From stress to distress: Conceptualizing the British family farming patriarchal way of life

‘Rural stress’ and ‘farming stress’ are terms that have become commonly appropriated by British health-based academic disciplines, the medical profession and social support networks, especially since the agricultural ‘crises’ of B.S.E. and Foot and Mouth Disease. Looking beyond the media headlines, it is apparent that the terms in fact are colloquial catch-alls for visible psychological and physiological outcomes shown by individuals. Seldom have the underlying causes and origins of presentable medical outcomes been probed, particularly within the context of the patriarchal and traditionally patrilineal way of life which family forms of farming business activity in Britain encapsulate. Thus, this paper argues that insufficient attention has been paid to the conceptualization of the terms. They have become both over-used and ill-defined in their application to British family farm individuals and their life situations. A conceptual framework is outlined that attempts to shift the stress research agenda into the unilluminated spaces of the family farming ‘way of life’ and focus instead on ‘distress’. Drawing upon theorization from agricultural and feminist geography together with cultural approaches from rural geography, four distinct clusters of distress originate from the thoughts of individuals and the social practices now required to enact patriarchal family farming gender identities. These are explored using case study evidence from ethnographic repeated life history interviews with members of seven farming families in Powys, Mid Wales, an area dominated by family forms of farming business. Future research agendas need to be based firmly on the distressing reality of patriarchal family farming and also be inclusive of those who, having rejected the associated way of life, now lie beyond the farm gate.

A Review of Demographic Ageing in the UK: Opportunities for Rural Research

Demographic ageing is a global phenomenon. UK policy and research have, until recently, focused on national trends and implications and largely viewed ageing as a 'pensions and care' problem. While other and more positive aspects are beginning to be acknowledged, regional, local, and rural impacts remain underinvestigated. This paper, by reviewing the literature from several disciplines and countries, introduces a series of research questions that could usefully inform future geographical inquiry. It argues that the nature, experiences, and consequences of demographic ageing will vary across space, stage in the life course and numerous aspects of our everyday lives. Our current knowledge and understanding are but the tip of the iceberg in terms of the research opportunities that lie ahead.

Ageing in changing community contexts: Cross-border perspectives from rural Ireland and Northern Ireland

Ongoing demographic, social, economic and cultural changes point to the dynamic and continually changing contexts of rural areas in Ireland and Northern Ireland. However, the influence of such changes on the lives of older people remains under-explored, particularly the question of how older people perceive, connect to and engage in their communities. Drawing on interviews and focus groups with indigenous and non-indigenous older people in three case-study sites in Ireland, Northern Ireland and a cross-border region, this article presents a comparative analysis of how changing community contexts have shaped the lives of rural-dwelling older people. The analysis focuses on four key areas: economic structure and service access; social relations and social cohesion; meanings and attachments; and community engagement. While the findings demonstrate that some dimensions of participants’ lives were affected by complex economic and social changes, others dimensions were connected in a more significant way to life course and residential history and the desire to maintain community capacity.

Pre-Retirement Age Migration to Remote Rural Areas

Recent literature suggests that the increasingly blurred relationship between paid employment and retirement facilitates a retirement transition period, a life course stage, which may involve a change of residence. The role of such pre-retirement age mobility in the repopulation of rural areas has, however, received relatively little academic scrutiny. This paper draws upon findings from a two-year study conducted in three UK case study areas. It examines the extent of pre-retirement age (aged 50–64) migration into remote rural communities and the impacts this type of movement has upon economic activity, social and community engagement and service provision. It is argued that while this under-researched cohort offers opportunities to support the social and economic sustainability of rural communities (at least in the short and medium term), there are notable challenges which are likely to emerge as it ages in situ. The findings are particularly relevant given national trends on population ageing.

