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To date, older adults have received little attention in the newly emerging technological narratives of transnational religion. This is surprising, given the strong association of later life with spiritual and religious engagement, but it likely reflects the ongoing assumption that older adults are technophobic or technologically incompetent. Drawing on ethnographic interviews with older Sinhalese Buddhist migrants from Sri Lanka, living in Melbourne, this paper explores the digital articulations of transnational religion that arise from older migrants' uses of digital media. We focus on how engagements with digital media enable older Sinhalese to respond to an urgent need to accumulate merit in later life, facilitating their temporal strategies for ageing as migrants. We argue that these digital articulations transform both the religious imaginary and the religious practices that validate and legitimize a life well‐lived. [ABSTRACT FROM AUTHOR]

Background: The global population is ageing rapidly and there is a need for strategies to promote health and wellbeing among older adults. Nutrition knowledge is a key predictor of dietary intake; therefore, effective educational programmes are urgently required to rectify poor dietary patterns. Digital health technologies provide a viable option for delivering nutrition education that is cost‐effective and widely accessible. However, few technologies have been developed to meet the unique needs and preferences of older adults. Objective: The aim of this study was to explore technology use among older adults and qualitatively determine the content needs and design preferences for an online nutrition education resource tailored to older adult consumers in Australia. Methods: Twenty adult participants aged 55 years and older (95% female) participated in one of four 2‐h participatory design workshops. In each workshop, prompted discussion questions were used to explore participants' technology use and preferences and to explore content needs and design preferences for an online nutrition education resource specific to older adults. Results: All participants were regularly using a range of different devices (e.g., smartphones, tablets and computers) and reported being comfortable doing so. Participants wanted a website that provided general nutrition information, practical advice and recipes. To enhance engagement, they sought a personalised resource that could be adjusted to suit their needs, included up‐to‐date information and allowed for easy sharing with others by exporting information as a PDF. Conclusions: Participatory design methods generate new knowledge for designing and tailoring digital health technologies to be appropriate and useful for the target audience. Specifically, older adults seek an online resource that has large and simple fonts with clear categories, providing them with practical advice and general nutrition information that can be personalised to suit their own needs and health concerns, with the option to export and print information into a paper‐based format. Patient or Public Contribution: Older adults actively participated in the development and evaluation process to generate ideas about potential features, functionalities, uses and practicalities of an online nutrition education resource. [ABSTRACT FROM AUTHOR]

Background: Non‐communicable diseases (NCDs), also known as chronic diseases, now constitute a major proportion of ill‐health across most adult and older populations including in people with intellectual disability. The current paper is a comparative analysis of prevalence of NCDs across mid‐aged and older‐aged people with mild intellectual disability. Method: Comparative data comes from two cross‐sectional surveys using similar methodology and timeframes. The analysis sample comprises mid‐aged group (30–50 years, N = 291) and older‐aged group (≥60 years, N = 391). Results: People with mild intellectual disability start developing NCDs in early to mid‐adulthood and increases with age. The mean number of NCDs in mid‐aged group was 0.86 (SD, 0.84) compared to 3.82 in older group (SD, 2.67). Conclusion: There needs to be early identification and management of NCDs using relevant health promotion and preventative measures at optimal intervention points. The training of healthcare professionals needs improvement. [ABSTRACT FROM AUTHOR]

Introduction: Occupational therapists recommending home modifications in Australia are often required by funding bodies to consider 'value' and 'value for money' (VFM); however, clear guidance on how to define and apply these concepts is not always provided. This paper reports on a qualitative study examining how the concepts of value and VFM are currently understood and operationalised by occupational therapists in Australian home modification practice, with the aim of positively contributing to both policy and practice in this area. Methods: The study utilised constructivist grounded theory to collect and analyse qualitative data from 20 occupational therapists who were currently working across Australia and had professional experience in home modifications. Findings: The grounded theory that was derived from the analysis highlights the unique position that occupational therapists occupy in home modification work as they strive to align the values of different stakeholders to create solutions that all consider to be valuable. In the absence of consistent frameworks or methods for determining value and VFM, evidence also emerged of occupational therapists using a range of individual approaches such as using formal and informal care as metrics, cheapest option approaches, and comparative costing. Conclusion: In addition to a clear need for consistent and transparent approaches to understanding and operationalising VFM in home modifications, there is also a need for further investigation into the value systems that underpin this work. A conceptualisation of occupational therapists as street‐level policy agents has proven useful here as it highlights the position occupational therapists occupy, enacting, making, and, at times, challenging policy in day‐to‐day practice as they work to align the values of the various stakeholders. [ABSTRACT FROM AUTHOR]

Loneliness is an important health issue facing older people due to its association with poor quality of life and poor health outcomes. This paper aimed to clarify key issues around loneliness among older adults and draw attention to innovative programs and the translation of emerging research into practice. Loneliness is a mismatch between a person's actual and desired social connections, experienced as negative emotions. Older adults are vulnerable to loneliness because of changes associated with ageing. As such, identifying as older is often seen as a burden, negatively impacting self‐esteem, sense of purpose and relevance, culminating in loneliness. Interventions combatting loneliness can target individuals, relationships, communities or societies. We advocate for an intersectoral approach to support healthy ageing and reduce loneliness. This will require further research to evaluate new approaches with loneliness as the primary outcome, and additional funding to translate evidence into an integrated multi‐level approach to addressing loneliness. [ABSTRACT FROM AUTHOR]

