Factors impacting on the well-being of older residents in rural communities

Negotiating the care convoys for a diverse group of older Australians living in rural communities: a large qualitative study

Whilst ageing in place is integral to international policy, there is less understanding of how individuals utilise formal services and informal supports in diverse rural environments to maintain their wellness and independence. Consequently, how older people negotiate their care within rural communities is subject to misconceptions. This paper draws on the convoy of care model to explore how older rural Australians negotiate their preferences and needs in the context of informal networks, availability of community resources, and the health and aged care system. The analysis draws on 60 in-depth interviews in six diverse rural communities across two Australian states. Three distinct care convoys are identified and demonstrate the interaction of multiple factors including individual preferences and needs, availability of family and community supports, and accessibility of local health and aged care services in the context of resource allocation. The findings highlight how families and communities compensate for a lack of accessible formal services. For older people without family and strong social networks, formal services are relied upon despite their inadequacy in some locales. This research has provided evidence that some Australian rural locales have limited resources resulting in challenges for older people to access home care and support. This results in many older people facing challenges to age in place. With aged care and health policy commonly designed for an urban context, our findings illustrate the importance of tailoring policy to respect the strengths and challenges existing in rural communities.

Employment and retirement impacts on health and wellbeing among a sample of rural Australians

Background

In Australia, it is projected that one in four individuals will be at the nominal retirement age of 65 or over by 2056; this effect is expected to be especially pronounced in rural areas. Previous findings on the effects of retirement on wellbeing have been mixed. The present study explores the effects of employment and retirement on health and wellbeing among a sample of rural Australians.

Methods

Australian Rural Mental Health Study participants who were aged 45 or over (N = 2013) were included in a series of analyses to compare the health and wellbeing of individuals with differing employment and retirement circumstances. Self-reported outcome variables included perceived physical health and everyday functioning, financial wellbeing, mental health, relationships, and satisfaction with life.

Results

Across the outcomes, participants who were employed or retired generally reported better health and wellbeing than those not in the workforce. Retired participants rated more highly than employed participants on mental health, relationships, and satisfaction with life. There was also a short-term benefit for perceived financial status for retired participants compared to employed participants, but this effect diminished over time.

Conclusions

While retirement is a significant life transition that may affect multiple facets of an individual’s life, the direction and magnitude of these effects vary depending on the retirement context, namely the pre-retirement and concurrent circumstances within which an individual is retiring. Personal perceptions of status changes may also contribute to an individual’s wellbeing more so than objective factors such as income. Policies that promote rural work/retirement opportunities and diversity and address rural disadvantage are needed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10876-9.

Coping with ageing in rural Australia

OBJECTIVE

Ageing is a time of change that might involve financial, health and social losses. To maintain well-being, older people need to engage a range of resources to cope with these losses. However, national policies mainly focus on financial resources. This study used Folkman and Lazarus's transactional theory to identify coping methods engaged by older adults living in three rural communities.

DESIGN

A qualitative research design was undertaken using an ethnographic case study approach.

SETTING

Three rural communities within northern Australia.

PARTICIPANTS

Older Australians aged 65 or over, living in their own homes.

MAIN OUTCOME MEASURES

Exploration of techniques that older adults use to cope with ageing (including both problem-focused and emotion-focused strategies).

RESULTS

People in rural areas planned their ageing journey using both problem-focused and emotion-focused coping strategies, to deal with the uncertainties of ageing. When participants could control the event, problem-focused coping strategies were mainly such as used seeking social support and planful problem-solving. Conversely, emotion-focused strategies were used to deal with uncertainty and emotive issues such as health decline, and the possibility of needing future care.

CONCLUSION

There is a need for health community workers to encourage older people to consider initiating a discussion of future care needs with their social network. This is of particular importance in rural areas, which have larger numbers of older residents and limited resources to support ageing in place.

