The hopes and fears of older Australians: for self, family, and society.

Quine, Susan ; Morrell, Stephen ; Kendig, Hal 等

Introduction

The literature on older people and ageing in western industrialised countries is replete with negative assumptions and evidence of ageism. A belief that old age is a time of worry, fear, loss and decline has been evident in the literature for over fifty years (Wilson 1967, Diefenbach, Stanley and Beck 2001). While some research (Wisocki et al 1986, Diener et al 1999, Neikrug 2003) suggests that this is not the case, the myth lives on, and the media has played a role in perpetuating it, frequently portraying older people as weak and defenceless (Roberts and Zhou 1997). A qualitative study reported that older Australians report perceptions of ageism in their daily lives--being made to 'feel old'--with demoralising and limiting consequences (Minichiello, Browne and Kendig 2000).

Hopes and fears for the future reveal people's highest aspirations and concerns. They may be viewed as a dynamic part of an evolving self through the life span (Markus and Ruvolo 1989), but curiously there are few studies of the hopes and fears among older people. In their study on adaptation in old age, Smith and Freund (2003) suggest that this gap may arise because hopes (and to some extent fears) require a sense that a person has a future-something that implicitly social researchers (and the public at large) may be reluctant to accept. A literature review we conducted on hopes, fears and related concepts highlights the research emphasis on negative aspects of ageing, with little on positive aspects. The largest body of literature is on the fears of older people and it revolves around physical decline, particularly fear of falling and its implications (Salkeld et al 2000).

While there are some exceptions (eg Headey 1999; Gabriel and Bowling 2004), the general absence of literature reporting positive aspects of ageing supports the view that as older people age they become increasingly fearful and self focused, concerned with their impending frailty, and vulnerability., having few or no hopes for the future and little to contribute to society. Livingstone (2005: 61) notes that: 'The old are stigmatized as infirm in mind and body. Apart from their continuing role as consumers, the idea that old people have anything useful to contribute to society is seldom entertained.'

Older, especially retired, people have little social power, and this is reflected in social policy, where old age has a high profile, but primarily as a social problem, with older people viewed in terms of ill health, poverty, dependency, and high users of services (Bernard and Phillips 1998). In the UK the importance of considering the views, interests and concerns of the older people who are part of the "demographic time-bomb' has been stressed by Pensioner and advocacy groups who are aware that older people are frequently marginalised and their voices unheard (Dunning 1998). Similarly in Australia, while there is much current policy, centred on addressing the problem of the burden of an ageing population, the views of older people themselves are rarely sought (Kendig et al 2001, Quine and Kendig 1999). To counter this negativity, the Framework for an Australian Ageing Research Agenda has set a strategic research theme of 'developing positive images of ageing and supporting continued social participation.' (Australian Government, 2003:4).

By grouping all people over a certain age into a homogenous category of 'elderly' not only is individual variation lost, but broader differences associated with gender and age implicitly denied. Ginn and Arber (1998: 143) note that: 'Use of terms like 'the elderly' have served to construct older people as 'other', dewing their agency, their voice and their positive contributions to society, as well as obscuring their gender and other dimensions of diversity'.

Advocacy has been used to help empower older people, enable their voices to be heard, and as a means of facilitating their participation in the wider society (Dunning 1998). Rather than viewing older people merely as high users of services, participation involves recognising that older people have a range of characteristics, perspectives and interests which should be identified and acknowledged (Dunning 1995, Lindow and Morris 1995). While professional and lay advocates play a role in representing the rights of older people, self advocacy, means older people speaking for themselves. In an era of evidence-based policy (Australian Government, 2003), it is important that self advocacy to policymakers be reinforced by credible information on the views of older populations. Quantitative evidence on the aspirations and concerns of large numbers of older people can enhance the chances that they will be heard by and acted upon by policy makers. However, most government sponsored research has a strong emphasis on older people's needs, with little attention to their aspirations and contributions (Kendig et al, 2001).

