Understanding ageing well in Australian rural and regional settings: Applying an age-friendly lens.

OBJECTIVE: This study investigates how rural community-dwelling older adults' views on what is important in maintaining health and wellbeing align with the eight age-friendly domains proposed by the World Health Organisation, and which domains are most salient. DESIGN: Data were gathered through open-ended response postcards distributed using a whole-of-community approach. SETTING: The Rural City of Wangaratta, a rural local government area located in north-east Victoria. PARTICIPANTS: 262 postcards were returned by rural older adults, carers and family members. MAIN OUTCOME MEASURE: Thematic analysis of open-ended responses to the following question: what is important to you as you grow older (or your loved one), in terms of keeping healthy and well? RESULTS: Even though all eight age-friendly domains were identified as important for health and wellbeing, community and health services was the most frequently discussed domain, followed by transportation and access to outdoor spaces and buildings. However, individual-level factors, inclusive of personal activities, attitudes and capacities, were also identified as important to rural older adults. CONCLUSION: Findings support the use of the World Health Organization's age-friendly city framework in assessing what is important to rural older adults' health and wellbeing, with the community and health services domain most salient. However, individual-level activities, attitudes and capacities must also be considered.

Organizational Responsibility for Age-Friendly Social Participation: Views of Australian Rural Community Stakeholders.

This qualitative study critically explores the barriers experienced by diverse rural community stakeholders in facilitating environments that enable age-friendly social participation. Twenty-six semi-structured interviews were conducted across two rural Australian communities with stakeholders from local government, health, social care, and community organizations. Findings identify that rural community stakeholders face significant difficulties in securing resources for groups and activities catering to older adults, which subsequently impacts their capacity to undertake outreach to older adults. However, in discussing these issues, questions were raised in relation to whose responsibility it is to provide resources for community groups and organizations providing social initiatives and whose responsibility it is to engage isolated seniors. These findings provide a much-needed critical perspective on current age-friendly research by acknowledging the responsibilities of various macro-level social structures-different community-level organizations, local government, and policy in fostering environments to enable participation of diverse rural older adults.

Making rural and remote communities more age-friendly: experts' perspectives on issues, challenges, and priorities.

With the growing interest worldwide in making communities more age-friendly, it is becoming increasingly important to understand the factors that help or hinder communities in attaining this goal. In this article, we focus on rural and remote communities and present perspectives of 42 experts in the areas of aging, rural and remote issues, and policy who participated in a consensus conference on age-friendly rural and remote communities. Discussions highlighted that strengths in rural and remote communities, such as easy access to local leaders and existing partnerships, can help to further age-friendly goals; however, addressing major challenges, such as lack of infrastructure and limited availability of social and health services, requires regional or national government buy-in and funding opportunities. Age-friendly work in rural and remote communities is, therefore, ideally embedded in larger age-friendly initiatives and supported by regional or national policies, programs, and funding sources.

Understanding the role of agency in the navigation of regional dementia care and support service pathways.

INTRODUCTION: Reliable dementia care and support service pathways are essential for timely diagnoses and for reducing the delay in time from diagnosis to care and support. However, carers commonly experience difficulties in finding information about where to go and what to do before and following a dementia diagnosis. In rural and regional areas, accessing dementia care and support services can be especially challenging. This qualitative, narrative inquiry study explores the agency of carers, and people living with dementia, in their navigation of regional dementia care and support service pathways. METHODS: Semi-structured interviews were conducted with ten carers of people living with dementia from a regional location in Victoria, Australia. Data analysis was guided by the tripartite framework of Giddens' Theory of Structuration which considered the carers' intentionality, capacity and power to act in the navigation of their dementia care and support service pathways. FINDINGS: Carers had intentionality; however, they did not always have the capacity and power to act. Information played a critical role in facilitating agency. Health literacy was important - as knowledge about where to look for/find information, and knowledge gained through experience, education or learning from others. Where carers encountered barriers, they lacked capacity and power. This occurred where there was an absence of information or knowledge, incorrect information (e.g. misdiagnoses), and where government bodies impeded carers' efforts. CONCLUSIONS: Information and knowledge are critical to the progression of dementia care and support service pathways. Health literacy is a significant resource, and carers would benefit from dementia education/training. The agency of carers in navigating their dementia care and support service pathways relies on carers themselves finding information and seeking out knowledge and education. However, GPs, local health providers, and dementia organisations have an important role to play in helping carers to find information towards accessing dementia care and support services.

