ageing in place and space: spatial strategies for ageing societies

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Ageing in Place and Space:Spatial Strategies for Ageing Societies

Presented By Hamish Robertson

Contents

• Introduction

• Location in an ageing world

• Coping with rising complexity

• GIScience’s contribution to our present and future problems

• Opportunities for spatial technology

• Building spatial literacy and capacity

• Conclusion

• Shameless self-promotion slide

Introduction

• We have spent more than a decade presenting spatial applications to health and social service audiences

• We are lucky if they even know what a GIS is – the rest of giscience is often completely new

• Understanding how and where spatial science and technology can be applied remains a fringe audience

• Digital literacy in health and social care is usually rare and piecemeal at best – this needs to change

• Population ageing is changing the face of health, social and economic policy globally – how and where will we contribute?

• How do we make health and social care more spatial?

Location Matters

Population Ageing is a Global PhenomenonSource: UNFPA

Australian Population DynamicsMedium Level ABS Forecasts 2006-2031

2006 2011 2016 2021 2026 2031 2036 2041 2046 2051

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Aged 65 years and over

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Ageing in China: Towards 250 million

Significant Data Limitations – Still!Ferri et al, (2005) “Global prevalence of dementia: a Delphi consensus study”, The Lancet

Dementia in West Africa

Location in an ageing world

• Where you age has an impact on how you age e.g. rural vs urban, travel times, public transport access, emergency service response times, local shopping, GP and pharmacy access, allied health supports, family connections, Post Office, availability and quality of a hospital, quality and experience of staff in the hospital, geriatrics expertise?, dementia care? Residential care facility? Respite and referral services and on and on it goes…

Coping with Complexity

• Our systems and, of necessity, our models are getting increasingly complex – but communication still matters e.g. ‘big data’

• The interactions between the natural and built environments are intensifying and becoming more variable e.g. natural disasters

• Extreme natural events are on the rise with significant societal and economic implications e.g. Munich Re

• Human perception, will and strategies are lagging

• Few other technologies with the capacity to capture these levels on interconnection-interaction – an major opportunity for spatial science and technology

Tobler’s First Law

"Everything is related to everything else, but near things are more related than

distant things.”

Tobler W., (1970) "A computer movie simulating urban growth in the

Detroit region” Economic Geography, 46(2): 234-240.

Earthquake and Tsunami Debris Reaches Mainland USSource: BBC News US and Canada 7 June 2012 Last updated at 08:29 GMT

Japan - 11 March, 2011Massive Impact and Ongoing Consequences – Long Tailed Events!

Differential Effects: Vulnerable Groups50% of Victims Were 65+

Source: http://www.guardian.co.uk/world/blog/2011/mar/13/japan-earthquake-and-tsunami-japan

It Was Ever Thus

Viewing Social

Inequalities from Space

Steady State Vulnerabilities in Healthcare SystemsSource: Travaglia, 2009

• The elderly (older, very old, oldest old, centenarians and supercentenarians)

• Indigenous peoples

• Immigrants – especially those with limited local language skills

• People with disabilities, especially cognitive/communicative impairments

• Children and youth

• Patients with literacy and communication problems

• People from lower SES

• Geographically isolated individuals

• Socially isolated individuals

• The homeless

• The frail and malnourished

• Patients with co-morbidities and chronic illness

• Patients with high acuity and complex system dependence (e.g. dialysis)

• Those with liminal (social, physical, geographic) status

• Those without an advocate

Disease, Illness, Prevention and Location

• Every few years healthcare realises that location matters again e.g. Gawande and the Hot Spotters, 2001

• Then they go back to business as usual – mostly

• In a system about aged people, location can only increase in importance e.g. RACFs vs acute care admissions

• Occasionally we produce digital versions of the analogue maps we produced in the first place –still limited applications

Everyone Knows, But They Don’t Always UnderstandSource: http://thehealthcareblog.com/

Fertility Decline + Cohort Size + Life Expectancy = Ageing

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Age Cohorts

Age Cohorts (Census 2011)

Total Spend Estimation for NSW

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Expenditure by Major Conditions by Age

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Other causes

Maternal conditions

Injuries

Nervous system

Musculoskeletal

Neoplasms

Cardiovascular

People Aged 65-74

People Aged 75-79

People Aged 80-84

People Aged 85+

Aged 65+ and Ambulance Stations

Accessibility to Services

The Opportunity and the Contribution

• Possible, probable and actual?• Effective, relevant and efficient service provision –

in a time of rising costs and political interventions• Quality and safety issues can only increase – for

staff and clients e.g. travel times, injuries, isolation, dying alone

• Connections between services e.g. NDIS => ageing, disability and diversity in Australia

• Family supports, advocacy organisations, service evaluation, site location (RACF) etc

• Spatialising the whole aged care sector (health and social services) - for every issue that has a useful locational component

Some Key Spatial Concepts for Health Research

• Human beings are innately spatial – cognition, memory and behavior => brains, languages, cultures, evolutionary development (Keith Clarke, 2011)

• Settlement patterns, agriculture, urban processes, travel patterns, service logistics etc are all spatially constituted

• Most social constructs involve explicit or implicit spatial characteristics (e.g. society, population, social networks, social capital, embodiment)

• Maps and mapping are both data analysis and visualisation processes –back to spatial cognition – building on this knowledge

• Health policy and research use terms like ‘ageing in place’ in largely atheoretical ways – lack of critique and reflection

• It is often clear that health researchers and practitioners don’t know what they don’t know about space and place constructs, spatial technologies and spatial science more broadly still

Buildinging Capacity

• Spatial technology is pervasive, spatial literacy is not• Building on digital revolution and literacy for use• Translational knowledge and skills – clinical/field

applications e.g. disaster health management, obesity programs, health promotion, child health, ageing etc

• Addressing problems from multiple perspectives e.g. policy, service provision, advocacy, client/user, carers etc

• Creating and developing markets by investing in users –not just the technical ‘fix’ or another failed IT contract

• Multi-scalar approach – boards, executives, clinicians, administrators, other professionals

• Informatics integration – health informatics weak on locational applications, they think IT ‘conquers’ space –the only time you’ll hear doctors paraphrase Karl Marx

Conclusion

• Spatial science and technology has made limited inroads into health and social policy domains in Australia to date

• The rise of more complex and expensive problems presents an opportunity for spatial science and technology

• Population ageing is the demographic policy issue of our time and for another generation beyond to 2050

• Spatial science and technology has the potential to make population ageing policy and community ageing sustainable, effective and even efficient - maybe

• To do that, spatial skills and applications need to address the internal complexity and fragmented nature of the social policy domain – pilot projects won’t cut it

• Where possible, target the users, not the gate-keepers, because they’ll be a more digitally literate audience

Shameless Self-Promotion Slide

• If I don’t, it’s fairly unlikely anyone else will…

• Sometimes presentations and workshops linger – so start targeting health conferences!

• Presenting in 2014 (so far) at:

– International Sociological Association, Yokohama

– New Zealand Association of Gerontology

– Submissions in for numerous other Australian, regional and international conferences