Obstacles to conducting research with marginalised groups, including older people, have been reported (Quine and Browning 2007). Qualitative studies usually are rich and insightful and allow informants to speak openly on a topic without the constraints of fixed response categories. The samples of older people involved in such studies typically are small and purposeful, rather than random, thus restricting the generalisability of the findings. Population surveys of large numbers of representative respondents invariably employ highly structured questions with fixed response categories, and therefore provide a limited vehicle for the expression of self-nominated views, aspirations and concerns.

Study objectives

The main social issue reported here is how to address ageism by bringing the views of older people into a social discourse that is distorted by ageism and ageist stereotypes. The general study objective was to obtain population-based evidence that enables large numbers of older people to voice their own hopes and fears for the future. The analysis of their views by gender and age explored potential variation by these social dimensions. Specific study objectives were to identify the loci of those hopes and fears, and the extent to which older people express interest and concern on broad societal issues, rather than more narrowly focused on self or on family and friends. In this paper particular attention is given to presenting the types of broader general issues which older people report, with gender and age differences noted. A secondary objective was methodological, to demonstrate how the views of older people can be heard effectively and in some detail through the inclusion of open-ended questions in population surveys.

Survey Development

In 1999, the International Year of Older Persons, the NSW Department of Health, covering Australia's most populous state, funded the development of a Computer Assisted Telephone Interview (CATI) survey to monitor the health and well-being of community dwelling older (65+ years) Australians. While the emphasis was on health and well-being, rather than illness and disease, older persons' advocates were concerned that the questionnaire might not give older people sufficient opportunity to voice their concerns about issues which were important to them, which in turn would remain unrecognised as factors worth considering by researchers or policy makers. A specific request from older person advocacy groups was to include questions which would identify the hopes and fears for the future in older people, in order that, wherever feasible, expressed hopes could be supported and expressed fears minimised. For example, the hope to retain independence might be supported through increased provision of public transport and support services. Or the fear of feeling unsafe in one's neighbourhood could be reduced through improvements in community, measures to address such issues.

While members of the survey's Steering Committee generally recognised the merits of obtaining such information, they listed several obstacles to collecting open-ended data within a structured population-based survey, including:

* Concerns that responses to open-ended questions take longer to record and their inclusion would therefore increase the total time for administering the questionnaire.

* Uncertainty about whether the team of telephone interviewers, used to conducting structured interviews, had the skills to write down verbatim responses and if necessary to probe.

* Concerns about who would take responsibility, for analysing the verbatim responses to the open-ended questions, and interpreting the findings.

It was important that the questions be open-ended to explore the range of hopes and fears, rather than presenting respondents with a list of fixed responses which could produce data of limited relevance to older people. A solution reached by the first author was to examine answers to open-ended questions on hopes and fears in a pilot test of the full survey (n=270 persons 65+ years). The open-ended questions did take respondents longer to answer than closed-ended questions, but they were able to vocalise a response, which was recorded verbatim. The author conducted a content analysis of these responses and developed coding categories. It was clear from the analysis that responses could be coded at two levels. The first level coded the response into one of three categories for the loci of the hope or fear: 1) self; 2) family, friends, or significant others; or 3) a more general loci outside self or family. The second level coded the response into specific content categories within each loci. The resultant coding categories were tested for inter-rater reliability with the study research assistant and any queries resolved. Examples of verbatim responses have been reported in the Results section to illustrate the type of responses included in each coding category.

Findings from the pilot study showed that the concerns that had been raised about these questions could be resolved:

* Inclusion of the questions on hopes and fears would increase the length of the interview but only slightly, and if placed at the end of the interview then they could not adversely impact on the likelihood of completion of the main survey items.

* The telephone interviewers were not required to write down the verbatim response but could use the drop down menus of categories, developed from the pilot study, and code directly on the computer screen, thus saving time. Concerns about prompts were addressed in the Instructions to Interviewers (see Box 1). In addition, the interviewers were carefully trained by the Health Department with quality control monitored.