Perceived acceptability of online volunteer-led exercise classes: Perspectives of rural volunteer exercise leaders and older people.

OBJECTIVE: This study assessed perceived acceptability of online rural volunteer-led exercise classes among volunteer leaders and older people during the COVID-19 pandemic and interrogate differences in acceptability between older people who were currently participating in regular exercise and those who were not. METHOD: A case study was conducted of an existing volunteer-led exercise program using a cross-sectional preintervention survey (38 volunteer exercise leaders and 172 program participants). RESULTS: Thirty per cent (n = 11) of the volunteer leaders reported an interest in running the online classes. Motivations included providing opportunities for participants and keeping themselves and participants fit. Thirty-four per cent (n = 42) of the older participants reported an intent to join the online classes, which was primarily attributed to the desire to keep active and to socialise. However, over 60% of the respondents across both categories did not want to engage in online exercise classes. This was primarily attributed to a preference for face-to-face classes and lack of confidence in conducting or using online activities or services. Older participants who did not regularly exercise were statistically more likely to report perceived challenges attending an online class, and to identify the use of internet-based technologies as a barrier to attendance. CONCLUSION: Digital literacy was a challenge for the older respondents, particularly for those who were not currently engaged in regular exercise. Organisations implementing online exercise programs should recognise that this form of delivery will pose challenges to cohorts of rural older people who are not undertaking regular physical activity and address the individual and environmental barriers to digital uptake.

Media discourses on the socio-spatial rights of older people living with dementia and their carers.

INTRODUCTION: Media discourses about people living with dementia and carers contribute to the ways in which public, social spaces are designed, planned, and used. Negative media discourses play an important role in the socio-spatial exclusion of people living with dementia and stigmatising and dehumanising language prevents the achievement of genuine, rights-based dementia-friendly environments. Because the media plays a powerful role in shaping public attitudes, there is a need to understand media constructions of people living with dementia and carers in relation to their socio-spatial rights, which is the aim of this paper. METHOD: A Foucauldian-inspired discourse analysis (FDA) was conducted on the public news media texts of one regional Australian city, to identify discourses relating to the socio-spatial rights of people living with dementia and carers. Lefebvre's (1996) 'right to the city' concept was used as a conceptual framework, to define socio-spatial rights. RESULTS: Analysis revealed discourses relating to the right to urban citizenship, the right to difference and socio-spatial justice. Representations of participatory democracy, important to urban citizenship, are absent, as are the voices of people living with dementia. Through advocacy from others and a lens of citizenship, socio-spatial rights for people living with dementia, and in one instance carers, are recognised, in the context of dementia-awareness and dementia-friendly initiatives. While a lens of personhood constructs people living with dementia as historical and relational beings, a citizenship lens adds a spatial dimension. CONCLUSIONS: Advocacy and the lenses of personhood and citizenship are important in creating positive constructions of people living with dementia, however, their participation in decision-making processes would confer an active citizenship status, and the inclusion of their authentic voices in media discourse would contribute to raising awareness towards rights-based dementia-friendly communities.

Evaluating the Co-design of an Age-Friendly, Rural, Multidisciplinary Primary Care Model: A Study Protocol.

