Older Australians Research Articles

From the ground up: assessing the face validity of the Quality of Life – Aged Care Consumers (QOL-ACC) measure with older Australians

PurposeThis paper aims to assess the face validity to inform content validity of the Quality of Life – Aged Care Consumers (QOL-ACC), a new measure for quality assessment and economic evaluation in aged care.Design/methodology/approachSemi-structured interviews were conducted with older adults (66–100 years) receiving aged care services at home (n = 31) and in residential care (n = 28). Participants provided feedback on draft items to take forward to the next stage of psychometric assessment. Items were removed according to several decision criteria: ambiguity, sensitive wording, not easy to answer and/or least preferred by participants.FindingsThe initial candidate set was reduced from 34 items to 15 items to include in the next stage of the QOL-ACC development alongside the preferred response category. The reduced set reflected the views of older adults, increasing the measure’s acceptability, reliability and relevance.Originality/valueQuality of life is a key person-centred quality indicator recommended by the recent Royal Commission into Aged Care Quality and Safety. Responding to this policy reform objective, this study documents a key stage in the development of the QOL-ACC measure, a new measure designed to assess aged care specific quality of life.

Corrigendum to: Impact of the COVID-19 pandemic on access and use of health services by middle-aged and older Australians.

Objectives To examine: the impact of the coronavirus disease 2019 (COVID-19) pandemic on access to health services by middle-aged and older Australians; and the use of telehealth services during the COVID-19 pandemic and its ongoing usefulness. Methods A cross-sectional survey was conducted among participants who completed the COVID-19 supplement in the 45 and Up Study 2020 Survey. Multivariable logistic regression analysis was used to examine the association between socio-demographic characteristics and health conditions with missed/delayed access to health services, changes in health outcomes resulting from missed/delayed access, and use of telehealth services. Results Data for 45 071 participants were analysed (56% female, 72% aged ≥65 years). Almost half (42.2%) reported they had missed/delayed access to health care due to COVID-19; mainly for dental services (26.1%), visits to a general practitioner (GP) (16.3%) and specialists (12.6%). Missed/delayed visits to GPs and specialists were more likely among females, participants from non-English-speaking backgrounds, with disability/illness, living in outer regional/remote areas or with chronic health conditions. People with a disability or high/very high psychological distress were twice as likely to report worse health as a result of missed/delayed care. Half (48.0%) the study participants used telehealth during the COVID-19 pandemic and 81.9% indicated telehealth would be useful post-pandemic. Conclusions The COVID-19 pandemic impacted access to healthcare services, particularly for people with a disability, and chronic or mental health issues who also reported worse health. This may account for their higher use of telehealth services as an alternate way of accessing health care. Ongoing evaluation of telehealth services for vulnerable groups post-pandemic is required.

A Follow-Up Spatial Analysis of Naturally Occurring Retirement Communities in the Greater Brisbane Region: Using the Latest Australian Bureau of Statistics (ABS) Census Data (2021)

We conducted a spatial and temporal analysis of naturally occurring retirement communities (NORCs) in the Greater Brisbane region using the latest ABS Census 2021 data. Four methods of spatial analysis were employed to identify the distribution and evolution of NORCs: (i) geovisualisation, (ii) spatial autocorrelation, (iii) cluster and outlier analysis, and (iv) hotspot and cold spot analysis. The findings from this data analysis are consistent with previous research findings that NORCs are developing at a fast pace and are concentrated along the Brisbane River and coastline areas, where an increasing number of older people are relocating for better ageing in place, i.e., ageing at home in the community as long as possible. In addition, the spatial distribution of NORCs is characterized by a preference for cluster, with most of the NORC population located in coastal areas. Furthermore, older people moving out and younger people moving in are the primary reasons why the city and the south area are becoming cold spots. The findings of this study will provide practical implications for various stakeholders to assist older Australians in ageing in place as long as they desire by developing age-friendly community environments.

