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This study, which was part of a larger study on the Health Status of Older People conducted in Melbourne, Australia, aimed to identify factors that discriminate between multiple and occasional falls amongst older people living at home. It used a survey of 1000 Australians aged 65 years and over. Subjects were classified as multiple fallers (two or more falls in the past year), occasional fallers (one fall in the past year), or non-fallers. Twenty-nine percent of older people who lived at home reported falling once or more in the previous 12 months. Nearly 20% of older people fell once in the previous 12 months and just under 10% fell more than once. Occasional fallers were more likely to be women (OR 1.75, 95% CI 1.26 to 2.45), to have reported back pain (OR 1.54, 95% CI 1.10 to 2.16) and were nearly twice as likely to have more than three medical conditions compared to non-fallers (OR 1.88, 95% CI 1.22 to 2.90). Multiple fallers were also more likely to be women (OR 1.61, 95% CI 1.03 to 2.51). More multiple fallers (17%) than occasional fallers (9%) reported being very afraid of falling. Intervention strategies should take into account these differing predisposing factors for multiple and occasional falls.

Australia’s Intergenerational Reports (2010, 2015) make a case for restraining public expenditure on an ageing population given the sizeable post-WWII baby boom cohort, increasing longevity, and uncertain economic prospects for younger generations. There also is concern for major disparities within older and younger generations resulting from cumulative advantages or disadvantages over the life course. Drawing on national survey data from the Attitudes to Ageing in Australia study, this article investigates perceptions of inequity between age cohorts at two time points (2009–10, 2015–17) focusing on variations by age and gender around lifelong opportunities for baby boomers compared to other groups, share of government benefits, and support for increasing pension age eligibility. The findings indicate a shift in attitudes between 2009–10 and 2015–17 with more in the younger cohorts in 2015–17 reporting better lifelong opportunities for baby boomers; and baby boomers receiving a fair share/more than a fair share of government benefits. With pension age eligibility, there is a small but significant shift in attitudes supporting the increase and a corresponding drop in those opposing it, however opposition is highly gendered with more women in each of the age cohorts opposing it at both time points. While there is a perceptible shift in younger cohorts’ attitudes towards baby boomers’ perceived advantages, overall attitudes are not totally supportive of government arguments for expenditure restraint; although a more overt public discourse on intergenerational inequity is emerging as the declining life prospects of younger cohorts are juxtaposed with tax-advantaged housing and retirement wealth of many older age Australians.

The aims of this study were to investigate patterns of home and community care (HACC) use and to identify factors influencing first HACC use among older Australian women. Our analysis included 11,133 participants from the Australian Longitudinal Study of Women's Health (1921-1926 birth cohort) linked with HACC use and mortality data from 2001 to 2011. Patterns of HACC use were analysed using a k-median cluster approach. A multivariable competing risk analysis was used to estimate the risk of first HACC use. Approximately 54% of clients used a minimum volume and number of HACC services; 25% belonged to three complex care use clusters (referring to higher volume and number of services), while the remainder were intermediate users. The initiation of HACC use was significantly associated with (1) living in remote/inner/regional areas, (2) being widowed or divorced, (3) having difficulty in managing income, (4) not receiving Veterans' Affairs benefits, (5) having chronic conditions, (6) reporting lower scores on the SF-36 health-related quality of life, and (7) poor/fair self-rated health. Our findings highlight the importance of providing a range of services to meet the diverse care needs of older women, especially in the community setting.

Background The proportion of population ageing in China will grow significantly in the next few decades but the pace of population ageing and social change vary considerably across regions. Notably, Eastern coastal areas are economically more advanced compared to the Western region. These economic disparities could result in differing adverse health outcomes. Methods We investigate geographical variations in self-rated overall health and functional limitations in a national representative sample of Chinese aged 50 years and older (n = 13,175) using the WHO Study on global AGEing and adult health (WHO SAGE). We used multivariable logistic regression to investigate urban-rural inequalities across regions, adjusting for sociodemographic and health covariates. Two main outcomes were self-rated overall health and functional limitations based on the WHO Disability Assessment Schedule 2.0 for a range of daily activities. Results The largest urban-rural differences in adverse health outcomes were in Shandong (AORs for urban versus rural of 6.32 [95% Confidence Interval 4.53–8.82] for poor or very poor self-rated overall health and 5.14 [CI 3.55–7.44] for functional limitations), followed by Jilin (AORs 2.71 [CI 2.04–3.61] and 4.72 [CI 3.43–6.49]), and Hubei (AORs 2.36 [CI 1.82–3.07] and 4.11 [CI 2.80–6.04]), respectively. Covariates significantly associated with both adverse health outcomes were older age, poor income, no health insurance, and increasing number of chronic diseases. Conclusion Our study reveals substantial disparities between urban and rural areas observed in both the well-developed areas (eg Shandong) and also the lower end of the economic spectrum (eg Hubei and Jilin). Targeted economic development policy and systematic health prevention and healthcare policies could be beneficial in improving health in later life whilst minimising geographical inequalities.

