Royal Commission into Aged Care Quality and Safety releases third and fourth Background Papers

The papers are Understanding dementia treatment, care and its physical and social consequences and Restrictive practices in residential aged care.


Understanding dementia treatment, care and its physical and social consequences: Background Paper 3

Dementia is a significant issue for the Australian community, and particularly the aged care and health systems.


Dementia is one of the leading causes of disability for older people. In 2015, it was a contributing factor in approximately 15.8% of all deaths in Australia and in 2016, over half (52%) of people in living in residential care had dementia.


The paper, Dementia in Australia: nature, prevalence and care. Background Paper 3, aims to provide a high level introduction to dementia. It reviews the findings of broad-reaching Australian and international research, demographic reports and literature, and addresses a number of issues, including:

  • what is dementia
  • what are the physical and social consequences of dementia
  • how prevalent is dementia in Australia
  • what the research says about dementia care
  • support for families and carers
  • the dementia workforce.


The research presented highlights the potentially significant impact of timely diagnosis in primary care settings and positive outcomes of a person-centred or small domestic model of care on people living with dementia, as well as their family, friends and informal carers.


Statistics reveal the “much higher prevalence and incidence, and younger onset of dementia, as well as higher rates of risk factors for dementia” for Aboriginal and Torres Strait Islander people, presenting a significant challenge.


The need for improved, dementia-specific staff training in aged care settings is also explored.


Restrictive practices in residential aged care: Background Paper 4

The use of physical and chemical restraint in aged care is a contentious issue with many media reports highlighting accounts of physical restraint of residents and the overuse or misuse of psychotropic and other medication in aged care services in Australia.


Restrictive practices in residential aged care in Australia: Background Paper 4 notes that restrictive practices can elicit concern for a number of reasons because fundamentally, they impact on the liberty and dignity of the care recipient and without consent, their use may infringe on an elderly person’s legal rights.


“The term restrictive practices refers to activities or interventions, either physical or pharmacological that have the effect of restricting a person’s free movement or ability to make decisions. Restrictive practices are commonly referred to in the context of residential aged care as practices that control the behaviour of a resident, which may occur with the intention of reducing risks to a resident or others,” the paper notes.


“Physical and chemical restraint can have significant adverse effects on a resident, both physically and psychologically. There are also fundamental questions about their effectiveness.”


The paper also notes that there is an emerging body of evidence and guidance on strategies and non-pharmacological interventions to negate or mitigate the need for restraint by managing the underlying causes of challenging behaviour. These include measures to:

  • improve the environment for residents to reduce the risk of falls or confusion
  • engage familiar staff, sensory stimulation and other therapies
  • individualised care routines
  • increased staff interaction
  • comprehensive medical examination and review of medication.


Both papers are now available on the Commission's website -


5 May 2019.