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Diverse Needs of Older People

The Aged Care Act 2024 recognises 13 groups of older people who have had life experiences that require particular understanding and can add complexity to their care needs.

The diagram below shows these groups.

* Group names have been shorted for visual diagram purposes only. Please see full titles below.

Find out more about each group by opening the drop-down summaries below. You can download the ones relevant to your work or all of them.

Warning: Aboriginal and/or Torres Strait Islander Peoples should be aware that this page deals with topics like end of life and sorry business.

About Aboriginal and Torres Strait Islander peoples

Aboriginal and Torres Strait Islander peoples are the many First Nations culture and language groups in Australia. As of 2021, they are 3.8% of our population, and about 75% live in NSW, Queensland, and WA. The NT has the most Aboriginal and Torres Strait Islanders compared to its total people.

Experience of disadvantages

In Australia, the impact of colonisation and racism has led to the current gaps in health and wellness of First Nations people. Most have lower life spans and poorer health outcomes than non-indigenous people and are therefore able to use aged care from age 50 years. Many have had adverse contact with services through forced relocation of communities and removal of children, leading to trauma that persists in families.

Complex overlaps

Many Aboriginal and Torres Strait Islander people live with the lasting effects of trauma from the past and the impact of other concerns, such as being a care leaver (member of the Stolen Generations), loss of family and culture, poverty, social stigma, ill-health, disability, and dementia.

The impact on end of life

Aboriginal and Torres Strait Islander people may distrust mainstream healthcare and social services and may not feel safe when using them. To be able to use palliative care, they need respect for their culture. Their beliefs about death, dying, and grief can differ from Western beliefs, and carers need to understand and tailor care to suit. The kinship system extends beyond close family, so asking who needs to be involved in decision-making and “sorry business”, a period of mourning and memory, is crucial.

Caring for and being on Country, respect for Elders, use of language, and family and community connection can promote health and wellbeing and may be part of culturally safe end-of-life care. Working with Aboriginal and Torres Strait Islander groups will help create safety and show respect for culture.

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Veterans are men and women who have served in the Australian Defence Forces. Many have served in war or dangerous events. Over 250,000 veterans are over 65 years, and 2.3% are Aboriginal and Torres Strait islanders. There are 22,500 female veterans.

War Widows and Widowers are the spouses or partners of veterans who have died due to war or related illnesses. There are over 30,000 war widows (ers), most of whom are women.

Experience of disadvantage

Both Veterans and War Widows have unique experiences. Veterans endured stress, frequent moves away from family, and life-threatening events. This can lead to physical and mental trauma. The demands of strict rules and harsh jobs leave lasting effects on their well-being.

War Widows (ers) often faced long periods alone, frequent moves and the sole responsibility of raising children. Loss of their partner because of war or injuries brings deep grief, often mixed with feelings of duty and sacrifice. Many spent years caring for their partners, and faced emotional, physical, and financial strain.

Complex overlaps

Mental ill health and grief can make life hard for Veterans and War Widows (ers). Some, including Aboriginal and Torres Strait Islander veterans and widows (ers), have also faced other health and social problems. Disrespect and a lack of acceptance of their service can isolate them further. Many war widows have been carers and faced stress and hardship.

The impact on end-of-life care

Veterans and War Widows are often self-reliant, turning to each other for support rather than seeking services. However, as they age, they may struggle with limited choices, leading to emotional distress at the end of their lives. Services need to be aware of the trauma they have faced and ensure privacy, safety, and a sense of control.

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With migration, Australia's population is becoming more diverse. In 2024, 8.6 million Australians (31.5%) were born overseas. The top 4 countries of birth are England, India, China and New Zealand. Since 2016, migration has increased from India, China, the Philippines, Nepal, and Vietnam.

Over 5.8 million people speak a language other than English at home. The 5 most common are Mandarin, Arabic, Vietnamese, Cantonese and Punjabi. Up to 30 % of these people have low proficiency in English.

Older people who migrated after World War II (1940-5-60 ) were from Europe and spoke Spanish, Italian, German, French, and Polish. By 2010, many migrants were from Asia, with Asian languages now spoken at home .