* The first author offered to analyse and report on the findings from the open-ended questions.

The Steering Committee therefore agreed that two questions, one on hopes and one on fears, could be included in the NSW Older Persons Health Survey (OPHS).

Methods

The questionnaire for the OPHS survey was developed by consultants (Quine & Kendig, 2000), with expert input from a technical reference group (NSW Department of Health, 2000). The detailed sampling and survey methods employed by the Epidemiology and Surveillance Branch of the NSW Department of Health are available (NSW Department of Health, 2001). The large sample (n=8,881) of respondents consisted of approximately 500 older people randomly selected from each of the 17 Area Health Services in NSW. The response rate was 70.7%.

The two additional questions on hopes and fears (asked at the end of the interview) were:

'What is your main fear or concern for the future?'

'What is your main hope for the future?'

While ideally further questions could have been asked on hopes and fears, this was not feasible given the broad coverage of topics in the survey. Of the total respondents, 8,881 were able to respond to the survey without a proxy. Analysis consisted initially of calculating the frequencies of their expressed hopes and fears for the future. 95% confidence intervals for prevalence were estimated by the normal approximation to the binomial. Men and women were analysed separately and variation by 10-year age group, with trends across age groups tested by the Cochran-Armitage trend test (two-sided).

Results

I. Foci of main hope and main fear

The frequency of responses for hopes and fears for men and women by three main age groups ('young old' 65-74, 'old' 75-84, 'old old' 85+) are given in Tables 1 and 2. The majority, of participants expressed both a hope and a fear, while a minority reported that they had no main hope and/or fear, and a small number gave no response. In both men and women, the proportions reporting no hope for the future, or no fear for the future, increased significantly with age (p<0.001, and p<0.001 respectively).

Participants were more likely to report a hope (n=7,873) than a fear (n=6,212). Similar proportions of men and women reported a hope (88.1% men, 89.1% women), which was also the case for reported fears (68.0% men, 7L4% women). Of those participants who reported a hope, most of these hopes were self-focussed (70.4%), followed by general hopes (16.4%), then hopes for family (13.2%). The ordering for fears followed the same pattern with most self-focussed (67.2%), followed by general fears (2L8%) and then fears for family (11.0%).

Within the hope responses focussed on self (n=5,545) there was little variation by age or gender, except for a slight significant (p<0.05) downward trend with age in males only. Within the fear responses focused on self (n=4,172) a higher proportion of women overall than men expressed this fear, particularly in the 'young old' (65-74 years) age category, and there was a highly significant (p<0.001) downward trend of proportions of women expressing this fear with age, which was not found in the men.

Within the hope responses focussed on family, friends or significant others (n=l,040) there was little variation by gender, but a slight decline with increasing age which was a significant trend (p<0.05) in the women but not men. For fear responses similarly focused (n=688) a smaller proportion of both men and women in the 'old old' (85+ years) age category expressed this fear, with a significant (p<0.05) downward trend with increasing age in women but not men.

Within the hope responses focussed on general issues (n=1,288) there was little variation by age or gender, but for fear responses focussed on general issues (n=1,352) a higher proportion of 'young old' (65-74 years) voiced this fear, particularly among men. The proportions reporting general fears in the 'old' (75-84 years) and 'old old' (85+ years) age categories were very similar. However, the downward trend with age in males was highly significant (p<0.001) and steeper than in females which nonetheless was significant (p<0.01).

II. Types of HOPES for the future within each foci Hopes for self

Amongst those whose hope for the future focused on self, the predominant type of hope for both men (42.8%) and women (50.1%) was to stay healthy. This category included positive aspects of healthy ageing and well-being ('to stay healthy', 'to be healthy', 'remain well') in addition to physical health ('remain free of disability', 'not to lose my faculties'). This gender difference was modest but statistically significant. While men were somewhat less likely than women to emphasise health, they were twice as likely (15.2% versus 7.8%) to report the hope for a longer life (expressed as 'live another 10 years', 'live until I'm 130', 'live a bit longer'). This difference was statistically significant and may indicate recognition by men that their life span is considerably shorter than that of women. A similar proportion of men (13.4%) and women (11.5%) expressed the hope to continue to live as they currently do ('keep living as you are now', 'just carry on', 'go along as I am now', 'live normally').

