Women’s Wellbeing in Older Age: Opportunities for Risk Prevention and Early Intervention

Women’s Wellbeing in Older Age:

Opportunities for Risk Prevention and Early Intervention

ISBN 978-0-646-80149-0

Purpose

Family Life is a specialist family services provider working with vulnerable children, families and communities. Through our experience working with different populations in local communities, and listening to the lived experiences of our volunteers and employees, we recognised there were a number of life experiences and issues emerging for women in mid-life and later that had not been well enough understood or addressed.

We wanted to develop a better understanding of these issues and to identify the best means for supporting the wellbeing of women 50 years of age and older, commencing with those engaged with Family Life.

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| Women’s Wellbeing in Older Age: Opportunities for Risk Prevention and Early Intervention

Executive Summary

There is growing evidence that Australian women face unique risks to their financial security and general wellbeing, leading up to and through retirement.

We propose that risk prevention and early intervention initiatives are needed to better support women’s financial wellbeing leading up to and throughout postretirement age.

Beyond seeking to identify direct efforts we can contribute at the local community level, Family Life is concerned to add our voice to the wider public discourse to promote systems and policy change in relation to the financial, housing and personal security of mature women. A National Advisory Group has been formed to lead that engagement and ensure learnings from women at the local level are elevated into the public discourse and movement for women’s equality and social change.

This report presents our review of evidence and theory related to the social and economic determinants of well being for women over 50 years of age, with a focus on ecological theory and cultural concepts.

The report explores intersectional factors that determine levels of vulnerability and wellbeing for this group. It also discusses findings from a community consultation and needs assessment process conducted to gain an understanding of the needs and supports required to increase wellbeing. Risk factors were identified for the cohort and included asset division, unexpected life events (including ‘health shocks’), reliance on rental accommodation, social isolation and poor access to transport.

Our research explored the drivers, determinants and outcomes of wellbeing in this age group, and through this process, protective factors were identified. These include financial knowledge, retaining control over financial affairs, home ownership, social connection, positive social attitudes, values about gender roles and an improved social understanding of ageing.

This material has been synthesised to form 27 recommendations to inform design and implementation initiatives to take action to better support women’s social and financial wellbeing.

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| Women’s Wellbeing in Older Age: Opportunities for Risk Prevention and Early Intervention

Summary of Recommendations for Social Connection Program Approach

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Focus program on women aged from 50 years of age - as opposed to 65 years and over. Some of the issues facing older women may be supported by planning, knowledge and skill building in younger age, which may help to protect against unexpected events when they occur. In theory, such a program may be targeted at women of any age however this may not be feasible within the scope of this program.

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Any education provided about financial literacy as part of the program should aim to improve awareness and knowledge of financial scams, and provide strategies for avoiding them.

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Consider the strengthening of financial resilience and emotional resilience as possible aims for any educational component of a program.

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Women who undertake caring roles (of whom there are a significant proportion) may benefit from specific supports to undertake social activities, due to less opportunity for community participation.

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Intentionally target any program to reach women who are not socially connected, who have limited mobility, poor access to transport, or limited financial resources. This is imperative as they may be at higher risk of social isolation. Seeking feedback about what they need to access opportunities for social engagement will support additional program approaches for these individuals.

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The objective of such a program could remain broad - and be to “Support the financial security of women aged 65 years and over, in the Southern Melbourne region.”

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The approach should align with policy areas of the World Health Organization (WHO) Active Ageing Framework1 and United Nations (UN) Sustainable Development Goals (SDG)2.

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The program should work towards a number of key program outcomes. These should also align with outcomes of the Victorian Public Health and Wellbeing Outcomes Framework3.

Suggested outcomes include: • Participants in the program experience stable finances and housing stability • Participants’ establish and maintain strong relationships with others

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• I ncrease the bidirectional sharing of knowledge, skills, resources and support in the community, for optimal economic, social and health-related wellbeing • P articipants are aware of financial, social, and health services available to them, and access appropriate and timely support.

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| Women’s Wellbeing in Older Age: Opportunities for Risk Prevention and Early Intervention

It is recommended that the program content: 10

Continue to be co-designed, within context, and using a place-based approach. A primary and/or secondary prevention public health approach may be an appropriate.

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Raise awareness about protective factors, and factors that increase risk.

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Support individuals’ ability to face planning for unexpected life events.

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Establish and maintain meaningful social connections.

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Support long-term planning of finances, strong financial knowledge and retaining control of finances.

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Provide opportunity for women to learn and understand what will bring them a personal sense of purpose, aside from their career and family relationships. These can be simple (as opposed to a ‘larger purpose’). They may be social or solitary activities - e.g. photography, art, volunteering, taking care of a pet, writing/sharing their life story, gardening, spirituality, learning, working together with people on a common goal; mentoring.

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Develop skills for building social networks.

It is recommended that the program delivery method:

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Enhance opportunity for social connection. A desire to connect meaningfully with others is present - but the opportunity may not be there.

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Provide opportunity for individuals to impart and share of their life experiences, learnings, skills, and knowledge, to support a sense of purpose.

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Emphasise the ways in which individuals may add value or provide support to others - are not limited to skills or knowledge gained through formal education. In particular, encourage the value of sharing lived experience that may support others.

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Allow for regular reflection on program direction, allowing for emergent themes and responsive adaption and refinement.

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Prioritise equity throughout the co-production, implementation and evaluation process and develop strategies to address this. Particular consideration should be given to relationships where there may be actual or perceived dependent or unequal relationships or circumstances between participants, between participants and services, or between participants, program stakeholders and evaluators.

| Women’s Wellbeing in Older Age: Opportunities for Risk Prevention and Early Intervention

It is recommended that the following factors are considered when marketing the program, recruiting participants or raising awareness: 22

Enhance opportunity for women to participate in the program, or when this is not feasible, make relevant resources or other supports available to them, in a effort to support equitable access to supports in line with the recommended aims of the program.

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Consider that where social isolation is already present, first address mental and physical health problems and provide access to transport.

