Speaker slides from the 2014 GeoNext conference held in Sydney, Australia. Paper co-authored with Nick Nicholas, demographer and GIS specialist.

1. Click for title
Ageing in Place and Space:
Spatial Strategies for Ageing Societies
Presented By Hamish Robertson

2. 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

3. 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?

4. Location Matters

5. Population Ageing is a Global Phenomenon
Source: UNFPA

6. Australian Population Dynamics
Medium Level ABS Forecasts 2006-2031
2006 2011 2016 2021 2026 2031 2036 2041 2046 2051
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
9.00
Projected Australian Population
Aged 65 years and over
Year
Millions

7. Ageing in China: Towards 250 million

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

9. Dementia in West Africa

10. 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…

11. 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

12. 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.

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

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

16. Differential Effects: Vulnerable Groups
50% of Victims Were 65+
Source: http://www.guardian.co.uk/world/blog/2011/mar/13/japan-earthquake-and-tsunami-japan

17. It Was Ever Thus

18. Viewing
Social
Inequalities
from
Space

19. Steady State Vulnerabilities in Healthcare Systems
Source: 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

20. 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

21. Everyone Knows, But They Don’t Always Understand
Source: http://thehealthcareblog.com/

22. Fertility Decline + Cohort Size + Life Expectancy = Ageing
0
100000
200000
300000
400000
500000
600000
Population
Age Cohorts
Age Cohorts (Census 2011)

23. Total Spend Estimation for NSW
0
200
400
600
800
1000
1200
1400
1600
1800
2000
TotalSpend($m)
Age Cohorts
Total Spend

24. Expenditure by Major Conditions by Age
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Other causes
Maternal conditions
Injuries
Nervous system
Musculoskeletal
Neoplasms
Cardiovascular

25. People Aged 65-74

26. People Aged 75-79

27. People Aged 80-84

28. People Aged 85+

29. Aged 65+ and Ambulance Stations

30. Accessibility to Services

31. 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

32. 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

33. 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

34. 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

35. 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