While only a small percentage of respondents gave a main hope for self of retaining their independence ('living independently in own home', 'stay in own home', 'care for self') this proportion was significantly higher for women (9.0%) than men (3.0%), which is consistent with the higher proportion of women expressing their main fear for self as losing their independence or of being admitted to a nursing home. A higher proportion of men (7.9%) than women (4.1%) held hopes for personal financial security ('adequate super', 'be OK for money') and this gender difference was also statistically significant. There were no significant gender differences among those whose hopes were to lead an active life ('live life to fullest', 'go fishing', 'study', 'travel') or for being happy ('live a contented life', 'be happy'), and these proportions ranged between 3.5% and 5.0%.

Hopes for family, friends, significant others

For those respondents whose main hope was focused on family and friends, the most frequently expressed hope was for family harmony and health ('harmony', 'well being', 'be happy'), expressed by 44.5% of men and 48.5% of women. While women were more likely to voice this hope, the difference was not statistically significant. Slightly lower proportions expressed specific hopes for their children and grandchildren ('to grow up prosperous', 'be employed', 'be settled') (40.6% of men and 44.6% of women), and again while higher in women, this difference was not significant. However, a significant gender difference was evident in the higher proportion of men (13.9%) than women (6.6%) expressing the hope that their partner survive so they could live together ('partner lives longer', 'can survive', 'can live together').

General Hopes

Of those responding that their main hope for the future was a general hope for the world at large (rather than for self, or family and friends) these specific hopes were broad ranging, as can be seen from Figure 1. The most frequently expressed hope was for world peace and happiness for all ('world peace', 'no wars', 'harmony'), reported more frequently by women (43.1%) than men (29.4%), and this gender difference was statistically significant. In contrast, a higher proportion of men than women (17.2% and 4.7% respectively) expressed a hope for a better political and governmental system ('sort out the politics', 'government to get its act together'), and this gender difference was also statistically significant. A similar proportion of men and women (24.8% and 26.6% respectively) held hopes for improvements and a better future for the next generation ('make the world a better place for the next generation'). Similar proportions by gender also expressed hopes for more tolerance in the future (7.9% and 8.2% respectively) ('equality", 'national reconciliation', "tolerance').

[FIGURE 1 OMITTED]

The proportions of other types of general hopes for the future were low (less than 5%) and there were no significant gender differences in these. However, these less frequently reported categories of hope were not aggregated since this would result in loss of insight into the range and type of generally focussed hopes. These categories included hopes for a better health system and service, protection of the environment, employment for all, improved attitudes towards older people, fixing the drug problem, resolving crime and violence problems, and achieving better conditions for rural areas.

III. Types of FEARS for the future within each loci Fears for self

Of those participants whose fear was self focussed, the most frequently reported fear for both men and women was concern about their own physical health ('fear of becoming disabled or an invalid', 'going blind', 'losing hearing', 'having a major accident/fall/ illness', 'having a major operation', 'suffering pain'). An interesting and significant gender difference was that men more frequently emphasised fears for deterioration in their physical health than women (43.1% versus 33.6%), while women were more likely than men to report fear of losing their independence (29.9% versus 17.8%) ('losing ability, to cope on oven', 'unable to stay in own home') mid of entering a nursing home ('ending up in a nursing home', 'adequacy. of nursing homes') (8.2% versus 4.2%). A more detailed statistical analysis of fear of loss of independence and fear of nursing home admission has been reported (Quine and Morrell 2007). Other significant gender differences were that men more frequently reported financial concerns ('price rises', 'food costs', 'the GST') (9.5% versus 4.3%), while women more frequently reported concerns about the way of dying ('dying like a vegetable', 'compulsory euthanasia') (3.4% versus 1.7%). There were no significant gender differences in the remaining categories of loneliness ('left on one's own', 'lack of contact'), mental health ('developing Alzheimer's', 'going demented'), the ageing process ('getting old', 'living too long') and safety ('home invasion'), and the proportions for all these categories were less than 4%.

