Health literacy and older adults: Findings from a national population-based survey.

ISSUE ADDRESSED: With an ageing population and growing complexity and fragmentation of health care systems, health literacy is increasingly important in managing health. This study investigated health literacy strengths and challenges reported by older Australians (people aged 65 or over) and identified how socio-demographic and health factors related to their health literacy profiles. METHODS: The sample comprised 1578 individuals responding to the Australian Government's 2018 Health Literacy Survey, conducted between January and August. Regression modelling was used to estimate the association between each of nine domains of the Health Literacy Questionnaire (HLQ) and individual socio-demographic and health characteristics. The model allowed for correlation between HLQ scores that was linked to unobserved characteristics of individuals. RESULTS: Across the health literacy domains, few individuals received mean scores in the lowest score range. Key individual characteristics associated with higher health literacy were increasing age, English proficiency, higher education levels, better self-assessed health and having certain chronic conditions (cancer, hypertension and arthritis). CONCLUSIONS: Our findings suggest that, among those aged 65 or over, being older or living with chronic illnesses were associated with greater confidence in engaging with providers, accessing information and navigating health services compared to individuals aged 65-69 and those older individuals without chronic illness. Lower health literacy was associated with psychological distress and low English proficiency. SO WHAT?: Interventions to improve individual health literacy and organisation health literacy responsiveness to minimise complexity of the Australian health system are required. This may enhance uptake and use of health information and services for the underserviced members of the community.

Large Discrepancies in Dementia Mortality Reported in Vital Statistics: The Need for Improved Data to Inform Policy.

PURPOSE: There is limited understanding of the intercountry comparability of dementia mortality data. This study compares reported dementia mortality in national vital statistics between countries and over time. In countries with low dementia reporting, this study identifies other causes to which dementia may be misclassified. METHODS: Using the World Health Organization (WHO) Mortality Database, we calculated the ratio of reported to expected (Global Burden of Disease estimated) age-standardized dementia death rates in 90 countries from 2000 to 2019. Other causes to which dementia may be misclassified were identified as having relatively high cause fractions compared with other countries. PATIENTS: No patients were involved. RESULTS: There is a large intercountry variation in reported dementia mortality rates. The ratio of reported to expected dementia mortality exceeded 100% in high-income countries but was below 50% in other super regions. In countries with low reported dementia mortality, cardiovascular diseases, ill-defined causes, and pneumonia have relatively high cause fractions and may be misclassified from dementia. DISCUSSION: Large discrepancies in dementia mortality reporting between countries, including often implausibly low reported mortality, makes comparison extremely difficult. Improved guidance for and training of certifiers and the use of multiple cause-of-death data can help strengthen the policy utility of dementia mortality data.

Is the Rise in Reported Dementia Mortality Real? Analysis of Multiple-Cause-of-Death Data for Australia and the United States.

Official statistics in Australia and the United States show large recent increases in dementia mortality rates. In this study, we assessed whether these trends are biased by an increasing tendency of medical certifiers (predominantly physicians) to report on the death certificate that dementia was a direct cause of death. Regression models of multiple-cause-of-death data in Australia (2006-2016) and the United States (2006-2017) were constructed to adjust dementia mortality rates for changes in death certification practices. Compared with official statistics, the recent increase in adjusted age-standardized dementia death rates was less than half as large in Australia and about two-thirds as large in the United States. Further adjustment for changes in reporting of dementia anywhere on the death certificate implied even lower increases in dementia mortality. Declines in reporting of cardiovascular diseases as comorbid conditions also contributed to rises in dementia mortality rates. The increasing likelihood of dementia's being reported as directly leading to death largely explains recent increases in dementia mortality rates in both countries. However, studies have found that reported dementia on death certificates remains low compared with clinical evaluations of its prevalence. Improved guidance and training for certifiers in reporting of dementia on death certificates will help standardize mortality statistics within and between countries.

Discrepancies in self-reported and measured anthropometric measurements and indices among older Australians: prevalence and correlates.

