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Professor Hal Kendig, Professor of Ageing and Public Policy, Centre for Research on Ageing, Health, and Wellbeing, ANU Research School of Population Health delivered this presentation at the 2013 Social Determinants of Health conference. The conference brought together health, social services and public policy organisations to discuss how social determinants affect the health of the nation and to consider how policy decisions can be targeted to reduce health inequities. The agenda facilitated much needed discussion on new approaches to manage social determinants of health and bridge the gap in health between the socially disadvantaged and the broader Australian population. For more information about the event, please visit the conference website: http://www.informa.com.au/social-determinants.
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Social Determinants of Health Conference
Informa
Sydney, 11 December, 2013
Social Determinants of Health Inequalities over the Life Course
Hal Kendig
Professor of Ageing and Public Policy
Centre for Research in Ageing, Health, and Wellbeing (CRAHW) Research School of Population Health
Chief Investigator
ARC Centre of Excellence in Population Ageing Research (CEPAR)
Overview
1. Research informing change and new ways of thinking
a. Ageing perspectives on the WHO Closing the Gap
b. Ageing people and attitudes
c. Research funding priorities: what can we know?
2. Ageing Well Research: some Findings
a. Determinants of ageing well
b. Life Course Influences on ageing well
3. Actions on Ageing Well: Policies
4 Actions on Ageing Well: Service and Practice Innovations
5. Concluding Questions: How can all of us take ageing into account
Note: an earlier version of this paper was presented as ‘Ageing Well: Actions and Evidence’, Keynote Address, Australian
Association of Gerontology, Sydney, November, 2013. See www.cepar.edu.au for for more evidence
2
Centre for Research on Ageing, Health and Wellbeing
ARC Centre of Excellence in Population Ageing Research
3
1. Research informing change
and new ways of thinking
Kendig, H, and C. Browning (2010) A Social view on healthy ageing: Multi-disciplinary
perspectives and Australian Evidence. In D. Dannifer and C.Phillipson (eds), SAGE
Handbook of Social Gerontology. London, Sage Publications: 459-471
Centre for Research on Ageing, Health and Wellbeing; ARC Centre of Excellence in Population Ageing Research
1a WHO Closing the Gap (2008) and
Australian developments
Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the
Commission on Social determinants of Health, Geneva, World Health Organisation (CSDH, 2008) RECOMMENDS
1. Improve Daily Living Conditions Improve the well-being of girls and women and the circumstances in which
their children are born .. Early childhood development and education for boys and girls, improve living
conditions and working conditions and create social protection policy supportive of all, and create conditions
for a flourishing older life……
2. Tackle the Inequitable Distribution of Power, Money, and Resources…...
3. Measure and Understand the Problem and Assess the Impact of Action……
The Australian Senate Committee report 2013
Recommends (but no action has been taken):
1. Adopt the WHO Report
2. Adopt administrative practices that ensure consideration of the social determinants of health in all …. policy.
1. Responsibility within one agency with a mandate to address issues across portfolios.
2. The NHMRC gives greater priority to .. Public health and social determinants research.
3. Annual reports to Parliament……..
And important leadership from the Public Health Association Australia
4 Centre for Research on Ageing, Health and Wellbeing
ARC Centre of Excellence in Population Ageing Research
1b ‘Who it is for’ Older People and Life Goals (and boomers more so and much diversity)
Qualitative investigations with older people guiding our work from the beginning of the ‘health status’ research that led to the Ageing Well findings.
• Striving to ‘be oneself’ and self determining
• Fierce will for independence (not a burden)
• Imperative for Ageing in Place (and importance of the local environment)
• Goals: feel well, health as a resource, and quality of life
Clearly a life span approach is how people can and wish to be understood in all their diversity and commonalities ‘I am me and I have grown older’
(eg Davison, B., H. Kendig, F. Stephens and V. Merrill (1993). “It’s my place”, older people talk about their homes, Canberra: Australian Government Publishing Service.
Quine, S., H. Kendig, D. Touchard, and C. Russell (2004) Health promotion for socially disadvantaged groups: The case of homeless older men Health Promotion International, 19(2):157-165.
Experiences of public (dis)respect and social treatment being made to ‘feel old’, devalued, & powerless (ageism) versus ‘normal ageing’ [health professionals are the ‘worst’]
Minichiello, J. Browne, and H. Kendig (2000) Perceptions and consequences of ageism: Views from
older persons. Ageing and Society, 20:253-278.