Population ageing is profoundly challenging the institutions and systems that organise paid work, healthcare, and retirement. A major response to these challenges has been to encourage older workers to remain longer in employment, thereby extending the period of 'productive life' in which they are net contributors to government revenue. Yet this strategy depends on a range of micro-level adjustments, about which relatively little is known. These include how willingly older workers and employers adjust their attitudes and practices, and what types of policies facilitate these adjustments. In this paper, we critique the major policy responses to workforce ageing in Australia to date, and consider further measures to improve recruitment and retention of older workers. We argue that a more holistic policy response will require better evidence about ageist employment barriers, late-career transitions, and older workers' job performance. We outline a research agenda to improve evidence and policy in these areas. [ABSTRACT FROM AUTHOR]

Isolating the impact of policy, demographic shifts, and market volatility on changes in income inequality is of great interest to policymakers. However, such estimation can be difficult due to the complex interactions and evolutions in the social and economic environment. Through an extended decomposition framework, this paper estimates the effect of four main components (policy, demography, market income and other factors) on the year‐over‐year changes in income inequality in Australia between 2002 and 2016. This was a period marked by substantial policy, population, and economic shifts due to factors such as the mining boom, the global financial crisis and increasing immigration. The framework also incorporates a flexible non‐parametric market income model which captures demand‐side shock better than a standard parametric model. Our results suggest that market income was the primary driver of income inequality for all segments of the income distribution in Australia over the past 15 years. Policy factors, moreover, have had the largest net impact on reducing inequality overall, especially for lower income earners. [ABSTRACT FROM AUTHOR]

Background: There is paucity of research from Australia about comorbidity in older people with intellectual disability (PwID). This paper examines the burden of chronic diseases and associated sociodemographic correlates in a cohort of PwID aged 60+. Methods: A cross‐sectional survey was used with community‐dwelling older PwID in urban/rural regions of two Australian states. Recruitment was undertaken via a multi‐prong approach and each subject (N = 391; 236 urban/155 rural) personally interviewed. Results: Findings show older PwID experience considerable multimorbidity (X = 3.8; 53.5% had 2–6 conditions). Conditions included arthritis (40%), diabetes (26%), cardiovascular diseases (23.6%), asthma (16.1%), carcinomas (10.0%) and mental health disorders (34.5%). Conclusions: There was significant multimorbidity in older PwID, with evolution of life trajectories of select conditions associated with socioeconomic disadvantage and heath facility access barriers. Greater scrutiny of progressive health debilitation leading into older age and increased engagement by healthcare systems is required earlier in the lives of PwID. [ABSTRACT FROM AUTHOR]

Background: This study contributes further research into the assessment and treatment of older psychiatric patients with medical comorbidities. Methods: A retrospective file audit was conducted at the acute inpatient psychogeriatric unit of St Vincent's Aged Mental Health Service, Melbourne, in order to determine the prevalence of certain medical comorbidities and the nature of medical interventions provided for psychogeriatric inpatients. Results: This study, investigating 165 admissions into an acute inpatient psychogeriatric unit, highlights that psychiatric and medical comorbidities are routine in this population: the vast majority (91.5%) of all inpatients had at least one medical comorbidity. Conclusions: As the population ages, psychogeriatric wards are likely to see more of the oldest‐olds, who are likely to have comorbid medical illnesses. Currently, appropriate detection, investigation, and management of these illnesses are often suboptimal and can affect quality of life, increase mortality, and complicate treatment. This paper adds to the literature about the need for integrating medical and psychiatric care to create a more comprehensive strategy for treating the older person with psychiatric illness. [ABSTRACT FROM AUTHOR]

This paper is about older people with learning disabilities who live in the country in Australia. We talked to both individuals and their carers to find out what things helped them they got older, and what things made it harder. These people said that they were well supported by the local community and particularly their doctors. However, many people in this project also reported problems about living in the country such as limited choices and being forced to make decisions they did not like. Access to support services in rural areas is known to be problematic both in Australia, and in other countries around the world, but the majority of research on the population of people ageing with learning disability has so far focussed on metropolitan residents. The authors report about select aspects of the lived experience of older adults with learning disability resident in rural locations in two states of Australia. This pilot project examined data drawn from 34 semi-structured interviews conducted with 17 older adults and 17 carers. Responses were analysed for thematic areas. It was observed that the capacity of certain rural areas to support meaningful choice-making was limited due to constraints of access to key services, including community-based aged care, generic and specialist health services, and both supported disability and aged-care residential options. Responses indicated that those living in both small- and medium-sized congregate care settings (such as group homes and residential aged-care facilities) had more limited choices and only partial (if any) control over their living situation. An understanding of the needs of older adults with learning disability resident in rural areas is important to ensure that both aged-care and disability support structures are built on individuals' needs. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aim This paper explored how gerontology experts described baby boomers, whether they challenged the popular image, and if they provided alternatives to the popularly reported baby boomer behaviours and characteristics. Methods Qualitative interviews were conducted with ten experts from different areas across Australia. The interviews were semi-structured and guided by a 'sense-making' approach to explore the baby boomer construct and identify expert narratives that differed from the popularly tendered image. Results The majority of experts were identified as baby boomers and made use of phrases associated with the popular baby boomer image, such as 'cashed up', 'reinventing retirement' and 'sea change'. Lifestyle and wealth were recognised as staple features of the popular image. To a lesser degree, the experts also recognised alternative characteristics and behaviours, including people with disabilities and those who struggle financially. Conclusions Experts appeared to identify with the popular baby boomer label, but not necessarily the accompanying stereotypes. [ABSTRACT FROM AUTHOR]