BACKGROUND: Anthropometric measurements and indices such as weight, height and Body Mass Index (BMI) are often used to assess overall health and nutritional status. Clinicians and epidemiologists often rely on self-reported weight and height to measure BMI. Differences between self-reported and measured weight and height can lead to differences between self-reported and measured BMI, biasing relative risks of diseases associated with differential BMI. METHODS: Applying regression analysis to a large nationally representative survey data with contemporaneous self-reports and measurements on 3412 individuals aged 65 or over, we provided estimates of the difference between self-reports and measurements of weight, height and BMI for older Australians, analysing demographic, socioeconomic and health correlates of estimated differences. RESULTS: We found both males and females underestimated weight, overestimated height and underestimated BMI and there was some evidence these differences increased with age. There was also evidence that these differences were associated with high levels of education and household composition. CONCLUSION: Although average differences were small, for many individuals the differences may be significant, indicating measurements should be taken in clinically focused research and practice. This is important as systematic underestimation of BMI in older adults can have implications for estimating the size of populations at risk of many health conditions, including diabetes, hypertension and functional limitations.

Identifying patterns of potentially preventable hospitalisations in people living with dementia.

BACKGROUND: Older Australians make up 46% of all potentially preventable hospitalisations (PPHs) and people living with dementia are at significantly greater risk. While policy reforms aim to reduce PPHs, there is currently little evidence available on what drives this, especially for people living with dementia. This study examines patterns of PPHs in people living with dementia to inform service delivery and the development of evidence-based interventions. METHODS: We used the Victorian Admitted Episodes Dataset from Victoria, Australia, to extract data for people aged 50 and over with a diagnosis of dementia between 2015 and 2016. Potentially avoidable admissions, known as ambulatory care sensitive conditions (ACSCs), were identified. The chi-square test was used to detect differences between admissions for ACSCs and non-ACSCs by demographic, geographical, and administrative factors. Predictors of ACSCs admissions were analysed using univariate and multiple logistic regression. RESULTS: Of the 8156 hospital records, there were 3884 (48%) ACSCs admissions, of which admissions for urinary tract infections accounted for 31%, followed by diabetes complications (21%). Mean bed-days were 8.26 for non-ACSCs compared with 9.74 for ACSCs (p ≤ 0.001). There were no differences between admissions for ACSCs and non-ACSCs by sex, marital status, region (rural vs metro), and admission source (private accommodation vs residential facility). Culture and language predicted ASCS admission rates in the univariate regression analyses, with ACSC admission rates increasing by 20 and 29% if English was not the preferred language or if an interpreter was required, respectively. Results from the multiple regression analysis confirmed that language was a significant predictor of ACSC admission rates. CONCLUSIONS: Improved primary health care may help to reduce the most common causes of PPHs for people living with dementia, particularly for those from culturally and linguistically diverse backgrounds.

Culturally competent communication in Indigenous disability assessment: a qualitative study.

BACKGROUND: Indigenous people tend to exhibit a higher burden of disability than their non-Indigenous counterparts, and are often underserved by disability services. Engaging appropriately with Indigenous communities, families and individuals in the initial stages of disability assessment and planning is crucial in order to build trust and understanding of disability service models and ensure that Indigenous people receive support that is tailored to their needs and cultural realities. This article aims to identify key elements of culturally competent communication in Indigenous disability assessment and planning, and provide recommendations for strengthening capacity in this area. METHODS: This qualitative research was designed to involve Aboriginal and Torres Strait Islander people at all stages and to reflect the views of Aboriginal and Torres Strait Islander researchers, people and families affected by disability and the community-controlled health sector. Semi-structured individual interviews were undertaken with staff implementing the National Disability Insurance Scheme (NDIS) (n = 4), NDIS participants (n = 24), disability support providers and organisational partners (n = 19) and Community Connectors (n = 8) in Queensland and the Northern Territory of Australia. Key themes derived from thematic analysis included appropriate and adequate engagement of individuals with disability and their families, the role of trusted relationships, and culturally safe and appropriate communication during planning meetings. RESULTS: Overall, the research findings highlight that a low level of cultural competence in the initial stages of the disability assessment and planning process exacerbated participant confusion and distrust towards assessment staff and the NDIS. Given difficulties in communication, participant understanding of the NDIS was generally limited. The necessity of culturally safe and appropriate use of interpreters was stressed, as was the role of trusted individuals, including existing service providers, Community Connectors and family members in providing a solid base for participant understanding of the NDIS. CONCLUSIONS: Cultural competence in disability assessment and planning can be strengthened through multi-level engagement with the Aboriginal community-controlled sector and community leaders. Implementing mechanisms to enable the involvement of families, trusted service providers and Community Connectors can support a more meaningful understanding of individuals' needs within their cultural context and in relation to their cultural roles.