Background Major concerns have arisen about the challenges facing China in providing sufficient care to its older population in light of rapid population ageing, changing family structure, and considerable rates of internal migration. At the family level, these societal changes may produce care uncertainty which may adversely influence the psychological wellbeing of older individuals. This paper applies social support and control theories to examine the relationship between perceived availability of future care and psychological wellbeing of older adults in China, and how this relationship is moderated by economic insufficiency, health vulnerability, and urban/rural context. Methods Analyses are based on data from the China Health and Retirement Longitudinal Study, a multi-panel nationally representative household survey of the Chinese population aged 45 years and older. Data are taken from 2013 and 2011 waves of the study, with an initial sample size around 17,000, in which around 11,000–14,000 respondents are used for our final regression model. The score of depressive symptoms was measured in both waves with the Center for Epidemiologic Studies Depression Scale (CES-D10), and perceived availability of future care was measured in 2013 by asking respondents the question “Suppose that in the future, you need help with basic daily activities like eating or dressing, do you have relatives or friends (besides your spouse/partner) who would be willing and able to help you over a long period of time (yes/no)?” Results Multivariate regression analysis revealed that uncertainty regarding future care support was associated with greater depressive symptoms even after controlling for factors confounded with care uncertainty such as family structure, socio- economic status, and a lagged measure of depression. Further, older adults without an anticipated source of care faced double jeopardy in their depressive symptoms if they also experienced functional limitations. Conclusions Considering rapid aging of the Chinese population, anticipated increases in chronic disease burden, and possible attenuation of filial care, this analysis suggests that older adults in China may increasingly face health and social conditions detrimental to their mental health. Polices that remedy these concerns should be discussed, developed and implemented.

Attitudes to ageing can predispose decision-making as governments, interest groups and electorates negotiate competing demands in the context of economic constraints and social change. This paper, based on national survey data, investigates change and stability in Australian attitudes to intergenerational equity from 2009–2010 to 2015–2017, alongside concurrent socio-economic and policy change as well as cohort succession. The emphasis is on the baby-boom cohort who are viewed as significant beneficiaries of social change relative to opportunities of younger and older cohorts. Views of older people as a needy group may be changing slightly as more enter later life with substantial wealth and resources. Our results show that there is little perception of intergenerational conflict with the exception of the Millennial cohort whose life chances are compromised by economic and expenditure constraint over the past decade. Overall, attitudes remain sympathetic to older people, especially among women and people rendered vulnerable by poor health, non-home-ownership and low socio-economic positions. The findings do not align with government portrayals of intergenerational inequalities notwithstanding many having negative views of the future and ongoing expenditure restraint strategies. At what appears to be a critical turning point in the life chances of successive cohorts, the findings indicate the interplay between attitudes and social and policy change, as well as implications for social equity and processes of attitudinal change.

This study investigates the long-term impact of English adult migration to Australia by comparing health and wellbeing outcomes in later life of English migrants to their counterparts who remained in England (non-migrants) and to native-born Australians. It traces the influence of selection, adaptation and advantage as three mechanisms that can influence migrant health in later life. The analysis utilises data for a cohort aged 60 to 64 years from the Australian Life Histories and Health (LHH) survey (n=1088), a sub-study of the Australian 45 and Up Study, in combination with a matched cohort from the English Longitudinal Study of Ageing (ELSA) (n=1139). Social rather than health characteristics were found to play a role in the selection of English migrants. English migrants reported higher subjective quality of life than English non-migrants, and better physical health than the Australian-born, but their mental health outcomes did not significantly differ from the other cohorts. The comparatively better later-life outcomes for the English migrants can partly be linked to advantage, as they hold higher prestige jobs than Australian-born at lower levels of education.

China’s unprecedented population aging and social and economic change raise important issues concerning life course determinants of advantage or disadvantage into later life. Data from the China Health and Retirement Longitudinal Study (CHARLS) 2013 were analysed to identify the influence of childhood health on later life health as indicated by self-rated health and how this influence could be mediated by social and economic positions (SEP) and resources later in the life span. CHARLS provides nationally representative data on 18, 000 individuals aged 45 years and above in approximately 150 districts and 450 villages. Both multivariate logit regression model and KHB method (Karlson/Holm/Breen method) were applied to examine and decompose the life span influences on later life health. The results show that the childhood health, accounts for approximately half of the effect directly and another half of the effect indirectly through social and economic variations during adulthood. Relative living standard, marital status and urban residence are the most significant and important social and economic mediators for men; For women, living standard and secondary schooling are most influential while marital status is not significant. Implications for social and economic policies to improve later life health are discussed., Highlights • Early life health influences later life health • Early life health enables better education, adulthood SEP and resources • Lifelong disadvantage existed in health for women, minorities and rural residents • Impact of childhood health can be partially mediated by adulthood socio-economic positions and resources • Socio-economic positions and resources have larger influence on health for men than women

Background: Levels of internal migration vary significantly between countries. Australia and the United States consistently record among the highest levels of migration anywhere in the world. Very little is known, however, about the factors underlying mobility differentials. We argue that this is because existing evidence is almost exclusively based on period measures applied to cross-sectional data. Aims: We seek to advance understanding of cross-national variations in levels of residential mobility by drawing on a newly proposed suite of cohort migration measures, coupled with the recent release of internationally comparable retrospective residential history data. Data and methods: Focusing on the early cohort of baby boomers born between 1947 and 1951, the paper examines residential mobility levels and patterns in early and mid-adulthood in Australia and the United States and compares them with 14 European countries. Differences in completed levels of residential mobility are assessed in terms of four components: the proportion of a cohort who moved at least once; mean age at first move; mean age at last move; and average interval between moves. Results: While cohort analysis confirms high levels of mobility in Australia and the United States, it does not support the notion of a common ‘new world’ mobility regime distinct from other advanced economies. Conclusion: A cohort perspective offers refined insights into population mobility. The increasing availability of retrospective survey data means that researchers can now apply cohort measures to a wide range of countries.