Fears for family and friends, significant others

Of those participants whose fears for the future centred on family and friends (rather than self or more generally) the most frequently expressed fear was for offspring, ('concern about the future for my children and grand children') reported by 50.0% of men and 54.3% of women. Corresponding proportions were lower for fears for the future of dependents (spouse or disabled child, etc), reported by 42.9% of men and 36.2% women ('who will take care of my spouse/disabled child/dependents'). Fears of becoming a burden on family members ('I don't want to be a burden on my family') were reported by 6.5% of men and 8.0% of women. There were no statistically significant differences between the genders in any of these proportions.

General fears

Of those responding that their fears for the future were general fears for the world at large (rather than for self, or family and friends), these fears were broad ranging (Figure 2). The most dominant fear was for the economy, politics and the country as a whole ('welfare of country', 'problem politicians', 'the government making a mess of the country'), reported significantly more frequently by men (42.8%) than women (34.8%). This gender difference was reversed for fears relating more to wars, national security threats and human rights ('too many wars everywhere', 'a World War 3', "wars and human suffering are never ending'), reported significantly more frequently by women (18.3%) than men (9.3%). Similar proportions of men and women (12.5% and 11.9% respectively) were concerned for the future of the health system ('difficult to access services', 'long waiting lists', 'hospital closures'), while concerns for the future of the environment ('destruction of the forests', 'air pollution') were expressed by 8.3% of men and 10.5% of women (not significant).

The remaining categories of general fears were expressed in less than 5% of participants reporting general fears, and there were no significant gender differences in these. As with the less frequently reported general hope categories, these general fear categories were not aggregated since the range and type of fears is of interest. These fears included concern about the high rates of unemployment, racial intolerance and immigration issues, law and order issues (crime, violence), concerns about how older people are treated, perceived decline in values/morals/family cohesion, concerns about today's youth especially lack of discipline, population movements, and coping with new technology and modernisation.

[FIGURE 2 OMITTED]

Discussion

Foci of hopes and fears for the future

An important finding of this study is that community dwelling older Australians are not solely focused on hopes and fears for their own future as individuals. Certainly the majority of respondents reported that their main hopes and fears were for themselves rather than for others, but a sizeable minority were more concerned for their family and/or friends than for themselves, and an even larger minority expressed general hopes and fears which were not personalised to either self or family. This finding suggests that many older people do not have a primary focus on self or family, but have an uppermost concern for social and environmental issues. If more than one fear and one hope could have been recorded, it seems likely that more participants would have expressed a focus on other individuals and general issues

Respondents who were relatively older were less likely to have fears about the future focused on themselves, more so in women than men. In advanced old age, especially from 85 years onwards, women's main fears were less focused on themselves, and a third expressed no fears at all for the future. Among men the strongest decline with advancing age was in general fears for the future. Age and gender effects in future hopes were less pronounced, but decreasing proportions of men expressed self-focussed hopes for the future with increasing age, while older women had fewer hopes for family and friends and more general hopes. Overall, while gender differences were apparent, the distributions for foci of hopes and fears were similar among men and women.

Of note were significantly increasing trends with age, in both the men and women, of proportions expressing no hopes and also no fears for the future, suggesting an increasing likelihood of a 'detached' outlook with increasing age. This trend has been analysed in detail and reported elsewhere (Quine et al. in press).

Specific hopes and fears

The specific types of hopes and fears reported by participants demonstrate a range of perspectives, particularly evident in those having a general focus. Clearly there are frequently-mentioned hopes and fears which provide useful information for policy makers. Nevertheless, the findings show also that there is diversity in the views expressed, emphasising that older people are not an undifferentiated homogenous group and consequently the views of sub groups should also be taken into consideration.

