Population ageing and the politics of demographic alarmism : implications for the nursing profession

Objectives
This article provides a brief examination of the prejudices and politics framing current public debate on population ageing in Australia and the possible implications of this for the allocation of required health and social sector resources. The role and responsibility of nurses and professional nursing organisations to engage in and influence public policy debate concerning the health and social care of older people is highlighted.

Setting
Australia

Subjects
Australia's ageing population and succeeding generations over the next 40 years

Primary argument
According to the Australian government, population ageing in Australia is poised to cause unmanageable chaos for the nation's public services. The cost of meeting the future health and social care needs of older Australians is predicted to be unsustainable. Officials argue that government has a stringent responsibility to ration current and future resources in the health and social care sector, cautioning that if this is not done, the nation's public services will ultimately collapse under the strain of the ever increasing demands placed on these services by older people. This characterisation of population ageing and its consequences to the nation's social wellbeing may however be false and misleading and needs to be questioned.

Conclusion
The nursing profession has a fundamental role to play in ensuring responsible debate about population ageing and contributing to public policy agenda setting for the effective health and social care of Australia's ageing population.

Positive ageing, neoliberalism and Australian sociology

Australian sociology has wrestled with most of the big issues facing this society; however, when it comes to one of the most significant changes to face Australia in the next 30 years, it has suddenly lost its capacity to engage with the nexus between demography, social processes and political structures. While governments have forged ahead with responsibilization agendas in health, welfare and unemployment, sociology has voiced its concern about the implications for Australia’s most disadvantaged. Yet, when it comes to population ageing, sociology has been, in large part, silent in the face of neoliberal policies of positive ageing, which have framed the ‘problem’ as a deficit that must be managed primarily by individuals and their families. This article maps the field of positive ageing, identifies key social concerns with this policy approach and asks, where is Australian sociology?

The care crunch: changing work, families and welfare in Australia

Structural shifts in labour markets and in households are impacting on the capacity of households and families to deal with risk. In Australia the post-Federation and post-war social settlement, based on the gendered assumptions underpinning the male breadwinner/female carer model, is no longer viable in an era of increasingly precarious employment, diverse family forms and deepening inequalities. Labour market and industrial relations changes, when combined with major demographic shifts such as divorce and population ageing, and increasing expectations for community care are contributing to a 'care crunch'. The article canvasses the challenge of developing a social risk protection framework that balances caring, work and quality of life.

Aged care provision in Greater Bendigo : current provision and future requirements

In the following paper, ratios which correlate aged care places with physical infrastructure requirements are developed for the regional Victorian Local Government Area of Greater Bendigo, by analysing its existing aged care facilities. These ratios are then used in conjunction with the federal government’s population based measures to model scenarios of future aged care infrastructure requirements for Greater Bendigo. Strategies for the provision of additional residential aged care facilities are explored using a matrix governed by size and configuration. Variations in these two aspects are shown to affect the location options for future facilities in Greater Bendigo.

The management of depressed elderly care recipients : family perspectives on the skills of professional carers

Recent studies have identified high levels of depression among older people, both those in their own homes and those in residential care. With the world's population ageing, it is timely for health service providers to consider how the escalating population of depressed elderly people will be managed. Although treating general practitioners may be the health professionals most expected to detect, treat, and monitor depression among the elderly, professional carers are well placed to assist in the detection and monitoring of the disorder. This study conducted individual interviews with 15 family members of depressed aged-care recipients to determine their perceptions of the skills and knowledge of depression of professional carers. Family members reported that carers are more likely to avoid than engage with their clients about depressive symptomatology and do not communicate their concerns with managers or general practitioners (GPs). Family members believed that, in general, professional carers were undertrained in these areas. The implications of these findings for health service planning and staff training are discussed.

Healthcare in continuum for an ageing population: national self monitoring or remote offshore monitoring for Australia?

Australia is a country, similar to other developed nations, confronting an ageing population with complex demographics. Ensuring continued healthcare for the ageing, while providing sufficient support for the already aged population requiring assistance, is at the forefront of the national agenda. Varied initiatives are with foci to leverage the advantages of lCTs leading to e-Health provisioning and assisted technologies. While these initiatives increasingly put budgetary constraints on local and federal governments, there is also a case for offshore resourcing of non-critical health services, to support, streamline and enhance the continuum of care, as the nation faces acute shortages of medical practitioners and nurses. However, privacy and confidentiality concerns in this context are a significant issue in Australia. In this paper, we take the position that if the National and state electronic health records system initiatives, are fully implemented, offshore resourcing can be a feasible complementary option resulting in a win-win situation of cutting costs and enabling the continuum of healthcare.