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Consider providing or supporting a means to access existing resources (this may be technology, transport or other) for people who are experiencing existing disadvantage.

It is recommended that if possible, the program adopt the following secondary aim:

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De-stigmatise the challenges of growing older - e.g. fears experienced, and support a shared positive understanding and respect for ageing in the community.

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Promote the concept of help-seeking as a positive way to both receive support, and provide support to others in the community; de-stigmatise the shame or perceived shame often associated with disadvantage and help-seeking.

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Pilot and test a program within the Southern Melbourne region with the aim of scaling horizontally and vertically, in other communities within Victoria and Australia, based on program refinement.

| Women’s Wellbeing in Older Age: Opportunities for Risk Prevention and Early Intervention

Table of Contents

Women’s Wellbeing in Older Age: Opportunities for Risk Prevention and Early Intervention

1

Purpose

2

Executive Summary

3

Summary of Recommendations for Social Connection Program Approach

4

Introduction

8

Background and Rationale

9

Methods

10

Review of Evidence and Theory

10

Community Consultation and Needs Assessment

10

Findings

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Wellbeing in Ageing: Overview of Evidence and Theory

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Ecological Theories and Cultural Concepts

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The National Context

12

Social and Economic Determinants of Wellbeing

12

Community Consultation and Needs Assessment

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Table 1. Themes Identified for Social Wellbeing

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Table 2. Themes Identified for Physical and Emotional Wellbeing

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Table 3. Themes Identified for Financial Wellbeing

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Table 4. Practical Suggestions for Service Delivery

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Recommendations and Conclusion

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Recommendations for Social Connection Program Approach

26

Further Information and Acknowledgements

29

Authorship

29

Suggested Citation

29

Reference List

30

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Introduction

Experiencing a reasonable quality of life (QOL) as one ages is a basic human right.

Objectively, measurement of QOL takes into account multiple factors which intersect across the life-course. Some factors are modifiable by individuals (micro-level) whilst others are influenced by the broader societal context (macro-level).

QOL can be defined as the concept of wellbeing across three categories - health, economic, and social. In older age, it is often associated with physical functioning and health-related outcomes - but without preceding and coexisting mental-health, social and economic security optimal health may be difficult to achieve and maintain.

Australians are fortunate to enjoy a very good standard of living on average. However many population groups continue to face an increased risk of disadvantage. One such group are women aged 65 years or over - some of whom face inadequate levels of superannuation, and increasing risks to housing security.

In this research report, a summary of findings from research and community consultation undertaken by Family Life, within the context of the Southern Region of Melbourne, are presented and discussed. Twenty-

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five recommendations have been synthesised with the aim of informing programs addressing risk of financial security, at age 65 and over.

Based on these findings, Family Life is currently coproducing a social connection initiative for women who are aged 50 years and over as part of Family Life’s ‘Catch Up for Women’ program. The program aims to support women’s long-term financial security, by facilitating social connection and reducing social isolation from 50 years of age; to subsequently support quality of life and wellbeing outcomes from 65 years of age. A pilot program will be implemented and evaluated in the Southern Region of Melbourne initially with the aim of refining the program for the local context, and if appropriate, for adapting and testing in other communities nationally.

| Women’s Wellbeing in Older Age: Opportunities for Risk Prevention and Early Intervention

Background and Rationale

This paper provides an overview of the findings arising from a participatory research process led by Family Life Ltd., a community services organisation located in the Southern Region of Melbourne.

The participatory research process was integrated within a broader co-design process, which was undertaken with the purpose of co-designing and coproducing a program to support women’s wellbeing, with a focus on long-term housing security and financial stability. The co-design process focuses on needs of women in the local region - but with keeping in-mind the national need for such programs and supports for women in post-retirement age - a secondary purpose of this process has been to produce a program that is scalable and with transferrable elements that may be of benefit to other communities for replication nationally.

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Throughout this paper, key findings arising from the summarised research have been highlighted as ‘Practice Points’ within each section. Practice Points reflect areas for which the quality of evidence, amount of evidence, or relevance of concepts were strongest. Judgements about strength and relevance of evidence were made by the authors’ in consultation with participating community members, and program advisory groups. Practice Points were synthesised together with broader findings, to form a program hypothesis and 27 recommendations for design of a pilot program, which will be tested through implementation and evaluation.

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Methods

1. Review of Evidence and Theory Primary, secondary and grey literature was sourced through keyword searches of social science databases, forward citation searching, and basic web searches. A narrative review was undertaken, based on key concepts related to wellbeing in ageing across two theme areas of social and financial wellbeing. Physical and emotional health were also referenced as part of their equal relevance to overall wellbeing, however they were not the core focus of this review. Specific areas of inquiry were informed by program consultation and co-design meetings.

2. Community

Consultation and Needs Assessment

1. Ecological Theories and Cultural Concepts

A survey questionnaire focusing across domains of social, financial, and general wellbeing was posted to 200 women aged 50 years or over, who volunteer with Family Life. Completion was invited through a process involving a participant information form, consent forms, anonymous, voluntary, and subject to an informed consent process. Melbourne completed by 86 women aged 50 years or over from our local community of volunteers. The results were not intended to be representational of the broader community, rather to gain a better understanding of the needs of community members engaged with Family Life, which would inspire further areas of investigation.

2. The National Context

The aim of the survey was to:

3. Social and Economic Determinants of Wellbeing

1. Capture the opinions and perspectives of women from the surrounding communities, who volunteer with Family Life.

The following key areas were included in the review:

Synthesis of the literature was undertaken, yielding a number of recommendations for program approaches based on gaps in existing services, and novel approaches that may address such gaps.

2. Identify any particular areas of concern they have.

3. Identify service gaps and learn about the types of programs and services they would like to see implemented.

4. Identify additional areas in which participants may need support, and identify gaps in awareness of, or access to, existing supports or service delivery.