Discrimination reported by older adults living with mental health conditions: types, contexts and association with healthcare barriers.

OBJECTIVE: Australian policy-making needs better information on the prevalence, context and types of discrimination reported by people living with mental health conditions and the association of exposure to discrimination with experiencing a barrier to accessing healthcare. METHODS: Secondary data analysis using the national representative General Social Survey 2014 to examine discrimination and healthcare barriers. Multivariable logistic regression was used to examine the association between discrimination and barriers to healthcare. RESULTS: Around 10% of older adults without mental health conditions reported an instance of discrimination in the last 12 months, compared to 22-25% of those with mental health conditions. Approximately 20% with mental health conditions attributed discrimination to their health conditions, along with other characteristics including age. Discrimination was reported in settings important to human capital (e.g., healthcare, workplace), but also in general social and public contexts. Everyday discrimination (OR = 2.11 p < 0.001), discrimination in healthcare (OR = 2.92 p < 0.001), and discrimination attributed to the person's health condition (OR = 1.99 p < 0.05) increased the odds of experiencing a barrier to care two-to-three-fold. For each type of discrimination reported (e.g., racism, ageism etc.), the odds of experiencing a barrier to care increased 1.3 times (OR = 1.29 p < 0.01). CONCLUSION: This new population-level evidence shows older adults with mental health conditions are experiencing discrimination at more than twofold compared to those without mental health conditions. Discrimination was associated with preventing or delaying healthcare access. These findings indicate that future strategies to promote mental healthcare in underserved groups of older people will need to be multidimensional and consideration given to address discrimination.

Physical violence and violent threats reported by Aboriginal and Torres Strait Islander people with a disability: cross sectional evidence from a nationally representative survey.

BACKGROUND: A recent Royal Commission into the treatment of Australians living with disabilities has underscored the considerable exposure to violence and harm in this population. Yet, little is known about exposure to violence among Aboriginal and Torres Strait Islander people living with disabilities. The objective of this paper was to examine the prevalence, disability correlates and aspects of violence and threats reported by Aboriginal and Torres Strait Islander people living with disabilities. METHODS: Data from the 2014-15 National Aboriginal and Torres Strait Islander Social Survey were used to measure physical violence, violent threats and disability. Multivariable logistic and ordinal logistic regression models adjusted for complex survey design were used to examine the association between measures of disability and exposure to violence and violent threats. RESULTS: In 2014-15, 17% of Aboriginal and Torres Strait Islander people aged 15-64 with disability experienced an instance of physical violence compared with 13% of those with no disability. Approximately 22% of those with a profound or severe disability reported experiencing the threat of physical violence. After adjusting for a comprehensive set of confounding factors and accounting for complex survey design, presence of a disability was associated with a 1.5 odds increase in exposure to physical violence (OR = 1.54 p < 0.001), violence with harm (OR = 1.55 p < 0.001), more frequent experience of violence (OR = 1.55 p < 0.001) and a 2.1 odds increase (OR = 2.13 p < 0.001) in exposure to violent threats. Severity of disability, higher numbers of disabling conditions as well as specific disability types (e.g., psychological or intellectual) were associated with increased odds of both physical violence and threats beyond this level. Independent of these effects, removal from one's natural family was strongly associated with experiences of physical violence and violent threats. Aboriginal and Torres Strait Islander women, regardless of disability status, were more likely to report partner or family violence, whereas men were more likely to report violence from other known individuals. CONCLUSION: Aboriginal and Torres Strait Islander people with disability are at heightened risk of physical violence and threats compared to Aboriginal and Torres Strait Islander people without disability, with increased exposure for people with multiple, severe or specific disabilities.