Experience of disadvantage

Many migrants were displaced from their homes by war and persecution. In Australia, they faced challenges in learning a new language, finding work, and adjusting to a different culture. Most experienced some prejudice, taking low-paid jobs to restart their lives. Refugees from recent wars also escaped conflicts and faced language and cultural barriers when they arrived. Many refugees have experienced trauma and find it hard to get support. They may also have difficulty finding housing and jobs. Language barriers, different cultural beliefs and practices, make using services harder.

Complex overlaps

While welcome in Australia, people with traditions and languages from other countries can feel excluded. They may not understand palliative and end of life aged care. They face many difficulties with language, low income, and complex health conditions. Many live in rural areas and have limited access to services.

The impact on end-of-life care

Many will distrust care if they feel misunderstood or their background and cultural traditions are not recognised. Many rely on family members to provide care rather than use services. Access to appropriate end-of-life care can be difficult, causing distress for the older person and the family.

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Over 3 million Australians live in poverty, and 41% of Australians describe themselves as poor or struggling.

This limits their education, housing options and job opportunities. It can be difficult to afford health care and lead to social isolation. These are called social determinants of health . They are non-medical factors that lead to almost half of health problems.

Financial and social disadvantage is spread across Australia, but the most disadvantaged areas are in regional and rural areas (see the red parts in Figure 1).

Experience of disadvantage

Socially disadvantaged people are typically alienated from friends and family. They have few networks and may isolate themselves. Combined with poverty, many cannot use services, get a good education, or hold jobs. The stress of low income, unemployment, poor housing and family conflict can increase risks to mental health.

Complex overlaps

Aboriginal and Torres Strait Islanders, and people living in rural and remote areas, are often disadvantaged. People with disability or mental illness, homeless people and migrants who do not speak English may also be disadvantaged. These experiences can exist across lifetimes and families, making life more difficult.

The impact on end-of-life care

Advance care planning is not common in disadvantaged areas, which can lead to lower quality end of life care. It may be hard to get aged care in remote areas, and people worry about how they may be treated. They may delay seeking help and avoid services. Partnering with local services may allay concerns and could improve care and understanding.

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Around 270,000 Australians are homeless or at risk of it. They may live in poor or unsafe housing, with no tenure or control, such as a tent or a car. Their home may be very crowded, or a temporary refuge or crisis housing . 1 in 7(15%) people who are homeless were aged over 55 years .

Experience of disadvantage

Homelessness makes people feel unsafe and isolated from their community or family. This may worsen mental and physical health. The main causes include financial problems, lack of cheap housing, and long-term unemployment. Some face additional risks, such as trauma, family violence, and abuse. Mental illness, and addiction make stable housing even harder to maintain.

Complex overlaps

A wide range of people are affected. Aboriginal and Torres Strait Islanders often lack adequate housing. People with mental illness and addiction face financial difficulties. Safe housing is hard to find for people in family breakdown and for women escaping violence. Older people may have long-term housing problems, and struggle with poor health, low income and support. Many hesitate to seek help due to fear or distrust of services.

The impact on end-of-life care

Long-term poverty and isolation make it hard for homeless people to access health and aged care. Many avoid seeking help due to financial concerns or fear that services may not accept them. People may delay seeking help to avoid contact with formal services. Trusted services can help aged care to tailor care better. This can reduce barriers to aged care and ensure support for palliative and end-of-life care.

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Up until the 1970s, forced adoption was a government policy to remove children from unwed mothers and indigenous families. This affected 1 in 15 Australians. Children who were taken or removed were placed with adoptive parents, foster care, orphanages or other institutions. These places were outside of their family and broke their relationships. Indigenous children were taken from their families since colonisation.

The reasons included: poverty, mixed race, illness or disability, and neglect. Sadly, many children suffered mistreatment. This still affects their lives today. This policy caused harm to mothers and children and the loss of their families. A formal apology by the Prime Minister in 2013 recognised the pain and suffering caused by these policies.