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Findings Wellbeing in Ageing: Overview of Evidence and Theory Ecological Theories and Cultural Concepts Concept of Wellbeing Sociological, psychosocial and biological theories underpin concepts of wellbeing as they relate to risk of vulnerability in ageing and across a life-course. They are concepts which cannot easily be simplified into a linear cause-and-effect model but rather operate across multiple layers incorporating stressors, response to stressors and resources. The interplay between macro and micro-level influences during the course of an individual’s lifespan continually affects their interaction with their social environment and risk of vulnerability4.

The concept of wellbeing may be subjective or objective and may relate to the psychological wellbeing of an individual or population group. Wellbeing is influenced by biological and social dimensions, cultural variables, and individual values.5, 6 Historically it has been a difficult concept to define and measure, and debate around this continues.7 Subjective wellbeing as a concept, may be defined as having three elements: hedonic (feelings of happiness and sadness), evaluative (life satisfaction) and eudemonic (sense of purpose and meaning in life). These three elements are closely linked to health and influence each other bi-directionally4.

Intersectional Factors Factors that determine the level of vulnerability, health and ‘wellbeing’ and individual experiences in older age are complex, and dependent on intersectional experiences throughout one’s life-course8. For example, Crowe & Butterworth9 found that individuals experiencing unemployment and/or underemployment were significantly more likely to report depression.

This was also the case for those experiencing financial hardship and a low sense of mastery over their circumstances. This was significant after controlling for a number of social and health factors, suggesting that a sense of mastery and financial security may be a mediating link between unemployment and depression.

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Similarly, authors’ suggested that financial security, but not mastery, may mediate an association between underemployment and depression, and ultimately social support may influence how unemployed or underemployed individuals respond to their situation – providing a ‘buffer’9. The identification of social support as a mediating factor highlights the role of social connection in promoting health and wellbeing.

Cultural Attitudes Societal or cultural attitudes and values that drive inequity or discrimination – whether directly or indirectly – contribute to the socio-economic disadvantage experienced. For example, the presence of gender inequity limits women’s ability to gain education and employment, to live free from violence and harm; to be financially secure and independent, and to access proper housing and healthcare.10 Community culture dictates whether a community or society is more-so ‘independent’ or ‘collectivist’.

Independence is a concept considered particularly in Western society, to be indicative of positive life circumstances. Settersen11 suggests that the idea of ‘interdependence’ may be a favourable alternative, and may offer individuals, families and communities a safety net of support that is not necessarily as available within a more independent culture. Achieving interdependence may be difficult though, for people who are already socio-economically disadvantaged or marginalised.

Cultural theory is further complemented by a growing understanding of social and developmental neuroscience. The interrelationship between these concepts supports a potential benefit of promoting interdependence; for individuals and broader communities12.

In addition, Bowman and Bodsworth13 argue that individualisation of policy further intensifies some of the structural inequalities present in Australia, leading to more disparity and more risk to those who are vulnerable to it.

| Women’s Wellbeing in Older Age: Opportunities for Risk Prevention and Early Intervention

The National Context Within the global context, Australia performs well on measures of health and wellbeing, and ranks above average on most health, wellbeing and socio-economicrelated indicators.14 Overall the health of Australian citizens has improved over time. Burden of disease has decreased, life expectancies are rising and older people are living longer due to improvements in disease screening and treatment. Although a positive shift, non-communicable diseases remain a risk to health, particularly in older age and represent an area of large health expenditure.15 Despite Australia’s high performance on global indicators, a large gap exists between the rich and poor with the top 20% of incomes over five times higher than the lowest 20%.14 The number of homeless women aged 55 years and over in Australia increased by 31% to 6,866 in 2016, up from 5,234 persons in 201116.

On average, Australian women retire with $113,000 less in superannuation than men and are more likely to experience poverty in older age.17 These figures are concerning given research demonstrates a clear association between disadvantage and health outcomes.

In 2015, the United Nations General Assembly adopted 17 goals (SDGs) for the 2030 Agenda for Sustainable Development. Two of these goals are particularly relevant to women’s wellbeing and quality of life in ageing; those being gender equality, and reducing inequalities.1 Australian advocacy bodies such as Homelessness Australia and Equality Rights Alliance advocate for long-term structural reform, building on existing supports that can prevent homelessness and poverty, and strengthening superannuation for women.

These are critical changes to be made; they are longterm goals and require systemic issues to be addressed.

Alongside such work, shorter-term solutions may also offer benefit in mitigating women’s risk of socioeconomic disadvantage and supporting wellbeing. Such solutions may complement longer-term strategies

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Practice Point 1 Shorter-term solutions may play an important and complementary role at both the micro and macro levels, particularly secondary prevention of socioeconomic disadvantage, and primary prevention may mitigate immediate or future risk, contributing towards long-term change and supporting short- and long-term socio-economic and health outcomes, and quality of life. Solutions must incorporate an awareness of the importance of promoting interdependence and positive social connection.

Social and Economic Determinants of Wellbeing It is well-accepted that people who live in environments with the most disadvantaged social and economic circumstances are at higher risk of premature death.18 Conversely, self-reported good health in older age predicts longevity.19,4 Higher income, education level, occupation and positive psychological wellbeing are associated with positive health outcomes.20 Practice Point 2 Disadvantage often occurs gradually as risk accumulates, and may progress over a short timeframe or over decades. Movement up or down Australia’s ‘social gradient’ ladder is associated with decreased or increased risk of disadvantage.21 As disadvantage progresses, so does access to equal socio-economic opportunity, and risk for poor health outcomes is raised.22

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Housing and Financial Security Australian data suggests that most Australians (of all ages) rate their housing circumstances and financial circumstances as at least reasonably comfortable.23 From this same research, older people living alone reported that they were ‘just getting along’ (or better) financially. Older men and women mainly rated their housing and financial situation well but they were less likely to report high levels of comfort as compared to younger respondents.

Most residents of public housing are women, and aged over 50.21 Social housing, however is often reserved for those with the most complex need.24 Reliance on the private rental market in older age is often related to financial vulnerability. Relationship changes through widowhood, divorce or separation appear to be strongly related to this. Additional factors include employment instability and illness.24 It is important to note that these relationship changes often place women at risk of increased social isolation, with the potential for this to impact adversely on health and wellbeing.