Methodological issue

When this study was planned a concern was raised by the technical reference group that a fear would merely be the reverse of a hope and therefore it was not necessary to include separate questions on hopes and fears. Certainly, such matching of hopes and fears has been proposed in the literature (Markus & Ruvolo 1989, Oyserman & Markus 1990). While there was some matching of hopes and fears in the present study, in general the findings do not support the mirroring of hopes and fears. In particular, the hope to remain independent and the fear of losing one's independence were often reported differently by the same participants. There are also certain categories of response which are specific to a hope or fear, for example the hope to live as now, or the fear about the way of dying.

Conclusion

The main study objective here was to identify and describe the hopes and fears of older people on a population basis. An important finding is that older people report more hopes than fears. While a higher proportion of their main hopes are self focussed, rather than on others or generally, these hopes are to maintain health and independence and indicate how older people wish to cope with their old age. Family, friends and significant others were also a focus of both their hopes and fears, emphasising the importance of these relationships in older people's lives. But they reported higher proportions of general hopes and fears, than hopes and fears for family, indicating that they are aware of, and concerned about, a broad range of social and environmental and world issues, which was retained into the oldest age category of 85 years and over. In the main, the findings describe a varied and largely positive picture of an engaged older population concerned about family and friends and society in general as well as themselves. These findings refute negative stereotypes of ageing and should be disseminated to dispel negative images of older people. The specific findings on the types of hopes and fears held by older people-for others and in general as well as for themselves-should inform policy, actions to support attainment of hopes, such as maintenance of independence and increased resources to remain living at home, and reduce fears, such as the adequacy of finances in old age.

A secondary study objective in conducting this research was to demonstrate how the self-nominated views of older people can be collected on a population basis by including open-ended questions in epidemiological surveys. This study is the first representative population survey of the hopes and fears of older Australians. The findings have validity in being population based, with participants rigorously sampled by the Epidemiology branch of the NSW Health Department, resulting in robust samples of older people across a wide age range with excellent geographic spread. A search of the international literature failed to locate any large-scale population studies on this topic, and consequently the findings contribute to our understanding of the dominant and specific types of hopes and fears of older people, and add to the limited international literature on this topic. Furthermore, this study demonstrates that it is feasible to include more qualitative open-ended questions in a large scale structured questionnaire survey, providing there is commitment to analysis of responses to such questions during the pilot phase in order to develop the coding categories used in the main survey. Training of interviewers is also essential to ensure quality control and consistency, in coding during the main survey.

The important substantive points are that:

* Older people have hopes and fears for the future, and these futures have action orientations for the benefit of others as well as themselves.

* Large minorities of older people express a focus outwardly to others rather than self, either to family and/or significant others, or more generally to populations and social issues.

* For hopes, there is a consistent pattern in loci, irrespective of age and gender.

* For fears, with increasing age, women are less likely to focus on self, whereas for men there is only a slight decrease in focus on self.

* Older men and women are less (rather than more) likely to express a fear with increasing age.

* There is diversity in the actual hopes and fears expressed, indicating that older people are not an homogenous group and the views of sub groups of older people should be considered.

* Methodologically, this study demonstrates that it is feasible to analyse participants' freely expressed views collected within a structured population-based questionnaire survey.

Acknowledgement

We thank the Epidemiology Branch of the NSW Department of Health for including the hopes and fears questions in the Older Persons Health Survey and making the de-identified unit record data available to the authors.

References

Australian Government (2003) Framework for an Australian Ageing Research Agenda. Department of Health and Ageing and the Australian Institute for health and Welfare,, Canberra, Commonwealth of Australia.

Bernard M. & Phillips J. (1998) Ageing in tomorrow's Britain. In M. Bernard & J. Phillips (eds) The social policy of old age, London, Centre for Policy on Ageing,. 289-309.