Disparities in social determinants of health outcomes and behaviours between older adults in Alaska and the contiguous US: evidence from a national survey

Few studies have focused on understanding how sociodemographic factors impact healthy ageing in the rapidly growing population of Alaskan older adults. Therefore, the objectives of this study are to compare the health of Alaskan older adults to those in the contiguous US, and determine how the associations differ between older adults in Alaska and the contiguous US. We abstracted 165,295 respondents age 65+ from the 2016 Behavioral Risk Factor Surveillance System. We used generalised linear models to assess the associations between sociodemographic factors and six health outcomes accounting for confounders and complex sampling. In the contiguous US, females were less likely than males to be obese (OR 0.96, 95%CI 0.96-0.97), while in Alaska, females were more likely to be obese (OR 1.24, 95%CI 1.19-1.29). In the contiguous US, Alaska Natives/American Indians were more likely than respondents of other races to be smokers (OR 1.62, 95%CI 1.60-1.63), while in Alaska, the association between race and smoking was not significant (OR 1.00, 95%CI 0.94-1.06). These differences between Alaska and the contiguous US results suggest that programs designed to reduce disparities and promote healthy behaviours may need to be tailored to meet the unique needs and challenges of older adults living in Alaska.

The effect of living in communal homes on the depressive symptoms of older women living in rural areas: the mediating role of the socio-physical environment

This study examined the effects of the village communal living model on depressive symptoms, focusing on mediating roles of perceived environment among rural older women in South Korea. Data came from the sample of residents in 18 housings and their peers in the conventional housing (n = 168). Propensity score analysis and structural equation modeling were used. The results showed the effect of living in VCH on depressive symptoms was mediated distinct aspect of socio-physical environment.

Chronic ill health in a regional Victoria setting: A 13-year comparison

OBJECTIVE

High-quality data regarding the prevalence of chronic disease in rural areas are essential in understanding the challenges faced by rural populations and for informing strategies to address health care needs. This study compared the prevalence of a range of self-reported chronic conditions and utilisation of GP services and emergency department in a regional Victorian setting between two studies conducted in the same region in 2001-2003 and 2014.

DESIGN

Repeat cross-sectional studies conducted over a decade apart.

SETTING

The projects were conducted in the Goulburn Valley in regional Victoria.

PARTICIPANTS

The earlier study randomly selected households from local government lists. The later study randomly selected householders from the telephone directory.

MAIN OUTCOME MEASURES

Participants were asked whether they had been diagnosed with a range of chronic health conditions and how often they had visited a general practitioner or emergency department in the past 12 months.

RESULTS

The age-standardised prevalence of depression was higher in the 2014 study than the 2001-2003 study in men (increased by 8.0% (95% CI 4.5, 11.5%)) and women (increased by 13.7% (95% CI 8.4, 19.0%)). Similarly, the prevalence of age-standardised diabetes and hypertension was higher in 2014 than 2001-2003 (men increased by 3.6% (95% CI 0.7, 6.5% (diabetes)) and 13.6% (95% CI 8.6, 18.6% (hypertension)), women increased by 3.1% (95% CI 0.3, 6.5% (diabetes)) and 8.4% (95% CI 2.3, 14.5% (hypertension))).

CONCLUSION

The results of this study indicate that the prevalence of self-reported depression, diabetes and hypertension has increased in this regional Victorian area over the past 13 years. The reasons for these observed increases and the subsequent impact on the health care needs of regional communities warrants further investigation.

Should I Stay or Go: Rural Ageing, a Time for Reflection

(1) Background: Studies have shown that older people prefer to continue living in their own home and community as they age; however this is dependent upon available services and social support. In Australia about two thirds of people will age at home. The Australian Government provides home care packages to support ageing in place yet in rural areas not all services are available. The lack of employment opportunities in rural areas often results in family residing at a distance reducing available social support. This study aims to evaluate informal social support and its influence on ageing in place amongst older people in three Australian rural communities in Australia. (2) Methods: A multiple embedded case study was undertaken in three diverse rural communities. Eleven older rural residents ageing in place aged 65+ were interviewed about their ageing experience and plans for their future in the light of available social support along with 15 members of their social networks. Social networks were then visually depicted with the use of ecomaps and network members were interviewed. (3) Results show that kin and non-kin social networks support ageing in place however ageing is a time of change and reflection. (4) Conclusions: There is a need for more discussion within these networks when it comes to future planning.