5 Centre for Research on Ageing, Health and Wellbeing; ARC Centre of Excellence in Population Ageing Research
Centre for Research on Ageing, Health and Wellbeing; ARC Centre of Excellence in Population Ageing Research
6
1c Building Evidence Envisaging Ageing and
Informing Change (A Big Picture)
New ways of thinking about ageing in Australia - increasingly led by older people
and their advocates – potentially can generate whole of society innovations to
enhance the well-being of older people and sustainability for future generations.
Australia is different from Europe and North America: eg, we face workforce
shortages as the large baby boom cohort retires over the coming decades. Ageing
people can be part of the solutions to the challenges of an ageing Australia.
‘Intergenerational Reports’ (IGRs), Commissions of Audit, and ‘think tanks’ are
contesting policies, prompting change, and reinforcing negative images of ageing. Kendig, H. (2010) The Intergenerational Report 2010: A double-edged sword. AJA, 29(4): 145-146.
Research funding determines what is ‘know-able’
- 2003 National Research Priority goal on ‘Ageing Well, Ageing Productively’. -
- Prime Minister’s 2003 PMSEIC research agenda and a ‘vision’ for another ten
years of healthy and productive ageing by 2050’
- Ageing Well, Ageing Productively Research Programs (2005)
- ARC/NHMRC Research Network in Ageing Well (2005)
- NHMRC Health Priorities (diseases) and Dementia research initiatives (2013)
2. Ageing Well Research Findings
Examples from the
– Melbourne Longitudinal Studies of Ageing
(MELSHA) and
– The Life History and Health Survey
(Social Determinants of Health Disparities)
(presenting mainly recent work now being published)
Centre for Research on Ageing, Health and Wellbeing ARC
Centre of Excellence in Population Ageing Research
7
2a. The Melbourne Longitudinal Studies of
Healthy Ageing (MELSHA) 1994-2010
Baseline Health Status of Older People Survey (N=1000)
- aged 65+ interviewed in private residences
- biennial follow-up: phone, home, mail or informant report
- 70 % response rate (some bias towards healthy people)
- Limited diversity – eg in terms of ethnicity and disadvantage
Funding Support
Victorian Health Promotion Foundation, National Health and Medical
Research Council, Australian Research Council, and our Universities (with thanks to the guidance of the VicHealth Health Status of Older People Working Group)
Browning, C. J. and H. Kendig (2010) Cohort profile: The Melbourne Longitudinal Studies
on Healthy Ageing Program. International Journal of Epidemiology, 39(5): e1-e7.
2b Melbourne Longitudinal Surveys of Healthy
Ageing (baseline findings)
Respondents say healthy ageing means
- being active physically and socially
- feeling well
- continuing to contribute
- as well as absence of disease
Value of a Health Action Approach
- what motivates, enables and constrains
Health as a resource for the ‘continuing self’ (identity)
9
2c Defining Ageing Well (quantitatively)
Components of Ageing Well (all positive; at Baseline)
1. Positive Affect (mood) : Scores > 17 (83%); and
2. Living Independently: Can shop for food, prepare meals, do own
housework. (81%); and
3. Excellent/Very Good Self rated health (80%)
Ageing Well (all of above) (64% at baseline)
Note: This holistic definition aims to have a wider scope than ‘successful
ageing’, ‘healthy ageing’, or ‘positive ageing. It builds on a small literature
on ‘lay conceptions’ and builds on our qualitative research.
