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SECG Blog - The influence of transitions on health and wellbeing

Dr Meg Polacsek, SECG Communications Lead

meg.polacsek@benetas.com.au

The need to improve the services and support older adults receive at home or in residential care is clear. However, sometimes overlooked is the influence of transitions on access to timely and appropriate care.

In its interim report, the Royal Commission into Aged Care Quality and Safety describes the challenges and trauma associated with transitioning into and between care environments. Another important category of transitions concerns the movement to and between wellness and illness. This applies in virtually every context, but is perhaps front-of-mind for me due to the COVID-19 pandemic.

We all experience multiple transitions throughout our lives. Although they occur over time, they are often triggered by an event which requires the adoption of new skills or behaviours. Many transitions are welcomed and positive, such as starting a family, moving to a new house or entering planned retirement. However, the experience of ageing is likely to also bring negative transitions, including grief and loss, or the onset of a chronic health condition. A change in living environments triggered by one of these transitions may see a person move into residential aged care, or engaging home care services.

Not surprisingly, successful transitions are associated with improved outcomes. Conversely, unsuccessful transitions move people towards vulnerability and risk. Examples include being discharged from hospital without proper home-care arrangements in place and difficulties associated with transition to palliative care.

Successful outcomes are enabled or hindered by individual, societal or global influences on the transition. These include personal beliefs and expectations, access to support or resources, and government policies that determine type and availability of services.

How individuals recognise and respond to the need for a transition is also reflected in the adaptive or maladaptive coping strategies they use in response to their circumstances. Adaptive strategies include help-seeking for formal and informal support, and treatment concordance, while maladaptive strategies may involve denial, family conflict or substance misuse.

The importance of facilitating effective wellness-illness transitions is particularly important in older adults. However, most research focuses on prevalence, diagnosis and treatment of older adults, and individual service design and delivery.

A wellness-illness transition is often triggered by the realisation that something is wrong with how we are feeling. This is often later confirmed by formal diagnosis and engagement (or not) in treatment. This begins the experience of health transitions on a continuum, as one moves back and forward in response to experiences and change.

Accepting a change in wellness-illness status is crucial to the overall experience of a transition, as we identify and implement actions that support the change in our wellness-illness status. While new behaviours and strategies are needed to respond to a transition, how we think and feel about a condition has a significant impact on our capacity to adapt to and manage a change in wellness-illness status.

Following acceptance, it’s important to adapt to the changeable nature of mental and physical health. This is where our experiences, skills, values and resources influence how we adapt to a diagnosis. The ways in which we adapt reflect our capacity to manage an illness by accessing information, enlisting support and engaging in healthy behaviours.

Another transition that often occurs later concerns the creation of new meaning or identity, as we seek, source and enact ways to improve our wellbeing and sense of self. Pursuing practical, short-term strategies for improving our wellbeing and sense of self are important, as are longer-term approaches to managing our transition. However, prevailing attitudes held by significant others, health professionals and others in the community regarding age have a significant influence on how certain triggers and transitions are recognised and addressed (just think of the influence of ageism or mental health stigma).

The key elements of a successful wellness-illness transition are entirely appropriate to the transitions that occur as we age. In any context, a successful transition occurs when feelings of distress are replaced with a sense of wellbeing and mastery of the situation. If we can enable and facilitate successful transitions for older adults – in and between health, community and residential services – we stand to play a major role in enhancing their overall health and wellbeing. We need to look beyond milestones and destinations, and recognise transitions as a critical factor in each person’s wellbeing, independence and quality of life.

Pic: Meg at her temporary COVID set-up at home, under the watchful eye of Gretel

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