Exposing Deficit Discourse in Aboriginal and Torres Strait Islander Peoples' Ageing Policy: Promoting Healthy Ageing for Our Elders

Abstract

In Australia, aged-care access is partly organised through age-based eligibility thresholds. For the general population, aged-care assessment and support generally begins from age 65. For Aboriginal and Torres Strait Islander Peoples (hereafter, Indigenous Peoples), eligibility begins from age 50. This threshold has a long policy history. Earlier aged-care planning and reporting under the Aged Care Act 1997 justified the use of age 50 on the basis that ‘conditions associated with ageing generally affect Indigenous Peoples substantially earlier than other Australians’ [1]. Aged-care planning recognises the earlier onset of age-related health decline among Indigenous Peoples by applying the age threshold of 50 years and over, compared with 70 years and over for non-Indigenous Australians [2, 3]. This distinction continues in contemporary aged-care law and service-planning [4, 5]. Although this threshold was introduced to improve access for people who experience chronic illness, disability or care needs earlier than non-Indigenous Australians, it can unintentionally reinforce deficit discourse. Additionally, this policy position cannot be separated from the ongoing impacts of colonisation, dispossession, segregation, forced removals and racist laws, which have disrupted Indigenous Peoples' families, languages, economies and connections to Country. These structural harms accumulate across generations and shape health and well-being throughout life. When policy operationalises 50 years as the threshold for ‘old age’, it risks turning inequity into identity, implying that being ‘old at 50’ is natural or inevitable [3]. Earlier care needs reflect preventable, long-term structural disadvantage, not Indigenous identity or biology.

The issue is not early access to aged-care services; there is broad agreement that Indigenous Peoples should receive earlier support when needed. The concern is the policy implication that Indigenous Peoples are ‘old at 50’ or ‘age prematurely’. Current aged-care guidance identifies Indigenous Peoples aged 50 years and over as ‘older’ for eligibility purposes, thereby linking age 50 with ‘older’ in service-access language [5]. This framing embodies the risk of normalising the impacts of inequity as both personal and biological decline [3]. Policy language can reinforce deficit discourse when it positions Indigenous Peoples' ageing primarily in terms of decline, disease and dependency [3, 6, 7]. A more accurate and culturally respectful view recognises that earlier onset of chronic disease, disability and care needs is shaped by cumulative social, historical, political and healthcare inequities, not Indigenous Peoples' identity, biology or ageing itself [3, 8].

Furthermore, policy language positioning Indigenous Peoples as ‘old’ from age 50 is not evidence-based. The assumption that Indigenous Peoples aged 50 years or older are equivalent to non-Indigenous people aged 70 years or older is not supported when compared with patterns of ageing-related conditions [3]. Although some preventable chronic conditions are more prevalent from midlife, the evidence does not show a consistent 20-year ‘premature ageing’ shift across conditions typically associated with older age [3, 7]. Interpreting midlife chronic disease as ‘ageing’ is therefore inaccurate and problematic as it misattributes structural inequity to biology and implies inevitable decline and reinforces deficit narratives rather than addressing preventable, systemic causes. The ‘early ageing’ construct can also imply irremediable disability and dependency, despite Indigenous Peoples in their fifties not necessarily being old, nor destined for dependency [3].

These findings support a different policy response. Higher rates of preventable chronic conditions in midlife call for targeted prevention, earlier intervention and equitable access to culturally safe care, not simply lowering the aged-care planning age [3]. When aged-care frameworks rely on a single chronological threshold, they risk reinforcing ageist and deficit-based narratives that position people over 50 years primarily through vulnerability and service need. A more appropriate approach recognises Elders and older Indigenous Peoples as traditional knowledge holders, carers, leaders and active contributors to family, Community, culture and Country [8, 9]. Current research shows that deficit discourse obscures strengths and the many older Indigenous Peoples who are ageing well [7]. The key drivers of healthy ageing are modifiable and service-related, including education, vascular risk management, appropriate prescribing and equitable access to care, rather than inevitable consequences of age or cultural identity [7]. The appropriate policy response is therefore not to classify Indigenous Peoples as ‘old’ at 50 years, but to address the preventable inequities and service gaps that contribute to earlier care needs. This reinforces the idea that earlier access to aged care should function as an equity mechanism, not as evidence of premature ageing or as a justification for expanding institutional models of care.

