Academic journal article Perspectives in Public Health

Factors Impacting on the Well-Being of Older Residents in Rural Communities

Academic journal article Perspectives in Public Health

Factors Impacting on the Well-Being of Older Residents in Rural Communities

Article excerpt

Abstract

Background: In Australia, rural areas have higher proportions of older persons than metropolitan areas, where ageing poses many challenges related to social isolation, reduced mobility, more chronic disease and comorbidity, greater socio-economic disadvantage, limited access to services, and economic restructuring. Although Australian national data indicate an age-dependent decline in the prevalence of mental disorders, physical ill health is clearly associated with mental disorder in the elderly. There are conflicting findings regarding rural-urban differences in the prevalence of mental disorder, reflecting the complexity of definitions of rurality, and the geographic, ethnic and cultural diversity that underpins location and its influence on health outcomes.

Aims: This study aims to investigate the determinants of well-being in a sample of older adults from rural and remote communities, with particular focus on the role of social factors.

Methods: Baseline cross-sectional survey data were used from the Australian Rural Mental Health Study, a population-based longitudinal cohort of adults aged 18-85 years randomly selected from electoral rolls. We compared measures of mental health and well-being in adults aged 65 years and over with middle-aged and younger adults living in rural and regional New South Wales. Factors associated with positive well-being and psychological distress in the older group were examined using multivariate logistic regressions, reporting adjusted odds ratios (AOR) and 99% confidence intervals (CI).

Results: Of the 2,624 participants, 722 (28%) were aged between 65 and 85 years. Well-being was generally higher among those aged 65 years or older, compared with younger groups, with the notable exception of perceived physical health. Among those aged 65 years or older, poorer well-being was independently associated with older age (AOR 0.29, 99% CI 0.13-0.64), one or more chronic diseases (AOR 0.34, 99% CI 0.17-0.69), and a history of depression, stress or anxiety (AOR 0.31, 99% CI 0.12-0.76). Having increased community and personal support (AOR 4.7, 99% CI 2.5-8.9) significantly increased well-being in the older participants. A comparable profile emerged for the predictors of psychological distress, with higher trait neuroticism also making a substantial contribution (AOR 6.4, 99% CI 2.3-7.8).

Conclusions: Despite increased rates of chronic illness and poorer physical health, older rural Australians reported better well-being than younger groups, possibly reflecting a survivor effect or perhaps a generational effect, in terms of greater resilience or stoicism in the older generation. Higher levels of perceived community and personal support improve current well-being and are protective for moderate to high psychological distress.

Keywords

healthy ageing; mental health; rural and remote health; well-being; social support

Introduction

Demographic trends indicate that the emergence of a disproportionately greater number of older people in rural and remote regions is becoming a feature of many countries.1 These same regions are, in many instances, facing considerable social and economic change, including loss of infrastructure (such as social and health services) and population change.2 This has occurred particularly as young people migrate out to urban centres for education and employment opportunities. The limited range of services in rural regions may become more critical to overall health status as age-related decline in health occurs. Ageing in rural areas poses challenges related to social isolation, reduced mobility, more chronic disease and comorbidity, and limited access to community and health services. Rural palliative care and aged-care services are also generally limited. Furthermore, economic adversity and climate-related adversity may be disproportionately affecting many rural regions, with their greater reliance on primary industry. …

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