The Emergence of Rural Support Organisations in the UK and Canada: Providing Support for Patrilineal Family Farming

A certain type of rural support has emerged since agricultural restructuring of the 1980s. The article draws on research from the UK and Canada to suggest that support in both countries is derived from a patrilineal culture that still dominates family farming in both countries. Such a way of life, it is argued, involves the majority of farming men and women across generations working increasingly hard to ensure farm survival in order to facilitate an overall pattern of farm succession via the male or ‘patrilineal’ line. The article begins by providing a conceptualisation of patrilineal family farming drawing on insights from gender-informed work on farming identities, political-economy approaches from agricultural geography and the cultural turn in rural studies. This section will provide theoretical direction for discussion of the research findings. Here the article presents a discussion of the context to and typologies of organisations that emerged and five key findings derived from research conducted with members of the organisations in the UK and Canada. This assists in developing the argument that the emergent organisations are responding to and supporting this way of life and highlights some of the potential implications of doing so. The article has two aims. Firstly, it suggests that family farming in the UK and Canada continues to be predominantly structured by a way of life transmitted across generations which has the overall prerequisite of maintaining farm survival to enable patrilineal succession. Secondly, it suggests that a particular type of support for farming families emerged as a response to perceived threats to this way of life and provides evidence of its enduring nature.

Segregation Preferences of Urban and Rural 16-year-olds in Northern Ireland

Sectarian violence in the Northern Ireland is often perceived to be mostly confined to cities. The aim of this paper is to explore statistically what factors contribute to segregation preferences among young people living in rural and urban areas, using the 2005–2009 Young Life and Times (YLT) survey – an annual attitudes survey of 16-year-olds. The findings show that religious and national identities are the strongest predictors of segregation preferences among 16-year-olds, regardless of where they live and what background they have. Those living in rural areas of Northern Ireland are more supportive of residential, workplace and educational segregation than those living in more urban areas. This research highlights the need for government policy to take rurality into account. Nevertheless, some variables significantly determine segregation preferences regardless of where respondents live, such as attendance of segregated schools, being female, or strength of national and religious identity. Consequently, policy initiatives should continue to address the effect of segregation, especially in relation to education, and future research exploring social class and gender is recommended. In conclusion, the perception of the violent ‘urban spaces’ and the ‘peaceful countryside’ has to be challenged.

Resistance or Resilience? Tracking the Pathway of Recent Arrivals to a ‘New’ Rural Destination

Recent patterns of migration indicate that international migrants are not confined to urban gateways. Instead many migrants have settled in new destination areas located in rural and small town areas. While this might appear to be a positive phenomenon for rural areas struggling with decline and stagnation, the reality is that many of these areas are ill-equipped to manage the rate and pace of change that has been witnessed in recent years. Migration to established, typically urban areas has been the subject of extensive research. However, little is known about the way in which migrants navigate their way through social structures as they settle into destinations with little experience of immigration. Using empirical research, this article considers the way in which migrants navigate their way through social structures to establish life in a so-called ‘new’ migration destination. It analyses the way in which government and civil society respond to their needs of recent arrivals, showing how both NGO’s and the statutory sector play an important role in this process. It considers the ramifications for these different sectors and the implications for so-called ‘new’ destinations as they become more established or ‘mature’ areas of immigration.

A Life Course Perspective on Urban–Rural Migration: the Importance of the Local Context

The relationship between migration and age has long been established, and most recently, there have been calls for the inclusion of a life course perspective to migration research. In this paper, we explore Northern Ireland’s internal migration patterns, and in particular, we test for the importance of urban to rural migration at different stages of the life course. Data from the Northern Ireland Longitudinal Study are used for the first time to analyse urban–rural migration patterns. The resulting modelling demonstrates unique aspects of urban to rural migration within Northern Ireland, which up until now have gone largely
unreported. Results from logistic regression modelling suggest that there is an age selectivity to urban– rural mobility but not necessarily at the life course stages predicted from a review of the life course migration literature. Individuals in younger age groups (at the household and family formation stages of the life course) are most likely to make an urban to rural move in Northern Ireland, with a decline in the likelihood of this move type with age. Possible explanations are offered linked to Northern Ireland’s settlement hierarchy, rural planning policy, and family farming traditions. The findings challenge researchers to pay due attention to how migration processes may play out differently in varying geographical, social, and planning contexts and emphasise the importance of structural factors to explain migration patterns.

