Oh, god. So, here we go. Straight into preparing the research base needed to do an essay, due next month. The first one I’m going to focus on is from a class about providing mental healthcare for older people. Where many students are pretty reliant upon the older members of their families or memories of elderly neighbours for any true lived experience of being with older people, I’ve got a truckload of experience, due to my work in the community as an oral historian and a media professional with a mental health specialisation.
I’ve met seniors from all walks of life, from countries all over the world, with many varying incomes and families and abilities and homes and social statuses. I’ve sat with them at the kitchen table or walked around their farms with them, recording and documenting their immigration history for posterity and for my column. The learning opportunities granted to me by these families have been endlessly valuable, and forever appreciated.
I am buddies with a local GP who specialises in geriatrics and he is a passionate activist who inspires us all to become “Dementia Friends” to those in our communities who depend on us to know a little bit about dementia and behave accordingly. My other friend Peter is a “Dementia Coach”; a passionate advocate and educator for my local area and beyond.
That is, I have no excuse to stuff this up. I’ve had extensive formal and informal education on myriad issues which affect people in old age… mostly informal and self-directed. When you have taken a break from research reports to do a lot of professional writing for media, it’s very difficult to rein in that “education for community entertainment” vibe from your writings, and pull it back to sharply-disciplined scientific writing. My big challenge is to get back into university life and re-learn how to funnel that complex breadth of face-to-face experience into well-written academic work. And now, for bonus fun, in APA 7th! Perhaps that is a big challenge for me as I reach a new stage in my own development; learning anew when I am no longer a young, highly-adaptable and dynamic spongelike creature, and more rigid in my ideas. I am forever struggling against my personality when it comes to writing for university. “Why can’t I just write the way I’d speak to a community group? This is stupid! I sound like a robot! I just want to talk about the issues affecting older Australians as if I’m having a cuppa with you!”
But… it is what it is. Universities have granted the title of “Dr” to many a rebel. Heck, Tom Morello is my hero. Brian May. Jonathan Miller. Huge shitstirrers, all.
So I shall write obediently (in APA 7 formatting thank you) about an issue which affects people in older age. I have previously felt I wasn’t an advanced enough student to approach sexology and sexuality in my work, but now that I’m at the level I’m at, I feel I should try to make my first attempt at this.
And no, not every person will encounter the same issues in their old age. For example, if you are someone who lives in poverty but are referred to a urologist with a large fee, specialist healthcare is going to be something you either struggle to afford and experience great distress over, or it’s something you just cannot access at all; even with a Medicare card. Whether you’ve got prostate cancer or you just need a few consults or minor surgery to deal with erectile dysfunction, the impacts on your life really can’t be reduced to, “Well, this one’s going to kill you and this one’s just going to really affect your enjoyment of sex and your relationship with your partner.” That’s just not how healthcare should ever work.
If you’re someone living in rural and remote communities and must spend a lot of money travelling to treatment, you may be foregoing nutritious food and medication to pay for that travel, even if the treatment has no gap fee. For Aboriginal and Torres Strait Islander families needing treatment such as dialysis, the distress of moving off Country and away from our kinship group is a real, measurable risk factor. End of life care for mob – at the time of my researching the evidence – was mostly poorly understood by the community, and there was a real discrepancy between what the research says is good care and what actually happens at the patient’s end. I am fairly sure this has progressed very little in the years since. I chose to research dialysis and end of life care for Aboriginal communities in an assignment several years ago, and the reading and statistics for this reduced me to tears more than once. I got a great mark for it, but by the time you really immerse yourself in that reading and hear the stories, the mark feels pretty meaningless, and you just want our social systems and legislation to bloody MOVE on it. Racism is costly, and it is a measurable health risk.
Only last month, an article in the Australian and New Zealand Journal of Public Health came out, outlining a clear path ahead in this area. To so many of us – especially advocates who have been yelling the same message for years – it’s a bit maddening to see stuff coming out which states the bleeding obvious, but maybe we need that serious literature to spell it out to some people.
