a research journey health - university of tasmania · healthy eating for healthy ageing in rural...

Univ

ers

ity D

epart

me

nt

of R

ura

l H

ealth

R

ura

l H

ealth

U N

I V

E R

S I T

Y

O F

T

A S

M A

N I A

A Research Journey In search of the secrets of

ageing well in rural

communities

Dr Peter Orpin For the Rural Ageing Research

Team

The Team

Team Principals

• Prof. Judi Walker

• Dr Peter Orpin

• Ms Kim Boyer

All Projects

• Dr Hazel Baynes (RCS); Ms Heidi Behrens (RCS); A/Prof. Ros Bull

(UDRH/Nursing); Ms Janet Carty (DHHS HACC Program); Prof.

Bruce Felmingham (Economics); Dr Ros Foskey (RCS); Ms Nadia

Mahjouri (DHHS); Myriad Consultancy; Dr Carol Patterson

(TasCOSS); Prof. Andrew Robinson (Nursing); A/Prof. Elaine

Stratford (Geography & Environmental Studies); TasCOSS; Ms

Tracey Tasker (DHHS) ; Prof. James Vickers (Pathology)

www.utas.edu.au/ruralhealth 2

Research Drivers – People, Policy and Practice

The challenges of supporting ageing well in a rural-

regional environment.

An Ageing Australia

– Structural (proportion) and numerical (numbers) ageing [Australian Bureau of

Statistics]

• 65+: 2004 13%; 2021 18-19% (5 million); 2051 26-28% (7+ million)

• 85+: the major users of health services, projected to increase from

12% of those 65+ in 2006 to 18% in 2036

• Old Age Dependency Ratio: 2007 = 20% (5:1) 2056 = 38-42%(<3:1)

– Regional and rural populations ageing fastest

• Outflow of young, inflow of older retirees and semi-retirees

• 2056 projected dependency ratio of 66% (two working age for each

non-working over 65)


Being Regional and Rural

• Health – poorer on most indicators – travel further for many

services

• Demographic Change - Overall growing but more slowly than

urban – declines mainly inland agricultural and remote - gains

mainly regional hubs, high amenity coastal and peri-urban

• Economic Change – no overall decline - highly variable pattern ––

most vulnerable are low amenity single industry areas; agriculture,

mining or manufacturing.

• Community – powerful ‘rural idyll/community’ narrative with

plentiful anecdotal support, but research evidence mixed or

missing.

• The Rural/Regional Case – urban-rural dichotomy becoming

blurred – major change processes, demographic and social churn

• Policy and Service Planning – challenges of change and lack of

small-area evidence




The Older Person as:

– People – diverse and complex, not a neat category

– Net asset not net drain

– Full participating, contributing members of society not a social

problem to be managed

In Search Of: An adequate and appropriate support

based on need not ‘aged care’

The Experience of Ageing

– Marked by loss: physical and cognitive capacity; roles and

functions; relationships; social norms; forms and activities

BUT

– Highly individual and linked to life course – social and

psychological resources, meaning-making, agency, earlier life

patterns, context

– No convincing evidence that they are, as a group, more lonely

or less satisfied with life than at any other age.

5

Social Engagement and Ageing Well

• ‘Unsatisfactory’ social engagement patterns

consistently linked to poorer physical and psychological

health and wellbeing, and earlier death

• Perceptions and match to expectation stronger

indicators than objective health or circumstance

measures

• Social networks – become smaller and more

concentrated with age – focus on emotional value over

utility – part of a process of selection and optimisation

(making the best of the hand you are dealt).


Cradle-Coast Pilot 2005-2007

• Aim: to understand the present and future support

needs of rural older people

• Semi- structured interviews with approximately 200

people 65+ in Cradle Coast region.

• Snowball sampling – implications for generalizability of

findings about social engagement

• Two interviews 18 month apart n=193 (phase I), n=154

(phase II)

• Questions about:

– Demographics

– Social support

– Getting about

– Service usage and service needs

– Future planning


Cradle-Coast Pilot - Findings

Overall

• Very positive about most aspects of their lives although

facing major health challenges

• Highly engaged and active in their communities

• ‘Doing very nicely thank you’ but highly vulnerable

Social Support

• Almost everyone had someone that provided regular

contact and support – predominantly family

• Majority engaged in community activities weekly

Mobility

• Many reporting increasing incapacity BUT met with

acceptance, adaptation and coping

• Most remain highly mobile BUT almost totally reliant on

access to a private car. www.utas.edu.au/ruralhealth 9

Cradle-Coast Pilot - Findings

Service Usage and Needs

• Surprisingly low usage and concern about traditional

services apart from GP and chemist

• Despite average age 75.9 years, most managing own

activities of daily living

• Most help needed in maintaining household – heavy

housework and house/garden maintenance

Forward Planning

• Resistance to forward planning for frailty – ‘Go out of

here in a box’

• Strong preference for ageing in place through

graduated downsizing.