Psychological distress among migrant groups in Australia: results from the 2015 National Health Survey.

PURPOSE: To understand the relationship between migration and psychological distress, we (a) calculated the prevalence of psychological distress in specific migrant groups, and (b) examined the association between specific birth groups and psychological distress, while controlling for confounding variables to understand vulnerabilities across migrant groups. METHODS: The prevalence of psychological distress, disaggregated by birthplace, was calculated using data from the Australian 2015 National Health Survey, which measures psychological distress via the Kessler Screening Scale for Psychological Distress (K10). Multivariable logistic regression models, with adjustments for complex survey design, were fitted to examine the association between country of birth and psychological distress once extensive controls for demographic, and socioeconomics factors were included. RESULTS: 14,466 individuals ≥ 18 years completed the K10. Migrants from Italy (20.7%), Greece (20.4%), Southern and Eastern European (18.2%), and North African and Middle Eastern (21.9%) countries had higher prevalence estimates of distress compared to Australian born (12.4%) or those born in the United Kingdom (UK) (9.5%)-the largest migrant group in Australia. After adjusting for demographics, SES factors, duration in Australia, a birthplace in Italy (OR = 2.79 95% CI 1.4, 5.7), Greece (OR = 2.46 95% CI 1.1, 5.5), India (OR = 2.28 95% CI 1.3, 3.9), Southern and Eastern Europe (excluding Greece and Italy) (OR = 2.43 95% CI 1.5, 3.9), North Africa and the Middle East (OR = 3.39 95% CI 1.9, 6.2) was associated with increased odds of distress relative to those born in the UK. CONCLUSIONS: Illuminating variability in prevalence of psychological distress across migrant communities, highlights vulnerabilities in particular migrant groups, which have not previously been described. Identifying such communities can aid mental health policy-makers and service providers provide targeted culturally appropriate care.

Disability discrimination and avoidance in later life: prevalence, disability differentials and association with mental health.

BACKGROUND: Later life is a period of increased risk of disability, but there is little quantitative evidence regarding the exclusion of older people (through discrimination and avoidance) due to their health conditions. This study aims to (1) measure the prevalence of disability exclusion in later life, (2) examine how experiences of exclusion differ by disability type, and (3) investigate the association of exposure to exclusion with psychological distress. METHODS: Using data from the 2015 ABS Survey of Disability, Ageing and Carers, we calculated the prevalence of people aged 55 years and over with a disability experiencing discrimination and engaging in avoidance behaviors, disaggregated by 18 detailed disability types. Modified Log-Poisson models were fitted to estimate Prevalence Ratios to measure the association between exclusion and psychological distress, stratified by disability type. RESULTS: In 2015, about 5% of Australians aged 55 years and over with a disability reported experiencing an instance of disability discrimination, and one in four reported avoiding a situation or context due to their disability. Accounting for psychosocial comorbidities and with extensive demographic controls, exposure to disability avoidance (PR = 1.9, 95% CI 1.7, 2.1) or discrimination (PR = 1.7, 95% CI 1.4, 2.1) almost doubled the probability of experiencing psychological distress. Effects were heightened for individuals reporting specific disabilities including sensory and speech and physical disabilities as well as those reporting a head injury, stroke, or acquired brain injury. CONCLUSIONS: Despite protections against disability discrimination in legislation, discrimination and avoidance due to disability is prevalent and is associated with poor mental health outcomes.

The unmet support needs of carers of older Australians: prevalence and mental health.