Relative Association of Multi-Level Supportive Environments on Poor Health among Older Adults

Background: The aging of the United States population poses significant challenges to American healthcare and informal caregiving systems. Additional research is needed to understand how health promotion programs and policies based on a socio-ecological perspective impact the health and well-being of older persons. The purpose of this study was to investigate personal characteristics and supportive environments associated with poor health among older individuals aged 65 and over. Methods: This study used a cross-sectional design and was guided by a conceptual framework developed by the authors to depict the relationship between personal characteristics and environments associated with poor health status. Environment types included in this study were family, home, financial, neighborhood, and healthcare. The sample was comprised of 1319 adults aged 65 years and older residing in Central Texas. From a random selection of households, participants were administered a mail-based survey created by a community collaborative effort. Descriptive statistics and three binary logistic regression models were fitted to examine associations with poor health status (i.e., physical, mental, and combined physical/mental). Results: Two personal characteristics (number of chronic conditions and educational level) were consistently related (p < 0.05) to health outcomes. Supportive family, home, financial, neighborhood, and health care environmental factors were shown to be related (p < 0.05) to various aspects of physical or mental health outcomes. Conclusions: Multidimensional factors including personal characteristics and protective environments are related to health status among older individuals. The unique roles of each environment can help inform public health interventions to create and enhance support for older adults to engage in healthful activities and improve their physical and mental health.

Participation in rural community groups and links with psychological well-being and resilience: a cross-sectional community-based study

Background

Fostering the development of community groups can be an important part of boosting community participation and improving health and well-being outcomes in rural communities. In this article, we examine whether psychological well-being and resilience are linked to participating in particular kinds of rural community groups.

Methods

We conducted a household survey involving 176 participants aged 18 to 94 years from a medium-sized rural Australian town. We gathered data on psychological well-being (Warwick-Edinburgh Mental Well-being Scale), resilience (Brief Resilience Scale), and the types of community groups that people participated in as well as a range of characteristics of those groups, such as size, frequency of group meetings, perceived openness to new members, and whether groups had leaders, defined roles for members, hierarchies, and rules.

Results

Univariable regression analyses revealed significant links between particular group characteristics and individual psychological well-being and resilience, suggesting that the characteristics of the group that an individual participates in are strongly tied to that person’s well-being outcomes. Multivariable analyses revealed two significant independent factors. First, psychological well-being was greatest among those who participated in groups without a hierarchy, that is, equal-status relationships between members. Second, resilience was greater among those who reported having a sense of influence within a group.

Conclusions

Our findings suggest that policymakers wishing to promote participation in rural community groups for health and well-being benefits may do well to encourage the development of particular characteristics within those groups, in particular equal-status relationships and a sense of influence for all group members.

Electronic supplementary material

The online version of this article (doi:10.1186/s40359-016-0121-8) contains supplementary material, which is available to authorized users.

Psychogeriatric SOS (services-on-screen) - a unique e-health model of psychogeriatric rural and remote outreach

Mental health service delivery to rural and remote communities can be significantly impeded by the tyranny of distance. In Australia, rural and remote mental health services are characterized by limited resources stretched across geographically large and socio-economically disadvantaged regions (Inderet al., 2012; Thomaset al., 2012). Internationally, rural and remote area mental health workforce shortages are common, especially in relation to specialist mental health services for older people (McCarthyet al., 2012; Bascuet al., 2012).

Predictors of suicidal ideation in older people: a decision tree analysis

OBJECTIVES

Suicide among older adults is a major public health issue worldwide. Although studies have identified psychological, physical, and social contributors to suicidal thoughts in older adults, few have explored the specific interactions between these factors. This article used a novel statistical approach to explore predictors of suicidal ideation in a community-based sample of older adults.

DESIGN

Prospective cohort study.

PARTICIPANTS AND SETTING

Participants aged 55-85 years were randomly selected from the Hunter Region, a large regional center in New South Wales, Australia.

MEASUREMENTS

Baseline psychological, physical, and social factors, including psychological distress, physical functioning, and social support, were used to predict suicidal ideation at the 5-year follow-up. Classification and regression tree modeling was used to determine specific risk profiles for participants depending on their individual well-being in each of these key areas.

RESULTS

Psychological distress was the strongest predictor, with 25% of people with high distress reporting suicidal ideation. Within high psychological distress, lower physical functioning significantly increased the likelihood of suicidal ideation, with high distress and low functioning being associated with ideation in 50% of cases. A substantial subgroup reported suicidal ideation in the absence of psychological distress; dissatisfaction with social support was the most important predictor among this group. The performance of the model was high (area under the curve: 0.81).