Introduction: Multimorbidity is common among people living with HIV (PLWH), with numerous cross‐sectional studies demonstrating associations with older age and past immunosuppression. Little is known about the progression of multimorbidity, particularly in the setting of long‐term access to antiretrovirals. This study aims to determine factors predictive of change in multimorbidity in PLWH. Methods: People living with HIV who attended a regional HIV service were recruited to a consented observational cohort between September 2016 and March 2020. Demographic data, laboratory results and a Cumulative Illness Rating Scale (CIRS) were collected at enrolment and first clinical review of every subsequent year. Change in CIRS score was calculated from enrolment to February 2021. Associations with change were determined through univariate and multivariate linear regression. Results: Of 253 people, median age was 58.9 [interquartile range (IQR): 51.9–64.4] years, 91.3% were male, and HIV was diagnosed a median of 22.16 years (IQR: 12.1–30.9) beforehand. Length of time in the study was a median of 134 weeks (IQR: 89.0–179.0), in which a mean CIRS score change of 1.21 (SD 2.60) was observed. Being older (p < 0.001) and having a higher body mass index (p = 0.008) and diabetes (p = 0.014) were associated with an increased likelihood of worsening multimorbidity. PLWH with a higher level of multimorbidity at baseline were less likely to worsen over time (p < 0.001). Conclusion: As diabetes and weight predict worsening multimorbidity, routine diabetes screening, body mass index measurement, and multimorbidity status awareness are recommended. [ABSTRACT FROM AUTHOR]

Objective: To describe the agents, pattern and trends of unintentional farm fatalities in Australia (2001–2020). Methods: Review of study of National Coronial Information System data. Design: Descriptive. Setting: Australia (2001–2020). Participants: All cases involving fatal work and non‐work injury events on a farm. Main outcome measures: Patterns and agents of injury events, with trends for all‐cause deaths based on rates per 10 000 farms and work‐related incidents (per 100 000 workers and 1 000 000 h worked). Results: There were 1584 unintentional farm fatalities (annual mean 79). Two‐thirds of cases were work‐related (68%). Major agents of injury were farm vehicles (39%) and machinery (26%). Persons aged over 55 years were involved in 58% of all work‐related incidents and were significantly more likely to die than younger cohorts when assessed against hours worked. Death rates involving all on‐farm fatal incidents (both work and non‐work) per 10 000 farms (p = 0.015) and work‐related rates per 100 000 workers (p = 0.015) reduced over the period, with both demonstrating a fluctuating rate. There was no change in the work‐related rates when assessed against hours worked (p = 0.276). Conclusion: Over the period, the annualised number of deaths fell by approximately 24% (98–75), with agents of injury remaining similar. General trends suggest a reduction in the overall death rates for work and non‐work incidents. However, trends were less apparent when the reduction of farms (~19%), workers (~7%) and hours worked (no change), were accounted for. Targeted approaches are required to stimulate improvements in these preventable incidents. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to explore the impact of the COVID-19 pandemic on the financial well-being of older Australian retirees. Methods: Thirty Australian retirees (16 females and 14 males), older than 65 years of age, were asked ‘Have your finances been affected by the events surrounding COVID-19?’. Data were analysed using Braun and Clarke's six-step approach, and Bronfenbrenner’s socio-ecological model was utilised to analyse thematic responses at individual, household, community and societal levels. Results: Two COVID-19- related themes emerged from interviews: COVID-19 and increased financial stress and COVID-19 and frustration with digital banking. Conclusions: This study revealed that the financial well-being of older Australians and especially self-funded retirees has been negatively impacted by the COVID-19 pandemic. Participants felt financially worse off primarily due to the volatility of the financial markets, the need to support adult children and the increased cost of living. Also, participants expressed their hesitation and frustration with digital banking services, and their desire for greater personal contact with financial institutions, particularly during times of uncertainty. [ABSTRACT FROM AUTHOR]

Currently, individuals living in rural and remote areas experience 1.4 times the total burden of chronic disease, including an 80% greater risk of late-life cognitive impairment and dementia, 2.5 times the number of preventable hospitalisations and a reduced life expectancy of up to 12 years compared to their metropolitan counterparts. Traditionally, health service planning and public health interventions have been largely built on the needs and characteristics of metropolitan populations. This disproportional focus can contribute to significant physical and cognitive health status disparities for rural and remote communities. This article focuses on existing challenges and strategies surrounding the cognitive health of rural and remote populations and provides short and long-term opportunities involving Australian public health policy and clinical practice to innovate dementia prevention for rural and remote communities. [ABSTRACT FROM AUTHOR]

This article provides a comprehensive profile of individual healthcare expenditure using the 45 and Up Study of over 267,000 NSW residents linked to administrative medical service records. Individuals aged 45 and over consume two-thirds of healthcare expenditure in Australia. We compute annual total healthcare expenditure comprising hospital admissions, emergency presentations, out-of-hospital medical consultations and diagnostic tests and subsidised drugs. The average annual expenditure in the sample is $4334 in 2009 dollars. Less than 3 per cent have zero expenditure. Health service mix varies with age, with the share of hospital expenditure increasing with age. The age trends of total expenditure and its components are then examined by key demographic, socioeconomic and health characteristics, providing important insights into future healthcare demand and a foundation for future research into the drivers of healthcare expenditures and the distribution of health subsidies. [ABSTRACT FROM AUTHOR]

The author looks at the treatment and recovery of those with heroin addiction and related policy issues, commenting on the article "Long-term mortality, remission, criminality and psychiatric comorbidity of heroin dependence: 11-year findings from the Australian Treatment Outcome Study" by Maree Teesson and colleagues in the current issue. Topics include harm reduction, relapse, and the difference between the medical and recovery care models in mental health services.