Resource utilization and cost analyses of home-based palliative care service provision:The Niagara West End-of-Life Shared-Care Project

Background: Increasing emphasis is being placed on the economics of health care service delivery - including home-based palliative care. Aim: This paper analyzes resource utilization and costs of a shared-care demonstration project in rural Ontario (Canada) from the public health care system's perspective. Design: To provide enhanced end-of-life care, the shared-care approach ensured exchange of expertise and knowledge and coordination of services in line with the understood goals of care. Resource utilization and costs were tracked over the 15 month study period from January 2005 to March 2006. Results: Of the 95 study participants (average age 71 years), 83 had a cancer diagnosis (87%); the non-cancer diagnoses (12 patients, 13%) included mainly advanced heart diseases and COPD. Community Care Access Centre and Enhanced Palliative Care Team-based homemaking and specialized nursing services were the most frequented offerings, followed by equipment/transportation services and palliative care consults for pain and symptom management. Total costs for all patient-related services (in 2007 CAN) were 1,625,658.07 - or 17,112.19 per patient/117.95 per patient day. Conclusion: While higher than expenditures previously reported for a cancer-only population in an urban Ontario setting, the costs were still within the parameters of the US Medicare Hospice Benefits, on a par with the per diem funding assigned for long-term care homes and lower than both average alternate level of care and hospital costs within the Province of Ontario. The study results may assist service planners in the appropriate allocation of resources and service packaging to meet the complex needs of palliative care populations. © 2012 The Author(s).

A shared care model pilot for palliative home care in a rural area:Impact on symptoms, distress, and place of death

Context: Shared care models integrating family physician services with interdisciplinary palliative care specialist teams are critical to improve access to quality palliative home care and address multiple domains of end-of-life issues and needs. Objectives: To examine the impact of a shared care pilot program on the primary outcomes of symptom severity and emotional distress (patient and family separately) over time and, secondarily, the concordance between patient preferences and place of death. Methods: An inception cohort of patients (n = 95) with advanced, progressive disease, expected to die within six months, were recruited from three rural family physician group practices (21 physicians) and followed prospectively until death or pilot end. Serial measurement of symptoms, emotional distress (patient and family), and preferences for place of death was performed, with analysis of changes in distress outcomes assessed using t-tests and general linear models. Results: Symptoms trended toward improvement, with a significant reduction in anxiety from baseline to 14 days noted. Symptom and emotional distress were maintained below high severity (7-10), and a high rate of home death compared with population norms was observed. Conclusion: Future controlled studies are needed to examine outcomes for shared care models with comparison groups. Shared care models build on family physician capacity and as such are promising in the development of palliative home care programs to improve access to quality palliative home care and foster health system integration. © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Optimizing Research on End-of-Life Care for Seniors:The Collective New Emerging Team on End of Life Care for Seniors University of Ottawa, Institute of Palliative Care

Background: End-of-life care for seniors is an important and neglected area of research. The University of Ottawa Institute of Palliative Care has expanded its research capacity by developing a Canadian Institutes of Health Research (CIHR) funded new emerging team on end-of-life care for seniors. This initiative brings together an interdisciplinary team of researchers from palliative care and geriatrics to develop a comprehensive program of research. Methods: 1) A variety of investigators from the fields of palliative care and geriatrics and disciplines of epidemiology, medicine, nursing, psychology and social work will collaborate on the development of a research agenda focussed on end-of-life care for seniors. 2) The conceptual model for the research program consists of 4 broad interrelated domains that are congruent with the CIHR themes of health services, clinical issues, population health and psychosocial, cultural, spiritual and ethical issues; this framework will guide the research program and all studies emanating from the program. 3) Research studies will focus on 5 areas of inquiry that are central to end-of-life care for seniors: palliative end-of-life care for rural seniors, care settings, burden, role of volunteers, and delirium. Results: This new team has the potential to obtain peer-reviewed funding, recruit and train a new generation of researchers, and build a network of concerned researchers. Conclusions: The new team should ultimately contribute to an improved quality of care for seniors who are approaching death.