Experience of disadvantage

Many mothers live with lifelong trauma and distress at the loss of their child. Children who were adopted have struggled with their identity and were confused about the reasons. Growing up in care has left many children with long-term difficulties. Childhood abuse and trauma add to health problems, through depression, anxiety, and grief. They had poor education, making it hard to get a job. Over time, difficulties in building strong relationships have led to isolation. Many of these children are now older and may need aged care supports, but distrust services.

Complex overlaps

Some care leavers struggle with mental health issues, substance abuse, and are homeless. A lack of support makes life harder for care leavers.

The impact on end-of-life care

Because of their experiences, many care leavers don’t trust institutions and health care. When facing old age and end of life, they may feel scared or powerless and react with emotional distress. They need care that understands their past trauma and makes them feel safe, respected, and in control.

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A National Tragedy

Over many generations, tens of thousands of children in Australia suffered sexual abuse while in the care of institutions meant to protect them. These institutions included schools, religious organisations, health services, cultural programs, and juvenile justice systems. Tragically, the abuse was often committed by trusted members of these organisations.

As adults, survivors bravely spoke out and advocated for justice, leading to the Royal Commission into Institutional Responses to Child Sexual Abuse. Their stories revealed deep and lasting trauma caused not only by the abuse itself, but also by the failure of institutions to protect them or believe their experiences.

Most survivors are now men who were very young when the abuse began, often lasting for years. Many came from vulnerable backgrounds - some were separated from their families, lived with disabilities, were part of Aboriginal or Torres Strait Islander communities, or came from culturally and linguistically diverse backgrounds.

Living with long-term impacts

The trauma experienced in childhood can affect every part of a survivor’s life. Many live with:

  • distrust of institutions and authority figures
  • strained family relationships
  • disconnection from culture, language, and traditions
  • mental health challenges and suicidal thoughts
  • difficulty with education and employment
  • social isolation and poor physical health.

Some survivors also face homelessness, substance use issues, and ongoing mental health struggles. Many were removed from their families due to poverty, disability, or family breakdown. Without proper recognition of their trauma, they may find it difficult to trust services or seek help.

The impact on end-of-life care

As survivors age, they may carry both physical and emotional pain. Their experiences can make them feel vulnerable, fearful, or powerless - especially in unfamiliar care settings. By understanding their past and responding with kindness and sensitivity, aged care staff can make a meaningful difference in the lives of survivors - especially during the end of life.

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Care leavers are people who have ever spent time in care as children (under 18 years). Care includes foster care, residential care, orphanages or other institutions, or care outside of their family.

More than 500,000 Australians grew up in these places before 1989, when Government policies changed. Children were taken from their families since colonial times because of poverty, race, illness or disability, and family breakdown. Sadly, many children suffered neglect, abuse, and poor treatment in institutions. This still affects their lives today. They might call themselves Forgotten Australians, Former Child Migrants, Stolen Generations, or state wards.

Experience of disadvantage

Growing up in care has left many care leavers with long-term difficulties. Abuse and trauma add to health problems with depression, anxiety, and grief. They had poor education, which has made it hard to get a job. They find it hard to build relationships. Over time, this has led to poor health outcomes and social isolation.

Complex overlaps

Some care leavers struggle with mental health issues, substance abuse, and are homeless.   A lack of support and understanding makes life harder for care leavers.

The impact on end-of-life care

Many care leavers don’t trust institutions and health services.  When facing old age and the end of life, they may feel scared or powerless and react with emotional distress. They need care that understands their past trauma and makes them feel safe, respected, and in control.

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LGBTQIA+ stands for Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual. The plus sign (+) is there to include other ways of being too. It describes people whose sexual or gender identity differs from what’s believed to be the norm. In Australia, around 1.4% of older adults (aged 65 and over) are LGBTI+, and 4.5% of the total population . Because of past discrimination and not seeing their needs, some don’t feel willing to share their identity or life story. This means that aged care and the broader community may not cater for their preferences and needs.

Experience of disadvantage

Homosexuality was a crime up until the 1970s in Australia, and same-sex marriage was only recently made law. Younger people may feel more willing to be open about their identity, but many older LGBTI+ people have hidden their sexual or gender identity and their relationships. This is due to fear of discrimination, legal action, violence, and harassment. This can cause long-term stress and impact mental health and substance use .