Trends in utilisation of ultrasound by older Australians (2010–2019)

BackgroundOlder people have increasingly complex healthcare needs, often requiring appropriate access to diagnostic imaging, an essential component of their health and disease management planning. Ultrasound is a safe imaging tool used to diagnose several conditions commonly experienced by older people such as deep vein thrombosis.PurposeTo evaluate the utilisation of major ultrasound services by Australians ≥ 65 years old between 2009- and 2019.MethodsThis population-based and yearly cross-sectional study of ultrasound utilisation per 1,000 Australians ≥ 65 years old was conducted using publicly available data sources. Overall, examination site and age- and sex-specific incidence rate (IR) of ultrasound per 1,000 people, adjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were calculated using negative binomial regression models.ResultsOver the study period, the crude utilisation of ultrasound increased by 83% in older Australians. Most ultrasound examinations were conducted on extremities (39%) and the chest (21%), with 25% of all ultrasounds investigating the vascular system. More men than women use ultrasounds of the chest (184/1,000 vs 268/1,000 people), particularly echocardiograms (177/1,000 vs 261/1,000 people), and abdomen (88/1,000 vs 92/1,000 people), especially in those ≥ 85 years old. Hip and pelvic ultrasound were used more by women than men (212/1,000 vs 182/1,000 people). There were increases in vascular abdominal (IRR:1.07, 95%CI:1.06–1.08) and extremeties (IRR:1.06, 95%CI:1.05–1.07) ultrasounds over the study period, particularly in ≥ 75 years old men.ConclusionsUltrasound is a common and increasingly used diagnostic tool for conditions commonly experienced by older Australians.

Virtual Care Initiatives for Older Adults in Australia: Scoping Review.

There has been a rapid shift toward the adoption of virtual health care services in Australia. It is unknown how widely virtual care has been implemented or evaluated for the care of older adults in Australia. We aimed to review the literature evaluating virtual care initiatives for older adults across a wide range of health conditions and modalities and identify key challenges and opportunities for wider adoption at both patient and system levels in Australia. A scoping review of the literature was conducted. We searched MEDLINE, Embase, PsycINFO, CINAHL, AgeLine, and gray literature (January 1, 2011, to March 8, 2021) to identify virtual care initiatives for older Australians (aged ≥65 years). The results were reported according to the World Health Organization's digital health evaluation framework. Among the 6296 documents in the search results, we identified 94 that reported 80 unique virtual care initiatives. Most (69/80, 89%) were at the pilot stage and targeted community-dwelling older adults (64/79, 81%) with chronic diseases (52/80, 65%). The modes of delivery included videoconference, telephone, apps, device or monitoring systems, and web-based technologies. Most initiatives showed either similar or better health and behavioral outcomes compared with in-person care. The key barriers for wider adoption were physical, cognitive, or sensory impairment in older adults and staffing issues, legislative issues, and a lack of motivation among providers. Virtual care is a viable model of care to address a wide range of health conditions among older adults in Australia. More embedded and integrative evaluations are needed to ensure that virtually enabled care can be used more widely by older Australians and health care providers.

“I don’t trust it, so I don’t read it”: How do older Australians navigate and search for information about their health and driving?

Objectives Driving is pivotal to successful aging, yet older people may need to adapt their driving to changes associated with aging or transition to driving retirement at some stage. However, most older people are reluctant to discuss or plan for changes to their future mobility. This study describes formative research to inform a social marketing campaign to promote the “DRIVING AND STAYING INDEPENDENT” resource assisting older drivers to make informed decisions about timely changes to their driving. Methods Semi-structured interviews were conducted with 16 drivers aged between 67 and 84 years living in the state of NSW, Australia. A discussion guide based on social marketing principles was used to explore the perspectives and experiences of older drivers seeking health and driving information. Thematic analysis was conducted on the interview data. Results Succinct, clear messages with a clear call to action were identified as essential features of social marketing campaigns targeting older drivers. Realistic portrayals of older people in marketing material are important in engaging the audience. Older drivers preferred positive messages that emphasize the relevance of the product to them. Trusted and reputable sources were of utmost importance when seeking health and driving information. Traditional channels such as TV and radio remain the dominant media consumed by the older participants, however, digital resources are being used increasingly. Conclusions This study provides important insights for an evidence-based social marketing campaign promoting the “DRIVING AND STAYING INDEPENDENT” resource to older drivers. The findings add to the limited literature on campaigns targeting older adults and may prove valuable for promoting other issues relevant to older adults. Campaigns targeting older drivers should consider selecting clear messages, demonstrating relevance to the audience, using trustworthy sources and selecting channels used by older adults.