The revised Dietary Guideline Index (DGI-2013) scores individuals’ diets according to their compliance with the Australian Dietary Guideline (ADG). This cross-sectional study assesses the diet quality of 794 community-dwelling men aged 74 years and older, living in Sydney, Australia participating in the Concord Health and Ageing in Men Project; it also examines sociodemographic and lifestyle factors associated with DGI-2013 scores; it studies associations between DGI-2103 scores and the following measures: homoeostasis model assessment – insulin resistance, LDL-cholesterol, HDL-cholesterol, TAG, blood pressure, waist:hip ratio, BMI, number of co-morbidities and medications and frailty status while also accounting for the effect of ethnicity in these relationships. Median DGI-2013 score was 93·7 (54·4, 121·2); most individuals failed to meet recommendations for vegetables, dairy products and alternatives, added sugar, unsaturated fat and SFA, fluid and discretionary foods. Lower education, income, physical activity levels and smoking were associated with low scores. After adjustments for confounders, high DGI-2013 scores were associated with lower HDL-cholesterol, lower waist:hip ratios and lower probability of being frail. Proxies of good health (fewer co-morbidities and medications) were not associated with better compliance to the ADG. However, in participants with a Mediterranean background, low DGI-2013 scores were not generally associated with poorer health. Older men demonstrated poor diet quality as assessed by the DGI-2013, and the association between dietary guidelines and health measures and indices may be influenced by ethnic background.

Purpose The influence of social capital has been shown to improve health and wellbeing. This study investigates the relationship between changes in social capital and health outcomes during a 6-year follow-up in mid to later life in Australia. Methods Nationally representative data from the Household, Income and Labour Dynamics in Australia (HILDA) survey included participants aged 45 years and over who responded in 2006, 2010 and 2012 (N = 3606). Each of the three components of social capital (connectedness, trust and participation) was measured in Waves 2006 and 2010 and categorised as: ‘never low’, ‘transitioned to low’, ‘transitioned out of low’ and ‘consistently low’. Health outcomes in 2012 included self-rated overall health, physical functioning, and mental health based on the Short Form 36-item health survey (SF-36). Multivariable logistic regression assessed changes in social capital (measured in 2006 and 2010) predicted poor health (measured in 2012), adjusting for covariates. Results Consistently low trust was significantly associated with higher odds of transitions into poor physical functioning (AOR 1.54; 95% Confidence Interval 1.06–1.22), poor mental health (AOR 1.59; 95% CI 1.08–2.36) and poor self-rated health (AOR 1.86; 95% CI 1.27–2.72). Transition into low trust was also a predictor of poor self-rated health after adjusting for covariates (AOR 1.74; 95% CI 1.11–2.73). Changes in social connectedness in both directions (transitioned out of and into low) were statistically associated with poor self-rated health (AORs 1.40; 95% CI 1.00–1.97 and 1.61; 95% CI 1.11–2.34, respectively) after adjusting for confounders as well as other social capital components. Conclusions Our longitudinal findings reveal social capital dynamics and effects on health in mid to later life. Social trust and connectedness could be important enablers for older persons to be more active in the community and potentially benefit their health and wellbeing over time. Electronic supplementary material The online version of this article (doi:10.1007/s11136-017-1655-9) contains supplementary material, which is available to authorized users.

This paper explores whether middle-income Asian countries are reorienting their health services in response to non-communicable diseases (NCDs). Malaysia, Sri Lanka, and Thailand were selected as case studies of Asian societies experiencing rapid increases both in NCDs and an aging population. While NCD programs, especially those related to diabetes and stroke, are well-established in Thailand, health services struggle to respond to increasing numbers of people with chronic health problems. Health services at all levels must plan ahead for more patients with chronic and often multiple conditions who require better integrated health care.

Supporting caregivers and enabling continued workforce participation are central strategies in Australia's response to an ageing population, however these strategies have potential disadvantages for carers, particularly women, including reduced workforce participation and retirement income, and poorer health status. This paper explores the nexus between paid work and caregiving for Australia's baby boomer cohort as this group faces unprecedented pressures to manage paid work alongside caring longer and more intensively for family members, including grandchildren. A sample of 1261 men and women aged 60 to 64 completed the 2011-12 Life Histories and Health survey, a sub-study of the New South Wales 45 and Up Study. The survey collected data on sociodemographic, psychosocial, life history and health-related variables including caregiving and employment status. Around a third (32.5%) of the sample (52.2% female) were involved in some type of caregiving at the time. Compared to non-carers, carers reported lower workforce participation (45.8% versus 54.7% for non-carers) as well as poorer health, more mobility difficulties, lower quality of life and lower self-rated SES. Carers who also cared for grandchildren were more likely to be in part-time or no paid work compared to other carers. Working carers tended to be more highly educated, have fewer mobility difficulties, better self-rated health and higher SES than non-working carers. Male carers were more likely than female carers to be in full-time or no paid work. Results indicate that reduced workforce participation and health status of caregivers varies by gender and type of caregiving. Policy reforms are recommended to mitigate these adverse consequences on those providing care, their families, employers and the community.