Diener E., Sub E.M., Lucas R.E., & Smith H.L. (1999) Subjective well-being: three decades of progress. Psychological Bulletin, 125,276-302.

Diefenbach G.J., Stanley M.A., & Beck J.G. (2001) Worry. content reported by older adults with and without generalised anxiety disorder. Aging and Mental Health, 5(3), 269-274.

Dunning A. (1998) Advocacy, empowerment and older people. In M. Bernard & J. Phillips (eds) The social policy of old age, London, Centre for Policy on Ageing.

Dunning A. (1995) Citizen advocacy with older people: a code of good practice, London, Centre for Policy on Ageing.

Gabriel ZG. & Bowling A. (2004) Quality. of life from the perspective of older people. Ageing and Society, 24: 675-694.

Ginn J. & Arber S. (1998) Gender and old age. In M. Bernard &J. Phillips (eds) The social policy of old age, London, Centre for Policy on Ageing, 142-162.

Headey B. (1999) Old age is not all downhill. Australian Journal on Ageing 18(3): 32-37.

Kendig H., Andrews G., Browning C., Quine S., & Parsons A. (2001)A Review of Healthy Ageing Research in Australia. Report prepared for the Office for Older Australians, Commonwealth Department of Health and Aged Care. Canberra, Commonwealth of Australia.

Lindow V. & and Morris J. (1995) User involvement: synthesis of findings and experience in the field of community care, York, Joseph Rowntree Foundation.

Livingstone G. (2005) Too soon late, too late smart, Sydney, Hodder Australia.

Markus H.& Ruvolo A. (1989) Possible selves: personalised representations of goals. In L.A. Pervin (ed) Goal concepts in personality and social psychology. Hillsdale N.J., Erlbaum (pp 211-241).

Minichiello V, Browne J.& Kendig H. (2000) Perceptions and consequences of ageism: views from older persons. Ageing and Society 20: 253-278.

Neikrug S.M. (2003) Worrying about a frightening old age. Aging and Mental Health 7(5): 326-333.

New South Wales Department of Health. (2000) New South Wales Older People's Health Survey. Sydney, NSW Department of Health.

New South Wales Department of Health. (2001) The NSW Health survey program: overview and methods, 1996-2000. Sydney, NSW Department of Health.

Oyserman D.& Markus H. (1990) Possible selves and delinquency. Journal of Personality and Social Psychology, 59, 112-125.

Quine S. & Browning C. (2007) Methodological and ethical issues in conducting research with older people. In M. Pitts & A. Smith (eds) Researching the margins. Sydney, Palgrave MacMillan.

Quine S. & Morrell S. (2007) Fear of loss of independence and nursing home admission in older Australians. Health and Social Care in the Community 15(3): 212-220.

Quine S., Morrell S. & Kendig H. Outlooks for the future in independently living older Australians. Aging and Mental Health (accepted for publication 2007).

Quine S. & Kendig H. (1999) Stakeholders in policy research for older Australians. Hallym International Journal of Ageing 1(2): 16-25.

Quine S. & Kendig H. (2000) NSW Older People's Health Survey (OPHS). Technical report prepared for NSW Department of Health on the construction of the CATI administered questionnaire. Sydney, NSW Department of Health.

Roberts S.D. & Zhou N. (1997) The 50 and older characters in the advertisements of modern maturity.: growing older, getting better? Journal of Applied Gerontology, 16, 208-220.

Salkeld G., Cameron I., Cumming R., Easter S., Seymour J., Kurrle S., Quine S. (2000) Quality of life related to fear of falling and hip fracture in older women: a time trade-off study. British Medical Journal 320, 341-345.

Smith J. & Freund A.M. (2002) The dynamics of possible selves in old age. Journal of Gerontology (Psychological Sciences), 57B, 6, 492-500.

Wilson W. (1967) Correlates of avowed happiness. Psychological Bulletin, 67, 294-306.

