This chapter begins by examining expectations for support, and the earlier as well as present contributions made by older people. It considers many kinds of assistance covered in the main survey: these include household tasks, transport, personal care, and financial help, asking about past and present contributions as well as support received. The study by Brody, Johnson and Fulcomer, found only weak expectations for support from other relatives, friends, and neighbours. Finally, the calculation of intergenerational exchange must take inheritances into account. Whether instrumental support is provided from within or beyond household depends largely on the demands of the particular task under question. An American study has also shown that making contributions in joint-households increases morale; the demoralisation of dependent joint-living was found to lessen as people apparently adjusted to the situation over time. Adult children, the primary beneficiaries of older people's earlier and continuing contributions, in turn are the primary providers of assistance should parents become widowed and disabled.

This chapter casts an eye toward the less certain future, anticipating the social pressures of an ageing population, and identifying social choices being made today which will influence the well-being of the next cohort of older Australians. The basic tenet of our study is that ageing is as much a social construction as a biological fact. Social ageing involves a withdrawal, out of choice as well as necessity, from many of the statuses which structure life in middle age. The chapter considers the likely impact of social change on ageing and family relations. It emphasises that modest improvements of social policies could substantially increase older people's power in negotiating their place within families and other arenas for intergenerational relations. One of the most difficult questions pertains to changes in the subjective quality of family relationships over time. The conversion of potential to actual family support will depend primarily on prevailing social attitudes, as interpreted by individual families.

Australia’s Intergenerational Reports (2010, 2015) make a case for restraining public expenditure on an ageing population given the sizeable post-WWII baby boom cohort, increasing longevity, and uncertain economic prospects for younger generations. There also is concern for major disparities within older and younger generations resulting from cumulative advantages or disadvantages over the life course. Drawing on national survey data from the Attitudes to Ageing in Australia study, this article investigates perceptions of inequity between age cohorts at two time points (2009–10, 2015–17) focusing on variations by age and gender around lifelong opportunities for baby boomers compared to other groups, share of government benefits, and support for increasing pension age eligibility. The findings indicate a shift in attitudes between 2009–10 and 2015–17 with more in the younger cohorts in 2015–17 reporting better lifelong opportunities for baby boomers; and baby boomers receiving a fair share/more than a fair share of government benefits. With pension age eligibility, there is a small but significant shift in attitudes supporting the increase and a corresponding drop in those opposing it, however opposition is highly gendered with more women in each of the age cohorts opposing it at both time points. While there is a perceptible shift in younger cohorts’ attitudes towards baby boomers’ perceived advantages, overall attitudes are not totally supportive of government arguments for expenditure restraint; although a more overt public discourse on intergenerational inequity is emerging as the declining life prospects of younger cohorts are juxtaposed with tax-advantaged housing and retirement wealth of many older age Australians.

Abstract Background Major concerns have arisen about the challenges facing China in providing sufficient care to its older population in light of rapid population ageing, changing family structure, and considerable rates of internal migration. At the family level, these societal changes may produce care uncertainty which may adversely influence the psychological wellbeing of older individuals. This paper applies social support and control theories to examine the relationship between perceived availability of future care and psychological wellbeing of older adults in China, and how this relationship is moderated by economic insufficiency, health vulnerability, and urban/rural context. Methods Analyses are based on data from the China Health and Retirement Longitudinal Study, a multi-panel nationally representative household survey of the Chinese population aged 45 years and older. Data are taken from 2013 and 2011 waves of the study, with an initial sample size around 17,000, in which around 11,000–14,000 respondents are used for our final regression model. The score of depressive symptoms was measured in both waves with the Center for Epidemiologic Studies Depression Scale (CES-D10), and perceived availability of future care was measured in 2013 by asking respondents the question “Suppose that in the future, you need help with basic daily activities like eating or dressing, do you have relatives or friends (besides your spouse/partner) who would be willing and able to help you over a long period of time (yes/no)?” Results Multivariate regression analysis revealed that uncertainty regarding future care support was associated with greater depressive symptoms even after controlling for factors confounded with care uncertainty such as family structure, socio- economic status, and a lagged measure of depression. Further, older adults without an anticipated source of care faced double jeopardy in their depressive symptoms if they also experienced functional limitations. Conclusions Considering rapid aging of the Chinese population, anticipated increases in chronic disease burden, and possible attenuation of filial care, this analysis suggests that older adults in China may increasingly face health and social conditions detrimental to their mental health. Polices that remedy these concerns should be discussed, developed and implemented.