This study is based on findings from the Attitudes to Ageing in Australia (AAA) component of Australian Survey of Social Attitudes (AuSSA). The AAA Study is funded by the ARC Centre of Excellence in Population Ageing Research (CEPAR)

Parental bonding is cited as a determinant of mental health outcomes in childhood, adolescence and early-mid adulthood. Examination of the long-term impact for older adults is limited. We therefore examine the long-term risk of perceived poor parental bonding on mental health across the lifespan and into early-old age.Participants (N = 1255) were aged 60-64 years of age and drawn from the Australian Life Histories and Health study. Quality of parental bonding was assessed with the Parental Bonding Instrument (PBI). Self-reported history of doctors' mental health diagnoses and current treatment for each participant was recorded. Current depression was assessed with the Centre for Epidemiologic Studies Depression-8 (CESD-8). Due to known gender differences in mental health rates across the lifespan, analyses were stratified by sex.A bi-factor analysis of the PBI in a structural equation framework indicated perceived Poor Parental Quality as a risk for both ever and current depression for both sexes. For males, Over-Protective Fathers were a risk for ever and current depression, whilst overall Poor Parental Quality was a risk for reporting current depression treatment. Whilst a number of the risks associated with current depression and treatment were attenuated when controlling for current mood, parental quality remained a significant risk for having reported a lifetime diagnosis for depression and anxiety for men.Our results extend the existing literature base and demonstrate that mental health risk attributed to poor perceived parental quality continues across the life-course and into early-old age.

Background: By 2050, adults aged 80 years and over will represent around 20% of the global population. Little is known about how adults surviving into very old age use hospital services over time.Objective: The objective of the study was to examine patterns of hospital usage over a 10-year period for women who were aged 84 to 89 in 2010 and examine factors associated with increased use.Methods: Survey data from 1936 women from the 1921 to 1926 cohort of the Australian Longitudinal Study on Women's Health were matched with the state-based Admitted Patients Data Collection. Hospital use profiles were determined using repeated measures latent class analysis.Results: Four latent class trajectories were identified. One-quarter of the sample were at low risk of hospitalization, while 20.6% demonstrated increased risk of hospitalization and a further 38.1% had moderate hospitalization risk over time. Only 16.8% of the sample was classified as having high hospitalization risk. Correlates of hospital use for very old women differed according to hospital use class and were contingent on the timing of exposure (ie, short-term or long-term).Conclusions: Despite the perception that older adults place a significant burden on health care systems, the majority of women demonstrated relatively low hospital use over an extended period, even in the presence of chronic health conditions. High hospitalization risk was found to be concentrated among a small minority of these long-term survivors. The findings suggest the importance of service planning and treatment regimes that take account of the diverse trajectories of hospital use into and through advanced old age.

This article reports older Australians' preferences for aging in place and predictors of their subsequent experiences drawing on a longitudinal study in Melbourne over 16 years. At baseline, 40% ha...

Objective To explore differences between older male caregivers and non‐caregivers on health status, health behaviours and well‐being, including symptoms of anxiety. Methods Data were collected through self‐completed questionnaires and face‐to‐face interviews with 1705 community living men aged ≥70 in the Concord Health and Ageing in Men Project. Results Eleven per cent of older men were caregivers, of whom 81.7% were looking after their wives or partners. Older male caregivers did not have worse physical health or more depressive symptoms than non‐caregivers, but being a caregiver was associated with increased likelihood of reporting anxiety symptoms (OR: 2.32, 95% CI: 1.39–3.87). Caregivers had similar levels and frequencies of leisure activities but did more housework activities than non‐caregivers. Conclusion Higher anxiety levels were the main adverse health condition in older male caregivers. Strategies to assist minimising anxiety for caregivers should be a target of interventions. NHMRC, Ageing and Alzheimer's Institute, Cognitive Decline Partnership Centre (CDPC)

Background:Definitions of successful aging that incorporate dimensions of physical capacity and medical conditions are limited owing to the normative nature of experiencing medical conditions with age. We examine the capacity for older adults living in the community to live well with or without chronic disease as they age.Method:Participants (n = 1,001) were from the Melbourne Longitudinal Studies on Healthy Ageing (MELSHA) study who were aged 65+ years at baseline, were living in the community and followed for 16 years.Results:Aging was associated with not living well (OR = 1.21; p < 0.001) and having a chronic disease (OR = 1.09; p < 0.001). There was increasing proportion of older adults not living well with chronic disease as they aged. Those not living well were at a substantial risk of death with (OR = 3.63; p < 0.001) or without (OR = 3.59; p < 0.001) chronic disease.Discussion:The defining normative experience for older adults is that they are more likely to have a chronic disease and importantly not be living well with chronic disease as they age. However, it was the state of not living well that reflected the most substantial vulnerability for mortality, not chronic disease.