Healthcare in continuum for an ageing population - national self monitoring or remote offshore monitoring for Australia?

Australia is a country, similar to other developed nations, confronting an ageing population with complex demographics. Ensuring continued healthcare for the ageing, while providing sufficient support for the already aged population requiring assistance, is at the forefront of the national agenda. Varied initiatives are with foci to leverage the advantages of ICTs leading to e-Health provisioning and assisted technologies. While these initiatives increasingly put budgetary constraints on local and federal governments, there is also a case for offshore resourcing of non-critical health services, to support, streamline and enhance the continuum of care, as the nation faces acute shortages of medical practitioners and nurses. However, privacy and confidentiality concerns in this context are a significant issue in Australia. In this paper, we take the position that if the National and state electronic health records system initiatives, are fully implemented, offshore resourcing can be a feasible complementary option resulting in a win-win situation of cutting costs and enabling the continuum of healthcare.

Ageing well, ageing productively : the essential contribution of Australia's ageing population to the social and economic prosperity of the nation

In Australia we have become preoccupied with the potential adverse impact of our ageing population on our health and social systems. The projected cost of having increasing proportions of our population in the over 70s, retired, chronically ill category of the demographic profile is emerging as a major challenge for governments and private insurers: so much so in fact that the government is now urging older people to stay at work longer. In America, new approaches to the management and self-management of chronic diseases have been invoked to encourage and support older people to improve their quality of life and reduce their recourse to and dependence upon health care technologies, clinical interventions and health care management systems. Unless this is achieved, it is argued, the cost of looking after this emerging ‘bubble’ of elderly people will become increasingly unsustainable as fewer and fewer (proportionately) younger people work to pay the taxes that support ageing, retired, sick and dependent populations. This paper argues that we are at real risk of having our economic wealth and productivity impeded and truncated by the financial burden of looking after high demand and high cost dependants at the aged end of the social demographic. This paper offers an alternative view of our ageing population, as well as highlighting some of the assets we have in our elderly populations, and providing suggestions as to an alternative view of the phenomenon of ageing that incorporates elements such as flexible working arrangements and the application of new, enabling technologies. This approach to our ageing population dilemma is predicated on a concept of lifelong learning and social participation along with better preventive and early intervention systems of health care

Superannuation and the ageing myth

The ageing population rationale, which was the central plank underpinning compulsory superannuation, is flawed. The increase in individual wealth in the future more than compensates for the increasing number of older people. In addition to this, compulsory superannuation contributes to the ageing population problem because it provides less money to couples who wish to raise children and hence provides a disincentive for people to have children. The most appropriate method for dealing with the ageing problem is to encourage people to work longer - not because they need the money, but because it is good for their psyche and self-worth.

Sink or swim- ageing in Australia

As the number of people under the age of 65 declines, the number over 65 will double in the next half century. By 2031, it is estimated those over 65 will account for more than a quarter of the Australian population. The fastest rate of growth will be in the over-85-years category, projected to double over the next 20 years and to triple over 50 years to include 2.3 million people. Health care providers cannot afford to wait for the inevitable crises this vast demographic shift will provoke. To meet these future demands, educational and health care institutes should consider establishing interdisciplinary think-tanks for multidisciplinary research, policy development and innovations in aged care and health service delivery.
Aust Health Rev 2005: 29(2): 146-150

Marketing of place to attract and retain population in regional Australia

In Australia, as in many other developed countries, regional and rural areas are suffering from an overall decline in population with a specific loss of young adults (16-30 year olds). A decline in population, linked with the Australia-wide problems of ageing populations and diminishing birth rates, is leading to a social and economic decline in many regional cities and towns that threatens their long-term sustainability due to the lack of skilled workers and professionals. Although the loss of population from regional and rural areas has the potential to affect the national economy, it has mainly fallen to local government to combat the problem. Local government is beginning to use place marketing to attract and retain residents in addition to its traditional use of place marketing to attract industry and investment.

This exploratory paper examines regional decline in Australia and the concept of "place" marketing as means of arresting or reversing the decline, A conceptual model of place marketing by local government in Australia has been developed and a number of hypothesis are proposed for testing in future research.