Complex overlaps

LGBTI+ people come from diverse backgrounds and may also belong to other groups. These include migrant groups, Aboriginal and Torres Strait Islander people, veterans and war widows (ers), care leavers, people living with HIV, dementia, disability and those living in rural or remote areas. LGBTI+ people may not share their identity with family or when using services, for fear of discrimination or exclusion.

The impact on end-of-life care

The prospect of aged care and end of life care can be a worry for older LGBTI+ people. They may not trust that services will accept them. They often prefer close friends, same sex partners, or advocates rather than family members to assist with advance care planning and care choices. Due to past abuse, they may need extra safety and privacy to ensure their comfort and dignity.

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Around 5.5 million (21%) Australians have a disability. Most have physical conditions (75%), while fewer (25%) have mental and behavioural conditions, like Autism or anxiety. Disability becomes more common with age, where half of those over 65 years have a disability, and 5% have dementia .

About 4.3 million Australians experience a mental illness, and 9% are aged over 65 years .

Experience of disadvantage

Older people who live with disabilities or mental illness face daily struggles. They may find it difficult to move, communicate or care for themselves. Many experience pain, distress, stigma, and isolation. Those with long-term disabilities often have lower education and fewer job opportunities, leading to financial hardship.  People with mental illness also tend to have interrupted jobs, low incomes and other health concerns.

Complex overlaps

Older people with mental illness may develop dementia or other physical conditions like diabetes, stroke or heart disease. They often rely on daily help and may need 24-hour care. Those with disabilities face mental health concerns and financial and social barriers.  Both groups may be at risk of homelessness or live in rural and remote areas with limited support. Many have been through trauma due to war or conflicts,  the effects of treatments, or childhood adversity. Many Aboriginal and Torres Strait Islanders live with disabilities due to chronic illness or accidents. Ageing can intensify the impact of trauma.

The impact on end-of-life care

People with disabilities and mental illness may struggle to access aged care or end of life support. Some delay seeking help to avoid stigma and loss of independence, while others need specialised care.  Working with services that understand their needs can improve access to flexible home care.

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It is estimated that 15-20% of the global population is neurodiverse, meaning that these people process information in their brains differently from the majority of the population. Around 11% of the workforce is neurodivergent . The most common conditions are attention deficit hyperactivity disorder (ADHD), Autism (ASD), Dyslexia or Developmental coordination disorder (DCD). The experience of these conditions can interfere with memory, self-regulation and mental flexibility, which means that people who are neurodivergent may experience problems with concentration, communication, information processing, time management and emotions. Their abilities may not be recognised, and they may experience difficulty in education and employment. These conditions last into old age.

Experience of disadvantage

Older people who live with neurodiversity experience the world differently from other people and may struggle with sensory sensitivities, communication difficulties and anxiety related to change. They may face increased difficulties in mental health and physical health related to lifelong challenges. They may be subject to stigma and a lack of understanding during their lives, leading to social isolation.

Complex overlaps

Older people with neurodivergence may live with more than one condition or experience mental illness due to stress and anxiety. They also may live with many other disadvantages, such as poverty, social isolation, speak a language other than English or be Aboriginal or Torres Strait islanders. They rely on an environment to support their sensory sensitivities, and when using services, may be overwhelmed with noise or stimulation.

The impact on end-of-life care

People with neurodivergence may struggle to access aged care or end of life support. Their communication difficulties and routines may mean they delay seeking help to avoid stigma and change. They experience isolation and loneliness and may not have support as they approach end of life. By understanding that neurodiversity is part of human experience and adapting the environment and communication styles, aged care can offer support and end of life care.

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Vision loss

Over 13 million Australians have long-term vision problems. More than 500,000 are affected by conditions like cataracts, macular degeneration and blindness, which are more common with age.

Hearing loss

More than 1.5 million Australians experience deafness or hearing difficulties, due to illness, injury or ageing. About one in three people over 65 years has a hearing impairment.