Aim: This study attempts to identify any association between length of exposure to urban environmental risk and non-infectious chronic disease in a group of Australian residents who lived in the same location for at least 20 years. Methods: Using Australian survey data, we selected 1256 participants who were 45 years and older and had lived in the same location for at least 20 years. We used logistic regression and survival analysis to identify factors associated with the presence of non-infectious chronic disease at baseline and after 7 years. Results: Results show that increasing age, living in an urban area and living in an area with a lower socioeconomic status increase the odds of having a long-term health condition. Conclusion: This study provides empirical evidence that older long-term Australian urban residents are more likely to have a non-infectious chronic disease, which may be associated with environmental exposure, than those living in rural locations. [ABSTRACT FROM AUTHOR]

Abstract Demographic and epidemiological changes have resulted in increasing numbers of elderly people, and in increasing numbers of elderly people suffering from various degrees of cognitive impairment, including dementia. It is well recognized that the presence of cognitive impairment may impact upon an older person's decision-making capacity, which has, in turn, been associated with increased acknowledgement of the need for greater accessibility to methods by which substitute decision-makers are appointed. To this end, legislation has been enacted throughout Australia to enable the appointment of substitute decision-makers in the form of guardians and financial managers. Medical practitioners are the largest group of health professional whose opinion is sought when appointments are being considered. Despite the significance of the legislation to the evaluation of elderly people with impaired cognition, many health professionals remain unaware of the provisions of the legislation and are unclear about what information will be required. The aims of this review are first, to provide health professionals with the legal context within which their evaluations of disability and capacity take place, by way of a review of the relevant guardianship and financial management legislation in each of the states and territories of Australia; and second, to discuss how these provisions relate to existing clinical practice, with suggested guidelines for the capacity assessment. The focus and quality of information that health professionals provide will be enhanced by them having a greater understanding of their role within the wider legal context by placing in their hands knowledge of the provisions of the relevant legislation. (Intern Med J 2005; 35: 482–487) [ABSTRACT FROM AUTHOR]

Background: Pain is a growing public health problem associated with significant health and functional implications. Limited data exist for Aboriginal Australians. Aims: To describe the prevalence, severity and sites of pain, analgesic use and associated factors, including depression and disability, in remote‐living Aboriginal Australians. Methods: Cross‐sectional study of 263 Aboriginal Australians aged ≥45 years from six remote Indigenous communities and the town of Derby in the Kimberley region of Western Australia between 2011 and 2013. Pain was assessed using a culturally adapted pain scale. Factors associated with pain were investigated with binary logistic regression. Results: One hundred and seventy (64.6%) participants reported having pain and 53 (20.2%) reported persistent pain. Of those reporting pain, 61 (35.9%) rated it as moderate and 70 (41.2%) as severe. The most common sites of pain were back and knee, and 38 (22.4%) participants with pain indicated three or more sites of pain. Only 70 (41.2%) participants with pain were on some type of analgesic medication. After adjustment, poor vision (odds ratio (OR) = 2.21; 95% confidence interval (CI) 1.22–4.00), hypertension (OR = 1.89; 95% CI 1.03–3.45) and heart problems (OR = 2.05; 95% CI 1.01–4.14) were associated with pain. Higher depression scores were associated with more persistent pain, but pain was not significantly associated with clinically relevant depressive symptoms, or requiring assistance with two or more personal and/or instrumental activities of daily living. Conclusion: High levels of pain were reported, although the prevalence of persistent pain was comparable to the general population. Identifying risk factors, improving pain recognition and assessment and evaluating culturally tailored management approaches should be a priority. [ABSTRACT FROM AUTHOR]

Background: The progressive increase in life expectancy of people with intellectual disability (ID) has resulted in enhanced survival into old age and has also seen a growth in research on both lifelong and emerging ageing‐related health issues. Health issues amongst provider‐supported adults have been previously studied, but these studies have not always included older community‐dwelling adults with ID. Methods: A study examining the extent of mental health of 391 community‐dwelling adults with ID age 60 and older in both metropolitan and rural areas of two East Coast Australian states was undertaken using a cross‐sectional survey. Examined were a range of demographic (age, sex, living arrangements, employment and socio‐economic status) and life (co‐morbidities, adverse life events and social support) factors. Data were parsed by two age groupings (60–65: n = 234 and >65: n = 157). Results: Findings revealed that older community‐dwelling adults with ID have many of the same mental health disorders as do other ageing people, with the exception of significant psychiatric disorders often associated with older age. Over a third (35%: n = 137) reported some one or more mental health disorders. Age, sex, location (rural or urban), financial hardship, social support or type of living arrangement were not statistically significant as risk factors for poor mental health. However, employment status was a clear predictor. Stepwise regression models showed a strong association between mental ill‐health and adverse life events and between mental ill‐health and multiple physical co‐morbidities. Conclusions: The cross‐sectional nature of the study limits causal inference. The cumulative effect of chronic health conditions and adverse life events cannot be prevented retrospectively. However, greater awareness amongst both health professionals and care staff that older adults with ID have a high likelihood of significant and/or repeated traumas and need better health care to limit physical co‐morbidity may assist in providing support that is better tailored to individual needs in older age to reduce the burden of mental ill‐health. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Little is known about how older parent caregivers from culturally and linguistically diverse (CALD) backgrounds experience caring for their family member with intellectual disability into late life. Method: In‐depth semi‐structured interviews were carried out with N = 19 family caregivers aged 50–91 from ten Italian and four Greek families. The Sociocultural Stress and Coping Model was used as a framework to interpret their experiences. Results: A number of stressors including the need to make sacrifices, physical and emotional demands, uncertain futures and challenges associated with "the system" were identified. While family members play a key role in providing support, changing values around filial responsibility were evident. Discussion: Further attention needs to be given to CALD families to address challenges associated with caring for their family member with intellectual disabilities as they age. This study also challenges assumptions that CALD families prefer to keep caring within the family long‐term. [ABSTRACT FROM AUTHOR]