Federally funded aged care provision in regional Victoria : Examining current provision and estimating future infrastructure requirements using existing population-based benchmarks

The following paper examines federally accredited and funded aged care provision in regional Victoria. Benchmarks that have been set by the Australian Department of Health and Ageing, are used to measure and compare the relative number of high and low level aged care positions and Community Aged Care Packages in six regional Victorian centres.
Using population forecasts, the additional aged care positions that each centre will require to meet the provision benchmarks in the year 2021 have been estimated. These figures are then translated into infrastructure requirements for the regional Victorian city of Greater Bendigo. This is done by surveying Greater Bendigo’s existing residential aged care facilities. Strategies for the provision of additional high and low level residential aged care infrastructure are explored using a matrix governed by size and configuration. Variations in these two aspects are shown to affect the location options for future facilities in Greater Bendigo. The implications of the benchmarks are also investigated in terms of facilities for the provision of Community Aged Care Packages.
The research is funded by a double ARC APAI grant between the Built Environment Research Group at Deakin University, The Centre for Sustainable Regional Centres at La Trobe University, the City of Greater Bendigo and the City of Warrnambool.

Cultural diversity and mental health : the relationship between leisure experiences and wellbeing in an ageing Italian community in Australia

One of the population health implications for Australia’s ageing population is that a larger proportion of the Australian community will be retired and have more time for leisure pursuits. Meaningful leisure activities for this group are thought to be a factor in promoting positive mental health. However, a search of health literature revealed a paucity of research on how older adults make use of their leisure time, what meaning these pursuits have to them, and whether their chosen leisure activities are health enhancing and promote wellbeing. Australia’s population is diverse with many cultures represented. As the population ages, mental health workers will be called upon to provide culturally-appropriate mental health services to clients from a range of ethnic groups. Literature on how people of culturally diverse backgrounds understand leisure activities is also limited. This paper reports on a study carried out in an Italian community in a large regional centre. The participants were selected based on the following criteria; aged 65 years and over, born in Italy, independently living in the community, ambulant, and retired from paid workforce. This study explored how a well-elderly group from an ethnic community derived meaning from their leisure activities and how this impacted on their mental health. Establishing the relationship between leisure and mental health in an ageing ethnic community is important because it sheds light on potential intervention strategies that can be used to maintain the mental health of people living independently in the community. Participants were interviewed using semi-structured questions about their perceptions of leisure, the meanings they derived from these activities, and their perceived impact of these activities on their health. Participant observation was also used to add trustworthiness to the data. Themes arising from the interviews and participant observation will be related to the participants’ sense of health. Results also revealed how older Italians engaged in leisure activities. Implications of the research findings will be directed towards mental health practice with older ethnic clients in community settings. The promotion of healthy lifestyles and positive mental health for Australia’s ageing population will also be discussed.

Marketing the Great South Coast : a regional approach to attracting population in Australia

In Australia, as in many other developed countries, regional and rural areas are suffering from an overall decline in population with a specific loss of young adults (16-30 year olds). A decline in population, linked with the Australia-wide problems of ageing populations and diminishing birth rates, is leading to a social and economic decline in many regional cities and towns that threaten their long-term sustainability due to the lack of skilled workers and professionals. Although the loss of population from regional and rural areas has the potential to affect the national economy, it has mainly fallen to local government to combat the problem. Local government is beginning to use place marketing to attract and retain residents in addition to its traditional use of place marketing to attract industry and investment. This paper examines the concept of “place” marketing as means of arresting or reversing the decline, and examines as a case study the approach of a group of adjoining local government areas in Australia who have developed a regional and collaborative approach to place marketing.

Belonging to a Victorian community choir : ageing, music and culture

Australia's ageing population created challenges for maintaining well-being and combating social isolation. Older Australians frequently rely on community arts organizations to enhance quality of life, specifically in health, happiness and community. Arts engagement takes place in many different contexts, from formal to informal and throughout the lifespan of the individual. Culture shapes the way in which we age and cultural identity is celebrated through the arts. This study will explore ageing and cultural diversity within Australian society through an examination of community arts engagement, specifically a community choir in Melbourne, Victoria, Australia. Much previous research concerning music engagement by older people has focused on its therapeutic applications, but there have been less attention given to healthy older people still living in communities. This paper reports on how music engagement can facilitate successful ageing be encouraging a sense of community, enhancing well-being and supporting cultural identity.