (2000-01) Published in The Australian

14. Falls as a National Issue In 1995, falls were the most frequent cause of most recent injury, affecting 188,700 people with a current injury of injury- related condition (1.0% of the population). Similar numbers of males and females were injured in falls (94,000 and 95,000 respectively). Falls accounted for 32% of all people having a recent injury, being the most frequent cause of injury among females (39%) and the second most common cause among males (27%). Persons aged less than 15 years and those 65 years and over had the highest prevalence of injury from falls.

15. Falls 120,660 Transportation 51,488 Hospital separations due to injury and poisoning, Australia 1999–00 Research Centre for Injury Studies, AIHW Australian Institute of Health and Welfare, 2002

16. Drugs recommended by WHO as requiring care due to adverse drug reactions Benzodiazepines Carbemazepine Haloperidol Levodopa Metoclopramide Benzhexol Chlopropamide Chlorpromazine Indomethacin Mefenamic acid Isoniazid Methyldopa Nitrofurantoin Tetracycline

19. Quality of Life for Older People – Values are Known Self determination and personal autonomy are the values.

20. Our perspectives on the priorities for the health dollar if research is driven by the values of older people Get older people well and home (efficient and effective acute and sub-acute care) Priority prevention of existing disease and disability (known as “secondary prevention”) Primary prevention of disease Promotion of healthy ageing (prevention of primary ageing)

22. Efficient and Effective Acute & Sub-Acute Health Care Services to the Elderly Patients admitted to the acute care of the elderly (ACE) unit at Canberra Hospital (1993/4-2001/2) comparing patients within the home ward ( ) with patients housed outside the ACE unit ward ( ). Allan McLean. The Future of Aged Care. Internal Medicine Journal. 2003; 33 (in press). 247 390 525 507 496 484 506 179 66 117 140 0 100 200 300 400 500 600 700 800 1993/941996/971997/981998/991999/002000/012001/02

23. Reducing heart attack in people with heart disease Intervention Risk reduction Mediterranean diet 72% Fish oil 35% Quit smoking advice 32% Statins 25% Antihypertensives 21% Aspirin 18% Source: de Lorgirel et al, The final report of the Lyon Diet Heart Study: Circulation.

24. Cost per life year gained (£ sterling) 50 66 290 5634 8240 Treatment Aspirin Thiazide (antihypertensive) Mediterranean Diet ACE Inhibitor (antihypertensive) Simvastatin (cholesterol lowering) Cost-effectiveness of prevention for heart disease Source: Ebrahim S, Davey-Smith G, McCabe C, Payne N, Pickin M, Sheldon TA et al. What role for statins? A review and Economic model. Health Technol Assess 1999;3:No (19)