Objective: To identify caregiving characteristics that are associated with financial stress in Australian carers of people with a chronic disease. Methods: Data were collected via the South Australian Health Omnibus, an annual population‐based, cross‐sectional survey. Individuals who provided care to someone with prevalent chronic conditions were asked about financial stress and caregiving characteristics. Results: Of 32.4% (988/3047) who were carers, 13.4% (132/988) experienced financial stress. Adjusting for age and household income, providing more than 20 hours of care per week (AOR = 2.39, 95% CI = 1.48‐3.86), transport assistance (AOR = 1.89, 95% CI = 1.15‐3.09) and assistance with household tasks (AOR = 1.92, 95% CI = 1.14‐3.26) and caring for a person with a mental illness (AOR = 2.01, 95% CI = 1.24‐3.28) were associated with a significant increase in odds of experiencing financial stress. Caring for a person with cancer (AOR = 0.49, 95% CI = 0.30‐0.81) or dementia (AOR = 0.40, 95% CI = 0.21‐0.76) was associated with decrease in odds. Conclusions: Financial stress was reported by more than 13% of carers, and factors other than household income were implicated. [ABSTRACT FROM AUTHOR]

Objective: To examine the prevalence and context of disability exclusion reported by people with disability, with and without communication and mobility problems. Methods: The 2015 Survey of Disability Ageing and Carers was used to measure the prevalence of reported exclusion. Tests of proportions were used to examine differences in prevalence rates. Proportional Venn diagrams were used to examine the intersection of measures of exclusion. Results: Approximately 53% of those with a communication or mobility difficulty reported at least one measure of exclusion. Among this group, 7% reported an instance of discrimination, 44% reported avoidance, and 29% reported an accessibility problem. The levels of discrimination and avoidance for those without communication or mobility difficulties were approximately half this level (16% avoidance and 3% discrimination). Avoidance and discrimination reduced with age, but accessibility was age‐invariant. Exclusion measures intersected and occurred in a variety of contexts. Conclusion: Despite protections provided in Australian law, disability exclusion persists and is high among those with communication and mobility difficulties. [ABSTRACT FROM AUTHOR]

Objective: To explore the experiences of older people receiving home care package (HCP) support following the introduction of consumer‐directed care (CDC) by the Australian government on 1 July 2015. Methods: Thirty‐one older people with existing HCP support from two service providers in regional New South Wales, Australia, participated in a face‐to‐face interview and/or a qualitative survey. Results: Analysis revealed the theme of Choices: Preferences, constraints, balancing and choosing. Participants described choosing to live at home with HCP support; however, they were constrained by poor communication and information about service changes and options, personal budgets and access to future care. HCP services remained largely unchanged during transition to CDC. Conclusion: Many aspects of the initial implementation of CDC were challenging for older people. Clear, relevant and timely communication and information about CDC and its consequences for consumers appear to be needed to enhance CDC. [ABSTRACT FROM AUTHOR]

Objective: Given recent rises in out-of-pocket health expenses, we examined the financial well-being of older Australians with multiple health conditions and disabilities. Methods: The 2014 General Social Survey was used to measure the: (i) current financial position; (ii) propensity to experience financial difficulties; and (iii) types of behaviours older people with multiple health conditions engage in to improve financial resilience. Results: Compared to older Australians with no health conditions, respondents with multiple health conditions had lower incomes and assets and a higher propensity to hold consumer debt (once controls were included). They were at a higher risk of cash flow difficulties, dissaving to meet day-to-day living expenses and exclusion from financial providers. However, the majority of people with multiple health conditions engaged in financially resilient behaviours. Conclusion: Many older Australians with multiple health conditions were in a financially precarious situation with implications for the ability to afford ongoing increases in out-of-pocket health-care costs. [ABSTRACT FROM AUTHOR]

Abstract: Adopting Kleinman's and Lock's ideas that there are cultural variations in understandings of health care and the medicalisation of ageing bodies, this study compares and contrasts older adults’ use of anti‐ageing medicine in two cultural settings. Based on 42 interviews conducted in Australia and Japan with adults aged 60 and over, findings revealed distinct pathways to initiating anti‐ageing medicine use between the two cohorts which reflect different attitudes to the medicalisation of ageing in the two settings. In Australia where consultation of medical doctors for major and minor ailments is routine for many older adults, supplement use was initiated on doctor's advice, or reactionary, in that dissatisfaction with doctors’ advice was the impetus. By contrast, many Japanese elders did not seek the advice of medical practitioners for minor health issues, considering them instead to be part of a natural process of ageing, and viewed their supplement use as co‐extensive with their use of Shokuji‐ryohou or a traditional corrective diet. Despite these cultural differences, both the Australian and Japanese elders resisted more extreme manifestations of the biomedicalisation of ageing and took anti‐ageing medicine to ward off the perceived danger of surgery in later life. [ABSTRACT FROM AUTHOR]

Objective To illustrate the use of National Transfer Accounts ( NTA) for understanding ageing and the economic life cycle in Australia. Methods The NTA methodology is applied utilising a range of unit record, demographic and administrative data sets from 1981 to 2010. Results During early and later life, total consumption (public and private) is greater than labour income. On a time series and cohort basis, we show that each successive generation has improved their level of well-being (as measured by consumption) relative to the previous years or previous cohorts from 1981 to 1982 onwards. We also show a substantial increase in labour income earned by mature age workers over this period. International comparisons show Australia to have consumption and labour income age profiles very similar to those of Canada but dissimilar to many other countries, driven by differences in demographic and policy settings. Conclusion The NTA approach provides a powerful framework to track differences in the economic life cycle across age groups, across time, across cohorts and across countries. [ABSTRACT FROM AUTHOR]