Background: As people in middle and lower income countries live longer, more people become sick, disabled, and frail and the demand for family caregiving grows. Thailand faces such challenges. This study investigates the relationship between caregiving and mental health among workers drawn from a large longitudinal cohort of Thai adults. Methods: Participants were drawn from the Thai Health-Risk Transition Study, a cohort study since 2005 of distance-learning adult Open University students residing nationwide. Caregiving status and binary psychological distress outcome (score 19–30 on Kessler 6) were recorded in 2009 and 2013 among cohort members who were paid workers at both years (n=33,972). Multivariate logistic regression was used to estimate the relationship between four-year longitudinal caregiving status and psychological distress in 2013, adjusting for potential covariates. Results: Longitudinal analyses revealed the transitional nature of care with 25% exiting and 10% entering the caring role during the four-year follow-up. Based on multivariate logistic regression, 2009–2013 caregiving status was significantly associated with psychological distress. Cohort members transitioning into caregiving and those who were caregivers in both 2009 and 2013 had a higher risk for psychological distress than non-caregivers (Adjusted Odds Ratios 1.40 [1.02–1.96] and 1.64 [1.16–2.33], respectively). Conclusion: Our findings provide evidence on caregiving and associated risk for psychological distress among working Thais. This adds to the limited existing literature in middle-income countries and highlights the potential pressure among caregivers in balancing work and care while preserving their own mental health. Keywords: Carers, Caregivers, Mental health, Work and health, Longitudinal data, Cohort study, Thailand

OBJECTIVES: This study aimed to investigate oral health-related factors affecting the self-assessed psychological well-being (PW) and depressive symptoms of independent-living Australians aged 79 years and over living in the community in metropolitan Melbourne. METHODS: The Melbourne Longitudinal Studies on Healthy Aging (MELSHA) program was used as the data source in this study and includes data on the health and well-being of older participants. The MELSHA baseline data collection occurred in 1994, the current study used data from the 2008 data collection and included 201 participants, who remained in the study. Data were analyzed using multiple linear regression (MLR) analysis with a stepwise procedure to identify the variables that accounted for a significant proportion of the variance in the participants' PW scores. RESULTS: Present findings indicate that oral health may play a significant mediating role in PW through maintaining a presentable and acceptable physical appearance. Some 16.4 percent of participants reported feeling concerned about their dental appearance, either "Sometimes," "Often," or "Very often." Multivariate analysis showed significantly influences on PW positive and negative affect scores (P

Aim To describe and compare the mental health and physical functioning of community-dwelling men aged 70 years and over who live alone, and those who live with their partner/spouse. Method Data were obtained from the baseline survey of the New South Wales 45 and Up Study. Mental health was measured using the Kessler Psychological Distress Scale and physical health was measured using the Medical Outcome Short Form 36 physical functioning scale. Results 37 690 community-dwelling men aged 70 years or over were included in the analyses. Men living alone were more likely to have high psychological distress scores and lower physical functioning scores compared to men living with a spouse/partner within each age group, except those 85 and over. Conclusions Specific health and welfare programs targeted to the increasing number of older men living alone may be needed to address their higher levels of psychological distress and lower levels of physical functioning.

The papers contained in this special issue of the Journal of Population Ageing originated in a session held at the 2014 International Sociological Association Conference, for which we organised a symposium for the Research Committee on Sociology of Aging, sharing the same title as this editorial. The main motivation for the symposium, and for this issue, is the recognition that outcomes in later life are influenced by social advantages and disadvantages over the life course. Of course this is a truism, but understanding the mechanisms through which such life course influences operate, and how context shapes them, is crucial to informing policy aimed at improving outcomes in later life (Dannefer and Settersten 2010). For example, we might consider how investments in childhood and early adulthood (such as in education, housing and welfare) set trajectories of accumulating advantage and disadvantage to influence outcomes in later life, or hownegative trajectories into later life thatmight be common for some population groups can be ‘broken’ by such policy driven investments. The importance of policy development with later life in mind cannot be overstated in the context of population ageing. This will not be a new argument for the readers of this journal, but it is worth recognising that much of the research that we undertake and publish makes only passing reference to the importance of the life course, even when there is a focus on inequalities. Policy responses require a thorough understanding of the most effective points in the life course for building resources and interventions that yield ongoing benefits for individuals and societies. The life course perspective provides a valuable corrective to crosssectional descriptions and policy discussions that focus on differences between age groups and generations, often in ideological laden debates on generational advantage and intergenerational justice without an acknowledgement of inequalities within generations and the importance of structural drivers of inequalities within and across generations. For adequate policy development it is crucial to elucidate the underlying social processes that underlie the emergence of inequalities over the life span. Population Ageing (2016) 9:1–7 DOI 10.1007/s12062-015-9138-7

Australia has conducted widely publicized campaigns to improve attitudes to ageing and combat ageism, however negative attitudes and discriminatory behaviours remain evident with implications for wellbeing, age equality and social inclusion. This paper examines perceptions and experiences of age discrimination in the workplace with a particular focus on those aged 55+ years. Data are from a representative national sample of adults in the Australian Attitudes to Ageing study conducted as a component of the 2015–2017 Australian Survey of Social Attitudes (n=2174). Participants responded to questions about their knowledge and experience of discrimination. Results show 23% of employed respondents experienced workplace-based discrimination, however the proportions varied by age group. Other factors with a statistically significant association with discrimination were self-assessed health status, marital status, location, and education level. The findings are discussed within public policy frameworks intended to maintain workforce participation and increase self-funded retirement as responses to population ageing.