Multi-variate Cox regression: Best fit models for baseline characteristics on continuing to live in a state of ‘ageing well’? (article under review)
10
2d Life Style Predictors & Outcomes to 2008
(significant potentially improvable actions)
Significant
Baseline
Predictors 1
Survival
Living in the
Community (not
in residential
care)
Ageing Well
Low Strain ✔
Physical Activity ✔
Healthy Nutrition ✔
BMI Acceptable ✔ ✔
Perceived Social
Support Adequacy
✔
Social Activity
Amount
✔ ✔
1 p < .01 (net of other health and socioeconomic predictors)
11
2e Gender, Life Style, & Ageing Well
Significant Baseline
Predictors 1
Women only Men only Total sample
High Strain ✔
Physical Activity ✔ ✔
Healthy Nutrition ✔
BMI acceptable ✔ ✔
No Urinary
Incontinence
✔
Perceived Social
Activity Adequacy
✔
Perceived Social
Support Adequacy
✔
Social Activity Amount ✔
Ex-Smoker ✔
12 1 p < .01 (net of other health and socio-economic factors)
2f Ageing, Living Well, and Chronic Disease
(more MELSHA findings)
Preliminary findings from the paper ‘Ageing Well with Chronic Disease’
presented by Kendig, Browning, and Burns presented to the Invited
Symposium ‘Multiple Chronic Disease: Australian and Canadian Perspectives’,
Chair Andrew Wister, Discussant Marcia Ory, Gerontological Society of
America, New Orleans, November 2013
Centre for Research on Ageing, Health and Wellbeing ARC
Centre of Excellence in Population Ageing Research
13
2i Defining Chronic Disease
Chronic Disease Self reports (Prevalence at baseline)
(The definitions could be wider – we are exploring further …)
– Heart disease (11%)
– Stroke (6%)
– Cancer (14%)
– Diabetes (6%)
– Arthritis (56%)
– Pct with any (72%)
– Pct with two or more (17%)
The analyses count are based on counts of chronic disease.
14
2j Ageing influences on not living
well and chronic disease (to 2008) • With increasing age there is an increased likelihood of
Not Living Well and also having a Chronic Disease.
• Ageing has a more significant impact on Not Living Well
than on Chronic Disease. Ageing well is complex that
involves multiple bio-psych-social factors.
• Especially at relatively younger ages most people having
a chronic disease are ageing well!
And the risk of both is increased among people who have
low socio-economic resources.
Centre for Research on Ageing, Health and Wellbeing ARC
Centre of Excellence in Population Ageing Research
15
2l Likelihood of Mortality
(ref Living Well/No Chronic Disease)
2.06
2.95
0.78
0
1
2
3
4
5
6
7
Not Living Well/NoChronic Disease
Not Living Well/HaveChronic Disease
Living Well/Have ChronicDisease
** p < .01
**
16
17
2m MELSHA Key findings so far
• Healthy life styles in later life are related to longer term benefits
• Life Style directly influences quality of life outcomes
• Social determinants (eg income) are more underlying influences
• Older women and men face different vulnerabilities
Question: Can life style interventions yield the same benefits as ‘natural’ variation?
(based on articles under review and in progress by Kendig, Browning, and colleagues)
2n Socio-economic determinants of health
disparities over the life course
Investigators: Kendig, Byles, Nazroo, O’Loughlin, Mishra, and collaborators
• ARC Discovery Grant and ARC CEPAR
• 2010-2011 Life History and Health Survey of babyboomers (60-64 yrs) in NSW
as a substudy of 45 and Up
Paper presented yesterday (article under review) by Vanessa Loh showing that
Quality of life (e.g., “I feel that my life has meaning’) and Life satisfaction
are influenced by childhood health and socio-economic status
which relate to adult health and occupational attainment; and hence
health and socio-economic resources on entry to later life.
Comparisons to the English Longitudinal Survey on Ageing will enable us to investigate the influence
of Australian post war social, economic, and policy factors on individuals life course developments.
Implication: The value of a life course and human capital approach to ageing well from an early start
onwards. It is never too early (nor too late!)
Centre for Research on Ageing, Health and Wellbeing ARC
Centre of Excellence in Population Ageing Research
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19
Part 3 Policy Directions
Centre for Research on Ageing, Health and Wellbeing; ARC Centre of Excellence in Population Ageing Research
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The broad context of increasing health and longevity of ageing people notwithstanding
increases of people ageing with obesity and chronic disease. Health promoting activities are
increasing among babyboomers but less so for disadvantaged people
Humpel, N., K. O'Loughlin, Y. Wells and H. Kendig (2009) Ageing baby boomers in Australia: Evidence for
informing actions for better retirement. Australian Journal of Social Issues, 44(4): 399-415.
The centrality of mainstream employment, housing, and income as well as health programs
with the evidence suggesting that health gain is maximised with distribution to those with the
least resources. Various CEPAR and other investigations underway. www.cepar.edu.au
Whole of government and whole of society strategies, eg the NSW Ageing Strategy and the
Age Friendly Communities movements. Kendig, H., & Phillipson, C. (in press). Building age friendly cities: New approaches and evidence. In N. Denison & L. Newby
(Eds.), Health inequalities: Social determinants at a local level: British Academy Policy Centre.