Objective To examine the role of variations in mature age labour force participation on labour force outcomes over Australia's recent past (2000-2015) and immediate future (to 2030). Methods To estimate the impact of rises in mature age participation on observed labour supply, we utilise demographic decomposition techniques. To examine future labour supply (to 2030), we simulate scenarios utilising a cohort-component projection model. Results Observed increases in mature age participation between 2000 and 2015 added approximately 786 000 mature age workers to the Australian labour force. Over the proceeding 15 years (2015-2030), conservative changes to prevailing mature age participation would add 304 000 additional workers. The speed of ageing is projected to increase and labour supply growth decrease in the next 15 years relative to that observed from 2000 to 2015. Conclusion To benefit from increased mature age labour force participation, the barriers to mature age participation must be addressed. [ABSTRACT FROM AUTHOR]

Objective Healthcare providers ( HCPs) can play an important role in supporting the sexual health of older adults; however, we know little about the experiences of older people in talking to HCPs about sex. This article examines older adults' experiences and perceptions of talking to HCPs about sex. Methods Semi-structured interviews were conducted with 30 men and 23 women aged 60 and older recruited from a national, online survey of older Australians. Data were analysed using a thematic approach. Results Most participants did not discuss sex with their HCP, and their HCP did not raise it. For those who did discuss sex with a HCP, negative and stigmatising responses were common. Positive responses could facilitate access to sexual health care. Conclusion Older people benefit when HCPs are proactive and ask about sexual health. Education in how to talk about sex with older people would also be beneficial for HCPs. [ABSTRACT FROM AUTHOR]

Objective To develop projections of the size of the Australian population aged 65 years and over eligible for disability support through the National Disability Insurance Scheme ( NDIS) for the decade following its introduction, to support planning and costing of the scheme. Methods We estimate disability and mortality transition probabilities and develop projections of the NDIS-eligible, ageing population from 2017 to 2026. Results An estimated 8000 men and 10 200 women aged 65 years and over will be eligible for support through the NDIS in 2017 (the scheme's first full year), increasing to 48 800 men and 56 900 women in 2026. Conclusions Growth in the NDIS-eligible, ageing population has implications for relative budget allocations between the NDIS and the aged-care system, and projections of the size of this population are useful for calculating the overall cost of the NDIS. [ABSTRACT FROM AUTHOR]

This article discusses how the arts and cultural activities are a vital part of a health and care system and have potential to fulfil the theme of active ageing. The changing nature of care provision in response to demographic change, fiscal pressure and increasingly consumerist attitudes on the part of care users, is considered. Selected examples of how participation in arts and cultural activities increases not only well-being but also health outcomes are then outlined. The article highlights the potential of 'cultural commissioning' and within that 'arts on prescription' - public funding of arts-related activities for people with care needs - and advocates investment in arts and cultural activities to better meet the demands of health, social care and aged care. Concluding remarks are made, and a way forward is suggested. [ABSTRACT FROM AUTHOR]

Aims The baby boomer generation poses challenges to understand how to enhance both the well-being and the continuing workforce participation of older workers. We sought to explore the role of social relations both at work and in other domains of life, in relation to the health and well-being of the baby boomer workforce in Australia. Methods Employed participants ( n = 743) born 1946-1965 inclusive provided information about their work environment, financial security and loneliness. Regressions were used to explore the relationships of those variables to well-being (work-life interference, absenteeism, job satisfaction, life satisfaction, health and psychological distress). Results Social environment indicators especially supervisor support and worker loneliness reliably increased the variance explained by demographics and work demands and control, in well-being outcomes. Conclusion To maintain the well-being and workforce participation of baby boomer generation workers, employers need to attend to creating worker-friendly environments. [ABSTRACT FROM AUTHOR]

Aim To explore the prevalence of unmet demand for training by mature age Australians and to identify the main barriers to accessing training. Methods A total of 3007 Australians aged 45-74 years were surveyed using Computer Assisted Telephone Interviewing. The sample frame was randomly selected and stratified based on the capital city and the rest of the state, and data were weighted to be nationally representative. Results Over one-third (37%) of respondents who had worked in the past five years reported wanting to attend some form of training but were unable to; these were most likely women and those aged 45-54 year. Commonly cited reasons for not being able to attend training included not being able to fit it in with work commitments, affordability and employer reluctance. Conclusion Reduction of these barriers to workplace training can improve mature age people's ability to remain engaged in the workforce. [ABSTRACT FROM AUTHOR]

The article presents the study on the health and services usage among old age Australian war veterans who are receiving health care support from the Australian government. Qualitative data gathering was designed and provide information on the group's community living, utilization of services, and the perceived burden of their family members and friends. Results were outlined and conclude the participants valuation of control to maximize and maintain their independence in their daily living.