Drawing Ageing: Using Participant-Generated Drawing to Explore Older Australians Expectations and Experiences of Ageing in a Retirement Village

This article discusses the use of an arts-based visual methodology, drawing, to explore older people’s experiences and expectations of ageing in a retirement village. Tactile, generative, and visual, drawing is a quick, inexpensive, and extremely participatory process, which, compared to traditional text-based data, provides rare and compelling insight into conscious and unconscious feelings, emotions, sentiments, and experiences. As part of a broader project exploring life in retirement villages, 12 older adults in their 70s and 80s were asked to sketch their experiences of ageing, as well as their expectations and experiences of retirement village life. Sketches were analysed using reflexive thematic analysis, which revealed that participants drew ageing as both a time for opportunity and enjoyment and decline, while retirement village life very much met their expectations in terms of being a place of fun, friendship, and leisure. While drawing as a method is rarely used in gerontological research, the outcomes of this project demonstrate how it enables the powerful production of evocative, interactive, and memorable imagery, and it should be a greater part of the methodological toolbox.

Adherence to a Mediterranean Diet for 6 Months Improves the Dietary Inflammatory Index in a Western Population: Results from the MedLey Study.

Increasing evidence supports that a higher dietary inflammatory index (DII®) score is associated with inflammation and cardiovascular disease (CVD) risk, events, and mortality. This randomized trial sought to determine if a change to a Mediterranean diet resulted in a reduction in the DII score, and then it evaluated the relationship between the DII and cardiometabolic outcomes following the administration of a traditional Mediterranean diet in older Australian adults. A total of 152 Australian adults (mean age 71 ± 5 years) was randomly allocated either a MedDiet (n = 80) or to continue their habitual diet (HabDiet) (n = 72) for 6 months. Diet and cardiovascular outcomes were measured at baseline and 3 and 6 months of the intervention. DII and energy-adjusted DII (E-DIITM) scores were calculated from 3-day weighed food records. There was a significant reduction in the DII score at 2 and 4 months for the MedDiet group (−1.40 ± 0.20 p < 0.001 and −1.47 ± 0.20 p < 0.001, respectively), which was significantly different from the HabDiet group over time (p < 0.001). The HabDiet DII score did not change significantly at the 2 and 4 months timepoints (0.47 ± 0.21 p = 0.35 and 0.54 ± 0.21 p = 0.21, respectively). The improvement in the DII in the MedDiet group was not related to any cardiometabolic outcome. Baseline cross-sectional analyses identified a positive association between the E-DII score and average BMI, body weight, WHR, abdominal adiposity, and SBP, and a negative association with HDL-C. We demonstrate that a MedDiet intervention significantly reduced DII scores compared with a habitual Australian diet in older Australians. This could be beneficial for healthy ageing and the avoidance of chronic disease in Western populations.

Allied health professionals' contribution to care at end of life in aged care settings.

The Australian population is aging, and the proportion of older Australians will continue to grow over the coming decades. However, there is a lack of research published on the specific roles and responsibilities of allied health professionals (AHPs) providing palliative care within an aged care context. Understanding the roles and needs of AHPs providing care during the last months of life in the community and aged care facilities could contribute to workforce planning, targeted information and improved care. In total, 108 eSurveys were collected between November 2019 to May 2020 from three allied health professions working in government-funded aged care; the majority of these being in residential aged care. Descriptive data are reported on the provision of care in key palliative care domains, care settings and practice activity. Nearly all respondents reported they had worked with older Australians who had palliative care needs. However, over one-third of respondents reported low levels of confidence in supporting clients or residents with palliative care needs. The majority indicated they would benefit from additional education and training and support in palliative care. This study investigated the role of the allied health workforce in contributing to the care of older Australians at the end of life. It has also demonstrated that there are gaps in practice activity and work role that must be addressed to ensure this workforce can support older people with palliative care needs in receipt of aged care services.

The effect of psychological factors on financial behaviour among older Australians: Evidence from the early stages of COVID-19 pandemic.

The current study investigated the association between psychological factors and financial behaviour during the COVID-19 pandemic in older people. Older people were chosen compared to other age groups because of the relatively greater impact in this age group of suboptimal financial decisions on future financial wellbeing. We hypothesised that the psychological factors facilitating general wellbeing during the COVID-I9 pandemic, i.e., positive mental wellbeing, hope, and positive coping, will have positive effects on financial behaviour. Based on telephone interviews, 1501 older Australians (Men = 750 and Women = 751; 55-64y = 630; > 65y = 871) completed an omnibus questionnaire examining coping, hope, mental wellbeing, and financial behaviour. Data was analysed using logistic regression and an ordinary and two-stage least square frameworks. Analyses revealed that the psychological factors identified as facilitating general wellbeing during the COVID-I9 pandemic also facilitated positive financial behaviour with hope and mental wellbeing emerging as significant determinants. Based on weightings from principal component analysis, one item each from the hope and mental wellbeing scale with eigenvalues > 1 were found to be robust predictors of positive financial behaviours. In conclusion, the findings support the assumption that the psychological factors associated with general wellbeing during the COVID-19 pandemic are also associated with positive financial behaviour. They further raise the possibility that single hope and positive mental well-being items can also be used to monitor psychological health and predict financial behaviour in older people and, in particular, at times of crisis. The latter may be useful measures for government to monitor psychological and financial wellbeing and inform policy for supporting older people at times of crisis.