Peterson and Parsell25 report that engagement with Australian welfare and other support services does not seem to predict a woman’s risk of becoming homeless in older age, however those with a conventional renting history who had raised families, or those who had endured housing disruption over time were more likely to be at risk.

Research has shown that living alone does not necessarily relate to economic or housing instability in and of itself26 and some research reports that women living alone have lower levels of financial comfort and physical health, than those living with others - a finding at odds with other Australian research.27 Practice Point 3 Women who are able to retain home ownership in older age are more likely to be protected against vulnerability, particularly as women have less opportunity to build their wealth in older age.28 Drivers for precarious economic stability for women are the gender pay gap; intermittent and unstable work as related to balancing caring roles; earnings-linked superannuation; women’s longer lifespan [compared to men], and a higher prevalence of single households as compared to men.29 13

Women experience multiple barriers to accumulating wealth, the effect of which is often not fully realised until older age. Particularly for women in the older age range, male partners may have traditionally held the role of managing household finances. Australian qualitative research highlights this as a key issue, quoting focus group participants “when you lose a husband you don’t know what to do - you are faced with bills for the first time…women need to know how to deal with this…”. “...I was so dependent on my husband. When he died I felt like a child - faced with crossing the road without any knowledge of the road rules…”. This issue appears to be related to levels of financial literacy, and financial confidence.29 Australian women have on average, lower levels of financial literacy than men. This may have increased relevance for long-term financial decisions, such as investments, as opposed to day-to-day money management. Women are also less likely to plan for retirement than men.28 Practice Point 4 Based on the evidence of multiple barriers to women’s economic stability, accumulating over time, it could be expected that intentional planning for unexpected life events could act as a strong protective measure.

Over the past 10 years, the overall poverty rate in Australia has both increased and decreased, but stayed largely stable at around 12%. Increases seen in this 10year period were likely a result of the broadening gap between ‘rich’ and ‘poor’ resulting from a rise in overall median income which did not transfer to equitable change for people receiving income support.30 Underemployment and low income were issues identified as specific to women in a small pilot study exploring the effects of gender and location on homelessness for older Victorians.31 Issues affecting both men and women in the study included the need for better access to affordable rental, public and community housing and access to services. Underemployment, limited access to services and limited community connection all have the potential to increase social isolation and therefore compromise health and wellbeing. Indeed, homelessness reduces one’s ability to access resources, and reduces an individual’s ‘voice’, and sense of agency.32

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People who are unemployed experience a high rate of poverty at around 60%, and this has stayed relatively stable over the last 10 years, due in part to unemployment benefits remaining below the poverty line. Poverty rates for people aged 65 and over improved marginally between 2004 and 2014, from 12.1% to 11.3%. However, the high cost of housing appears to be keeping the people aged 65 and over from escaping the poverty cycle. The risk of poverty is higher for people who have a disability, those aged under 15 or over 65, people who live in regional and rural areas as opposed to capital cities, and women.30 Practice Point 5 Reasons for Australian women experiencing slightly higher rates of poverty than men appear to be inequitable income, employment opportunity and greater caring responsibilities.30 In terms of employment in Australia, less women than men are employed, and more women than men are employed casually or part time. Overall, women’s earnings are lower than that of men in 16 of 19 key industries. The presence of women in senior roles within the public service are increasing, however are still represented less than men.33 Rates of underemployment are 6% for men and 9.7% for women aged 20-74. Underemployment is defined as a lack of employment relative to ability, skill or type of employment. Women undertake more unpaid work compared with men and are twice as likely to be carers for a person with a disability. People undertaking caring roles are less likely to work in full-time employment, therefore reducing income and superannuation earning capacity.33 People with a disability and women who were born overseas are significantly more likely to have less, or no, superannuation than other population groups.33

Practice Point 6 Women aged 55-64 have on average, approximately 37% less superannuation than men - a gap which is now narrowing for those aged under 45. 24% of women aged 15-64 have no superannuation at all, and both men and women who report no superannuation were more likely to experience financial hardship in other areas such as income, lower rates of home ownership.33 Australian data suggests that those who experience socio-economic vulnerability following retirement are more likely to rate satisfaction with their wellbeing and health as lower.34 Returning to work after voluntary absence is associated with lower levels of distress, possibly due to a personal sense of control and choice and/or opportunities for social connection. People leaving work involuntarily appear to be more reliant on public pensions than those who left of their own accord.

Levels of satisfaction with financial status following retirement appear to reduce for both groups.34 Research undertaken by the Lifelong Economic Wellbeing for Women in Australia project35 found that four main issues were perceived by women, as key to their economic security. These were: 1. Financial security; 2. Emotional and social safety and security; 3. Freedom and choice; 4. Equality of choice and opportunity.

Practice Point 7 Individuals experiencing unemployment and/or underemployment, financial hardship and a poor sense of agency - may be more likely to experience depression, irrespective of other social and health-related influences. Research suggests that a sense of agency or mastery, and financial security may be a mediating link between unemployment and depression. Additionally, levels of social support may influence how unemployed or underemployed people respond to an undesirable situation – providing a ‘buffer’.10 Research shows that higher income, higher level of education, ‘higher’ occupation level and positive psychological wellbeing are associated with more positive health outcomes22.

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Elder Abuse Elder abuse is un under-researched issue, and more information is needed in the area. Based on what is currently known, it affects up to 20% of Australian women, is usually financial in nature co-occurring with psychological abuse. Children, mostly sons, are most likely to perpetrate elder abuse and women are more likely to be the victims.37 Individual and interpersonal issues complicating elder abuse are cognitive health decline and disability, financial or relational dependence on the perpetrator, and social isolation.29 Experiencing family violence or elder abuse increases risk of economic vulnerability.33 This issue presents an added complexity - with women living in these circumstances often particularly isolated and fearful of seeking help. Based on the limited available empirical and analytical knowledge, factors raising risk of elder abuse appear to include cognitive impairment, disability, social isolation, prior experience of trauma, financial, emotional or relational dependence of perpetrator to victim, cultural or societal values that do not afford respect to elders, and inequitable/’traditional’ attitudes towards gender roles.