The Government’s Advisory Panel on Positive Ageing (now disbanded) [submissions and targeted consultations]
The UN human rights approach to ageing under the leadership of the Age
Discrimination Commissioner. [mainly consultancies and complaints]
3a Positive Policy Directions [& evidence base]
Centre for Research on Ageing, Health and Wellbeing; ARC Centre of Excellence in Population Ageing Research
3b The Living Longer Living Better Directions
The Government’s Living Longer, Living Better reforms (with bipartison
support) aim to radically refocus ‘aged care’ to support older people mainly
at home including new ‘consumer-directed’ approaches.
Leadership from the Council on the Ageing (Australia) Listening to Older
Australians and
Productivity Commission Report on Caring for Older People. [extensive review Trends in Aged Care, submissions, and secondary data analysis]
Kendig, H. (2011) Research and evaluation priorities: the Report of the Productivity
Commission on Care of Older People. Australasian Journal on Ageing, 30(2): 54-56.
21 Centre for Research on Ageing, Health and Wellbeing; ARC Centre of Excellence in Population Ageing Research
3c Big-Picture Aims for Care Systems
• Provide for changes (trajectories and transitions) and
multiple needs (social, economic, care & health)
• The importance of ‘upstream’ action (keep healthy) not
only ‘downstream’ care, e.g. centrality of health
promotion and maintaining and regaining independence
• Client centred: consumer-led, continuity, improvability,
integration, & timeliness – what service systems must
and can deliver
• Whole of government integration with mainstream
health, housing, transport... At the community level
Based on a range of ageing well and services research
Centre for Research on Ageing, Health and Wellbeing; ARC Centre of Excellence in Population Ageing Research
22
3d LLB and PC: Enable Independence
• Older People in the mainstream of health promotion and community supports eg transport (difficult but essential)
• Health promotion and self care in aged care and primary care (including chronic disease)
• Enable and regain independence in community care as well as rehabilitation (Active Service Model in Vic)
• The Home Independence Program Gill Lewin in WA (more below)
[Our research shows that choice and a control are valuable in themselves]
23 Centre for Research on Ageing, Health and Wellbeing; ARC Centre of Excellence in Population Ageing Research
3e Enhancing quality of life in older people
• Deliver what older people want rather than what we think they want
• Understand that there are individual differences in older people’s
wishes that need to be incorporated into service tailoring
• Explicitly include QOL measurement and concepts in service
evaluation and quality improvement
• Help older people avoid and manage chronic illness
• Promote meaningful social engagement
• Improve self perceptions of ageing by valuing and
promoting the contributions that older people make to Society
Professor Colette Browning FAPS and Professor Shane Thomas MAPS, ‘Enhancing
quality of life in older people’, InPsych | The bulletin of The Australian Psychological
Society Limited February 2013, pp 12-13
24 Centre for Research on Ageing, Health and Wellbeing; ARC Centre of Excellence in Population Ageing Research
3f A few policy observations on
prevention and health promotion • In Australia there is a strong policy focus on
chronic disease yet little attention to ageing and
older people.
• For prevention, self management, and
amelioration it is important to ensure inclusion of
the middle and older age groups for whom
chronic disease is most salient.
• There is encouraging evidence on the efficacy of
prevention and interventions for ageing people.
25
3g And the big picture on well being (or
can we only achieve what we measure) Flourishing refers to the experience of life going well. It is a combination of feeling good
and functioning effectively…high level of mental wellbeing,
Well-being matters for health outcomes
Burns,Byles, Mitchell and Anstey. Positive components of mental health provide significant protection
against likelihood of falling in older women over a 13-year period
International Psychogeriatrics (2012), 24:9, 1419–1428 C International Psychogeriatric Association
2012doi:10.1017/S1041610212000154
Can we monitor well-being along with other valued outcomes of ageing people Huppert, Marks,Clark, Siegrist, Stutzer, Vittersø and Wahrendorf
Measuring Well-being Across Europe: Description of the ESS Well-being Module and Preliminary Findings
Soc Indic Res (2009) 91:301–315 DOI 10.1007/s11205-008-9346-0
Centre for Research on Ageing, Health and Wellbeing ARC
Centre of Excellence in Population Ageing Research
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27
Part 4 Service Innovations
and Practice: A few Examples
Notes:
- The potential of Consumer-Directed Care under the Living Longer,
Living Better reforms.