ARC Linkage Grant: Community Engagement for

Productive Ageing 2007-2009

Prompted by findings of Cradle Coast Study

• The importance of social engagement in ageing well; and,

• The fragility of social engagement in the light of challenges related to

ageing in a rural area

The Study

• In-depth interviews with 69 rural community dwelling people 65+ across

three rural local government area in Tasmania (Central Highland,

Circular Head and West Coast)

• Interview/focus groups with 32 service providers in the study areas

• Interviews with 11 DHHS managers

Aim

• To explore the age-related challenges to social engagement and

participation in a rural context

• To inform the design and delivery of policies and services to support

older rural people to maintain their preferred levels of social engagement

into old age.

12

Findings – the voice of older rural people

Ageing as a natural process

• Viewed and accepted as simply part of life – not looking for a cure

Each ageing experience a unique product of:

• Challenges faced – not a good predictor of ageing well

• An individual: personality and social and psychological resources

• A context – a place, a time and a history

• Processes of meaning-making and agency

A shrinking social world

• Loss of capacity, energy, mobility, significant others and much of

the world as they know it

• Can be volitional, welcome and adaptive

– matching expectations and aspirations to capacity

– Selective optimisation/adaptive compensation – making the most of what you

have


Findings – the voice of older rural people II

Reluctant help seekers

• Stoic, un-reflexive acceptance – ‘Just get on with it’

• Self- reliant, independent and private – wary of loss of

independence and embarking on the ‘slippery slope’

• Clear demarcation between areas of government responsibility

(health and aged care) and their own (personal well-being and

social life)

• Reluctant to accept without being able to reciprocate

However

• Evidence of the lonely, marginalised and disconnected

• High vulnerability:

– Loss of capacity

– Loss of spouse

– Loss of licence

– Loss of cherished community organisations


The Voice of Service Providers

• Ageing as a constellation of pathologies

• Identified similar age-related challenges – especially

transport, loss of licence, morbidity and death of spouse

• Cognizant of importance of social engagement to health

and well-being and aspire (or are striving) to working

more flexibly and holistically to support ageing well

BUT

• Health and medical priorities for limited resources

• Constrained by:

– High and narrowly prescribed workloads and scopes of duty

– Environment of highly regulated accountability - financial, time,

OH&S, professional scopes of practice

– Reluctant help-seeking and help accepting among older rural

clients – wary of threats to independence, control and sense of

self-reliance.

16

A Practice Framework

Supplementing, enhancing and building the

processes of community

1. Making the connections as a core duty

2. Having the time and flexibility to build an understanding of, and

relationship with client and community

3. Having the flexibility and resources to respond to ‘need’ as and

when, and in whatever form, it presents. This requires – in

individual approach, ‘keeping an eye on’

4. Circumspection – finding ways to support without challenging

control, privacy, self-reliance and independence

5. Accountability: flexible, responsive individualised care

approaches hampered by current scope of practice, key

performance indicator and ‘occasions of service’ accountability

requirements – forces rural providers working at the margins of

official scopes of practice.

17

Healthy Eating for Healthy Ageing in Rural

Tasmania: Project I (HACC funded)

An examination of the operation of three models of government

provided meals to determine to what extent they are meeting client

needs:

– Day Centre Meals

– Eating with Friends

– Meals on Wheels

Methodology: Survey (63 clients); Interviews/focus groups (57 clients

and providers)

• Findings:

– For clients, the social, rather than the food or nutritional

dimensions of the service were of primary importance and

benefit

– The current nutritional goal focus in services’ policies and

design are limiting their capacity to respond to the diversity of

social need and individual eating preferences among clients

– Programs are likely to be missing the most isolated clients

18

Healthy Eating for Healthy Ageing in Rural

TasmaniaZ: Project 2 (HACC funded)

‘Perspective from a rural community’ – case study to examine

the capacity of a rural community to provide social eating opportunities for

its older members

Methodology: Small group and one-one-one interviews with independently living

older people, service providers and community leaders

Findings

• There is a very low level of awareness and recognition of nutritional insufficiency

or risk among older community members – where it exists (as existing research

suggests it must) it appears to be largely invisible even to health professionals

• While the community does provide a range of socialisation opportunities for its

older residents (many involving some sharing of food), few of these go the next

step of utilising these socialisation opportunities as a vehicle for simultaneously

and systematically addressing nutritional risk

• Individual sensitivities around food, eating and socialisation preferences, suggest

the issue may be best addressed by a range of flexible, ‘bottom-up’ approaches

utilising the community’s own social and infrastructural resources.