Countries in the Asian region facing the need for developing community services for older adults may find the Australian experience illuminating. Australia has a relatively small population, approaching 20 million, 90 percent of whom are concentrated in coastal urban areas, notably Sydney and Melbourne. The Australian population has been aging at a modest rate, mainly because of the continuing arrival of younger immigrants and a continuing baby boom from 1946 to 1965. Among the minority of older people with a substantial disability, most resided in some form of long-term care accommodation, including hospitals, nursing homes, hostels, and the care-intensive sections of retirement villages. There is considerable controversy about the value base and sustainability of informal support for older Australians. Community-care services are delivered by a large number of organizations in the voluntary and public sectors. Some policymakers propose that one level of government should take full responsibility for aged care, but such radical proposals are unlikely to gain political acceptance.

OBJECTIVE To investigate the perceptions of intergenerational conflict and lifelong opportunities of the Millennial cohort. METHODS Data were collected in the Attitudes to Ageing in Australia Study as part of the 2015-2017 national Australian Survey of Social Attitudes (n = 2049, aged 18 and older). Variations by age cohorts and individual characteristics were examined in descriptive analyses and binary logistic regressions. RESULTS Overall, the majority of people at all ages thought opportunities were worse for younger people than for baby boomers, but few perceived strong conflict between younger and older people. Millennials were the most likely to perceive strong conflict. People rendered 'disadvantaged' by their socio-economic positions were more likely to perceive better opportunities for younger people and strong intergenerational conflict. CONCLUSION Policymakers should address the barriers that Millennials and other socio-economically disadvantaged people face to improve their lifelong opportunities and address increasing social inequalities in Australia.

Objectives To examine whether older adults aged 85+, with different health and functional capacities, cluster in different ways and to demonstrate whether individuals within particular clusters report differential mortality risk. Design Retrospective cohort study. Setting The Dynamic Analyses to Optimize Aging (DYNOPTA) project is a harmonization project of nine Australian longitudinal surveys of health and well‐being in adults aged 50+ between 1991 and 2006. Participants Participants were 685 older adults (female = 52%) living in the community and aged 85 to 103 at baseline who were followed until death or December 31, 2006, for survivors. Measurement Latent class analysis (LCA) analyzed self‐reported information on physical health, mental health, and functional capacity to define homogeneous classes based on probable cognitive impairment and depression status, medical conditions, and number of activities of daily living and instrumental activities of daily living. Results LCA discriminated four classes reflecting two main survival patterns. Two classes reported half the median survival days; differences between these classes were related to high vs moderate depression and extent of functional limitations. Two classes reported better survival; differences between these classes were related to functional limitations, but both had low proportions with depression and dementia. The classes with shorter survival were associated with substantively higher rates of depression and dementia. Conclusion Higher rates of baseline depression and dementia were unique characteristics of those individuals in the clusters that reported shorter survival. However, a substantial proportion of very old adults experience good mental health with better survival outcomes.

Chapter 9 focuses on the challenges and opportunities associated with implementing age-friendly approaches in Australia. In this chapter, Hal Kendig, Cathy Gong and Lisa Cannon review the evolution of Australia’s ageing population, including its increasing diversity, and consider evidence on the liveability of Australian cities, especially for disadvantaged older people. The chapter provides a review of AFCC initiatives comparing Sydney, Melbourne, and Canberra in a State and national context. It concludes with a critical assessment of both challenges and achievements associated with age-friendly work, and suggests a number of ways forward for developing and evaluating the AFCC approach in Australia.

Previous research shows that older men tend to have lower nutritional intakes and higher risk of under-nutrition compared with younger men. The objectives of this study were to describe energy and nutrient intakes, assess nutritional risk and investigate factors associated with poor intake of energy and key nutrients in community-dwelling men aged ≥75 years participating in the Concord Health and Ageing in Men Project – a longitudinal cohort study on older men in Sydney, Australia. A total of 794 men (mean age 81·4 years) had a detailed diet history interview, which was carried out by a dietitian. Dietary adequacy was assessed by comparing median intakes with nutrient reference values (NRV): estimated average requirement, adequate intake or upper level of intake. Attainment of NRV of total energy and key nutrients in older age (protein, Fe, Zn, riboflavin, Ca and vitamin D) was incorporated into a ‘key nutrients’ variable dichotomised as ‘good’ (≥5) or ‘poor’ (≤4). Using logistic regression modelling, we examined associations between key nutrients with factors known to affect food intake. Median energy intake was 8728 kJ (P5=5762 kJ, P95=12 303 kJ), and mean BMI was 27·7 (sd4·0) kg/m2. Men met their NRV for most nutrients. However, only 1 % of men met their NRV for vitamin D, only 19 % for Ca, only 30 % for K and only 33 % for dietary fibre. Multivariate logistic regression analysis showed that only country of birth was significantly associated with poor nutritional intake. Dietary intakes were adequate for most nutrients; however, only half of the participants met the NRV of ≥5 key nutrients.

