UNIVERSITY OF TASMANIA University Department of Rural Health
- Slides: 14
UNIVERSITY OF TASMANIA University Department of Rural Health Supporting Rural ‘Ageing Well’ Dr Peter Orpin
University Department of Rural Health UNIVERSITY OF TASMANIA • Researching rural ageing • ‘Ageing Well’ • The rural context • Supporting ageing well –policy and practice www. utas. edu. au/ruralhealth 2
The 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 (Tas. COSS); Prof. Andrew Robinson (Nursing); A/Prof. Elaine Stratford (Geography & Environmental Studies); Tas. COSS; Ms Tracey Tasker (DHHS) ; Prof. James Vickers (Pathology) 3
Major Projects • Cradle-Coast Pilot – 2005 -7 – Approx. 200 participants at 18 month intervals – Future and present service needs – Very engaged and active but vulnerable • ARC Linkage Project: Community Engagement for Productive Ageing – 2008 -2011 – 69 older people, 32 services providers, 11 policy people – Ageing as normative, reluctant help-seeking due to resilience, stoicism and self reliance • Health Eating Healthy Ageing – HACC funded – Two project exploring eating option for rural older people – ‘Forget the food it’s the company that matters’ – Hidden nutritional risk 4
Ageing Well • Maximising the quality and richness of personal and social life in the face of the inevitable changes and challenges associated with the ageing process • Related to but not synonymous with: – Healthy ageing – primarily about preventing and managing chronic disease and containing health service costs • Objective health not good predictor of ageing well – Productive ageing – maintaining contribution and containing the dependency ratio – Positive ageing – psychological overtones – downplays lifetime personality traits – Successful ageing – living longer or ageing well? 5
The Rural Context – Advantage and Disadvantage • Health – poorer on most indicators – travel further for many services • Choice and access - more restricted than urban - including health, esp. specialist 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 – Ageing faster, empty ‘middle’ – Sea and tree change phenomenon • Revitalising but social churn and loss of the familiar • Incomers lack support networks – esp. family • Resources – lag behind urban in socio-economic, formal social capital and technological resources • Transport – almost total reliance on private cars due to lack of public transport – Major issue with loss of licence or family driver www. utas. edu. au/ruralhealth 6
The Rural Context – Advantage and Disadvantage • Economic Change – no overall decline - highly variable pattern –– most vulnerable are low amenity single industry areas; agriculture, mining or manufacturing. – Loss of resources exacerbated by economic in-migration. • Community – powerful ‘rural idyll/community’ narrative with plentiful anecdotal support, but research evidence mixed or missing. • Rural Culture – stoicism, resilience, self-reliance reluctant help-seeking (but changing with cohort and in-migration? ) • The Rural/Regional Case – urban-rural dichotomy becoming blurred – major change processes, demographic and social churn – Policy reliance on distance/access measures ASGC-RA • Policy and Service Planning – challenges of change and lack of small-area evidence 7
The Challenges of Ageing Largely defined by loss: • Of capacity, especially: – Mobility – Energy – threat to viability of cherished community organisations and infrastructure – Exacerbated by high demand carer roles • Time and energy demands • Decay of social networks and social skills • Of significant others through death and outmigration – Loss of spousal and/or confidants – Scattered families – Disruption of multi-generational cross family ties www. utas. edu. au/ruralhealth 8
The Challenges of Ageing • Of traditional support structures – Changing employment –especially women – Outmigration – especially younger generations – Incomers – support structures left behind in place of origin • Of important social roles and functions – Connections – Sense of meaning, identity, contribution and control • Of familiar social and cultural norms, forms and activities – Changing community structures and activities – not necessarily less but different – Incomers especially those seeking more affordable living – IT related change Result: A shrinking social world – declining engagement with age www. utas. edu. au/ruralhealth 9
BUT • To a large extent an adaptive response to declining capacity: – Volitional – Welcome – Adaptive • Adaptive Compensation – extracting greater value out of preserved capacity (Socio-emotional Selectivity Theory Carstensen 1992) • Not viewed by ORP as problem to be addressed: – Stoic, un-reflexive acceptance – ‘just get on with it’ – Reluctant help-seeking – protective of self-reliance and independence – Own business and responsibility – don’t expect anyone else, particularly government to do it for them 10
Supporting Ageing Well in Rural Regional: Policy and Service Challenges - Ageism The aged/elderly – Not a separate and distinct species – Older people encompass all the diversity of humanity– risks of categorisation in terms of years lived • Broadly similar challenges but very different rate/severity, experience and response – We age as we live – The pathologisation of ageing (providers and policy makers) compared to the normalisation of the ageing experience (older people) – Ageing cannot be cured and older people do not expect it to be. – Forced to define oppositionally in battle for scarce resources – danger of generational conflict and resentment 11
Policy and Service Challenges – ‘Aged Care’ • Support not ‘caring for’ – Focus on: • • • Social asset not social drain Capacity Choice and control Contribution and reciprocity Meaning • Reluctant help-seeking requires: – – Delivering within the context of a relationship Holistic care Sensitivity and patience – fears of loss of independence and control Flexibility and responsiveness– responding to client defined and timed need not service and organisational drivers – Preserving, building and rebuilding capacity and resources over delivering a service – Not dependent or independent but inter-dependent. 12
Policy and Service Challenges – Inbuilt tensions • A complex bureaucracy requires: – Efficient and effective organisation and delivery – Accountability • • • Financial – siloed funding Efficiency Equity Effectiveness Risk management – professional practice, OH&S, equity • Which are in tension with, and lead to restrictions on, flexibly responsive client centred approaches: – Highly and tightly regulated scopes of practice – A focus on process and output measures over outcomes – Financial and practice siloes • Lots of cracks to fall through • Episodic, fragmented, asocial care www. utas. edu. au/ruralhealth 13
University Department of Rural Health UNIVERSITY OF TASMANIA www. utas. edu. au/ruralhealth 14
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