- Past failures of policies and services to adopt valuable, proven
community based inovations
Centre for Research on Ageing, Health and Wellbeing; ARC Centre of Excellence in Population Ageing Research
4a. ACH Group ‘Good Lives for
Older People’ 2011 • Innovative community care agency … committed to shifting
• from client centred (organisation controlled ‘places’) - to consumer
directed (persons with entitlements)
• Language is important: - ‘customers’ (not clients/consumers) -
‘advisors’ (not coordinators)
• Redefine power relationships – so people can continue with - the
choice and the control they have had their whole lives - (not a
rationed system where other people decide for them)
• Restorative approaches, social participation & physical activity
(and Barnett with Dean 2012 for the evidence base)
Centre for Research on Ageing, Health and Wellbeing ARC
Centre of Excellence in Population Ageing Research
28
4b ACH Group Principles of a Good Life
1. Unique: “I am me!” ‘No life has been lived before and it won’t be lived
again… to be honoured, including my life experiences, strengths, culture,
and spirituality’
2. Being in Control: ‘I am in control of my life… I am my own boss’
3. Optimistic: ‘I have a sense of future and hope’ ‘I set goals for myself’
4. Belonging: ‘I love being with family and friends’ … a variety of relationships
in everyday life
5. Contributions and Engagement: ‘I want to do my bit’ … To give, take, and to
enjoy the fullness of life with interests and passions….
6. Healthy – ‘I want to stay fit!’ … I am as healthy as I can be
(based on Board Conversations with Older People and CDC customers’
comments)
And thanks to Jeff Fiebig, Mike Rungie, and colleagues
Centre for Research on Ageing, Health and Wellbeing ARC
Centre of Excellence in Population Ageing Research
29
4d Healthy Ageing and Inclusive Design
Healthy
Ageing
Agenda
Inclusive
Design
Agenda
Disability
Social
sustainability
Ageing continuum Kate Bridge UNSW
Eco sustainability
Maintain
activity levels
4e Evidence for Environmental
approaches Bridge, C. and H. Kendig. Environments, professionals, and positive ageing
(2005) In I. Coulsen and V. Minichiello (eds.) Contemporary issues in
gerontology: Promoting positive ageing. Sydney: Allen & Unwin,
• 144-166.
Plus additional Bridge publications available from the UNSW Cities Future
Program and the Australian Housing and Urban Research Institute (AHURI)
Centre for Research on Ageing, Health and Wellbeing ARC
Centre of Excellence in Population Ageing Research
31
5. Some Concluding Observations
33
5a Implications for practise
Importance of the Clinical and Service Relationship
- Attitudes and advice for each person (listening)
Don’t make people ‘feel old’!
More than a clinical problem on a body
Positive: what can be done
what matters for you?
Recoverable and Improvable
Not disability and death denying
- Reinforcing who we are and who we can become
- Enabling and facilitating
Centre for Research on Ageing, Health and Wellbeing; ARC Centre of Excellence in Population Ageing Research
5b Developing an ‘Age-sensitive’
perspective in Programs and Policies The centrality of a life span perspective:
The young will become old (human capital investments)
The old were once younger (and we can learn from them)
It is never to early nor to late (opportunities at all ages)
The main game is how ageing and older people fare in their
communities and mainstream services
Eg, the NSW Ageing Strategy (potential and difficulties)
The challenges:
Diversity across social groups and individuals
Entrenched disadvantage across family generations
Confronting Ageism
Centre for Research on Ageing, Health and Wellbeing ARC
Centre of Excellence in Population Ageing Research
34
Key Collaborators in Developing Ageing Well Research ANU Ageing and the Family Project ARC-NHMRC Research Network in Ageing Well (RNAW)
• Diane Gibson sociology - Kaarin Anstey psychology
• Jane Halton psychology - Helen Bartlett gerontology
• John McCallum sociology - Tony Broe geriatric medicine
• Don Rowland demography - Colette Browning psychology
- Julie Byles epidemiology and medicine
- Mathew Carroll psychology
- Judith Healy social policy
- Sue Richardson economics
- Barbara Squires social work
- Sue Richardson economics
La Trobe ARC Key Centre in Gerontology ANU Centre for Research in Ageing, Health, and Well-being (CRAHW
• Colette Browning psychology ARC Centre of Excellence in Population Ageing Research (CEPAR)
• Libby Brooke sociology - Kaarin Anstey psychology
• Barbara Davison occupational therapy - Richard Burns psychology
• David de Vaus sociology - Colette Browning psychology
• Victor Minichiello sociology - Julie Byles epidemiology and medicine
• Karen Teshuva public health - Cathy Gong economics
• Rhonda Nay nursing - Vanessa Loh psychology
• Yvonne Wells psychology - Kerry Sargent-Cox psychology
University of Sydney, Health Sciences and Centre for Education and Research on Ageing
• Kate Bridge, occupational therapy and architecture
• Lindy Clemson occupational therapy
• Bob Cumming geriatric medicine, epidemiology, and public health
• David Le Couteur geriatric medicine and biology
• Vanessa Loh psychology
• Jack Noone psychology
• Kate O’Loughlin sociology
• Susan Quine sociology and public health
Centre for Research on Ageing, Health and Wellbeing 35
Some References
• Browning, C. J. and H. Kendig (2010) Cohort profile: The Melbourne Longitudinal Studies on Healthy Ageing Program.