Practice Point 8 Factors protecting against elder abuse include financial knowledge, retention of control over financial affairs, positive societal attitudes and values about gender roles, and improved societal understanding of ageing.36

Life Transitions & Unexpected Life Events Relationship dissolution such as divorce or separation may impact women’s economic security through both immediate impacts (such as dividing assets), and through a reduced opportunity to save following the relationship breakdown.28 An issue which is affected by numerous intersectional factors.

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Similarly, health ‘shocks’ occurring in older age for women or their partners, can significantly impact on wealth in retirement for women. Rarely, do levels of wealth return to those experienced before the health event - they may be reduced by up to 20% over the following 10 years.37 These events also have the potential to impact of levels of social connectedness. For example, with divorce or separation, social networks may be reduced and health shocks may limit capacity to access community and connections once enjoyed.

Preparation for these events might include developing further understanding about protective factors and what emotional experiences may occur for women with life transitions. For example the role of close friend relationships in mitigating grief, or anticipating and addressing mixed feelings about retirement.38 Improved preparation may lead to a reduced dependence on a spouse. Government allowances can lead to improved economic outcomes and in turn improved economic security which in turn influences physical and emotional health.28 Research undertaken by Melbourne’s Lord Mayor’s Charitable Trust39 supported the notion of intersectional socio-economic factors impacting on women’s equality as they age. Their research found that key triggers for disadvantage were often unexpected life events foremost divorce, death of a partner, illness or injury and loss of employment. In accordance with this review, the report found little examples of long-term intervention models in the literature, which could work to address disadvantage for older women.

Practice Point 9 Research encourages supporting housing, information provision, financial counselling and advice to support women’s equality. Recommendations include the need to innovate, collaborate, and foster cross-sectoral collaborations to address gaps and opportunities.

| Women’s Wellbeing in Older Age: Opportunities for Risk Prevention and Early Intervention

Social Connection Social isolation impacts negatively on the health and wellbeing of older women in Victoria.29 Social isolation may occur due to social exclusion, situational factors, decreases in mobility, or due to physical or psychological health problems. Women’s social networks are generally stronger than that of men in Australia.40 Retirement does not seem to modify this – with women in retirement reporting more social engagement than those who have not retired.

Risk of social isolation increases for older women from culturally and linguistically diverse backgrounds (CALD), and those within the LGBTIQ Community may be at greater risk of experiencing social isolation, possibly more-so than younger women in some instances due to a historical context of societal stigma.40 Undertaking caring roles, and experiencing the death of a family member (particularly a parent or partner) for whom one was caring raise the risk of psychological distress and social isolation for women. Other risk factors may include living in rental accommodation, poor health, low occupational status, and never having married.47 Relationship dissolution can have a significant effect on women’s wellbeing; with potential impacts on financial and housing stability, mental and physical health, and death of a spouse impacts on psychological wellbeing particularly in the short-term.41 Women without children are less likely to lack social contact.42 Some women demonstrate a stronger connection with society than male population groups, however single mothers’ experience lower social engagement. This is enhanced when there are additional intersecting variables.

Evidence suggests that having strong social networks in older age may protect health – and lengthen survival. This protective effect may be more significantly associated with friendships than for family relationships. Reasons for this may include the improved sense of mental wellbeing, self-esteem, resilience and agency that may result from social engagement – which appears significant even when considering the occurrence of life-events affecting social networks - such as death of friends or family, or geographical relocation.44,45 Practice Point 10 Social isolation can significantly increase risk of mortality in older age, with the risk of death equivalent to that of engaging in smoking and alcohol consumption. Research suggests that objectively measured social isolation is a stronger predictor of poor health than obesity or physical inactivity – regardless of subjective or self-reported interest in social connection, perceived social connection or satisfaction with relationships.

Modifiable lifestyle factors increase risk to health and mortality significantly, a correlate which is highly preventable15.

Research undertaken for this review particularly highlights the strong mediating role that social connection, that is - the number and quality of connections - plays between experiencing life stressors and health and wellbeing outcomes. Associated with this is the importance of having a sense of purpose, control and choice in life as one ages.

Social isolation if experienced in mid-life, tends to magnify over time. It occurs at key ‘transition’ points in life (such as loss of a partner). Even in the face of insecurity, having strong social connections facilitates improvements in wellbeing.43

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Practice Point 11 Factors which appear to protect against risk: • S trong social connections (particularly friendships) protects wellbeing, even in the face of serious life transitions • Owning a home • Strong financial literacy • R etaining control over finances after life transitions • S trong sense of agency, purpose, and self-esteem (self-efficacy)

Practice Point 12 Factors which appear to increase risk: • Asset division following relationship breakdown • D ecreased capacity for wealth accumulation following relationship breakdown • E xperiencing unexpected life events/transitions, including health ‘shocks’ (either self or partner) eg. relationship breakdown, death of spouse • Reliance on rental housing • Poor access to transport • O verly dependent on another (partner or family) for financial wellbeing • Overly independent - reduced help seeking • U ntreated or unresolved physical/mental health issues • S ome population groups experience increased risk. These include single women who have experienced divorce or death of a spouse, single mothers; people who have a disability, or are from CALD, ATSI, LGBTIQ and other groups who experience disadvantage.

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Community Consultation and Needs Assessment Findings from the community consultation process suggest that the main issues facing the participants included social connection, barriers to taking part in daily activities, and financial wellbeing. These issues were not problematic for the majority of women involved, however some variables, for example social connection, affected a reasonable proportion of the group. Some issues were not identified by a significant proportion of people, however were observed, analysed, discussed and included in findings to ensure an equitable, co-designed, and effective approach.