In the context of increased rates of frailty and chronic disease among older people, there is a need to develop age-friendly, integrated primary care models that place the older person at the centre of their care. However, there is little evidence about how age-friendly integrated care frameworks that are sensitive to the challenges of rural regions can be developed. This protocol paper outlines a study that will examine how the use of an age-friendly care framework (the Indigo 4Ms Framework) within a co-design process can facilitate the development of models of integrated care for rural older people within the Upper Hume region (Victoria, Australia). A co-design team will be assembled, which will include older people and individuals from local health, aged care, and community organisations. Process and outcome evaluation of the co-design activities will be undertaken to determine (1) the processes, activities and outputs that facilitate or hinder the co-design of a 4Ms integrated approach, and (2) how the use of the Indigo 4Ms Framework within a co-design process contributes to more integrated working practices. This protocol contributes to the development of a field of study examining how rural health and aged care services can become more age-friendly, with an emphasis on the role of co-design in developing integrated approaches to health care for older adults.

Age-friendly care for older adults within rural Australian health systems: An integrative review.

OBJECTIVES: To identify the core elements of interventions and models that facilitate age-friendly care for older adults within rural Australian health systems, and assess the extent to which these align with core elements of the Institute for Health Improvement's (IHI) Age-Friendly Health Systems 4Ms Model. METHODS: Peer-reviewed journal articles examining core elements of Australian rural geriatric care models were collected and analysed using an integrative review methodology. RESULTS: Identified models and interventions addressed all four core elements of the IHI model-what matters, medications, mobility and mentation. There was more evidence relating to mobility and mentation, with lesser evidence relating to medications and what matters. A series of core elements not aligned with the model were also identified. CONCLUSION: The IHI 4Ms Model appears to be applicable in the rural Australian context. More high-quality, systematic evidence is needed to investigate the core elements of age-friendly care across diverse rural contexts.

How Can the Lived Environment Support Healthy Ageing? A Spatial Indicators Framework for the Assessment of Age-Friendly Communities.

The Age-Friendly Cities and Communities Guide was released by the World Health Organization over a decade ago with the aim of creating environments that support healthy ageing. The comprehensive framework includes the domains of outdoor spaces and buildings, transportation, housing, social participation, respect and inclusion, civic participation and employment, communication and information, and community and health services. A major critique of the age-friendly community movement has argued for a more clearly defined scope of actions, the need to measure or quantify results and increase the connections to policy and funding levers. This paper provides a quantifiable spatial indicators framework to assess local lived environments according to each Age-Friendly Cities and Communities (AFC) domain. The selection of these AFC spatial indicators can be applied within local neighbourhoods, census tracts, suburbs, municipalities, or cities with minimal resource requirements other than applied spatial analysis, which addresses past critiques of the Age-Friendly Community movement. The framework has great potential for applications within local, national, and international policy and planning contexts in the future.

Mobilities of Older Chinese Rural-Urban Migrants: A Case Study in Beijing.

Along with the rapid urbanization process in Beijing, China, the number of older rural-urban migrants is increasing. This study aims to understand how Chinese rural-urban migration in older age is influenced by, and impacts on the migrants' mobilities. This study draws on a new conceptual framework of mobile vulnerability, influenced by physical, economic, institutional, social and cultural mobility, to understand older people' experiences of migration from rural to urban areas. Forty-five structured in-depth interviews with older rural-urban migrants aged 55 and over were undertaken in four study sites in Beijing, using the constant comparative method. Results demonstrate that rural household registration (hukou) is an important factor that restricts rural older migrants' institutional mobility. As older migrants' physical mobility declines, their mobile vulnerability increases. Economic mobility is the key factor that influences their intention to stay in Beijing. Older migrants also described coping strategies to improve their socio-cultural mobility post-migration. These findings will inform service planning for older rural-urban migrants aimed at maintaining their health and wellbeing.

Interrogating the Contested Spaces of Rural Aging: Implications for Research, Policy, and Practice.

Informed by a critical turn underway in rural gerontology, this article explores how the intersection of global and local trends relating to population aging and rural change create contested spaces of rural aging. The aim is to build our understanding of rural as a dynamic context within which the processes, outcomes, and experiences of aging are created, confronted, and contested by older adults and their communities. A review of key developments within gerontology and rural studies reveals how competing policies, discourses, and practices relating to healthy aging and aging in place, rural citizenship and governmentality, and social inclusion and inequality combine in particular ways to empower or disempower a diverse range of older rural adults aging in a diverse range of rural communities. The article provides a contextually sensitive perspective on potential sources of conflict and exclusion for older adults in dynamic rural spaces and further enhances our understanding of how rural physical and social environments are constructed and experienced in older age. A framework for interrogating emergent questions about aging in rural contexts is developed and implications for advancing research, policy, and practice are discussed.