19

Where to from here?: Projects in the Pipeline

NHMRC Partnership Application Aged Support and Aged Care:

program and policy structures to support ageing well in rural and regional

Australia

• Flowing from the ARC finding that current bureaucratic age

care program frameworks are frequently at odds with their

underlying aim of providing older people with the truly

flexible, individualised, relationship based, community

oriented support they need to enable them to ‘age well’

within their communities.

• To develop an audit tool to be used in developing new, and

refining existing, policies and programs to better support

older regional and rural people to remain engaged and

contributing members of their communities into old age.

20

Projects in the Pipeline II

Flexible Models for Delivered Meals (HACC funded)

An examination of current developments within NSW

Meals on Wheels that are designed to allow for a range

flexible and socially based approaches to the provision of

delivered meals to nutritionally at-risk older people.

National Seniors Grant Application: Living without a

licence: maintaining social engagement and contribution in rural

communities without access to private transport

• Arising out of our work highlighting the crucial role that access to

private transport plays in assisting older rural people to remain

engaged and contributing members of their families and

communities.

• An action research project aimed at developing and refining a

community development approach for ensuring that older

community members can maintain their community involvement

despite the loss of access to private transport

21

Current PhD Studies

‘Factor influencing older people’s physical activity decisions and

behaviours’ - Sharon Hetherington (submitting September 2011)

• There is overwhelming evidence that maintaining physical activity into older age has

multiple benefits for health and wellbeing yet, research suggests that at present

50% of over 65s are inadequately active.

• The project explores the reasons behind older people’s to undertake or not

undertake adequate physical activity.

‘The Experience of Food Insecurity for Elderly Tasmanians’ -

Alexandra King (PhD commenced June 2011)

• Research shows that there are elderly Australians living in the community who are

experiencing food insecurity.

• Food insecurity risks for older people stem from complex social, cultural, personal

and community factors which are frequently specific to the elderly population.

• The project will take an in-depth or longitudinal approach to teasing out the complex

interplay of these factors in food insecurity amongst elderly people.

• The project aims to capture individual experiences of ageing but also examine the

commonality of factors which impact on elderly people’s food security, as well as the

effectiveness of food security interventions for elderly people.

22

Ageing Well in Regional and Rural Areas

Note: There are very few empirical studies that make a direct urban-rural

comparisons and little solid evidence that ageing experience can be

usefully and reliable distinguished simply along regional/rural-urban divide

lines – what they share in the experience of ageing likely outweighs the

differences.

However, as a broad group regional/rural older people do appear face

some specific place-related challenges :

• Poorer health and poorer access to specialist health and human services

• Infrastructure gaps – especially transport - although not in RAC places &

community support packages, at least on aggregate statistics [AIHW]

• Lower education levels, lower incomes, and a ‘information age’ skill gap

– conservatism and resistance to change

• Compromised support structures as the result of an ageing and ‘empty

middle’ population structure.

• Sea and tree changers who have left their support networks behind

• A culture of reluctant help-seeking

BUT 23

Ageing Well in Regional and Rural Areas II Rural and Regional Living may have its advantages – although the

evidence is largely anecdotal or based on regional/rural rather than rural-

urban comparative studies.

• Community – considerable anecdotal and some empirical evidence for

supportive and caring community – especially for those with a long

history – and obligation to ‘Look out for’.

– Some questions around mental health, marginalised and incomers

• Safety: Possibly more perception than fact but perceptions are crucial –

similarly with support

• Resilience – strong narrative backed by our research – for current

ageing generations based in surviving hardship

– Stoic acceptance

– Self-reliance, independence and interdependence

– ‘Making the best of it’ ‘ Just getting on with it’

The degree to which these advantages apply to the baby boomer

generation, and especially sea and tree changers, is an open

question

24

In Summary

25

• Most are not needing to be ‘cared for’ but

simply to be provided the support that will

allow them to get on with living their lives

in the face of some extra challenges

• Remaining active, engaged and

contributing members of their

communities and families is crucial to

ageing well

a research journey health - university of tasmania · healthy eating for healthy ageing in rural...

Documents