Older people’s health

Priority Area

Health Needs Assessment 2025 - 2028

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Over 1 in 4 (26%) people on the North Coast were aged 65 years and older in 2021. This is higher than both NSW (18%) and Australia (17%). The local government areas (LGAs) of Tweed and Port Macquarie-Hastings and Coffs Harbour have the highest number of people aged 65 and over in the region. The LGAs with the largest proportion of the populations aged 65 and over are Nambucca Valley (30%) and Port Macquarie-Hastings (29%), followed by Clarence Valley, Ballina, Bellingen and Tweed (27%). In contrast, Byron (19%), Lismore (21%) and Coffs Harbour (23%) have the smallest proportions of older people on the North Coast.

By 2041, the number of people aged 65 and over on the North Coast is projected to increase by 28%. The oldest cohort within that group, those aged 85 and over, is projected to increase by 86%. This demographic shift will increase the need for services to support older peoples, putting pressure on existing services and infrastructure.

The LGAs with the highest proportion of people aged 65 and over, such as Nambucca Valley and Port Macquarie-Hastings may face challenges in meeting service demands for older people if the working-age population is not large enough to provide the necessary support. This may require the implementation of new care models, such as digital and virtual health services, to ensure that the needs of older people can be met effectively (ABS (Australian Bureau of Statistics), 2021).

This concern was raised in the survey and consultations held by Healthy North Coast. Nearly 60% of survey respondents identified the ageing population as a serious health concern. While the ageing population was acknowledged in consultations for its positive contributions to communities, there were serious concerns raised about infrastructure and the availability of services needed to meet the growing demand. This highlights the urgency of adapting community and healthcare infrastructure to better support an ageing population.

Nearly 6 in 10 (59%) people 65 years and older on the North Coast reported living with chronic conditions in 2021. As people age, the likelihood of living with 2 or more chronic conditions simultaneously (known as multimorbidity) increases substantially. On the North Coast region, nearly 3 in 10 (29%) people aged 65 and older reported having multimorbidity, which is slightly higher than the rates in NSW (27%) and Australia (28%). The number of older people living with multimorbidity varies across LGAs. Less of the older people living in Byron and Kyogle live with multimorbidity (19% and 20% respectively), whereas Nambucca Valley (33%), Kempsey, Richmond Valley and Clarence Valley (32%) have higher percent of people living with multiple chronic conditions.

The high prevalence of multimorbidity means patients are more complex to manage and create greater demand for healthcare services, leading to challenges such as long wait times for specialised care, particularly for geriatricians and dementia specialists. As a result, older people often rely heavily on their general practitioners (GPs) for support.

Osteoarthritis and osteoporosis are the most prevalent chronic conditions among people aged 65 and older on the North Coast general practices, affecting 20% and 16% of the nearly 260,000 active patients in this age group, respectively. The prevalence of chronic conditions varies significantly across different LGAs on the North Coast region. The prevalence of osteoarthritis in people aged 65 and older ranges from 28% in Kyogle, Kempsey and Lismore to 12% in Byron. Similarly, the prevalence of osteoporosis varies from 22% in Richmond Valley and Ballina to 10% in Coffs Harbour and Clarence Valley. These variations highlight the need for tailored healthcare approaches to address the specific needs of older adults in different areas within the North Coast region (ABS, 2021).

Less older people are hospitalised due to falls in the North Coast than in NSW. For every 10,000 residents, there are 39 falls-related hospitalisations in the Mid North Coast Local Health District (LHD) area and 36 in the Northern NSW LHD area, compared to 42 in NSW. This suggests that regional health strategies and community health initiatives are positively impacting falls prevention (NSW Government, 2023). Healthy North Coast’s Healthy Ageing Strategy focuses on supporting and educating practitioners to better assist older people to reduce falls and improve safety for the ageing population (Healthy North Coast, 2023).

Dementia is the second  leading cause of death on the North Coast, as it is across Australia, only second to coronary heart disease. Dementia poses significant health, social and economic challenges for individuals, families and society. Over 1.6 million Australians are involved in caring for someone with dementia, with two-thirds of those affected living in the community.