Social Wellbeing Experiencing social isolation, risk of social isolation, sense of connection with community and an interest in developing social networks were the most prominent findings to arise from the community consultation results. Around 22% of respondents indicated they currently experienced social isolation, or appeared to be at risk of social isolation. Many women who were consulted indicated an interest in building social connections, and increasing opportunities to connect with others.

Barriers to Daily Activities Barriers to employment or daily activities were noted by some women in the community, as something they had faced within the past 12 months. Barriers to employment that were encountered included perceived age discrimination, unsuitable hours, transport issues, lack of work experience, own ill health or disability, no jobs available in their areas of work experience, difficulties finding childcare, competing against too many applicants, returning after a career break, and just no jobs at all.

Reasons that were not an issue for this group of women included ‘transport problems or it was too far to travel’, and ‘did not have the required education, training and skills.’

18

Encountering barriers to undertaking daily activities (such as managing household, healthcare, hobbies, training, education) were multifactorial eg. costs AND health reasons, or costs AND access to transport.

Reasons cited included health issues, costs, availability in community, access to transport, age and carer duties.

Financial Wellbeing Results indicated that women involved in the community consultation experienced an overall high level of financial wellbeing. Areas of the least need overall were understanding of rights and responsibilities, ability to recognise a scam, and service availability (most responses were neutral, possibly indicating a lack of need to access such resources or an unwillingness to disclose difficulties). Areas that were more difficult included ease of accessing information, and understanding financial language. Most indicators showed little variance in answers. Indicators that showed a slightly higher degree of variance in responses included ‘I have the ability to understand financial language’, ‘I could get by for some time in case of a financial emergency’ and ‘dealing with money is stressful and overwhelming.’

Some results indicated that women may be reliant on their partner for the management of household finances, and that some may therefore perceive no need to understand or strengthen financial literacy or money management skills. This is concerning, given the sudden financial disadvantage that may be experienced when unexpected life events occur - and the risk of resulting stress and potential further disadvantage.

Tables 1 to 4 provide an overview of key themes and comments gathered through the community consultation. The types of services suggested by participants across the domains of health and social wellbeing were centred on socially-focused objectives and are listed in descending order of popularity.

| Women’s Wellbeing in Older Age: Opportunities for Risk Prevention and Early Intervention

Table 1. Themes Identified for Social Wellbeing 1. Informal/Conversational Coffee catch up, drop in centre, walks and picnics in the park; networking; positive thinking

“There are many single and lonely women in this age group so perhaps services such as weekly coffee mornings, cards and board games sessions, walks and picnics in the parks”

2. Services Not Needed Not required, or current services are adequate

“I’m lucky but I understand that others are not for whatever reasons…” “(My) Council provides plenty” “Not really applicable to me. Have a good friendship network and my family/husband”

3. Defined Activities Arts, musical events, theatre trips, cards and board games

“Evenings out, eg. theatre trips, musical events, would be lovely to share with other ladies who enjoy the arts. Even just regular ‘coffee mornings’ at local cafes would be lovely” “Regular, organised activities for physical and mental wellbeing that involve physicality and not just sitting on your bum drinking coffee and eating biscuits”

4. Educational Environmental education, drop in centre with information available

“Teaching people about recycling for future families. Too much going in skips - landfill problems later. For our children”

5. Other Comments Barriers to accessing supports; specific support for carers; promote volunteering

19

‘Do not drive therefore feel very helpless’ “...am watching friends negotiate care for parents at home. Available but very time and emotionally consuming” “...I would like to suggest that many people would be helped by volunteering. I would like to see it promoted more to help socially isolated people meet others and add to their confidence and sense of community”

| Women’s Wellbeing in Older Age: Opportunities for Risk Prevention and Early Intervention

Table 2. Themes Identified for Physical and Emotional Wellbeing 1. Group and Social Activities Groups for individual or family members; coffee, lunch activities and gatherings

“I find going to op shops helps lift my mood up. Lots of fun, talk over problems and most important lots of laughter”

2. Support for Specific Health Issues and Topics Mental health support groups, more discussion about women’s health, nutrition, health, wellness, gratitude, mindfulness meditation

“Anxiety or depression groups for one self or family members. Nothing in (my council) “Perhaps advice on meditation, nutrition information”

3. Services Not Needed Not required, or current services are adequate

“Not applicable to me - all services near me are good” “Not really. I go to gym and have a good friendship network”

4. Physical Activity Activities in the park for over 50s; strength training; dance classes

“Need strength training and would love some dance classes for oldies”

5. Life Transitions Support for major life transitions - retirement and children leaving home

“Support around life transitions - empty nest syndrome” “Support for life changes after retirement, especially if the retirement is unexpected”

6. Enhanced Security Property and housing security and safety

“More security [where I live]” “More frequently now we hear of home invasions. More advice on protecting ourselves and our property would be useful”

7. Other Comments Accessibility to services; practical home-based assistance;

20

“Better access to out of business hours hydrotherapy” “I know home help is available but I would like someone to come and do what I need doing not what they’re allowed to do. I’m quite capable of cleaning my floors, washing my benches and cleaning my bathroom”

| Women’s Wellbeing in Older Age: Opportunities for Risk Prevention and Early Intervention

Table 3. Themes Identified for Financial Wellbeing 1. Financial Advice Free or low fee; rights and responsibilities; navigating the service system; saving money; pensions; health insurance; womens financial future; affordable housing; budgeting; managing a budget

“Unsure if free or moderate fee based financial planning service available - if it is its not known about by many women who have separated or divorced and unsure of their rights.

I often hear stories from friends and friends of friends who’ve spent a lot of settlement monies due to them on lawyers and endless hours at Centrelink. This must be improved, so women can understand their rights without feeling vilified” “This age group often don’t have enough super so services such as ‘money saving ideas’, ‘dealing with centrelink’ and ‘assistance with filling out centrelink forms’” “Would like to see more affordable housing for people on pensions”

2. Services Not Needed Not required, or current services are adequate

“Not applicable to me - I have good access to financial support” “My husband is in finance. He usually explains financial matters/questions I have.”