In many countries like Australia and the United States, baby boomers are referred to as the ‘lucky cohort’, yet there has been little research on the origins and extent of inequalities within this cohort. This study uses path analysis to investigate direct and indirect effects of childhood and adult socioeconomic status and health on two subjective well-being measures: quality of life and life satisfaction. Retrospective life course data were obtained for 1,261 people aged 60 to 64 in the 2011–12 Life Histories and Health survey, a sub-study of the Australian 45 and Up Study. Supporting an accumulation model, the number of negative childhood and adult exposures were inversely related to both types of well-being. Consistent with a critical period model, childhood exposures had small but significant effects on subjective well-being and were relatively more important for quality of life than for life satisfaction. However, these childhood effects were largely indirect and significantly mediated by more proximal adult exposures, providing support for a pathway model. A key implication of this research is that the critical period for later life well-being is significant in adulthood rather than childhood, suggesting that there may be key opportunities for improving individuals’ later life well-being far beyond the early, formative years. This research highlights the importance of understanding how earlier life exposures impact experiences in later life, and investing in health and socioeconomic opportunities to reduce inequalities across all stages of life. Electronic supplementary material The online version of this article (doi:10.1007/s12062-015-9132-0) contains supplementary material, which is available to authorized users.

Background:Becoming widowed is a significant event. There is considerable evidence that surviving partners report substantial changes in their wellbeing and mental health. Changes can occur prior to partner's death as an anticipatory effect and consequently during the period after partner's death. For most, declines in wellbeing and mental health dissipate over time. However, there is a limited long-term evidence to compare age-normative trajectories in mental health and wellbeing with the trajectories of those who transition into widowhood.Methods:Participants (n= 652) were older adults (aged 65–94 years at baseline) from the 16-year Melbourne Longitudinal Studies on Healthy Ageing project who were either married orde facto(n= 577), or recently widowed (n= 75). Generalized Estimating Equations (GEE) examined the immediate and long-term impact of widowhood. GEE piecewise regression analyses examined the trajectories of wellbeing and mental health in those who transitioned into widowed with time centered at time of partner's death. Analyses were stratified by gender.Results:For both men and women, becoming widowed was strongly related to a strong decline in positive affect post partner's death. Otherwise, no long-term impact of widowhood on negative affect or depressive symptomology was reported.Conclusions:The impact of widowhood reports differential impacts on different indicators of wellbeing and mental health, which were inconsistent between men and women.

This research was supported by the Australian Research Council Centre of Excellence in Population Ageing Research (project number CE110001029).

Objective: The aim of the study is to present case studies and assess the impact of political, policy, consultative, and research processes used to implement Age Friendly Cities (AFC) initiatives in Australia. Method: A review and interpretation was conducted based on public documents, community consultations, survey analyses, and participant observation. Results: Governments in Australia have drawn on World Health Organization (WHO) concepts to establish AFC initiatives. In Melbourne, state political leadership established Positive Ageing plans that have reinforced local government actions. In Canberra, a baseline survey and an Older Persons Assembly were followed by modest positive ageing plans. In Sydney, a State Ageing Strategy developed a whole-of-government plan that has yet to be incorporated into budget processes. Discussion: AFC initiatives in Australia have had promising and varied starts with some aims to benefit disadvantaged older people. Notwithstanding the potential benefits, AFC influence on mainstream actions of government has been limited by uncertain political commitment and growing fiscal austerity.

There is widespread belief and evidence from clinical practice that health professionals are implicitly and explicitly ageist in their dealings with older people. However, apart from hospital and health-systems reviews, there are few large-scale population-based studies that have explored this issue across age-cohorts. The data for this paper comes from two consecutive waves of the Australian Attitudes to Ageing (AAA) module of the Australian Survey of Social Attitudes (AuSSA), conducted in 2009–10 (n=1520) and replicated in 2015–16 (n=1211). AuSSA is a cross-sectional, nationally-representative postal survey of adults (>18 years).

Our Attitudes to Ageing in Australia (AAA) Study is being conducted with the support of the ARC Centre of Excellence in Population Ageing (CEPAR).

Objectives Explore characteristics of hospital use for adults aged 85 and over in their last year of life and examine factors associated with cumulative overnight length of stay (LOS). Data source/study setting NSW 45 and Up Study linked with hospital data. Study design Longitudinal cohort study. Methods Quantile regression models were performed for men and women (N = 3145) to examine heterogeneity in predictors of overnight hospital admissions. Coefficients were estimated at the 25th, 50th, 75th and 90th percentiles of the LOS distribution. Principal findings 86% had at least one hospitalisation in their last year of life, with 60% dying in hospital. For men, first admission for organ failure was associated with a 26 day increase at the 90th LOS percentile, and a 0.22 day increase at the 10th percentile compared to men with cancer. Women admitted with influenza had decreased LOS of 20.5 days at the 75th percentile and 6 to 8 fewer days at the lower percentiles compared to those women with cancer. Conclusions Poor health behaviours were a major driver of highest LOS among older men, pointing to opportunities to achieve health care savings through prevention. For older women, influenza was associated with shorter LOS, which could be an indicator of the high and rapid mortality rates at older ages, and may be easily prevented. Other factors associated with LOS among women, included where they lived before they were admitted, and discharge destination.