Health is considered one of the domains to assess people’s life satisfaction. However, other factors including social relationships are also as crucial as health in determining their life assessment, particularly among older adults in Asia. This paper used the data of Vietnam National Ageing Survey 2011 (VNAS 2011 ) to examine life satisfaction of Vietnamese older people’s (aged 60 and older) in rural and urban areas in relation to their health conditions and their social relationships, including with adult children. Logistic regression was employed and revealed that sufficient income had positive influence on older people’s satisfaction of life in both rural and urban areas (Rural OR 2.27; 95% CI 1.72–2.99; Urban OR 2.30; 95% CI 1.47–3.58). Difficulties with mobility and sleeping were negatively associated with older person’s life satisfaction, however, affectual solidarity was the most influential factor (Rural OR 5.88; 95% CI 4.40–7.83; Urban OR 5.92; 95% CI 3.52–9.93). Therefore, intergenerational relationships are vital to older people’s life satisfaction beyond health, income, household socioeconomic status, which varied between rural and urban areas. Living in multigenerational households, and children daily call positively shapes the assessment of life among older people who live in urban areas, while it is social and entertaining activities that significantly contribute to life satisfaction of older people in rural areas.

OBJECTIVES This study aimed to investigate oral health-related factors affecting the self-assessed psychological well-being (PW) and depressive symptoms of independent-living Australians aged 79 years and over living in the community in metropolitan Melbourne. METHODS The Melbourne Longitudinal Studies on Healthy Aging (MELSHA) program was used as the data source in this study and includes data on the health and well-being of older participants. The MELSHA baseline data collection occurred in 1994, the current study used data from the 2008 data collection and included 201 participants, who remained in the study. Data were analyzed using multiple linear regression (MLR) analysis with a stepwise procedure to identify the variables that accounted for a significant proportion of the variance in the participants' PW scores. RESULTS Present findings indicate that oral health may play a significant mediating role in PW through maintaining a presentable and acceptable physical appearance. Some 16.4 percent of participants reported feeling concerned about their dental appearance, either "Sometimes," "Often," or "Very often." Multivariate analysis showed significantly influences on PW positive and negative affect scores (P < 0.0001); and depressive symptoms (P < 0.0001) by participants' dentition status, enjoyment of meals, self-reported feeling of concern about the appearance of the mouth, social activity and self-assessment of general health. Final models explained 17.8, 20.1, and 24.6 percent of the variance of PW positive, negative affect scores, and depressive symptoms, respectively. CONCLUSIONS Oral health, specifically the appearance of the mouth and dentition, plays a significant role in the PW of older Melbournians. Future cross-sectional and longitudinal studies are indicated to raise awareness on the changes required to improve the quality of life of the older population.

In this chapter, the author presents examples from his own applied studies with older people and focuses on generic issues which arise with research that relates to any constituency group. He discusses the viewpoint of researchers inside the academy looking to the outside in representing community views. Research can also be important for social action by organised community groups. The author suggests that independent research by community organisations is most appropriately limited to small-scale action research. Community groups can benefit considerably from research when they proactively form partnerships with university researchers, lobby governments for funding, and apply the findings to policy. A cross-sectional community care study obviously presents an overly optimistic view because it excludes those who were no longer able to stay in their homes. Community involvement can heighten understanding and increase research funding. However, promotion criteria in universities pay little direct regard to community contributions and time is scarce for desirable but non-essential activities.

Abstract Attitudes to ageing can predispose decision-making as governments, interest groups and electorates negotiate competing demands in the context of economic constraints and social change. This paper, based on national survey data, investigates change and stability in Australian attitudes to intergenerational equity from 2009–2010 to 2015–2017, alongside concurrent socio-economic and policy change as well as cohort succession. The emphasis is on the baby-boom cohort who are viewed as significant beneficiaries of social change relative to opportunities of younger and older cohorts. Views of older people as a needy group may be changing slightly as more enter later life with substantial wealth and resources. Our results show that there is little perception of intergenerational conflict with the exception of the Millennial cohort whose life chances are compromised by economic and expenditure constraint over the past decade. Overall, attitudes remain sympathetic to older people, especially among women and people rendered vulnerable by poor health, non-home-ownership and low socio-economic positions. The findings do not align with government portrayals of intergenerational inequalities notwithstanding many having negative views of the future and ongoing expenditure restraint strategies. At what appears to be a critical turning point in the life chances of successive cohorts, the findings indicate the interplay between attitudes and social and policy change, as well as implications for social equity and processes of attitudinal change.