3. Easier to Access and Understand Information Advice and information is more readily available; delivered in a simplistic way

“ Easier financial advice and information” “Financial advice in simplistic way. i.e easy to understand”

4. Other Comments Financial independence; employment seeking for over 50s; managing stress related to juggling bills

21

“I would like to be more independent financially” “what help is available - how to get work for over 50s 60s 70s” “Scared! Too many bills. Food going up, elec, gas, rates etc. Not enough pension to cover it all”

| Women’s Wellbeing in Older Age: Opportunities for Risk Prevention and Early Intervention

Table 4. Practical Suggestions for Service Delivery 1. Location Drop in centre; local community; continued relationships between cultural organisations

“Better connection with local community. Most of my friends live north of the CBD. It is hard to connect now I no longer work”

2. Frequency of Activities Once per week

“I would be interested in meeting new people! A social group for older people to meet, once a week, would be valuable.”

3. Delivery Method for Education Seminars and lectures; one-on-one services

22

“I think seminars/lectures on women’s finances and financial futures would be beneficial” “Someone to talk about managing your finances”

| Women’s Wellbeing in Older Age: Opportunities for Risk Prevention and Early Intervention

Key messages gathered through the community consultation process found that: •

xperiencing an average, or above average, standard E of living after age 50 may not automatically protect against the risk of future economic insecurity.

Sudden changes in financial circumstance may be precipitated by a sudden and unexpected life event, such as the sudden illness or death of a spouse, which when coupled with other risk factors may increase risk.

•

I n general, community members reported a high degree of confidence in their ability to recognise a financial scam that seemed to them to be too good to be true. Although this may be the case, consider retaining the topic in any program model as it is possible people underestimate their actual level of vulnerability on this indicator.46

•

I t may be beneficial to develop services or supports that specifically address financial planning and financial resilience for reducing risk of unexpected life events or life transitions. In particular for women with multiple responsibilities, such as those who undertake caring roles in addition to their own employment.

•

upport more opportunities for women of postS retirement age to engage socially with others in the community, and develop interdependent social connections. Reaching individuals who are not socially connected, who have limited mobility, poor access to transport, or limited financial resources is imperative as they may be at higher risk. Seeking feedback about what they need to access opportunities for social engagement will support additional program approaches for these individuals.

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| Women’s Wellbeing in Older Age: Opportunities for Risk Prevention and Early Intervention

Recommendations and Conclusion

Many complex and intersecting factors appear to exist between the domains of social and economic wellbeing, and health and security for women aged over 50. It is hypothesised that in order to effectively influence beneficial change in a community through a program addressing long-term women’s wellbeing - a systems approach is needed. This systems approach should ideally consist of key elements that may be transferred and replicated between contexts, but that do not limit co-design and adaptation to any community.

Protective and Risk Factors Findings summarised in this report suggest that there are a number of key intersectional factors which may be targeted, in order to protect women’s wellbeing in older age. These included the following factors which appear to be protective of wellbeing, and offer an opportunity for inclusion in awareness raising or supporting interventions: •

trong social connections (particularly friendships) S protects wellbeing, even in the face of serious life transitions

•

Owning a home

•

Strong financial literacy

•

Retaining control over finances after life transitions

•

trong sense of agency, purpose, and self-esteem S (self-efficacy)

24

The following factors appear to increase the risk of disadvantage for women in older age: •

Asset division following relationship breakdown

•

ecreased capacity for wealth accumulation D following relationship breakdown

•

xperiencing unexpected life events/transitions, E including health ‘shocks’ (either self or partner), eg. relationship breakdown, death of spouse

•

Reliance on rental housing

•

Poor access to transport

•

Social isolation

•

verly dependent on another (partner or family) for O financial wellbeing

•

Overly independent - reduced help seeking

•

ntreated or unresolved physical/mental health U issues

•

ome population groups experience increased risk.

S These include single women who have experienced divorce or death of a spouse, single mothers; people who have a disability, or are from CALD, ATSI, LGBTIQ and other groups who experience disadvantage.

| Women’s Wellbeing in Older Age: Opportunities for Risk Prevention and Early Intervention

Limitations

The Catch Up Program

The findings discussed in this report should be interpreted with a number of caveats, due to limitations of the research. Limitations exist in terms of associations made between variables and resulting findings - these associations are not necessarily causal in nature and the links made in this report are speculative and form a hypothesis that requires further testing. The literature reviewed was not exhaustive, and key literature may have been inadvertently excluded.

The research process described in this paper has provided the genesis for Family Life to create the ‘Catch Up for Women’ program. Still in the development phase, this social connection program will initially center around Family Life’s local community of volunteers.

The focus will be on promoting social connections and facilitating access to existing resources through a localised directory.

In conclusion, based on the theory, research, and community consultation findings undertaken and summarised in this report, a program focusing on social connection may provide the most effective opportunity to quickly contribute to positive outcomes for women.

A growing body of research appears to strongly support the association between social connection and longevity, health-related outcomes, and wellbeing. It appears to mediate numerous intersectional factors which impact on financial wellbeing, and plays a protective role. Therefore it is recommended that the focus of a prevention and early intervention program aiming to support older women’s financial and overall wellbeing, should focus on facilitating and securing social connections in the community. It is also possible that increased social connections will facilitate increased confidence to access resources and seek timely help when needed. Whilst such a program will not benefit those who are already experiencing homelessness and poverty, we can use the evidence to try to stop and reduce the current trajectory of more women experiencing these extreme levels of disadvantage and distress.

Key recommendations for such a prevention and early intervention program are summarised in the summary of recommendations on p. 26. It is hypothesised that these factors, placed into a systems-focused program model, are key to supporting women’s long-term social and financial wellbeing.

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| Women’s Wellbeing in Older Age: Opportunities for Risk Prevention and Early Intervention

Recommendations for Social Connection Program Approach

1

Focus program on women aged from 50 years of age - as opposed to 65 years and over. Some of the issues facing older women may be supported by planning, knowledge and skill building in younger age, which may help to protect against unexpected events when they occur. In theory, such a program may be targeted at women of any age however this may not be feasible within the scope of this program.