Despite assumptions that Indigenous Communities require a major increase in residential aged-care beds, service use data does not support this view. Indigenous Peoples make up nearly 5% of Australians aged 65 years and over, yet account for < 1% of residential and transitional aged-care service use [9]. Caring roles further underscore this mismatch. Indigenous Peoples take on disproportionately high levels of caregiving compared with the general population [10]. Home-based care is not only preferred but often culturally essential. It maintains connection to family, Community and Country, and enables care to be delivered in ways that align with cultural obligations and relational responsibilities. These patterns suggest that focusing on institutional expansion risks misunderstanding how care is lived for many Indigenous Peoples. However, residential aged-care facilities remain highly visible in reform discussions, including announcements about culturally safe aged-care homes and additional residential aged-care places for Indigenous Peoples [11]. Although culturally safe residential care is essential for those who require it, this emphasis may inadvertently position institutional care as the primary response to ageing. This reinforces the need to prioritise culturally grounded, home-based supports that align with Indigenous preferences and lived experience [8]. In practice, this means funding flexible care models that support transport, meals, social and cultural connection, respite for family carers, care coordination and local Aboriginal and Torres Strait Islander workforces [8]. Policy settings should therefore recognise the cumulative weight of cultural, family and community responsibilities, and respond by resourcing carers and strengthening culturally safe, community-led models of care.

When systems frame Indigenous ageing primarily through ‘need’, engagement often becomes shaped by organisational priorities rather than community benefit. Consultation is frequently experienced as performative and compliance-driven, aimed at meeting reporting requirements, demonstrating activity or legitimising decisions already made [8, 12]. In these situations, engagement reflects organisational agendas rather than diverse community priorities [8, 12]. This dynamic shifts power away from cultural governance and undermines the principle that services should be accountable to the people who use them. It also risks reducing Cultural Safety to a procedural task, in which engagement serves government or organisational goals rather than functioning as a relational, ethical commitment defined by Indigenous Peoples and grounded in genuine partnership, reciprocity and shared decision-making.

Although policy and research discourse on ageing has begun to shift from narratives of decline towards participation, independence and well-being, this shift has not been consistently applied to how ageing of Indigenous Peoples is described, with research showing that mainstream ageing frameworks do not fully reflect the priorities, cultural identity, resilience and lived experiences of older Indigenous Peoples [12]. The Aboriginal and Torres Strait Islander Aged Care Framework 2025–2035 clearly positions older Aboriginal and Torres Strait Islander Peoples as knowledge holders and the hearts of communities [13]. If this is the intended policy direction, then the broader policy and research language must align, and consultation must be genuine. Genuine consultation should occur before policy decisions are finalised, be adequately resourced, include Elders, carers and Aboriginal Community Controlled Organisations, and demonstrate how community advice has shaped final policy, funding and service-design decisions [12]. Without this alignment, systems will continue to speak in deficit terms while claiming to support strengths-based approaches.

The argument is not that Indigenous Peoples should be denied earlier access to aged-care support. Rather, eligibility from age 50 must be understood as an equity measure responding to the ongoing impacts of colonisation, structural disadvantage, chronic disease burden and barriers to culturally safe care, not as evidence that Indigenous Peoples are inherently ‘old’ or ‘ageing prematurely’ [3, 5, 7]. If systems continue to treat ‘old at 50’ as a proxy for decline, policy responses risk becoming misdirected; prioritising age-based categorisation over prevention, culturally safe access and the practical supports that enable people to age well on their own terms. A more appropriate policy position is to retain equitable access while reframing Eldership as a strength, investing in culturally safe, community-led supports and addressing inequity at its source rather than treating it as biological or inevitable.

The call to action is clear. First, Australian aged-care policy should retain earlier access to supports for Indigenous Peoples where needed but discontinue deficit discourse that implicitly defines age 50 as ‘older’. A more accurate and culturally respectful framing is that earlier eligibility reflects the cumulative impacts of structural inequities, chronic disease burden and barriers to culturally safe care. Positioning eligibility as an equity measure rather than aligned with ageing would help shift policy away from deficit-based narratives. Second, future reform should prioritise Aboriginal and Torres Strait Islander-led, home- and community-based supports; strengthen local workforces and unpaid carers; and recognise Elders and older people as knowledge holders, leaders, carers and central members of family, Community, culture and Country. Thirdly, further research is needed to better understand Aboriginal and Torres Strait Islander ways of caring for older people, including the roles of family, kinship, Community, culture, Country and Island Home in shaping care preferences and ageing well. Crucially, this work must be led by Indigenous Peoples and grounded in self-determination, cultural governance, adequately resourced community consultation and genuine partnership.

The authors have nothing to report.

The authors declare no conflicts of interest.

The authors have nothing to report.