CONCLUSIONS

Decision tree modeling enabled individualized "risk" profiles for suicidal ideation to be determined. Although psychological factors are important for predicting suicidal ideation, both physical and social factors significantly improved the predictive ability of the model. Assessing these factors may enhance identification of older people at risk of suicidal ideation.

Identifying environmental health priorities in underserved populations: a study of rural versus urban communities

OBJECTIVES

Understanding and effectively addressing persistent health disparities in minority communities requires a clear picture of members' concerns and priorities. This study was intended to engage residents in urban and rural communities in order to identify environmental health priorities. Specific emphasis was placed on how the communities: defined the term environment; their perceptions of environmental exposures as affecting their health; specific priorities in their communities; and differences in urban versus rural populations.

STUDY DESIGN

A community-engaged approach was used to develop and implement focus groups and compare environmental health priorities in urban versus rural communities.

METHODS

A total of eight focus groups were conducted: four in rural and four in urban communities. Topics included: defining the term environment; how the environment may affect health; and environmental priorities within their communities, using both open discussion and a predefined list. Data were analysed both qualitatively and quantitatively to identify patterns and trends.

RESULTS

There were important areas of overlap in priorities between urban and rural communities; both emphasized the importance of the social environment and shared a concern over air pollution from industrial sources. In contrast, for urban focus groups, abandoned houses and their social and physical sequelae were a high priority while concerns about adequate sewer and water services and road maintenance were high priorities in rural communities.

CONCLUSIONS

This study was able to identify environmental health priorities in urban versus rural minority communities. In contrast to some previous risk perception research, the results of this study suggest prioritization of tangible, known risks in everyday life instead of rare, disaster-related events, even in communities that have recently experienced devastating damage from tornadoes. The findings can help inform future efforts to study, understand and effectively address environmental issues, and are particularly relevant to developing effective community-based strategies in vulnerable populations.

Comparing the Future Concerns of Early Wave Baby Boomers With the Concerns of Young-Old Adults

Using data from a statewide needs assessment survey, this study examines and compares the self-reported future concerns of two age groups in Mississippi: Early wave Baby Boomers (age 55 to 64; n = 383) and the young-old (age 65 to 75; n = 349). Items under analysis focus on issues related to future concerns surrounding financial resources, health, and employment. Results from multivariate analyses of variance (MANOVA) indicate that Early wave Baby Boomers have higher levels of future concern than the young-old group in all three areas. Hierarchical regression analyses showed that the financial and employment concerns of the Baby Boomers were higher than the concerns of the older group even after subjective well-being and income were taken into account. However, age differences in health concerns disappeared after controlling for current health and well-being. These findings suggest that the financial concerns of the Baby Boomers extend to the whole cohort and not just to the most financially stressed.

The AMEL study, a cross sectional population-based survey on aging and malnutrition in 1200 elderly Lebanese living in rural settings: protocol and sample characteristics

Background

Lebanon is faced with a particular challenge because of large socioeconomic inequality and accelerated demographic transition. Rural residents seem more vulnerable because of limited access to transport, health and social services. No information is available regarding health, nutrition and living conditions of this specific population. The purpose of the AMEL (Aging and Malnutrition in Elderly Lebanese) study is to assess the nutritional status of community dwelling elderly people, aged 65 years and above, living in a rural settings in Lebanon, in line of socioeconomic factors, health and living conditions. The present paper will describe the gender specific characteristics of the study population.

Methods

AMEL is a cross-sectional population based study conducted between April 2011 and April 2012 including 1200 elderly individuals living in the 24 rural Caza (districts) of Lebanon. People aged greater than or equal to 65 y were randomly selected through multistage cluster sampling. Subjects were interviewed at their homes by trained interviewers. The questionnaire included the following measures: socio-demographic factors, nutritional status (Mini Nutritional Assessment, MNA), health related characteristics, functional ability, cognitive status, mood and social network.