2

Any education provided about financial literacy as part of the program should aim to improve awareness and knowledge of financial scams, and provide strategies for avoiding them.

3

Consider the strengthening of financial resilience and emotional resilience as possible aims for any educational component of a program.

4

Women who undertake caring roles (of whom there are a significant proportion) may benefit from specific supports to undertake social activities, due to less opportunity for community participation.

5

Intentionally target any program to reach women who are not socially connected, who have limited mobility, poor access to transport, or limited financial resources. This is imperative as they may be at higher risk of social isolation. Seeking feedback about what they need to access opportunities for social engagement will support additional program approaches for these individuals.

6

The objective of such a program could remain broad - and be to “Support the financial security of women aged 65 years and over, in the Southern Melbourne region.”

7

The approach should align with policy areas of the World Health Organization (WHO) Active Ageing Framework1 and United Nations (UN) Sustainable Development Goals (SDG)2.

8

The program should work towards a number of key program outcomes. These should also align with outcomes of the Victorian Public Health and Wellbeing Outcomes Framework3.

Suggested outcomes include: • Participants in the program experience stable finances and housing stability • Participants’ establish and maintain strong relationships with others

9

• I ncrease the bidirectional sharing of knowledge, skills, resources and support in the community, for optimal economic, social and health-related wellbeing • P articipants are aware of financial, social, and health services available to them, and access appropriate and timely support.

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| Women’s Wellbeing in Older Age: Opportunities for Risk Prevention and Early Intervention

It is recommended that the program content: 10

Continue to be co-designed, within context, and using a place-based approach. A primary and/or secondary prevention public health approach may be an appropriate.

11

Raise awareness about protective factors, and factors that increase risk.

12

Support individuals’ ability to face planning for unexpected life events.

13

Establish and maintain meaningful social connections.

14

Support long-term planning of finances, strong financial knowledge and retaining control of finances.

15

Provide opportunity for women to learn and understand what will bring them a personal sense of purpose, aside from their career and family relationships. These can be simple (as opposed to a ‘larger purpose’). They may be social or solitary activities - e.g. photography, art, volunteering, taking care of a pet, writing/sharing their life story, gardening, spirituality, learning, working together with people on a common goal; mentoring.

16

Develop skills for building social networks.

It is recommended that the program delivery method: 17

Enhance opportunity for social connection. A desire to connect meaningfully with others is present - but the opportunity may not be there.

18

Provide opportunity for individuals to impart and share of their life experiences, learnings, skills, and knowledge, to support a sense of purpose.

19

Emphasise the ways in which individuals may add value or provide support to others - are not limited to skills or knowledge gained through formal education. In particular, encourage the value of sharing lived experience that may support others.

20

Allow for regular reflection on program direction, allowing for emergent themes and responsive adaption and refinement.

21

Prioritise equity throughout the co-production, implementation and evaluation process and develop strategies to address this. Particular consideration should be given to relationships where there may be actual or perceived dependent or unequal relationships or circumstances between participants, between participants and services, or between participants, program stakeholders and evaluators.

27

| Women’s Wellbeing in Older Age: Opportunities for Risk Prevention and Early Intervention

It is recommended that the following factors are considered when marketing the program, recruiting participants or raising awareness: 22

Enhance opportunity for women to participate in the program, or when this is not feasible, make relevant resources or other supports available to them, in a effort to support equitable access to supports in line with the recommended aims of the program.

23

Consider that where social isolation is already present, first address mental and physical health problems and provide access to transport.

24

Consider providing or supporting a means to access existing resources (this may be technology, transport or other) for people who are experiencing existing disadvantage.

It is recommended that if possible, the program adopt the following secondary aim: 25

De-stigmatise the challenges of growing older - e.g. fears experienced, and support a shared positive understanding and respect for ageing in the community.

26

Promote the concept of help-seeking as a positive way to both receive support, and provide support to others in the community; de-stigmatise the shame or perceived shame often associated with disadvantage and help-seeking.

27

Pilot and test a program within the Southern Melbourne region with the aim of scaling horizontally and vertically, in other communities within Victoria and Australia, based on program refinement.

28

| Women’s Wellbeing in Older Age: Opportunities for Risk Prevention and Early Intervention

Further Information and Acknowledgements

Authorship

Financial and In-Kind Support

This research report was prepared by Allison Byrnes, Research and Evaluation Coordinator at Family Life.

Establishment and co-design of the ‘Catch Up for Women’ program has been financially supported by Family Life; a Fleur Spitzer Sub-Fund Grant provided

by The Victorian Women’s Trust, and a community Crowdfunding Campaign. Further details are available at https://www.vwt.org.au/grant/catch-up-womensengagement-tool-kit/, and https://catchup.familylife. com.au/.

Contribution to the scope, editing and design were made

by Jo Cavanagh OAM, CEO Family Life; the Catch Up for Women National Advisory Board, Steering Committee and Co-Design Group; Family Life’s Impact and Strategy team, and Community Engagement team.

Ethical Statement All participant data collected through the needs analysis process were collected, analysed and stored in accordance with Family Life’s internal ethics policy, and in line with the National Health and Medical Research Council (NHMRC) National Statement on Ethical Conduct in Human Research 2007 (updated 2018).

Participation was voluntary, anonymous and subject to an informed consent process.

We particularly wish to acknowledge and thank all community members who have volunteered their time as collaborators on the co-design and research of the program. Your contributions of lived experience, perspectives, ideas, knowledge and skill has informed the research scope, program planning, program strategy and recommendations, and the subsequent program design has been shaped as a result of your valuable contribution.

Questions, comments or expressions of interest in being involved in the ‘Catch Up for Women’ program are welcomed. Contact details and further information about the program are available at https://catchup. familylife.com.au/.

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| Women’s Wellbeing in Older Age: Opportunities for Risk Prevention and Early Intervention

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