In 2024 there were over 13,000 people estimated to be living with dementia on the North Coast. This represents 3% of the total population of the region, which is slightly higher than the 2% in both NSW and Australia. Tweed and Port Macquarie-Hastings LGAs have the highest number of people living with dementia. By 2054 the number of people living with dementia is projected to increase by 80% in the region, with the LGAs of Tweed, Ballina, Port-Macquarie-Hastings and Coffs Harbour surpassing the region’s overall increase.

The increasing prevalence of dementia highlights the need for support services and care models to address the growing demand. With the region expecting a substantial rise in dementia cases over the coming decades, particularly in the LGAs of Tweed, Port Macquarie-Hastings, Coffs Harbour, Clarence Valley and Ballina, it is critical to invest in resources that support both individuals living with dementia and their caregivers.

Overall, the rates of aged care services use on the North Coast region are higher than the state and national average.

In 2022-23, the North Coast region had 78 residential aged care facilities, operating at an occupancy rate of 85% on average. The LGAs of Tweed (1,129) and Port Macquarie-Hastings (1,045) have the largest number of people in residential care across the region, followed by Coffs Harbour (706), Clarence Valley (592) and Ballina (589). For every 1,000 people aged 65 and over, on the North Coast there are 40 people living in residential care. Kempsey is in the region with the highest population aged 65 years and over in residential care (55 per 1,000), followed by Ballina (46) and Tweed (43). These 3 LGAs exceed the NSW and national average of 42 residents per 1,000 people 65 and over (GEN Aged Care, 2023).

The rates of older people in residential care across the North Coast are indicative of a region where ageing populations are growing quickly and where the demand for services exceeds what is available. With 1 in every 4 older people living alone on the North Coast, it is clear there is a strong demand for both residential care and home care services. For some communities, particularly in more remote areas, residential care may be one of the few available options for older adults who are in need of assistance.

The Commonwealth Home Support Program (CHSP) provides lower-level support for older people in need. For every 1,000 people aged 65 and over, there are 183 on CHSP on the North Coast, compared to 157 in NSW and 178 across Australia. The highest rates of people in CHSP are found in Richmond Valley, Coffs Harbour and Nambucca Valley, with rates over 200 beneficiaries per 1,000 people. This is indicative of a region with a large proportion of older adults who are seeking support but may not require full-time residential care or higher-level of care packages (GEN Aged Care, 2023).

Home Care Packages (HCPs) are designed for those who have more complex care needs, that are beyond the support that the CHSP can provide. On the North Coast there are 74 people with HCPs per 1,000 people aged 65 and over, more than the 58 in NSW and 56 in Australia. Richmond Valley LGA has the highest rate of people with HCPs per 1,000 older people (88), followed by Ballina (86) and Tweed (82). This suggests that people in these areas may be using home care packages to allow them to remain at home more than in other areas such as Byron, Bellingen or Kyogle, where HCP use is lowest (GEN Aged Care, 2023).

There is uneven distribution of aged care services throughout the region. For some providers, only office locations are listed, which makes it difficult to understand the true service reach. This further complicates efforts to ensure equitable access for older people to receive the care they need, where they need it.

Community consultations highlighted the lived experiences of older adults in the region in accessing health and aged care systems. Difficulty navigating the aged care system to secure home care funding, challenges gaining admission to residential aged care homes and access to services were highlighted as major concerns. The consultations highlighted issues with loneliness and isolation. For many older adults, the social fabric of their communities is not enough to offset the isolation they experience. These feelings of loneliness, combined with physical health challenges, underscore the urgent need for more comprehensive support to improve the quality of life for older people. Healthy North Coast is committed to supporting people to live and age well and stay connected to community and country.

Social prescribing continues to gather momentum in Australia as a contemporary approach to health care and is already widely adopted in countries such as the United Kingdom. From April 2025, Healthy North Coast will be engaging with towns across the region to explore becoming ones of a new group of Healthy Towns – where people can live and age well, with ongoing opportunities to contribute and stay connected to community and country.