Aim To investigate if, when and how assessments regarding residents' sexual health and needs occur within Australian residential aged care facilities. Method A census of all Australian residential aged care facilities was conducted. A survey developed specifically for the project was posted to all 2766 residential aged care services in Australia. Eight weeks were allowed for the return of surveys. Results A total of 1094 completed surveys were returned, representing a 39.7% response rate. The type of information most often collected concerned disruptive sexual behaviour, and assessments most frequently occurred following disruptive behaviour. One-quarter of facilities reported having a sexual health/needs assessment form, although only 10 facilities provided evidence of this. Conclusion Survey responses indicated that sexual health and needs are not routinely assessed in residential aged care, and facilities do not commonly have a dedicated sexual health/needs assessment form to guide them through an assessment process. [ABSTRACT FROM AUTHOR]

There is an ageing imperative in Australia as in many other industrialized nations, and these populations are extremely heterogeneous. In young adults, the factors which influence decision making for oral health care are whether the patient has the will, the time or the finances to pay for care, while for clinicians, the decisions are whether they have the skill and the resources to carry out the treatment plan. For older adults, the decision making includes all of the previous identified factors, but they are now complicated by the patient's medical and medication problems, the side effects of the medications they are taking, their cognitive status as well as the cumulative effects of a lifetime of physiological, traumatic and iatrogenic effects on the dentition and the oral cavity. The decision-making process which has evolved has been called many names, from cost-effective care to minimal invasive dentistry to rational dental care. Fundamentally, they are similar. Rational dental care has been defined as the process of decision making, which develops a treatment plan that is in the best interest of the patient after evaluating all of the modifying factors. This article will discuss the various concepts, and the strengths and weaknesses of some of these systems. It will also illustrate some of the clinical problems as there is very little evidence-based data to support any of these concepts. However, treatment planning is still an art, which can only be carried out for an individual and not a group, and the result must serve the needs of the patient and enhance the quality of his or her life. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to explore the way in which community living staff engaged with people with intellectual disability (ID) about dying and death. Method Guided by grounded theory methodology, focus groups and individual interviews were conducted with staff who had either no experience with client death, experience of a client sudden death, or a client death experience which was pre-dated by a period of end-of-life care. Results While in principle, staff unanimously supported the belief that people with ID should know about dying, there was limited in-practice engagement with clients about the topic. Engagement varied according to staff experience, client capacity to understand and the nature of the 'opportunity' to engage. Four 'opportunities' were identified: 'when family die', 'incidental opportunities', 'when clients live with someone who is dying' and 'when a client is dying'. Despite limited engagement by staff, people with ID are regularly exposed to dying and death. Conclusions People with ID have a fundamental right to know about dying and death. Sophisticated staff skills are required to ensure that people with ID can meaningfully engage with end-of-life issues as opportunities arise. [ABSTRACT FROM AUTHOR]

The article summarises and analyses the significant changes that have occurred in the Australian population between the 1981 and 2011 population censuses. Total population increased from 14.6 to 21.5 million over the 1981-2011 period, which is considered high by high-income country standards. Several charts and diagrams are also presented that show age-sex distribution in 1981 to 2011 and proportion of the population with disabilities from 1981-2009.

Winterton R, Warburton J, Oppenheimer M. The future for Meals on Wheels? Reviewing innovative approaches to meal provision for ageing populations The global phenomenon of population ageing is impacting on how community care is delivered, and a key component of health and social care services for the frail elderly is Meals on Wheels (MOW), a service that has traditionally encompassed delivering meals to older people in their homes. However, aspects of this conceptualisation of MOW are being redefined in order to address challenges posed by tightening global financial contexts, a reliance on volunteers and increasing social isolation among ageing populations. Through a review of the literature and websites from selected countries (UK, USA, Canada, Australia), this article explores and critically evaluates models of MOW delivery addressing these challenges. Findings suggest that MOW services are utilising a marketised approach, moving outside of the home and incorporating diverse volunteer roles. These findings demonstrate how services such as MOW can develop sustainable approaches to service delivery in a contemporary context. Key Practitioner Message:• A review of innovative MOW highlights service models of broader applicability;• Varied delivery models and more diverse volunteer roles appeal to new sources of volunteers;• Research into the development of sustainable models with positive client social outcomes is now required. [ABSTRACT FROM AUTHOR]

Background Considerable attention is currently being directed towards both active ageing and the revising of standards for disability services within Australia and internationally. Yet, to date, no consideration appears to have been given to ways to promote active ageing among older adults with intellectual disabilities (IDs). Methods Semi-structured interviews were conducted with 16 Australian professional direct-care support staff (service providers) about their perceptions of ageing among older adults with lifelong IDs and what active ageing might entail for an individual from this population who is currently under their care, in both the present and future. Data were analysed against the six core World Health Organization active ageing outcomes for people with IDs. Results Service providers appeared to be strongly focused on encouraging active ageing among their clients. However, their perceptions of the individual characteristics, circumstances and experiences of older adults with IDs for whom they care suggest that active ageing principles need to be applied to this group in a way that considers both their individual and diverse needs, particularly with respect to them transitioning from day services, employment or voluntary work to reduced activity, and finally to aged care facilities. The appropriateness of this group being placed in nursing homes in old age was also questioned. Conclusion Direct-care staff of older adults with IDs have a vital role to play in encouraging and facilitating active ageing, as well as informing strategies that need to be implemented to ensure appropriate care for this diverse group as they proceed to old age. [ABSTRACT FROM AUTHOR]

Background Promoting self-determination is recognized to be an essential element of disability service provision; however, the extent to which older people with intellectual disability working in supported employment are enabled to make intentional decisions about retirement is not well understood. Methods This research explored the views of older people with disability and service providers to understand the elements that impact on people's decision to retire. Seventy-six people participated in semi-structured interviews, including 33 older people with intellectual disability working in supported employment, 10 people who had retired and 30 service providers. Results Service providers strongly supported the right of people to retire; however, people with disability almost never reported the ability to make self-determined choices about retirement. Barriers to self-determination included an association between retirement, poor health and meaningless activities, which was perpetuated through structural service gaps. Conclusion Although disability services and service providers emphasize the importance of promoting self-determination for people with disability, those working in supported employment are not currently enabled to make self-directed choices about retirement. To address this requires more flexible services, better information about retirement, exposure to real experiences and assistance to express preferences and participate in problem solving throughout the lifespan. [ABSTRACT FROM AUTHOR]