Unravelling the migration decision-making process: English early retirees moving to rural mid-Wales

There are established migrant reasons to explain rural in-migration. These include quality of life, rural idyll and lifestyle motivations. However, such one-dimensional sound bites portray rural in-migration in overly simplistic and stereotypical terms. In contrast, this paper distinguishes the decision to move from the reason for moving and in doing so sheds new light on the interconnections between different domains (family, work, finance, health) of the migrant's life which contribute to migration behaviour. Focussing on early retirees to mid-Wales and adopting a life course perspective the overall decision to move is disaggregated into a series of decisions. Giving voices to the migrants themselves demonstrates the combination of life events necessary to lead to migration behaviour, the variable factors (and often economic dominance) considered in the choice of destination (including that many are reluctant migrants to Wales), and the perceived 'accidental' choice of location and/or property. It is argued that quality of life, rural idyll and lifestyle sound bites offer an inadequate understanding of rural in-migration and associated decision-making processes. Moreover, they disguise the true nature of migrant decision making.

A Comparison of Support Needs Between Rural and Urban Family Caregivers Providing Palliative Care

The present study examined the support needs for urban and rural family caregivers of a palliative family member using a cross-sectional telephone survey in northeastern Ontario, Canada (n = 140; 70 urban, 70 rural). Support needs identified as most important by both the groups were informational. Rural caregivers reported greater unmet needs in tangible support (P =.01). No differences were observed between the groups for emotional or informational support needs (P =.25 and P =.35, respectively). Rural and urban caregivers perceived care for care recipients as accessible (mean accessibility score 1.9, standard deviation [SD] = 0.09 and 1.7, SD = 0.7, respectively, P =.20); the majority indicated that when needed, services were easily and quickly obtained. Although there are similarities in the formal care experiences, rural caregivers experience greater unmet needs in receiving support for instrumental activities. © The Author(s) 2013.

Comparing the experiences of rural and urban family caregivers of the terminally ill

Introduction: There are many challenges in delivering rural health services; this is particularly true for the delivery of palliative care. Previous work has identified consistent themes around end-of-life care, including caregiver burden in providing care, the importance of informal care networks and barriers imposed by geography. Despite these well-known barriers, few studies have explored the experience of palliative care in rural settings. The purpose of the present study was to compare the experiences of rural family caregivers actively providing end-of-life care to the experiences of their urban counterparts. Methods: Caregivers' perceived health status, the experience of burden in caregiving, assessment of social supports and the pattern of formal care used by the terminally ill were explored using a consistent and standardized measurement approach. A cross-sectional survey study was conducted with 100 informal caregivers (44 rural, 56 urban) actively providing care to a terminally ill patient recruited from a publicly funded community agency located in northeastern Ontario, Canada. The telephone-based survey included questions assessing: (i) caregiver perceived burden (14-item instrument based on the Caregiver's Burden Scale in End-of-Life Care [CBS-EOLC]); (ii) perceived social support (modified version of the Multidimensional Scale of Perceived Social Support [MSPSS] consisting of 12 items); and (iii) functional status of the care recipient (assessed using the Eastern Collaborative Oncology Group performance scale). Results: Rural and urban caregivers were providing care to recipients with similar functional status; the majority of care recipients were either capable of all self-care or experiencing some limitation in self-care. No group differences were observed for caregiver perceived burden: both rural and urban caregivers reported low levels of burden (CBS-EOLC score of 26.5 [SD=8.1] and 25.0 [SD=9.2], respectively; p=0.41). Urban and rural caregivers also reported similarly high levels of social support (mean MSPSS total score of 4.3 [SD=0.7] and 4.1 [SD=0.8], respectively; p=0.40). Although caregivers across both settings reported using a comparable number of services (rural 4.8 [SD=1.9] vs urban 4.5 [SD=1.8]; p=0.39), the types of services used differed. Rural caregivers reported greater use of family physicians (65.1% vs 40.7%; p=0.02), emergency room visits (31.8% vs 13.0%; p=0.02) and pharmacy services (95.3% vs 70.4%; p=0.002), while urban caregivers reported greater use of caregiver respite services (29.6% vs 11.6%; p=0.03). Conclusion: Through the use of standardized tools, this study explored the experiences of rural informal family caregivers providing palliative care in contrast to the experiences of their urban counterparts. The results of the present study suggest that while there are commonalities to the caregiving experience regardless of setting, key differences also exist. Thus, location is a factor to be considered when implementing palliative care programs and services. © K Brazil, S Kaasalainen, A Williams, C Rodriguez, 2013.