It’s difficult to keep our spirits up without spending time on Country and with our family and loved ones. (OR)
Going back to the bush is good for the heart and mind. (VR)
Many people come from home communities where we are leaders and have important roles and responsibilities. When we have to leave that behind to access treatment in the city …, we feel like rubbish, and we are treated like [these things] are unimportant. (MC)
We moved here to support my uncle, but we need just as much support to know what we should be doing. (VR)
(Kelly et al., 2022)
In gerontology, it seems like such a basic thing, but the wee undergrads are first reminded that those in old age (generally understood to be those aged 65+) are people, like us, and that as we age, we never stop having the same rights, hopes, wishes, sensitivities, needs and wants as anyone else. And you’d think this goes without saying, but when you look at all the news headlines this week, you can see that as a society, some part of us is perfectly alright with putting our elderly away into substandard care, and never fixing that situation until truth-tellers remind us about our responsibility to the aged population. From many corners now, Australians are calling for a cultural shift on aged care.
And that population is growing. Nearly 8% of the world population is over 65, compared with only 2% a century ago. In Australia, the percentage of our population over 65 is 13%, with that figure set to rise still more.
New conversations, such as the above, are beginning to project a better potential future for aged care; not just for today’s government to claim credit for, but for the diverse, older, healthier service users aged 65+ over the next three generations. Who are these ageing populations, and what can we do to better provide for them?
“I live in an incredible amount of fear about my future. Not just as an older person. But as a gay older person. Institutions, they’re very straight. My god, I hope I don’t have to go into a care home, I really do . . . When I think about it, I find it quite scary. It frightens me that I am just going to be invisible, a nobody; that I am just going to be lost. And what I would want to do is just die.“
May, aged 64, ‘Finding Out’
This incredibly impactful quote is out of a publication called “Ageing, Gender and Sexuality”, by a researcher called Dr Sue Westwood, who’s from the UK. I can’t even begin to list all the magnificent work she’s done; she is just a very busy bee and you can click here to have a look at all the research she has done on the intersections between sexuality, ageing, religious organisations, the COVID-19 pandemic, and the successful delivery of community mental health services given these variables and populations. I’m in awe of her. Importantly, she’s not just a social scientist; she’s a lawyer. This brings into all her work an authoritative human rights perspective with a firm pointer to where the law or public health fall short.
As stated by the author, “Ageing, Gender and Sexuality focuses on the experiences of older lesbian, gay and bisexual (LGB) individuals, in order to analyse how ageing, gender and sexuality intersect to produce particular inequalities relating to resources, recognition and representation in later life.”
This is the sort of work that busts apart our tendency to categorise older people as simply “old people”. It acknowledges that like the rest of our care over our lifespan, aged care must meet us all where we are at. It must recognise our differences and cater to groups whose health needs and protective factors intersect with our communities – our sense of belonging.
I imagine that work of such cross-disciplinary spunk brings the old guard a well-deserved headache from time to time. When I consider the future implications and recommendations listed in the Kelly et al. paper (the one about Aboriginal patients driving kidney and healthcare improvements) I can’t help but wish that all research out of the social sciences could always have that sort of legal clout. Too often, arts and humanities faculties and psychological science research is given nothing like the consideration it deserves by governments who refuse to see any relationship between humanities and economics. Heaven forbid they just start where they should; by caring.
Having spent a good deal of time with older Australians, I’ve seen with my own eyes how much someone’s health and wellbeing is impacted by a transition to under-resourced, under-prioritised aged care. Arguably, nobody wants to spend year upon year in a place like that. Have you ever heard anyone sound excited to go into aged care? Me neither. And happy anticipation of comfort and happiness with folks we feel are still our community should be the standard we’re reaching for as aged care reform continues. No less.
Kelly, J., Stevenson, T., Arnold-Chamney, M., Bateman, S., Jesudason, S., McDonald, S., O’Donnell, K., Pearson, O., Sinclair, N. and Williamson, I. (2022), Aboriginal patients driving kidney and healthcare improvements: recommendations from South Australian community consultations. Australian and New Zealand Journal of Public Health. https://doi.org/10.1111/1753-6405.13279
Westwood, S. (2016). Ageing, Gender and Sexuality: Equality in later life (1st ed.). Routledge. https://doi-org.ezproxy.ecu.edu.au/10.4324/9781315691961
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