Engaging older Australians in sexual health research: SHAPE2 survey recruitment and sample.

Sexual health research rarely includes older age groups and the sexual health needs of older Australians are not well understood. Older adults are online in increasing numbers; however, internet surveys involving samples of older adults and sensitive topics remain uncommon. In 2021, we developed an online survey to explore the sexual health needs of Australians aged 60+years. We describe here survey recruitment and sample obtained, comparing it with national population data (Australian Bureau of Statistics) and the sample of the similar 'Sex, Age and Me' study from 2015. We recruited 1470 people with a staggered three-phase strategy: (1) emails to organisations and community groups; (2) paid Facebook advertising; and (3) passive recruitment. Half (50.6%) found out about the study via an organisation or group and just over a third (35.7%) from Facebook. The sample was equally balanced between men (49.9%) and women (49.7%) (0.4% other gender identities). Participants were aged 60-92years (median 69years) with all Australian States/Territories represented. Facebook recruits were younger, more likely to be working rather than retired, and more likely to live outside a major city, than those recruited by other means. Using the recruitment methods described, we successfully obtained a diverse and fairly representative sample of older Australians within the constraints of a convenience sample and on a modest budget. This research sheds light on ways to engage an under-served demographic in sexual health research. Our experience shows that many older adults are amenable to recruitment for online sexual health surveys using the approaches outlined.

Adherence to a Mediterranean Diet is associated with physical and cognitive health: a cross-sectional analysis of community-dwelling older Australians

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Co-Creating ICT Risk Strategies with Older Australians: A Workshop Model.

As digital inclusion becomes a growing indicator of wellbeing in later life, the ability to understand older adults' preferences for information and communication technologies (ICTs) and develop strategies to support their digital literacy is critical. The barriers older adults face include their perceived ICT risks and capacity to learn. Complexities, including ICT environmental stressors and societal norms, may require concerted engagement with older adults to achieve higher digital literacy competencies. This article describes the results of a series of co-design workshops to develop strategies for increased ICT competencies and reduced perceived risks among older adults. Engaging older Australians in three in-person workshops (each workshop consisting of 15 people), this study adapted the "Scenario Personarrative Method" to illustrate the experiences of people with technology and rich pictures of the strategies seniors employ. Through the enrichment of low-to-high-digital-literacy personas and mapping workshop participant responses to several scenarios, the workshops contextualized the different opportunities and barriers seniors may face, offering a useful approach toward collaborative strategy development. We argued that in using co-designed persona methods, scholars can develop more nuance in generating ICT risk strategies that are built with and for older adults. By allowing risks to be contextualized through this approach, we illustrated the novelty of adapting the Scenario Personarrative Method to provide insights into perceived barriers and to build skills, motivations, and strategies toward enhancing digital literacy.

Impacts of the 2019/20 bushfires and COVID-19 pandemic on the physical and mental health of older Australians: a cross-sectional survey.

In 2019/20 major bushfires devastated Australia's East Coast. Shortly afterward the COVID-19 pandemic was declared. Older people are disproportionately affected by disasters and are at high risk from respiratory pandemics. However, little is known about how these events impact on older peoples' health and well-being and engagement with services such as primary care. To explore the health impacts of the 2019/20 bushfires and the COVID-19 pandemic on older Australians' health and well-being. One hundred and fifty-five people aged over 65 years living in South-eastern New South Wales, Australia participated in an online survey. The survey measured the impacts of the bushfires and COVID-19 on physical and mental health and the capacity of older people to manage these impacts. Most respondents felt that the bushfires caused them to feel anxious/worried (86.2%) and negatively affected their physical (59.9%) and mental (57.2%) health. While many participants had similar feelings about COVID-19, significantly fewer felt these physical and mental health impacts than from the bushfires. A significantly greater perceived level of impact was observed for females and those with health problems. More respondents described negative mental health than physical health effects. Those who felt more impacted by the events had lower levels of resilience, social connection and support, and self-rated health. The health impacts identified in this study represent an opportunity for primary care to intervene to both ensure that people with support needs are identified and provided timely support and that older people are prepared for future disasters.