Wisocki P.A., Handen B., Morse C.K. (1986). The worry scale as a measure of anxiety among homebound and community active elderly. The Behaviour Therapist, 5, 91-95.

Preamble and Instructions for Interviewer

Preamble

We are nearly at the end of the interview. I would like to ask you two final questions which are about your MAIN fear and MAIN hope for the future.

First, can you tell me your MAIN fear or concern for the future.

Now I would like to ask you about your MAIN hope for the future.

Instructions for interviewer

If an informant gives more than one fear/hope, the interviewer should prompt and ask 'which is the MAIN fear/hope'.

Occasionally an informant may give a double-barreled response e.g. the fear

"To lose my independence AND become a burden on my family".

In this situation the interviewer should probe to identify what is the main fear (i.e. the loss of independence or the outcome, which is becoming a burden), and code accordingly.

Another example is "I hope to lead a long AND happy life". In this example on hope the interviewer needs to clarify whether it is the length of life or happiness which is central.

If an informant asks whether the main fear/hope is for self or others, the interviewer should say 'just YOUR main fear/hope', i.e. the interviewer should NOT be directive about the focus of the fear/hope.

Once the response has been given and is clearly understood, the interviewer should code into one of the three main focus categories:

SELF

FAMILY (family, friends, significant others)

GENERAL (people, Australia, world)

And then code the relevant response from those given in the drop down menu within each of these categories.

Table 1. Main HOPE for the future, NSW Older Persons Health Survey
1999-2000, by gender and proportion (%) in each age group (N = 8,881)

Main Hope Men

 65-74 75-84 85+

Self 64.7 60.5 57.0 *
Family 10.6 11.1 9.9
General 14.8 13.2 12.8
No Hope 6.1 10.7 13.4 ***
No Response 3.9 4.5 7.0
Total (%) 100.0 100.0 100.0
Number 2,560 1,104 172

Main Hope Women

 65-74 75-84 85+

Self 61.1 63.4 60.9
Family 13.7 11.5 8.8 *
General 15.3 14.1 13.4
No Hope 5.5 6.2 11.5 ***
No Response 4.4 4.9 5.5
Total (%) 100.0 100.0 100.0
Number 2,795 1,831 419

Main Hope All

 65-74 75-84 85+

Self 62.8 62.3 59.7
Family 12.2 11.3 9.1 *
General 15.1 13.8 13.2
No Hope 5.8 7.9 12.0 ***
No Response 4.2 4.7 5.9 *
Total (%) 100.0 100.0 100.0
Number 5,355 2,935 591

* = p < 0.05; ** = p < 0.01; *** = p < 0.001 -- significance levels
for 2-sided Cochran-Armitage trend test across age groups

Table 2. Main FEAR for the future, NSW Older Persons Health Survey
1999-2000, by gender and proportion (%) in each age group

Main Fear Men

 65-74 75-84 85+

Self 43.2 43.7 40.1
Family 7.2 7.4 5.2
General 20.0 13.1 12.2 ***
No Fear 23.4 29.1 35.5 ***
No Response 6.3 6.7 7.0
Total (%) 100.0 100.0 100.0
Number 2,560 1,104 172

Main Fear Women

 65-74 75-84 85+

Self 51.8 49.4 39.1 ***
Family 8.9 7.8 5.5 *
General 14.9 11.4 11.9 **
No Fear 17.1 22.1 32.5 ***
No Response 7.3 9.5 11.0 *
Total (%) 100.0 100.0 100.0
Number 2,795 1,831 419

Main Fear All

 65-74 75-84 85+

Self 47.7 47.2 39.4 *
Family 8.1 7.6 5.4 *
General 17.3 12.0 12.0 ***
No Fear 20.1 24.7 33.3 ***
No Response 6.8 8.4 9.8 ***
Total (%) 100.0 100.0 100.0
Number 5,355 2,935 591

* = p < 0.05; ** = p < 0.01; *** = p < 0.001 -- significance levels
for 2-sided Cochran-Armitage trend test across age groups