ABSTRACTBackground:Population aging places greater demands on the supply of informal carers. The aims of this study were to examine (1) the types of unmet support needs of carers of older Australians and (2) the association of unmet needs with mental health. METHODS: Utilizing new data from the 2015 Australian Bureau of Statistics (ABS) Survey of Disability, Ageing and Carers, we calculated the prevalence of carers experiencing specific and multiple unmet needs for support, using single and multiple item measures. Logistic regression models were fitted to examine the association between unmet needs and psychological distress (using the Kessler psychological distress scale), once demographic and health factors were controlled for. RESULTS: In 2015, 35% of carers of older Australians cited at least one unmet need for support. Among this group, almost two-thirds cited multiple unmet support needs (64.7%). The most prevalent types of unmet needs included financial (18%), physical (13%), and emotional support (12%), as well as additional respite care and support to improve carer health (12%). After controlling for demographic and health characteristics of the carer, having any unmet need for support increased the odds of psychological distress by twofold (OR = 2.20, 95% CI = 1.65, 2.94). With each successive unmet need for support, the odds of psychological distress increased 1.37 times (OR = 1.36, 95% CI = 1.22, 1.54). Those who had received assistance with care, but required further support were 1.95 times more likely (OR = 1.95, 95% CI = 1.17, 3.24) to be in distress and those who had not received care assistance were about 2.4 times more likely (OR = 2.38 95% OR = 1.56, 3.62) to be in distress relative to those with no unmet need. CONCLUSIONS: Addressing unmet support needs of carers is important, not only for the planning of services for carers in an aging population, but also because of the association between unmet support needs and carers mental health.

Discrimination and avoidance due to disability in Australia: evidence from a National Cross Sectional Survey.

BACKGROUND: Across most high-income countries, populations are ageing. With this demographic change is an increase in the number of people living with disabilities. In this context, we sought to examine the prevalence of disability discrimination and disability avoidance in Australia, the demographic and health correlates of exclusion and the contexts in which disability discrimination and avoidance are experienced. METHODS: Utilising newly released measures from the 2015 ABS Survey of Disability, Ageing and Carers, we calculate the prevalence of people living with a disability who have experienced discrimination and engage in avoidance behaviours, and the contexts in which they occur. Logistic regression models were fitted to examine the correlates of discrimination and avoidance behaviours, once controls and complex survey design were accounted for. RESULTS: Approximately 9% (95% CI = 8.1, 9.2) of people with a disability experienced disability discrimination in 2015 and 31% (95% CI = 30.9, 32.9) engaged in avoidance behaviours because of their disability. With controls included, the prevalence of avoidance and discrimination declined with age, was higher for divorced people (versus married), the unemployed (versus employed) and was lower for people with lower levels of education (versus a degree) and those born overseas. Having a psychosocial or physical disability significantly increased the odds of experiencing discrimination or avoidance, as did having an increasing number of long-term health conditions. We further find that disability discrimination and avoidance occurs in contexts critical to human capital, such as the workforce, education and healthcare. CONCLUSIONS: Despite protections in legislation and international accords, significant proportions of Australians with a disability experience discrimination or engage in avoidance behaviours in various settings with potentially important human capital implications. Recently, sectoral responses (eg., in education and the workplace) have been offered by Government reports, providing direction for future research and evaluation.

Multiple health conditions and barriers to healthcare among older Australians: prevalence, reasons and types of barriers.

Accompanying population ageing is an increase in the number of older Australians living with multiple health conditions and disabilities (Australian Institute of Health and Welfare 2014). This study sought to examine the barriers to accessing healthcare faced by older Australians. Utilising the 2014 Australian Bureau of Statistics General Social Survey, it was found that 6% of respondents aged 50 years and over reported experiencing a barrier to accessing healthcare within the previous 12 months. Those with multiple health conditions are at a considerably higher risk of experiencing a barrier to healthcare (21% with four or more disabilities) compared with people with no or fewer health conditions, and this risk persists once wide-ranging control variables are included. Long waiting times or unavailability of appointments (43%) were the main type of barriers to accessing healthcare, followed by cost (23%). Points-of-care barriers experienced included accessing GPs, specialists and hospital sector care. Respondents who experienced a barrier were more likely to have low levels of trust in the healthcare system compared with people who had no experience of barriers to healthcare, and were more likely to have a perception of experiencing discrimination or unfair treatment in a healthcare setting.