Deafblindness

Around 2% of Australians are deafblind, meaning they have both vision and hearing loss. Some are born with one sensory impairment and develop the other later in life .

Experience of disadvantage

People with sensory impairments often face limited support, leading to poor education outcomes, difficulty finding jobs and poverty. Over time, these disadvantages build up. Many struggle with basic daily activities like moving around and self-care. Not being able to see or hear clearly can make it hard to communicate, often leading to isolation, loneliness and depression. People born deaf may be part of the Deaf community and use sign language to communicate. People born blind usually continue speaking and may use hearing aids. People with combined sensory loss may be part of either or both communities or neither. People who lose sight or hearing later in life can feel more isolated and may experience memory or thinking problems without regular social interaction.

Complex overlaps

Sensory impairments affect people in different ways depending on their age, culture and other health issues. Older Aboriginal and Torres Strait islanders often experience sensory loss alongside other health issues. Many also live with other disabilities, which can make life harder. With the right tools, like assistive technologies and peer support, many can feel less isolated and live more independently.

The impact on end-of-life care

At the end of life, people with sensory impairments may struggle to understand or communicate with caregivers. This is especially hard during emotional and complex end of life discussions. Misinterpretation and lack of information can lead to poor outcomes. People from disadvantaged backgrounds may need interpreters or culturally appropriate support to feel safe, understood and treated with dignity in their final stages of life.

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Around 2.7 million or 10% of Australians live in rural and remote areas. They face difficulties due to distance and limited services. Compared to city dwellers, they have fewer job opportunities, lower incomes and barriers to education and health care. This leads to poorer health outcomes. In remote areas, there is a higher proportion of Aboriginal and Torres Strait Islanders .

Experience of disadvantage

People in rural and remote areas pay more for goods and services, despite earning less. They work in physically demanding jobs, leading to illness such as chronic obstructive pulmonary disease (COPD), arthritis, hearing loss and mental health concerns. Smoking, poor diet, high blood pressure, and alcohol use increase their risk of serious illness and early death .

Complex overlaps

More Aboriginal and Torres Strait Islanders live in remote areas. People with disability or mental illness and those with financial and social hardships are impacted by low levels of services. Disadvantages can persist across generations, making it more difficult to overcome barriers.

The impact on end-of-life care

Advance care planning is uncommon in these areas, which can affect the quality of end of life care. Many people in rural and remote areas avoid formal services. They are unwilling to leave home or be separated from family and community. Telehealth and better collaboration with services in touch with local services could improve aged care and support for end-of-life care.

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Carers are people who give unpaid help and support to someone who cannot manage on their own because of disability, illness, or ageing. They provide billions of hours of unpaid care each year and are vital in helping people with daily needs. In 2022, there were about 3 million carers in Australia—nearly 12% of the population. Of these, 1.2 million were the main carer, most of them women. Main carers often help with important tasks such as moving around, self-care, and communication.

Experience of disadvantage

Many carers look after older family members because they feel a strong sense of duty or love. They may believe they can give better care than others. Carers can be spouses, children, siblings, neighbours, or friends. Some carers look after their own families while also caring for a parent, and some have health problems themselves. Main carers are often older, face stress from growing care needs, and may feel isolated or unwell. Many do not know of services that could support them.

Complex overlaps

Carers come from diverse backgrounds. One in three primary carers was born overseas, and more than 12% speak a language other than English at home. A quarter live in disadvantaged areas. Most do not earn an income and rely on pensions or allowances. Many carers also live with disability or illness and must manage their own health. Some are care leavers, identify as LGBTI+, or live in rural and remote areas where services are harder to access.

The impact on end-of-life care

Carers play a major role in supporting people at the end of life. They are an important part of aged and palliative care teams. This role is demanding, and carers may struggle to let others share the work. Accepting that the person they care for will not recover is deeply emotional. Carers often feel sadness, anxiety, and exhaustion, but may refuse help because of duty or lack of trust in services. It is important to recognise carers’ contributions, especially in meeting the emotional, spiritual, psychological, and cultural needs of the person who is dying. Listening to carers and respecting their concerns can help them accept support and ease their burden at this difficult time.

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