Results

The sample included 591 men (49.3%) and 609 women (50.8%). Mean age was 75.32 years and similar between genders. Malnutrition (MNA < 17) and risk of malnutrition (MNA between 17 and 23.5) were present in 8.0% (95%CI 4.9%-11.1%) and 29.1% (95%CI 24.0%-34.2%) respectively of the participants, and more frequent in women (9.1% and 35.3% respectively). Regarding socio-demographic status, among women the level of illiteracy and poor income was significantly higher than in men. Moreover, chronic diseases, poor self perceived health, frailty, functional disability, depressive symptoms and cognitive impairment were particularly high and significantly more frequent in women than in men.

Conclusion

The present study provides unique information about nutritional status, health and living conditions of community dwelling rural residents of Lebanon. These findings may alert policy makers to plan appropriate intervention in order to improve the quality of life and increase successful aging.

Knowledge, perceptions and thoughts of stroke among Arab-Muslim Israelis

BACKGROUND

Age-adjusted stroke mortality rates in Israel are higher among Arabs compared with Jews; therefore, knowledge of stroke signs and prevention strategies is especially important in the Arab population. Data on stroke knowledge among Arabs in Israel are lacking.

AIM

We aimed to examine knowledge, perceptions and thoughts of stroke among Arab-Muslim Israelis.

METHODS

A complementary mixed method design was used. Ninety-nine Arab Muslims living in Israel, older than 40 years, with no history of stroke, were personally interviewed. Knowledge of stroke was assessed using quantitative analysis by a semi-structured interview. Information on perceptions and thoughts evoked by stroke was analyzed using qualitative analysis by the constant comparative method. Rates of reported knowledge-related variables were presented.

RESULTS

Mean (SD) age of participants was 50.1 (8.0) years, 52.5% were women. Most of the participants (84.8%) knew the causes of stroke but only 29.3% mentioned sudden weakness or paralysis in one side of the body as a warning sign and other warning signs were even less known. The main known risk factor was hypertension (43.3%). Although knowledge of stroke prevention was poor, 89% were interested in learning about stroke and its prevention. The qualitative findings showed that stroke evokes negative thoughts of mental and physical burden and is associated with death, disability, dependence and depression.

CONCLUSION

Levels of stroke knowledge among Arab-Muslim Israelis are low to moderate. Healthcare professionals should assist high risk populations in controlling and treating risk factors in order to reduce mortality and disability following a stroke.

Contributors to suicidality in rural communities: beyond the effects of depression

BACKGROUND

Rural populations experience a higher suicide rate than urban areas despite their comparable prevalence of depression. This suggests the identification of additional contributors is necessary to improve our understanding of suicide risk in rural regions. Investigating the independent contribution of depression, and the impact of co-existing psychiatric disorders, to suicidal ideation and suicide attempts in a rural community sample may provide clarification of the role of depression in rural suicidality.

METHODS

618 participants in the Australian Rural Mental Health Study completed the Composite International Diagnostic Interview, providing assessment of lifetime suicidal ideation and attempts, affective disorders, anxiety disorders and substance-use disorders. Logistic regression analyses explored the independent contribution of depression and additional diagnoses to suicidality. A receiver operating characteristic (ROC) analysis was performed to illustrate the benefit of assessing secondary psychiatric diagnoses when determining suicide risk.

RESULTS

Diagnostic criteria for lifetime depressive disorder were met by 28% (174) of the sample; 25% (154) had a history of suicidal ideation. Overall, 41% (63) of participants with lifetime suicidal ideation and 34% (16) of participants with a lifetime suicide attempt had no history of depression. When lifetime depression was controlled for, suicidal ideation was predicted by younger age, being currently unmarried, and lifetime anxiety or post-traumatic stress disorder. In addition to depression, suicide attempts were predicted by lifetime anxiety and drug use disorders, as well as younger age; being currently married and employed were significant protective factors. The presence of comorbid depression and PTSD significantly increased the odds of reporting a suicide attempt above either of these conditions independently.

CONCLUSIONS

While depression contributes significantly to suicidal ideation, and is a key risk factor for suicide attempts, other clinical and demographic factors played an important role in this rural sample. Consideration of the contribution of factors such as substance use and anxiety disorders to suicidal ideation and behaviours may improve our ability to identify individuals at risk of suicide. Acknowledging the contribution of these factors to rural suicide may also result in more effective approaches for the identification and treatment of at-risk individuals.