Informal care relationships and residential aged care recommendations: evidence from administrative data.

BACKGROUND: The Australian government recognises the importance of informal care to enable ageing in place. Yet, few multivariable studies have examined aspects of informal care that alter the probability of entry to residential care in Australia. Existing Australian and international studies show differing effects of informal care on entry to residential care. METHODS: We utilise unique administrative data on aged care assessments collected from 2010 to 2013, consisting of 280,000 persons aged 65 and over. Logistic regression models were fitted to measure the propensity to be recommended care in a residential care setting, disaggregated by characteristics of informal care provision. RESULTS: Providing some explanation for the divergent findings in the literature, we show that close familial carer relationships (partner or child) and coresidence are associated with recommendations to live in the community. Weaker non-coresidential friend or neighbour carer relationships are associated with recommendations to live in residential care for women, as are non-coresidential other relatives (not a child, partner or in-law) for both males and females. Non-coresident carers who are in-laws (for females) or parents have no impact on assessor recommendations. Despite these significant differences, health conditions and assistance needs play a strong role in assessor recommendations about entry to residential care. CONCLUSION: Co-resident care clearly plays an important protective role in residential care admission. Government policy should consider the need for differential supports for co-resident carers as part of future aged care reform.

Counting the Ways That Aboriginal and Torres Strait Islander Older People Participate in Their Communities and Culture.

OBJECTIVES: This study aimed to determine the proportion of older Aboriginal and Torres Strait Islander peoples participating in cultural events and activities and determine the demographic and sociocultural characteristics associated with participation. METHODS: The Australian Bureau of Statistics National Aboriginal and Torres Strait Islander Social Survey (2014-2015) was used to measure the prevalence of participation in cultural events and activities. Multivariate logistic regression models were used to measure associations. Sociocultural factors were selected by matching survey items to the 12 sociocultural factors described in the Good Spirit Good Life Framework, a culturally validated quality-of-life tool for older people. RESULTS: The majority (62.0%) of survey respondents 45 years and older participated in cultural events (e.g., ceremonies, funerals/sorry business, NAIDOC week activities, sports carnivals, festivals/carnivals) or were involved in organizations. Many (58.5%) also participated in activities (e.g., fishing, hunting, gathering wild plants/berries, arts/crafts, music/dance/theater, writing/telling of stories). In regression models including demographic and cultural variables, participation in cultural events was highest among people living remotely (odds ratio [OR] = 2.71), reporting recognition of homelands (OR = 2.39), identifying with a cultural group (OR = 3.56), and those reporting having a say in their communities (OR = 1.57), with similar odds seen for participation in activities. Participation was inversely proportional to increasing age, with a greater proportion of females participating in events and males in activities. DISCUSSION: The social lives of older Aboriginal and Torres Strait Islander people were characterized by widespread participation in cultural events and activities. These findings provide important insights into services as they support older people to live a good life.

Barriers Experienced by Community-Dwelling Older Adults Navigating Formal Care: Evidence From an Australian Population-Based National Survey.

OBJECTIVES: This study aims to identify the relationship between psychosocial factors and unmet needs among community-dwelling older adults who have received or who expect to receive formal home-based aged care services. METHODS: A subsample of the national Survey of Disability, Ageing and Carers was used to examine the prevalence of having any unmet needs among older adults navigating care. We also examined associations between older adults' psychosocial factors and their unmet needs using logistic regression. RESULTS: Regression analyses highlighted that perceived social isolation (OR = 1.62, 95% CI: 1.30-2.01), high/very high psychological distress (OR = 2.11, 95% CI: 1.52-2.93), and occasional assistance from informal support (OR = 1.92, 95% CI: 1.22-3.05) were associated with increased odds of having unmet needs, after adjusting for other covariates. DISCUSSION: Our study suggests that older adults facing psychosocial difficulties or lacking informal support are more likely to encounter barriers in accessing formal care. Future policy should address the psychosocial needs and support networks of older adults.