The aims of this study were to investigate patterns of home and community care (HACC) use and to identify factors influencing first HACC use among older Australian women. Our analysis included 11,133 participants from the Australian Longitudinal Study of Women's Health (1921-1926 birth cohort) linked with HACC use and mortality data from 2001 to 2011. Patterns of HACC use were analysed using a k-median cluster approach. A multivariable competing risk analysis was used to estimate the risk of first HACC use. Approximately 54% of clients used a minimum volume and number of HACC services; 25% belonged to three complex care use clusters (referring to higher volume and number of services), while the remainder were intermediate users. The initiation of HACC use was significantly associated with (1) living in remote/inner/regional areas, (2) being widowed or divorced, (3) having difficulty in managing income, (4) not receiving Veterans' Affairs benefits, (5) having chronic conditions, (6) reporting lower scores on the SF-36 health-related quality of life, and (7) poor/fair self-rated health. Our findings highlight the importance of providing a range of services to meet the diverse care needs of older women, especially in the community setting.

Objectives: Explore characteristics of hospital use for adults aged 85 and over in their last year of life and examine factors associated with cumulative overnight length of stay (LOS). Data source/study setting: NSW 45 and Up Study linked with hospital data. Study design: Longitudinal cohort study. Methods: Quantile regression models were performed for men and women (N = 3145) to examine heterogeneity in predictors of overnight hospital admissions. Coefficients were estimated at the 25th, 50th, 75th and 90th percentiles of the LOS distribution. Principal findings: 86% had at least one hospitalisation in their last year of life, with 60% dying in hospital. For men, first admission for organ failure was associated with a 26 day increase at the 90th LOS percentile, and a 0.22 day increase at the 10th percentile compared to men with cancer. Women admitted with influenza had decreased LOS of 20.5 days at the 75th percentile and 6 to 8 fewer days at the lower percentiles compared to those women with cancer. Conclusions: Poor health behaviours were a major driver of highest LOS among older men, pointing to opportunities to achieve health care savings through prevention. For older women, influenza was associated with shorter LOS, which could be an indicator of the high and rapid mortality rates at older ages, and may be easily prevented. Other factors associated with LOS among women, included where they lived before they were admitted, and discharge destination.

The proportion of population ageing in China will grow significantly in the next few decades but the pace of population ageing and social change vary considerably across regions. Notably, Eastern coastal areas are economically more advanced compared to the Western region. These economic disparities could result in differing adverse health outcomes.

OBJECTIVES To examine whether older adults aged 85+, with different health and functional capacities, cluster in different ways and to demonstrate whether individuals within particular clusters report differential mortality risk. DESIGN Retrospective cohort study. SETTING The Dynamic Analyses to Optimize Aging (DYNOPTA) project is a harmonization project of nine Australian longitudinal surveys of health and well-being in adults aged 50+ between 1991 and 2006. PARTICIPANTS Participants were 685 older adults (female = 52%) living in the community and aged 85 to 103 at baseline who were followed until death or December 31, 2006, for survivors. MEASUREMENT Latent class analysis (LCA) analyzed self-reported information on physical health, mental health, and functional capacity to define homogeneous classes based on probable cognitive impairment and depression status, medical conditions, and number of activities of daily living and instrumental activities of daily living. RESULTS LCA discriminated four classes reflecting two main survival patterns. Two classes reported half the median survival days; differences between these classes were related to high vs moderate depression and extent of functional limitations. Two classes reported better survival; differences between these classes were related to functional limitations, but both had low proportions with depression and dementia. The classes with shorter survival were associated with substantively higher rates of depression and dementia. CONCLUSION Higher rates of baseline depression and dementia were unique characteristics of those individuals in the clusters that reported shorter survival. However, a substantial proportion of very old adults experience good mental health with better survival outcomes. J Am Geriatr Soc 67:1036-1042, 2019.

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.

Objective: Parental bonding is cited as a determinant of mental health outcomes in childhood, adolescence and early-mid adulthood. Examination of the long-term impact for older adults is limited. We therefore examine the long-term risk of perceived poor parental bonding on mental health across the lifespan and into early-old age.Methods: Participants (N = 1255) were aged 60-64years of age and drawn from the Australian Life Histories and Health study. Quality of parental bonding was assessed with the Parental Bonding Instrument (PBI). Self-reported history of doctors' mental health diagnoses and current treatment for each participant was recorded. Current depression was assessed with the Centre for Epidemiologic Studies Depression-8 (CESD-8). Due to known gender differences in mental health rates across the lifespan, analyses were stratified by sex.Results: A bi-factor analysis of the PBI in a structural equation framework indicated perceived Poor Parental Quality as a risk for both ever and current depression for both sexes. For males, Over-Protective Fathers were a risk for ever and current depression, whilst overall Poor Parental Quality was a risk for reporting current depression treatment. Whilst a number of the risks associated with current depression and treatment were attenuated when controlling for current mood, parental quality remained a significant risk for having reported a lifetime diagnosis for depression and anxiety for men.Conclusion: Our results extend the existing literature base and demonstrate that mental health risk attributed to poor perceived parental quality continues across the life-course and into early-old age.

