Supporting Rural ‘Ageing Well’ Dr Peter Orpin

1. Supporting Rural ‘Ageing Well’Dr Peter Orpin

2. Researching rural ageing • ‘Ageing Well’ • The rural context • Supporting ageing well –policy and practice www.utas.edu.au/ruralhealth

3. 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 RosFoskey (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)

4. 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

5. 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?

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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.

13. 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

14. www.utas.edu.au/ruralhealth