Georgina Johnstone is a Research Officer at the Bolton Clarke Research Institute. She has a particular interest in the psycho-social aspects of health and trauma. She also works as a Research Assistant within Cabrini Health, working on projects in the End-of-Life and elderly spheres, including a current project to improve recognition and documentation of delirium in acute and rehabilitation settings. She completed her Honours degree in Psychology.
Older Women Living Alone: co-creating health and social care services to support wellbeing using a multi-component approach
Dr Judy Lowthian is the Principal Research Fellow at the Bolton Clarke Research Institute, formerly known as RSL Care + Royal District Nursing Service Research Institute. She also holds an appointment at the School of Public Health and Preventive Medicine at Monash University and an honorary appointment with Alfred Health. Her research is underpinned by an allied health background and her specific interest is health services research designed to improve the quality and safety of care for older people. In the past five years, Judy has been the recipient of $2.6M in competitive grants and prizes/awards. She serves on national and international committees that focus on improving geriatric emergency care.
Dr Rajna Ogrin is a driver of innovation, with a proven track record of delivering evidence-based practice reform in models of care that make measurable change, to community members and health professionals’ lives. Success has been gained through extensive subject matter expertise on chronic disease management, knowledge on healthcare systems and strong project management and engagement of stakeholders across all levels to codesign interventions to deliver meaningful outcomes. Due to the gap in evidence being implemented in practice in health, Rajna completed a PhD and post doctoral studies in the area of providing best practice care in people with diabetes, developing education resources that have been co-designed with community members in order to improve health outcomes for people with diabetes, vulnerable groups and older people in general. Rajna’s focus is working on projects to improve delivery of services, ensuring that services are based on what older people need, incorporating the best available evidence, to ensure effectiveness so that community members receive care that makes a real difference. Rajna is currently an executive committee member in the Australian Association of Gerontology (Victoria), Vice-President of the Primary Care Diabetes Society of Australia and the Editor-in-Chief of this Society’s journal, and a member of Council of the Ageing, working to improve understanding of older people needs, and ensuring access to better care.
Population ageing alongside increased migration and other social trends, impact the lives of older people. Many working adults live away from their birthplace, leaving ageing parents without close family nearby to care for them. Younger people are also less likely to live with older generations. With declining support from families or a partner, the proportion of older people living alone is increasing worldwide. Australian women in particular are more likely to live in a lone person household as they age compared to Australian men. Older women who live alone are often socially and financially disadvantaged compared to their male counterparts, and longevity is typically accompanied by multiple chronic health conditions. Furthermore, many older women find themselves isolated, in financial decline, and ill-equipped to meet the challenges of living alone with increasingly complex health concerns. The knowledge gap is significant relating to older women living alone with an absence of proven strategies to optimise their wellbeing and independence while living in the community. This symposium presents the findings of a multi-component, mixed-methods study that uses co-creation to fill this gap in proven strategies for Australian women aged 55 or older who are living alone. The aim of this research is to optimise the wellbeing of older women, focusing on the social, economic and health disadvantages facing this group. This symposium will present four distinct components of this study; a systematic literature review, analysis of routinely collected health data from home-visiting nurses, interviews with women aged 55 or older, and co-creation forums that begin to bridge the gap in service provision to this group. In addition to the findings of each component, presenters will discuss the insights gained from conducting a multi-part project founded in co-creation. This study is building a foundation for co-creating new strategies to support the health and well-being of older women living alone in the community.
The first presentation will detail the findings from the systematic review that was conducted to identify and summarise the evidence regarding safety, effectiveness and cost-effectiveness of previously implemented interventions targeted at older people who lived alone. This review was not limited to women to ensure no relevant interventions were missed. Thirty-three studies from a range of different areas were identified as meeting the inclusion criteria. These studies investigated range of interventions, spanning horticulture to assistive robots and targeted domains including social, physical, psychological and education. This reflects the breadth of interventions required to keep older individuals independent and in their own homes despite increasing age and decreased functional status. The different interventions and their outcomes will be discussed.
The second presentation will detail findings relating to the analysis of routinely collected data from a home-nursing organisation from the ten-year period from 2006-2015. The purpose of this analysis was to profile the service utilisations of older women living alone, to understand their pathways to care and assist with the identification of predictors of vulnerability in this cohort. This analysis involved determining health and service profiles for more than 40,000 older women. These data revealed that approximately 40% had lived alone at some time during 2006-2015. In comparison to those who lived with others, women who lived alone received more visits from nurses and were more likely to require care related to medication management. Further analyses compared the burden of illness experienced by these two groups of women and the factors influencing their use of a home-based nursing service will also be discussed.
The third presentation will detail findings from semi-structured interviews that were conducted with 37 women aged 55 or older. These interviews were conducted to identify the enablers and barriers to service access, gaps in service provision related to health, wellbeing and quality of life, and support of independence. Women with diverse characteristics were included in the interviews to ensure a representative sample was included, with women ranging in their education level, socioeconomic status, and geographic location within Melbourne. Interviews with older women who lived alone captured their experiences on their living arrangement and their views on the factors important to them in maintaining their independence. These findings will be detailed throughout this presentation.
The final presentation will detail the process and findings relating to a series of co-creation forums conducted with older women and individuals from organisations providing services to this cohort. The forums were undertaken to co-create evidence-based interventions or strategies that addressed the identified service and support needs for older women living alone, to improve their health, wellbeing and quality of life, and support independence. These needs were identified through the systematic review, registry analysis and interviews. In addition, the forums included a priority-setting process using multiple criteria decision analysis which enabled the research team to ascertain those services that were of the highest priority.