Gaining resolution when creating imagery of aging.

In seeking to support healthy aging, designers have struggled to reduce their assumptions and biases toward older adults, been seen to interpret the worlds of later life through unfiltered imagery, as well as engage with stigmas, ultimately diminishing the technologies they construct. This article seeks to critically analyse this state-of-the-art from a design research perspective while engaging with the growing interdisciplinary study of aging and technologies. Toward this, we proposition "resolution" as a concept indicative of the level of detail that seeks to characterize the fidelity that representations of later life have. This concept is explored through a cultural probe study that investigated the sentiments of several older Australians regarding the inequities and social isolation brought on by the COVID-19 pandemic. Providing a diary alongside photovoice and mapping tasks, the study captured perceptions of social technology, practices, networks, and wellbeing, offering a diverse and complex picture of aging and technology. Through reflexive thematic analyses of some of these materials, this case study offers designers pathways to understanding and including older adults in their work. In determining the resolution of these images of aging, we discuss how transparency about the limitations and qualities of such participatory methods through incorporating reflexivity can influence the degree of detail such imagery gains. Ultimately this concept builds on the notion of participation configuration, supporting designers to realize better images of aging and representations of later life.

Assessing feasibility, construct validity, and reliability of a new aged care-specific preference-based quality of life instrument: evidence from older Australians in residential aged care

BackgroundQuality of Life-Aged Care Consumers (QOL-ACC) is a new older-person-specific quality of life instrument designed for application in quality assessment and economic evaluation in aged care. The QOL-ACC was designed from its inception with older people receiving aged care services ensuring its strong content validity. Given that the QOL-ACC has already been validated in home care settings and a preference-weighted value set developed, we aimed to assess feasibility, construct validity and reliability of the QOL-ACC in residential aged care settings. MethodsIndividuals living in residential aged care facilities participated in an interviewer-facilitated survey. The survey included the QOL-ACC, QCE-ACC (quality of aged care experience measure) and two other preference-based quality of life instruments (ASCOT and EQ-5D-5L). Feasibility was assessed using missing data and ceiling/floor effects. Construct validity was assessed by exploring the relationship between the QOL-ACC and other instruments (convergent validity) and the QOL-ACC’s ability to discriminate varying levels of self-rated health and quality of life. Internal consistency reliability was assessed using Cronbach’s alpha (α).ResultsOf the 200 residents (mean age, 85 ± 7.7 years) who completed the survey, 60% were female and 69% were born in Australia. One in three participating residents self-rated their health as fair/poor. The QOL-ACC had no missing data but had small floor effects (0.5%) and acceptable ceiling effects (7.5%). It demonstrated moderate correlation with ASCOT (r = 0.51, p < 0.001) and EQ-5D-5L (r = 0.52, p < 0.001) and a stronger correlation with the QCE-ACC (r = 0.57, p < 0.001). Residents with poor self-rated health and quality of life had significantly lower scores on the QOL-ACC. The internal consistency reliability of the QOL-ACC and its dimensions was good (α = 0.70–0.77).ConclusionsThe QOL-ACC demonstrated good feasibility, construct validity and internal consistency reliability to assess aged care-related quality of life. Moderate correlations of the QOL-ACC and other instruments provide evidence of its construct validity and signifies that the QOL-ACC adds non-redundant and non-interchangeable information beyond the existing instruments. A stronger correlation with the QCE-ACC than other instruments may indicate that quality of life is more intimately connected with the care experience than either health- or social-related quality of life in residential aged care settings.

Living with risk: Retired couples’ experiences of a financialised retirement income system

AbstractThis paper presents new data on the nature and consequences of the risks for retirees inherent in the Australian retirement income system. This system can be regarded as ‘financialised’ in that retirement savings are primarily managed by non-government financial institutions and, although the Age Pension remains as a safety net, responsibility for the provision and management of retirement incomes has increasingly shifted to individuals. In this article we report the results of a qualitative study of older mixed-sex couple households’ experiences of this system and discuss the implications for retirement incomes policy. We conclude that while the system of government-mandated employer superannuation contributions (the Superannuation Guarantee) is undoubtedly raising the living standard of many older Australians, the financialised nature of the retirement income system, as a whole, poses significant financial risks for many retirees.