International Journal of Epidemiology, 39(5): e1-e7.
• Browning, C., Heine, C., & Thomas, S. (2012). Promoting ageing well: Psychological contributions. In L. Ricciardelli & M.
Caltabiano (Eds.), Applied Topics in Health Psychology (pp 57-71). Wiley-Blackwell.
• Browning, C., & Heine, C. (2012). Ageing and health: Biological, social and environmental perspectives. In P. Liamputtong,
R. Fanny & G. Verrinder (Eds.), Health, Illness and Well-being: Perspectives and social determinants (pp 92-106). Oxford
University Press.
• Browning, C. J., Chapman, A., Cowlishaw, S., LI, Z. X., Thomas, S. A., Yang, H. & Zhang, T. (2011). The Happy Life Club™
study protocol: A cluster randomised controlled trial of a type 2 diabetes health coach intervention. BMC Public Health, 11.
• Browning, C., Thomas, S., Yang, H., Chapman, A., Zhang, T., Li, Z. (2011). The Happy Life Club: Improving the quality of life
of patients with type 2 diabetes mellitus. Chinese General Practice,14, 5A, 1397-1401.
• Shariff, S., Browning, C. & Yasin, S. (2012). Promoting physical activity in sedentary elderly Malays with type 2 diabetes: A
protocol for randomised controlled trial. BMJ Open, BMJ Open, 6 (2), available on BMJ Open 2012;2:e002119
• Kendig, H. and C. Browning (2010) A social view on healthy ageing: Multi-disciplinary perspectives and Australian evidence.
In D. Dannefer and C. Phillipson (Eds.) The SAGE Handbook of Social Gerontology. London, Sage Publications: 459-471.
• Kendig, H. and C. Browning (2011). Ageing well in a healthy Australia. ASSA Dialogue, Academy of the Social Sciences in
Australia, Canberra, 31(2): 22-30.
• Kendig, H., Browning, C.J. and Young, A.E. (2000) 'Impacts of illness and disability on the well-being of older people',
Disability & Rehabilitation, 22:1, 15 – 22
• Kendig, H. L., R. I. Pedlow, C. J. Browning, Y. D. Wells and S. A. Thomas (2010) Health, social and lifestyle factors in entry
to residential aged care: an Australian longitudinal analysis. Age and Ageing, 39: 342-34.
Some related to broader policy
Gibson, D. M. & Academy of the Social Sciences in Australia. (2010). Beyond life
expectancy. Canberra : Academy of the Social Sciences in Australia,
http://www.assa.edu.au/publications/occasional_papers/2010_CS5.php Jorm, L., Walter, S. R., Lujic, S., Byles, J & Kendig, H. (2010). Home & community care services: a major opportunity for preventive health care, BMC Geriatrics, 10, 26. Kendig, H. (2010). The intergenerational report 2010: a double-edged sword, Australasian Journal on Ageing, 29 (4): 145-146. Kendig, H., Browning, C., Pedlow, R., Wells, Y., & Thomas, S. (2010). Health, social, and life style predictors of entry to residential aged care: An Australian longitudinal analysis, Age and Ageing, 39 (3): 342-9. Kendig, H. & Duckett, S. (2001). Australian directions in aged care: The generation of policies for generations of older people, Australian Health Policy Institute at the University of Sydney, Commissioned Paper Series 2001/5 (113 pp.). Lewin, G. & Vandermeulen, S. (2010). A non-randomised controlled trial of the Home Independence Program, an Australian restorative programme for older home care clients, Health and Social Care in the Community, 18(1): 91-96.
37 Centre for Research on Ageing, Health and Wellbeing; ARC Centre of Excellence in Population Ageing Research