To move straight to the point, I am concerned that Australia has snatched failure from the jaws of victory on ageing policy and time is running out to get the settings right. Even with scarce research funding, we have abundant scholarly evidence, here and internationally, to inform astute policy decisions about ageing – arrangements that could not only ease the potential economic impact of significant population ageing but promise genuinely better futures for generations of older Australians to come. What is more, there have been multiple reports by independent voices such as The Productivity Commission and The Grattan Institute – let alone large, private accounting firms and the Business Council of Australia – all pointing to clear and sensible policy directions that remain largely ignored. Compared to most European countries and even the United States, Australia has established itself as a drowsy laggard when it comes to taking the action required to meet the challenges of an older population and the needs of its older citizens. Yet, as we entered the new century, a very different reputation seemed likely. In 2001, then Minister for Ageing (note: not Minister for Aged Care), the Hon Kevin Andrews MP, presided over the publication of Australia's landmark National Strategy for an Ageing Australia. Subtitled An Older Australia, Challenges and Opportunities for all, it is sober reading for those acquainted with the broad policy framework around ageing. Not only did it highlight the importance of ‘a good match between service demand and supply across the care sectors to ensure that people receive the right type of care for their needs’ 1; at a broader level than aged care, it offered a long-term strategic framework, intended ‘to be used as a blueprint’ for the government's ‘actions and decisions with respect to population ageing’. It is sober reading because the informed, coordinated blueprint it set out remains highly relevant, while action towards achieving it in any comprehensive way has faltered, almost grinding to a halt. Gone are the efforts towards a cohesive and consistent whole-of-government approach that can focus on both society and individuals and adapt to the needs of all Australians, as we grow older. With the exception of a handful of bright policy moments in the 17 years since – notably the Living Longer, Living Better aged care reforms of 2012, the expansion of home-based care, and the appointment of our first Age Discrimination Commissioner (Susan Ryan) in 2011 – we have seen only a mediocre piecemeal approach to population ageing, focused heavily on aged care, wrapped up and marketed to voters prior to elections. The current landscape lacks a positive horizon. Our long unquestioned faith in future has been severely challenged by economic pessimism in an uncertain new world order. There is real stress among younger generations striving to move ahead in difficult employment and housing markets. The Government's Intergenerational Reports, with their avowed aim of limiting public expenditure, have raised the spectre of future generations having lifetime prospects worse than those of their parents. Yet, substantial numbers of the current cohort of older people live with extreme disadvantage. At the same time, there remain significant shortfalls of badly needed care that the 2018 budget initiatives only begin to address; while potential benefits from evidence-based services aimed at rehabilitation, recovery and reablement drift further beyond reach. Attitudes and expectations are shifting, and there are signs of new, intergenerational tensions arising – alongside the traditional divides within generations around social class. The pressures of uncertain and uneven economic growth, combined with the certainty of significant population ageing for decades ahead, are anything but surprising. Yet taking the opportunity for a stitch in time continues to elude us and increasingly so in the last five years. Australia needs to shake off the ‘doomsday’ problem narrative around ageing and reframe longevity as a triumph for humanity. Ageing needs to be understood as a natural population transition that, for a rich country like Australia, can be managed constructively – without scapegoating older people or applying policies that inflict social deprivation on disadvantaged groups or future generations. Ageing well is achievable for most people. Contrary to pervasive negative attitudes, ageing is not an immutable process of decline. Quality of life is generally at its peak after people enter later life, and as with all stages of life, adverse outcomes are usually improvable. Two recent books published with the support of the ARC Centre for Population Ageing Research in collaboration with the Academy of Social Sciences in Australia 2, 3 help to advance a more positive framework for meeting the challenges and grasping the opportunities of population ageing. Leading authors describe approaches including policy design, across topics as variable as economic security, health policy and indigenous disadvantage. As a collection, they offer a coordinated approach around five broad themes that I have tried to articulate in the closing chapter of Ageing in Australia 4: These are essential guiding themes but, as my own opportunity to contribute to this future comes to an end, I would like to add some specific personal hopes. A bipartisan, whole of government approach to ageing is a necessity if we are to break the cycle of piecemeal, election-focused policymaking. Without a commitment to coordination, cooperation and communication within and between traditional government portfolios, Australia has little hope of changing its future prospects. I would like to see some form of Office on Ageing within government – attached to one of the central departments, like Treasury or PM&C – to leverage the broad-based policies and ensure this coordination. Reflecting this, the government needs a Minister for Ageing. Having a minister for ‘aged care’ sorely misses the point. We need national goals on ageing well that measure things such as participation, additional years of disability-free life gained and well-being. And we need a much, much broader research agenda – one that is clearly focused on improvable areas related to ageing – not just the aetiology of disease. The other very important requirement is political will. Australia and Australian governments are well positioned to manage population ageing yet we have had almost two decades of underwhelming progress. I hope our governments can find that will so future generations can enjoy outcomes better than my own. Due to my illness, I was unable to complete this editorial without assistance and I would like to thank Keryn Curtis for playing this role. Hal Kendig is an Emeritus Prof. in the ANU Research School of Population Health and Hon. Prof. in the ARC Centre of Excellence in Population Ageing. He is completing collaborative ARC-funded projects on Attitudes to Ageing and Ageing Well and Productively in China. After 45 years in ageing research, he is now living with a degenerative neurological condition and is a client of home care services. Prof. Kendig's observations extend far beyond the academic now, to the deeply personal. This is his final public contribution to this conversation.