A far greater sense of community: The impact of volunteer behaviour on the wellness of rural older Australians.

This paper builds on place-based research investigating the transformative potential of volunteering for service-deprived, ageing rural communities. Here, we critically explore the relationship between communities of place, voluntarism and wellness for rural older Australians. We draw on data from a large qualitative multi-site study, and utilise Ryan et al.'s (2005) systemic model of community attachment. Findings support the dual perspective of strong community sentiments through social embeddedness in rural communities; and personal interests, associated with rational choice theory, through healthy ageing practices. Both aspects have demonstrated positive impact on wellness, but also risks to wellness associated with over-expectations of volunteers.

Developing sustainable social programmes for rural ethnic seniors: perspectives of community stakeholders.

This qualitative study explores barriers to delivering sustainable rural community programmes to increase social participation among Australian ethnic seniors. In 2013, in-depth interviews were conducted with 14 stakeholders across eight rural/regional organisations that had received state government funding to provide social participation initiatives for ethnic seniors. Within interviews, participants were asked to outline factors that had enhanced or hindered their capacity to deliver the funded projects, and their plans for sustainability. Data were analysed thematically in accordance with Shediac-Rizkallah and Bone's (1998) tripartite programme sustainability framework (project design and implementation, organisational setting and broader community environment). Findings indicate that in the context of resource and staffing constraints and a lack of ethnic critical mass, programme sustainability reflected the increased capacity of rural ethnic seniors to integrate into existing community groups and maintain their own groups and activities. However, this is dependent on the ability of mainstream government, health and social care services to cater for diverse cultural needs and preferences, the ability of rural organisations to support ethnic seniors to manage their own cultural groups and activities, and the capacity of funding bodies, rural community and policy structures to maintain cultural sensitivity while compensating for the rural premium. In addition to identifying some key learnings for rural governments, health and community organisations, this research highlights the precarious nature of rural programme sustainability for ethnic seniors in the context of wider community, organisational and policy constraints.

'Although we're isolated, we're not really isolated': The value of information and communication technology for older people in rural Australia.

OBJECTIVE: Drawing from a larger study that identified the supports and services that facilitate wellness among older people from rural communities, this study examined the specific contribution made by information and communication technology (ICT). METHODS: Qualitative interviews were undertaken with 60 older adults from six Australian rural areas. A preliminary thematic analysis was conducted, followed by a higher-order inductive analysis. RESULTS: Information and communication technology use was discussed in terms of individual enrichment, and in terms of enabling connections between the individual and their social networks, community and wider service environments. CONCLUSION: Information and communication technologies may facilitate wellness for rural older people by compensating for geographical and social isolation. In the changing world of health and aged care service delivery, ICTs will be more important than ever for rural older people in building their capacity to access the services, socialisation and support that they need, regardless of location.

Local governance responses to social inclusion for older rural Victorians: building resources, opportunities and capabilities.

AIM: To explore how local governance enables access to resources, creates opportunities and increases capability for older people in rural communities to experience social inclusion. METHOD: Twenty-six semi-structured interviews were undertaken with community stakeholders across two rural communities in north-east Victoria. Stakeholders were drawn from local government, and a range of community groups and organisations, as identified in a scoping study. RESULTS: Through the provision of community resources (e.g. physical and human infrastructure, organisational partnerships), local services and supports offer social and productive environments for participation. They also build individual resources (e.g. health, skills, finances, networks) to enable older people to participate within these environments, and provide assistance to allow older people to use individual and community resources. CONCLUSIONS: Community resources are integral in facilitating the development of older people's individual resources, and opportunities and capabilities for participation. These enable greater choice in participation, and contribute to the sustainability of community resources serving ageing populations.