Kate O’Loughlin

Pathways to Well-Being in Later Life: Socioeconomic and Health Determinants Across the Life Course of Australian Baby Boomers

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.

Attitudes to Ageing

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.

Carer Characteristics and Health, Wellbeing and Employment Outcomes of Older Australian Baby Boomers

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.

Challenges and Opportunities for an Ageing Australia

Population ageing is a global phenomenon whose impact is only now being fully recognised and understood. Increased longevity, aspirations for improved quality of life, advances in health and better welfare provision are generally accepted as parts of a variable success story that will demand ongoing action with the expectation that populations worldwide will live to increasingly older ages (OECD 2015; WHO 2015). Governments around the world are now grappling with the significant social and economic challenges raised by population ageing: some of the notable policy responses in Australia to date include encouraging people to stay in the labour force beyond the traditional retirement age of 65 years, increasing the pension eligibility age, promoting healthy and active ageing, supporting older people to ‘age in place’ and the introduction of consumer-directed care and user-pays into aged care services.

Developing a falls prevention program for community-dwelling stroke survivors in Singapore: client and caregiver perspectives

Abstract Purpose: Drawing on the perspectives of stroke survivors, family members and domestic helpers, this study explores participants’ experiences of self-perceived fall risk factors after stroke, common fall prevention strategies used, and challenges to community participation after a fall. Methods: Semi-structured interviews were conducted in Singapore with community-dwelling stroke survivors with a previous fall (n = 9), family caregivers (n = 4), and domestic helpers (n = 4) who have cared for a stroke survivor with a previous fall. Purposive sampling was used for recruitment; all interviews were audio-recorded with permission and transcribed. Thematic analysis was conducted using NVivo (v10) software. Results: All participants shared their self-perceived intrinsic and extrinsic fall risk factors and main challenges after a fall. For stroke participants and family caregivers, motivational factors in developing safety strategies after a previous fall(s) include social connectedness, independent living and community participation. For family caregivers and domestic helpers, the stroke survivor’s safety is their top priority, however this can also lead to over-protective behavior outside of the rehabilitation process. Conclusions: Reducing the risk of falls in community-dwelling stroke survivors seems to be more important than promoting community participation among caregivers. The study findings highlight that a structured and client-centered fall prevention program targeting stroke survivors and caregivers is needed in Singapore. Implications for rehabilitation Falls after stroke can lead to functional decline in gait and mobility and restricted self-care activities. Community-dwelling stroke survivors develop adaptive safety strategies after a fall and want to be socially connected. However, caregivers see the safety of the stroke survivors as their top priority and demonstrate over-protective behaviors. Fall prevention programs for community-dwelling stroke survivors should target both stroke survivors and their caregivers. A structured and client-centered fall prevention program targeting at multiple risk factors post-stroke is needed for community-living stroke survivors.

Selection, adaptation and advantage. Later-life health and wellbeing of English migrants to Australia

ABSTRACT 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 60–64 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 the Australian-born at lower levels of education.

Therapists’ perspectives on adapting the Stepping On falls prevention programme for community-dwelling stroke survivors in Singapore

Abstract Purpose: This study investigates the perspectives of rehabilitation therapists on the implementation of fall prevention programmes with community-dwelling stroke survivors in the Singapore context, and elicits recommendations to adapt the Stepping On programme with stroke survivors. Method: Qualitative data were elicited during 4 focus groups with 23 rehabilitation therapists (15 occupational therapists [OTs]; 8 physiotherapists [PTs]) who had received training to deliver the original Stepping On programme, and had experienced delivery of fall-prevention intervention programmes locally. Collected data were analysed using thematic analysis method. Results: Three themes emerged from the focus groups describing: (a) limitations of existing falls prevention intervention for stroke clients; (b) the need to adapt the Stepping On programme to use with stroke clients; and (c) challenges in implementing fall prevention programmes in the stroke context. A series of new components were suggested to be included as part of the Stepping On after stroke (SOAS) programme, including involvement of family members and caregivers, and tailored community reintegration sessions (such as taking public transport and shopping). Conclusions: Rehabilitation therapists describe challenges in addressing fall prevention within a stroke context, and findings highlight the need for a structured, stroke-specific fall prevention programme rather than a more general approach to education and training. Contextual components identified provide valuable inputs towards the development of a culturally relevant fall prevention programme for stroke survivors in Singapore. Implications for Rehabilitation Stroke survivors living in the community are at a high risk of falls. A structured and culturally relevant fall prevention programme for community-living stroke survivors is needed. Falls prevention for community-living stroke survivors should be multi-dimensional and targeting the modifiable risk factors for falls in this group. Both stroke survivors and caregivers should be involved in any fall prevention after stroke programmes.