Adherence to a Mediterranean Diet is associated with physical and cognitive health: A cross-sectional analysis of community-dwelling older Australians.

Poor cognitive function is associated with reduced functional independence, risk of institutionalization and reduced health-related quality of life. The ability to independently perform instrumental activities of daily living (iADLs) is compromised in patients with mild cognitive impairment (MCI) or dementia. Emerging evidence suggests that adherence to a Mediterranean diet (MedDiet), may play an important protective role against cognitive decline and dementia risk, whilst preserving functional status. This cross-sectional study aimed to explore the independent associations between MedDiet adherence, cognitive risk, and functional status in community-dwelling older adults living in Australia. MedDiet adherence was assessed using the Mediterranean Diet Adherence Screener (MEDAS); a modified Lawton's iADL scale was used for the assessment of functional status and risk of cognitive impairment was assessed using the AD8 dementia screening intervention. A total of n = 294 participants were included in the final analyses (70.4 ± 6.2 years; Females, n = 201; Males, n = 91; n = 2 unspecified). Adherence to a MedDiet was positively associated with functional ability (β = 0.172; CI: 0.022, 0.132; P = 0.006) independent of age, gender, Body Mass Index (BMI), smoking status, sleep duration, physical activity duration, diabetes status, and level of education. Furthermore, MedDiet adherence was inversely associated with cognitive risk (β = -0.134; CI: -0.198, -0.007; P = 0.035) independent of all covariates. However, our sensitivity analyses further showed that adherence to a MedDiet was not associated with cognitive risk in older adults free from cognitive impairment. We showed that adherence to a MedDiet is associated with healthy physical and cognitive aging. Nevertheless, exploration of these findings in larger cohorts, using longitudinal analyses and controlling for important confounders to ascertain the direction of the relationship is warranted.

Understanding the planning and preparation for diabetes self-management of grey nomads when travelling in rural and remote Australia: An exploratory survey.

Many older Australians with chronic health conditions, including diabetes, are taking to the road in a recreational vehicle following retirement and are colloquially known as grey nomads. This exploratory online survey aimed to ascertain the issues on the road for grey nomads with diabetes and their experiences of self-management of their diabetes whilst in rural and remote regions of Australia. Following ethical approval and piloting, an online survey was distributed through social media sites used by grey nomads and those with diabetes. From the closed and open-ended responses from travelers with diabetes in rural and remote areas, the demographics of this cohort were explored, as well as their self-management of diabetes. A total of 103 grey nomads with diabetes responded and 81 completed all survey questions. There was wide variation in the respondents' answers in regard to their self-management including their preparation for travel; their knowledge of diabetes and accessing health-care services; their management of illness; and their experiences whilst travelling including the effects of COVID-19. It was identified that there was a need for an increase in preparation prior to travel, and several important checks were identified for this planning specific to rural and remote areas of Australia, including the expectations of health services in these regions. A pretravel checklist for travellers with diabetes is recommended to contribute to better self-management of grey nomads with diabetes on the road in order to alleviate the issues identified.

Opportunity, ideal or distraction? Exploring stakeholder perceptions of tackling energy poverty and vulnerability among older Australians

Energy vulnerability intersects with housing, social and health issues, yet current siloed approaches and piece-meal energy assistance initiatives are often leaving ‘hard to reach’ older householders behind. Cross-disciplinary strategies promise better identification of vulnerable people, sustained relief and scalable solutions, yet such innovative approaches are still rare. Using the Australian in-home aged care services as a case study, this research explored how stakeholders perceived the idea of integrating energy assistance with health services for people aged 65 and over. Understanding the views of potential advocates and adopters may guide the development, design and implementation of such an innovation.This study engaged front-line workers, executives and policy makers across organisations aiming at carbon emission reduction, equity and health. Climate action stakeholders and in-home aged care services staff recognised synergies across their programmes and welcomed the idea as an opportunity to address hidden energy poverty. Equity stakeholders perceived it as an ideal and doubted that its aspirations were likely to be fully realised given the priorities of vulnerable, older people. An aged care services industry representative, however, saw this proposition as a distraction from dealing with the broader challenges of an ageing population. These insights highlight the need to co-design such an initiative. The engagement of health policy makers is critical but challenging. Further research is needed to align energy assistance with the needs and circumstances of in-home aged care services clients and to develop solutions for older renters.