Commercial gillnet and beach-seine catches of Girella tricuspidata from seven estuaries in eastern Australia were examined for differences in fork length ( LF), sex and age composition, and populations were assessed for growth and mortality. Fish 220–350 mm LF dominated landings across all estuaries sampled, regardless of gear type. Few fish >10 years of age were observed in the catches, with fish aged 3–5 years, and 4–7 years, being most abundant in the catches in the four most northern estuaries and three southern estuaries, respectively. There was considerable variation in the LF of G. tricuspidata at any given age and the oldest male and female were 21 and 24 years, respectively. There were no consistent differences between sexes or latitudinal regions in the growth and mean LF at age of fish in each individual age class between 3 and 8 years. Growth of females was greater than males in the northern region, but not elsewhere. Estimates of the instantaneous rate of total mortality ( Z) were dependent on estuary and year, ranging from 0·30 to 1·01, whereas the corresponding estimates of fishing mortality ( F) ranged from 0·12 to 0·90. Populations of G. tricuspidata appear to have been heavily exploited, primarily relying on young fish recruiting to the fishery. The ecosystem-wide effects of harvesting this dominant mobile teleost herbivore need to be assessed further. [ABSTRACT FROM AUTHOR]

The article analyses the situation in Australia where the number of aged care workers are expected to triple within 25 years. It relates the problem of highly developed countries of meeting the demand for aged care workers from the international labour market. However, one of the existing hindrance for aged care workers, is that they do not qualify for immigration under the skill-driven policy. Therefore, it is argued that a careful consideration is needed to the development of a circular migration programme in order to partly meet these needs.

Effective policy responses to the ageing of the population are a priority area for government and non-government agencies across Australia, particularly at the community level. This article focuses on the policy goal of ageing well at the local level, and more specifically, the strong principle of collaboration that underpins this goal. Too little is known about how to achieve effective collaboration in the ageing field. This article aims to address this by developing an analytical framework from the broad literature on collaborative processes, and applying this framework to data collected from interviews with stakeholders in ageing across two local communities in Queensland. While participants recognise the importance and strength of working together and provide local examples of how this has been achieved effectively, they also acknowledge the associated challenges and complexity. This all spanned the six factors of the framework: the context of ageing; the characteristics and relationships between partners; the need for adequate procedures; as well as structure and relationships aimed at building capacity; a shared sense of purpose; and access to adequate resources. [ABSTRACT FROM AUTHOR]

Background: The dental workforce, like the Australian population, is ageing. As the large baby boomer cohort retires dental shortages will likely increase.Methods: Australian Bureau of Statistics census data from 1986 to 2001 were used to examine ageing of the dental workforce and attrition of dentists aged 50 years and over. The number of dentists to retire was projected over the next 20 years.Results: Since 1986, the dental workforce has aged significantly (p < 0.01). About half of the current dental workforce is projected to retire by 2026. Generation X dentists are significantly less likely to work long hours than the baby boomer cohort of dentists (p < 0.01). This is partly due to an increase in the proportion of women in the dental workforce and male Generation X dentists being less likely to work long hours (>41 per week) than male baby boomer dentists (p < 0.01).Conclusions: Ageing of the workforce will have an impact on dentistry later than on some other professions due to the 35 per cent of dentists who work beyond 65 years of age. Nonetheless, existing dental shortages are likely to be exacerbated over the short term by the 22 per cent of dentists projected to retire over the next 10 years. [ABSTRACT FROM AUTHOR]

Objective: To examine the household factors associated with older Australian's (aged 55 years and over) purchasing a varied diet. Design and methods: National cross-sectional survey. Setting: All states and territories of Australia. Subjects: A total of 1898 households headed by adults aged 55 years and over. Main outcome measures: Food diversity was measured using the Dietary Variety Score (DVS). The DVS is the total number of food items purchased within a two-week period, from a possible 110 individual food expenditure items. Data analysis: Negative binomial regression was used to examine the association between the respondent's individual and household characteristics with the DVS, after controlling for all factors in the model. Results: Among the demographic factors, living arrangements, age and education are found to be associated with dietary diversity. Lone males, lone females, and households headed by people with no secondary school education, or aged over 75 years were most likely to experience lower levels of dietary diversity. Conclusions: The finding that both poor education and low income in old age are associated with dietary diversity suggests the need for early life-course interventions to improve nutritional outcomes. Nutrition education programs that also focus on those with poor education and low income, as well as lone person households and those aged over 75 years, may improve nutritional wellbeing, and thereby reduce public health costs. [ABSTRACT FROM AUTHOR]

Adult day groups (ADGs) are used by older adults living at home in the community in Australia. Their aim is to prevent social isolation and to maintain independence through supporting social networks and providing a program of activities that enhance the physical, intellectual and social well-being of the participants and carers. The purpose of this study was to examine the experience of and reasons why older people attend ADGs. An ethnographic study of four ADGs in Victoria, Australia was conducted over a 4-month period. The study included observation of the four ADGs and interviews with eight clients, comprising five women and three men. Four major themes were derived from data analysis. The first was related to the importance of companionship with staff and clients of the ADGs. The second revealed how participants valued keeping occupied in activities not achievable at home, while the third identified how home was experienced as a place where time passed slowly and there were insufficient things to do. Lastly, participants identified dissatisfactions with ADGs. Community based programs that foster companionship and meaningful and purposeful occupations in older age are desirable. Improvements to ADGs to better meet the occupational and activity needs of older people living at home are suggested. [ABSTRACT FROM AUTHOR]