Assessing the Process of Retirement: a Cross-Cultural Review of Available Measures

Retirement research is now expanding beyond the post-World War II baby boomers’ retirement attitudes and plans to include the nature of their workforce exit and how successfully they adjust to their new life. These elements are collectively known as the process of retirement. However, there is insufficient research in developing countries to inform the management of their ageing populations regarding this process. This review aims to facilitate national and cross-cultural research in developing and non-English speaking countries by reviewing the existing measures of the retirement process published in English and Portuguese. The review identified 28 existing measures assessing retirement attitudes, planning, decision making, adjustment and satisfaction with retirement. Information on each scale’s item structure, internal reliability, grammatical structure and evidence of translations to other languages is presented. Of the 28 measures, 20 assessed retirement attitudes, plans and decision-making, 5 assessed adjustment to retirement and only two assessed retirement satisfaction. Only eight of the 28 scales had been translated into languages other than English. There is scope to translate measures of retirement attitudes and planning into other languages. However there is a paucity of translated measures of retirement decision-making and adjustment, and measures of retirement satisfaction in general. Within the limitations of this review, researchers are provided with the background to decide between translating existing measures or developing of more culturally appropriate assessment tools for addressing their research questions.

Erognomic education on housework for women with upper limb repetitive strain injury (RSI): a conceptual representation of therapists' clinical reasoning

Abstract Background: Ergonomic education in housework that aims to facilitate behavior change is important for women with upper limb repetitive strain injury. Therapists usually conduct such programs based on implicit reasoning. Making this reasoning explicit is important in contributing to the profession’s knowledge. Aim: To construct a conceptual representation of how occupational therapists make clinical decisions for such program. Method: Based on a constructivist-grounded theory methodology, data were collected through in-depth interviewing with 14 occupational therapists from a major hospital in Singapore. Interviews were audiotaped and transcribed. Data was analyzed with line by line, focused and axial coding with constant data comparison throughout data collection. Results: Therapists made clinical decisions based on their perceptions of their clients’ behavior change in three stages: (i) listen; (ii) try; and (iii) persevere, bearing significant similarities to the transtheoretical theory of change. The study also showed that therapists may not have considered the full range of meanings that their clients attach to housework when interacting with them, a gap that needs to be addressed. Conclusions: The present study indicates the importance of therapists’ understanding of the meanings that their clients attach to housework. Further research needs to address how to achieve this in a time-pressured clinical environment. Implications for Rehabilitation This study used qualitative research to demonstrate the process of translating therapists’ tacit knowledge into an explicit form. It elucidates the following major implications for practice when therapists conduct ergonomic education to facilitate behavior change in housework for female homemakers with upper limb RSI:The conceptual framework of clinical reasoning constructed from the results can be used to increase therapists’ awareness of how they make clinical decisions during an intervention. This framework can also be used for training new therapists. It is important for therapists to actively listen to their clients. Active listening will enable the therapists to understand and consider the personal meanings that these women attach to housework in order to facilitate a behavior change. Client–therapist interactions to facilitate clients’ willingness to change should become a major focus in such a program. Similar research should be conducted in other clinical areas to develop explicit clinical reasoning frameworks to facilitate learning of novice therapists and reflection of experienced therapists to address any gap in their clinical reasoning.