Objective: The objective of the study is to identify the intrinsic, psychosocial and lifestyle factors, which, over time, predict the incidence of having a fall requiring medical attention (injurious fall) or of acquiring a fear of falling (FOF). Method: Data from 1,000 participants in the Melbourne Longitudinal Studies on Healthy Ageing (MELSHA, 1994-2005) were analyzed using cox regressions and hazard ratios. Results: The predictors of injurious falls ( n = 900, events = 200) were increasing age, slower gait speed, and being depressed. Main predictors of developing a FOF ( n = 855, events =117) were increasing age, cognitive impairment, reduced social activity, and gender. A history of falls at baseline did not predict acquiring a FOF nor did FOF predict a future fall. Discussion: The profile of the person who will have an injurious fall differs from the profile of the person who develops a FOF and should be considered when designing interventions.

Introduction Baby Boomers are working and living longer than their pre-war counterparts, and are more likely to live in high density urban housing. This paper examines the relationship between housing type, working status and location of residence on health status in Baby Boomers. Methods We investigated location of residence and housing type in 1009 participants of the Ageing Baby Boomers in Australia (ABBA) Study to identify any predictors of, or correlations between, these variables and health status. Results Current workers were less likely to report depression than retirees. We found a significantly higher rate of diabetes, obesity and hypertension in retirees than in current workers however rates of obesity, diabetes and hypertension were higher than predicted in current workers. Conclusion The rates of chronic disease are higher than previous estimates and provide evidence to inform health promotion programs designed to increase physical activity and improve eating habits in baby boomers.

Over the past three decades, the United Nations (UN) has slowly devoted increasing attention to global ageing. Concern for individually based welfare or health-care programs for older people in developed countries has progressed to also consider the contributions of older people and implications of ageing for socioeconomic advancement in developing countries, including those in Asia Oceania. These shifts are evident in the International Plans of Action on Ageing from Vienna in 1982 to Madrid in 2002; recent 10-year reviews of the Madrid Plan; and current advocacy for inclusion of ageing in the influential UN Millennium Plan post-2015. Australia has demonstrated progressive policies and contributed to ageing developments by the UN, International Federation on Ageing the World Health Organization and the International Association of Gerontology. Key ideas driving further action are the importance of valuing people at all ages, addressing inequalities over the life-course and implementing human rights approaches to ageing.

The first of the baby boomers have reached retirement age, but some have retired ‘early’ with varying degrees of personal choice. Preparation for retirement can lead to well-being in later life, but few studies have considered the preparations of involuntary retirees or the pathways that link their preparations with retirement outcomes. This research draws on a sample of 304 retirees from the Ageing Baby Boomers in Australia Study (2009) to examine how preparedness for retirement relates to voluntary and involuntary retirees' life satisfaction and how this relationship is explained by psychological, activity-based, and economic theories. Preparedness predicted life satisfaction for voluntary and involuntary retirees and each of theoretical pathways was supported. Although those retiring involuntarily were less prepared than voluntary retirees, their preparatory behaviours were still associated with life satisfaction. These results suggest that retirement policy and planning initiatives should aim to facilitate a holistic approach to retirement planning for future retirees, particularly those facing an early and unexpected retirement.

AIM: The aims of the present study were to describe the trajectories of self-reported hearing difficulties over time, and evaluate the impacts of age, sex, lifestyle factors and social activity, in explaining individual differences in patterns of change over time. METHODS: As part of the Melbourne Longitudinal Studies on Healthy Aging (MELSHA) Program, the hearing status of 947 adults aged 65 years and older, across five measurement periods (over 10 years), were analyzed using Latent Growth Curve Modeling analysis. A multidimensional survey was also administered, which included questions relating to sociodemographic variables, self-reported hearing difficulties, nutrition, smoking habits and level of social activity. RESULTS: Although there was a general increase in hearing difficulties over time, older age, poor nutrition, a lifetime of smoking and increased social activity predicted more rapid increases in hearing difficulty over time. CONCLUSIONS: Findings support the importance of lifestyle factors in reducing the rate of perceived hearing difficulties in older people, and provide further evidence of the links between lifestyle and sensory loss in older people. Poor nutrition and smoking are areas that both clinicians and public health professionals should address in their work with older people.

‘Aged care’ is becoming a central concern in Australian society at large as well as for governments that aim to sustain the well-being of frail, older Australians. Timely and adequate health and aged care services are required to meet the challenges of the steady increase in people at advanced ages and the rising prevalence of chronic diseases. This chapter constructively examines ‘support and care’, inclusive of consumers and caregivers, provider organisations and care professionals, policymakers and governments. It presents a forward-looking view and identifies some complex issues and challenges in developing new directions for more effective systems of care and support. Key philosophies underpinning new approaches, such as person-centred care, reablement and consumer directed care, are highlighted, as well as efforts to improve quality assurance and better balance of provisions across care settings. Finally, the chapter identifies issues that will need to be addressed over the 10-year period from 2012 set by the government for implementation of its aged care reforms.

This chapter provides an overview of age-based attitudes and stereotypes, how they originate and are perpetuated in society, and the challenges and opportunities they present for individuals and the community. It examines intergenerational attitudes (younger to older, older to younger), who is most likely to be affected by age discrimination, and the available evidence on how these attitudes and stereotypes are manifested in the workplace, media, public institutions, the health care system and policy discourses and strategies. It considers the impacts on older people themselves as well as legislative and policy initiatives aimed at developing more constructive views on ageing and older people.