Chapter 9 focuses on the challenges and opportunities associated with implementing age-friendly approaches in Australia. In this chapter, Hal Kendig, Cathy Gong and Lisa Cannon review the evolution of Australia’s ageing population, including its increasing diversity, and consider evidence on the liveability of Australian cities, especially for disadvantaged older people. The chapter provides a review of AFCC initiatives comparing Sydney, Melbourne, and Canberra in a State and national context. It concludes with a critical assessment of both challenges and achievements associated with age-friendly work, and suggests a number of ways forward for developing and evaluating the AFCC approach in Australia.

Australia is at a critical demographic turning point as its baby boom cohort (born 1946–1965) enters later life with experiences and expectations profoundly different from previous generations. Governments and employers are aware the boomers' retirement from paid work will have a major bearing on Australia's economic and social wellbeing and future younger generations. Drawing on government publications and empirical evidence from current research, this chapter reviews demographic change and explores the diversity within the baby boomer cohort. We further consider the social and policy adaptations required for the labour force and intergenerational relations to adjust to a 'new normal' in ageing.

ABSTRACTIn this study we used individual differences concepts and analyses to examine whether older people achieve different ageing-well states universally or whether there are identifiable key groups that achieve them to different extents. The data used in the modelling were from a prospective 16-year longitudinal study of 1,000 older Australians. We examined predictors of trajectories for ageing well using self-rated health, psychological wellbeing and independence in daily living as joint indicators of ageing well in people aged over 65 years at baseline. We used group-trajectory modelling and multivariate regression to identify characteristics predicting ‘ageing well’. The results showed three distinct and sizeable ageing trajectory groups: (a) ‘stable-good ageing well’ (classified as ageing well in all longitudinal study waves; which was achieved by 30.2% of women and 28.0% of men); (b) ‘initially ageing well then deteriorating’ (50.5% women and 47.6% men); and (c) ‘stable-poor’ (not ageing well in any wave; 19.3% women and 24.4% men). Significant gender differences were found in membership in different ageing-well states. In the stable-poor groups there were 103/533 females which was significantly lower than 114/467 men (z-statistic = −2.6, p = 0.005); women had a ‘zero’ probability of progressing to a better ageing-well classification in later years, whilst males had a one-in-five probability of actually improving. Robust final state outcome predictors at baseline were lower age and fewer medical conditions for both genders; restful sleep and Australian-born for women; and good nutrition, decreased strain, non-smoker and good social support for men. These results support that ageing-well trajectories are influenced by modifiable factors. Findings will assist better targeting of health-promoting activities for older people.

Australia has conducted widely publicized campaigns to improve attitudes to ageing and combat ageism, however negative attitudes and discriminatory behaviours remain evident with implications for wellbeing, age equality and social inclusion. This paper examines perceptions and experiences of age discrimination in the workplace with a particular focus on those aged 55+ years. Data are from a representative national sample of adults in the Australian Attitudes to Ageing study conducted as a component of the 2015–2017 Australian Survey of Social Attitudes (n=2174). Participants responded to questions about their knowledge and experience of discrimination. Results show 23% of employed respondents experienced workplace-based discrimination, however the proportions varied by age group. Other factors with a statistically significant association with discrimination were self-assessed health status, marital status, location, and education level. The findings are discussed within public policy frameworks intended to maintain workforce participation and increase self-funded retirement as responses to population ageing.