Dementia and Rurality in Ireland
Eamon O’Shea and Kieran Walsh talk about their contribution to a new book on Remote and Rural Dementia Care.
The specific issue of rural ageing and dementia care has been neglected in many countries. As populations age, the need to provide services to an increasing number of older people with dementia living in rural areas will become more acute, even if the share of older people living in rural areas is likely to decline in the future, in Ireland and internationally. Concern for older people with dementia who continue to live in rural areas is based on a number of potential disadvantages arising from economic, social, geographical, environmental and demographic sources. There is a tendency for cumulative cycles of decline to occur in rural areas; structural economic change and poor employment opportunities tend to lead to out-migration which in turn leads to population decline, unbalanced age structures and falling economic activity, which reinforces unemployment issues and further intensifies the out-migration of younger people. This is quickly followed by a reduction in health and social care provision, placing greater responsibility for care on people themselves and their shrinking networks and more dispersed families. Such circumstances can lead to a decline in well-being and lower quality of life for people with dementia living in rural areas. It can also lead to higher rates of admission to residential care than is necessary or desirable for people with dementia.
Our contribution to the book Remote and Rural Dementia Care edited by Anthea Innes, Debra Morgan and Jane Farmer, published by Policy Press, examines resource allocation and equity issues for older people with dementia living in rural areas in Ireland. It reframes the challenges people with dementia face in the context of social exclusion and its capacity to detract from full participation in society. People living with dementia in rural areas may, in effect, be subscribed into the position of lesser citizens, separated and disconnected from a level of engagement in economic and social life enjoyed by mainstream society. We use the analytical frame of social exclusion to help unpack complex and multiple challenges facing older people with dementia living in rural areas. We adopt a multifaceted policy approach to support full societal participation of people with dementia, drawing on secondary data from a small number of recent studies carried out by the National University of Ireland Galway. Our argument supports the recalibration of current dementia policy towards a broader social strategy for rural-dwelling people with dementia. This will involve new investment and innovation in service infrastructure, service provision, new technologies, housing, transport and mobility and social relations, each of which, and in combination, can act positively as mediating factors for social exclusion.
A key element in the sustainability of rural communities generally is a broader vision of the regenerative nature of rural society. Development across Europe has, for too long, been narrowly defined in economic terms, while the social needs of people are relegated to a residual position, at best, or neglected entirely, at worst. This is catastrophic for people with dementia. People living in rural communities experience life in economic terms certainly, but also in social and cultural terms. A vibrant social model that is place oriented and rights-based would enable people with dementia living in rural areas to fully realise their capabilities and latent potential, even when cognitive decline has taken hold. It would also take pressure off family carers who provide much of the day-to-day care and support of people with dementia living in rural areas.