Local area population projections dataset for Australia.

A new dataset of population projections for local areas of Australia is described. The areas comprise SA3 areas of the Australian Statistical Geography Standard, which mostly range in population between 30,000 and 130,000. The projections are launched from the 2020 Estimated Resident Populations published by the Australian Bureau of Statistics and extend out to 2035. They are available by sex and five year age group up to 80-84 with 85+ as the final age group and in five year projection intervals. The projections were prepared using the synthetic migration cohort-component model, a new model for population projections which requires much less input data than conventional projection models, and therefore involves much lower costs and production time. Despite this, a recent evaluation demonstrated respectable forecast accuracy, and greater accuracy than equivalent simple projection models producing populations by age and sex. The age-sex projections are constrained to independent age-sex national projections and local area projections of total populations. The dataset consists of local area projections for the whole of the country which is consistent in methods, input data, and projection outputs due to the use of one model. This is rare in Australia because local area projections are most commonly prepared by individual State/Territory Governments using different methods, data sources, projection assumptions (which can be influenced by State/Territory population policies), and time periods. These nationally consistent projection data should be useful for a wide range of local area planning, policy, and research purposes, such as childcare demand, school enrolments, power and water usage, aged care provision, store and business site selection, living arrangements and household projections, labour force projections, and transport modelling.

Will the COVID-19 pandemic affect population ageing in Australia?

The COVID-19 pandemic has caused extensive disruption to economies and societies across the world. In terms of demographic processes, mortality has risen in many countries, international migration and mobility has been widely curtailed, and rising unemployment and job insecurity is expected to lower fertility rates in the near future. This paper attempts to examine the possible effects of COVID-19 on Australia's demography over the next two decades, focusing in particular on population ageing. Several population projections were prepared for the period 2019-41. We formulated three scenarios in which the pandemic has a short-lived impact of 2-3 years, a moderate impact lasting about 5 years, or a severe impact lasting up to a decade. We also created two hypothetical scenarios, one of which illustrates Australia's demographic future in the absence of a pandemic for comparative purposes, and another which demonstrates the demographic consequences if Australia had experienced excess mortality equivalent to that recorded in the first half of 2020 in England & Wales. Our projections show that the pandemic will probably have little impact on numerical population ageing but a moderate effect on structural ageing. Had Australia experienced the high mortality observed in England & Wales there would have been 19,400 excess deaths. We caution that considerable uncertainty surrounds the future trajectory of COVID-19 and therefore the demographic responses to it. The pandemic will need to be monitored closely and projection scenarios updated accordingly.

The Impact of Demographic and Economic Change on the Australian Generational Economy: Financial Sustainability, Intergenerational Inequality, and Material Living Standards.

The generational economy-which is that aspect of the economy that pertains to the economic activities of, and the economic relationships between, different ages and generations-can be evaluated on the basis of a number of different criteria. The most critical of these include the financial sustainability of the generational economy, the intergenerational inequality that the generational economy creates, and the material living standards associated with the generational economy. How the generational economy performs in terms of these three criteria is, moreover, shaped by underlying processes of demographic and economic change. This paper examines how the Australian generational economy can be expected to perform in coming decades in terms of financial sustainability, intergenerational inequality, and material living standards. How the performance of the Australian generational economy is shaped by variations in fertility, mortality, overseas migration, and labour-income growth is also assessed. The results reported in the paper indicate that, because of population aging, consumption can only grow at a substantially lower rate than labour income if financial sustainability is to be maintained. These results also suggest that increasing overseas migration is a distinctly useful policy tool for meeting the challenges posed by population aging, since increasing overseas migration both increases material living standards and decreases intergenerational inequality.