OTOH

The aim of this research is to investigate life-course and structural determinants of positive subjective health amongst older traveller and older homeless people, with a view to centralising the voice of these groups in effective, ethical and rights-based models of home care delivery.

Rationale:

With efforts to improve homecare (HC) services for older people in Ireland, and expected legislation to enshrine rights to these services, there is a critical need to ensure new HC reforms are accessible and relevant to the most marginalised older groups. Reflecting priority populations of the Health Service Executive (HSE) Social Inclusion Office, older adult Travellers and older homeless people (OTOH) are two such groups. However, OTOH voices are markedly absent from health policy and practice discourse (Smyth 2016). OTOH are also more likely to experience health inequalities and poor health outcomes (Abdalla 2010; Walsh 2013). This can be related to accumulated exclusions across the life course. Structural factors concerning discrimination/stigma, and lack of access to education and employment can construct disadvantage for OTOH (Reynolds et al. 2016).

Particular life-course experiences with respect to disability/ill-health, disrupted labour participation, family breakdown and irregular accommodation can dominate the life-paths of some OTOH (Coates et al. 2015; Watson et al. 2017). Such factors are reflected in greater prevalence of co-morbidities, higher rates of alcohol/substance abuse, and substantially lower healthy-life expectancies (McDonald et al. 2009). They are also reflected in complex challenges concerning care delivery. Therefore, although specific mechanisms of inequity are likely to differ for the two groups, OTOH can experience similar patterns of community, socio-cultural and political displacement within society. Critically, however, there is little focus on marginalised older adults who achieve more positive health outcomes, and healthy ageing biographies (Waldbrook 2015). The ways in which life-course and structural forces shape these more favourable trajectories, and perhaps experiences closer to that of health equity, are unknown.

Objectives:

1.

Systematically review existing international knowledge on life-course and structural determinants of subjective positive health, in community contexts, for marginalised and vulnerable groups of the older adult population;

2.

Contextualise and chart social and primary care provision for OTOH individuals in Ireland, identifying potential individual- and structural-level risk factors for health inequalities and health inequities, informal practices for addressing such disparities, and key on-the-ground knowledge deficits;

3.

Capture the lived experiences, expectations and needs of a diverse group of OTOH individuals, unpacking the role of individuals’ life events and experiences, and societal and institutional practices and norms in the construction of positive health biographies;

4.

Facilitate and advance the voice of OTOH individuals to highlight ‘insider’ perspectives on meanings of home and successful strategies for securing positive health biographies, and adapting to challenges with respect to HC utilisation;

5.

Harnessing learning from OTOH individuals, develop policy recommendations and practice-relevant tools to inform the development and implementation of forthcoming older adult HC structures, helping to ensure their and applicability to the needs and preferences of OTOH individuals.

Partners & Collaborators

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  • Prof Eamon O’Shea
     Centre for Economic and Social Research on Dementia (CESRD), Institute for Lifecourse and Society, NUI Galway
  • Prof Thomas Sharf
    Institute of Health & Society, and Newcastle University Institute for Ageing
  • Dr Diarmuid O’Donovan
    Senior Lecturer In Social & Preventive Medicine at NUI Galway; Director of Public Health, HSE West
  • Prof Anne MacFarlane
    Faculty of Education & Health Sciences, University of Limerick
  • Diane Nurse
    National Office for Social Inclusion HSE Primary Care Division
  • Dr Fiona O’Reilly
    Safetynet Primary Care Catherine McAuley Centre
  • Pat Bennett
    Community Healthcare Organisations 8 Health Service Executive
  • Ciaran McKinney
    Age & Opportunity Marino Institute of Education
  • Margaret O’Riada
    Galway Traveller Movement