McAuley Centre, Centre for Translational Neuroscience and Mental Health, University of Newcastle, Australia.
Perspect Public Health. 2012 Jul;132(4):182-91. doi: 10.1177/1757913912447018.
In Australia, rural areas have higher proportions of older persons than metropolitan areas, where ageing poses many challenges related to social isolation, reduced mobility, more chronic disease and comorbidity, greater socio-economic disadvantage, limited access to services, and economic restructuring. Although Australian national data indicate an age-dependent decline in the prevalence of mental disorders, physical ill health is clearly associated with mental disorder in the elderly. There are conflicting findings regarding rural-urban differences in the prevalence of mental disorder, reflecting the complexity of definitions of rurality, and the geographic, ethnic and cultural diversity that underpins location and its influence on health outcomes.
This study aims to investigate the determinants of well-being in a sample of older adults from rural and remote communities, with particular focus on the role of social factors.
Baseline cross-sectional survey data were used from the Australian Rural Mental Health Study, a population-based longitudinal cohort of adults aged 18-85 years randomly selected from electoral rolls. We compared measures of mental health and well-being in adults aged 65 years and over with middle-aged and younger adults living in rural and regional New South Wales. Factors associated with positive well-being and psychological distress in the older group were examined using multivariate logistic regressions, reporting adjusted odds ratios (AOR) and 99% confidence intervals (CI).
Of the 2,624 participants, 722 (28%) were aged between 65 and 85 years. Well-being was generally higher among those aged 65 years or older, compared with younger groups, with the notable exception of perceived physical health. Among those aged 65 years or older, poorer well-being was independently associated with older age (AOR 0.29, 99% CI 0.13-0.64), one or more chronic diseases (AOR 0.34, 99% CI 0.17-0.69), and a history of depression, stress or anxiety (AOR 0.31, 99% CI 0.12-0.76). Having increased community and personal support (AOR 4.7, 99% CI 2.5-8.9) significantly increased well-being in the older participants. A comparable profile emerged for the predictors of psychological distress, with higher trait neuroticism also making a substantial contribution (AOR 6.4, 99% CI 2.3-7.8).
Despite increased rates of chronic illness and poorer physical health, older rural Australians reported better well-being than younger groups, possibly reflecting a survivor effect or perhaps a generational effect, in terms of greater resilience or stoicism in the older generation. Higher levels of perceived community and personal support improve current well-being and are protective for moderate to high psychological distress.
在澳大利亚，农村地区的老年人比例高于城市地区，老年人在城市地区面临着许多挑战，如社交孤立、行动不便、更多的慢性疾病和合并症、更大的社会经济劣势、服务获取受限以及经济结构调整。尽管澳大利亚全国数据显示，精神障碍的患病率随年龄增长而下降，但身体不健康显然与老年人的精神障碍有关。农村与城市之间精神障碍患病率的差异存在矛盾的发现，这反映了农村地区定义的复杂性，以及地理位置的地理、种族和文化多样性及其对健康结果的影响。
本研究旨在调查农村和偏远社区老年人群样本的幸福感决定因素，特别关注社会因素的作用。
本研究使用澳大利亚农村心理健康研究的基线横断面调查数据，该研究是一项基于人群的成年人队列研究，年龄在 18-85 岁之间，从选举名单中随机抽取。我们比较了新南威尔士州农村和地区中 65 岁及以上成年人与中年和年轻成年人的心理健康和幸福感衡量标准。使用多变量逻辑回归检查与老年组积极幸福感和心理困扰相关的因素，报告调整后的优势比（AOR）和 99%置信区间（CI）。
在 2624 名参与者中，有 722 名（28%）年龄在 65 岁至 85 岁之间。与年轻组相比，65 岁及以上的人群幸福感普遍较高，除了感知到的身体健康状况外。在 65 岁及以上的人群中，较差的幸福感与年龄较大（AOR 0.29，99%CI 0.13-0.64）、一种或多种慢性疾病（AOR 0.34，99%CI 0.17-0.69）和抑郁、压力或焦虑史（AOR 0.31，99%CI 0.12-0.76）独立相关。社区和个人支持的增加（AOR 4.7，99%CI 2.5-8.9）显著提高了老年参与者的幸福感。心理困扰预测因素的情况类似，特质神经质程度较高也有很大贡献（AOR 6.4，99%CI 2.3-7.8）。
尽管农村地区的慢性疾病发病率较高，身体健康状况较差，但与年轻群体相比，澳大利亚农村老年人的幸福感更好，这可能反映了幸存者效应，或者更老一代的韧性或坚忍不拔的代际效应。感知到的社区和个人支持水平的提高可以改善当前的幸福感，并对中度至高度心理困扰具有保护作用。