The Australian Government Care Finder program initiative provides provides additional support for eligible older Australians to navigate the aged care system and use My Aged Care. The program aims to achieve positive health outcomes for people, including improved coordination of support when seeking to access aged care, improved understanding of aged care services and how to access them and improved openness to engage with the aged care system. The care finders program aims to increase workforce capability to meet client needs, increase access to aged care services and connections with other relevant supports and keep people connected to the services that they engage with.

Across the region, older people have varying access to general practice (GP) services. In the survey, some older adults reported no issues accessing their local GP, though it was common to experience wait times. Some participants in the in rural areas of Kyogle, Nambucca Valley and Clarence Valley, found it difficult to access their preferred GP, mentioning long wait times and limited availability. This reflects the shortage of GP services in certain areas and highlights disparity in healthcare provision across the North Coast. In some cases, survey participants noted that they had to visit different GPs if their preferred one was unavailable. The need for a more coordinated and accessible healthcare system is critical in these areas where residents face physical barriers.

Older people living the region reported a strong sense of social capital, which is a concept describing valuable networks of trust and support between individuals and communities. On the North Coast, older people reported similar levels of social capital compared to younger people. For older adults, 47% reported that they could rely on a family member, friend, or neighbour for financial assistance if needed. Similarly, 43% felt they could rely on others for mental health support and 47% believed they could rely on someone to care for them if they were sick or injured. There is a broad range of responses across different LGAs, suggesting that some communities have stronger support networks than others. In areas such as Nambucca Valley, Kyogle and Clarence Valley, where social capital appears lower than others, older people may be particularly vulnerable, especially as they face the dual challenges of isolation and limited access to care services.

The demand for palliative and end-of-life care services is rising both on the North Coast and across Australia This is driven by an ageing population, increasing rates of multimorbidity, a growing incidence of cancer and changing social perceptions. Accessibility is limited in regional and outer regional areas. Local care options may be scarce, preventing people from receiving preferred care. Improving coordination between existing services on the North Coast will make it easier for individuals and families to navigate the system as care needs evolve (Healthy North Coast, 2023).

There is limited awareness about palliative care in both the community and among healthcare providers. Many are unaware of how palliative care improves quality of life or what services are available. The region faces additional challenges, such as workforce shortages, limited hospice options and long distances to services. In Nambucca Valley, Kyogle and Clarence Valley, higher rates of palliative care hospitalisations may indicate a reliance on hospitals due to the lack of local support services. Effective coordination of care, especially for those requiring specialist care, is essential but remains limited in outer regional areas (Healthy North Coast, 2023).

Older Australians are a key focus for state, territory and national governments in efforts to reduce homelessness. Older people can face homelessness due to various factors. While some may have had stable housing earlier in life, social or financial difficulties can later place them at risk. Others may have experienced homelessness for much of their lives (Australian Bureau of Statistics, 2023).

For people experiencing homelessness or living in insecure housing, the impact on physical and mental health can be severe. They may experience health problems typically associated with older age at an earlier stage. For this reason, people aged 55 and older who are experiencing or at risk of homelessness are considered part of the “older population” in discussions around homelessness (Australian Institute of Health and Welfare, 2024).

The LGA of Tweed has the highest number of people aged 65 years and older experiencing homelessness or at risk of homelessness in the North Coast region. Of the 12 LGAs in the region, Tweed, Kyogle, Richmont Valley, Byron and Bellingen have more older people homeless per capita than NSW. All the 12 LGAs have a higher rate of older people at risk of homelessness than the NSW average. This is a growing concern given the region’s ageing population and the strain on housing and support services.

The North Coast region represents 9% of NSW’s homeless population aged 65 and older and 18% of older individuals at risk of homelessness. This highlights the significant challenge faced by the region in supporting older people at risk of or experiencing homelessness, further underscoring the need for targeted housing solutions and support services (Australian Bureau of Statistics, 2023).

Throughout this document ‘survey’ refers to the 2024 Better Health Community survey undertaken as part of the Health Needs Assessment 2025-28 consultation process.

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