'Grey nomad' travellers' use of remote health services in Australia: a qualitative enquiry of hospital managers' perspectives.

BACKGROUND: For more than the last two decades, older Australians travelling domestically in self-sufficient accommodation and recreational vehicles for extended periods of time have been referred to as 'Grey Nomads'. By 2021 more than 750,000 such recreational vehicles were registered in Australia. Tourism data for the year to September 2017 show 11.8 million domestic camping and caravanning trips in Australia, 29% of which were people aged 55 and over. As the 'baby boomer' generation increasingly comes to retirement, the size of this travelling population is growing. This term applies to the spike in birth rates after World War II from 1946-1964. This growing group of domestic travellers are potential healthcare consumers in remote areas but relatively little is known about their travel, healthcare needs or care seeking practices. Grey nomads have been described as reflective of the age-comparable sector of the Australian population in that many live with chronic illness. Early concerns were raised that they may "burden" already stretched rural and remote healthcare services but relatively little is known about the impact of these travellers. METHODS: The aim of this study was to explore the utilisation of healthcare services in remote locations in Australia by grey nomads including women travellers, from the perspective of healthcare professionals working in these settings. The study objective was to interview healthcare professionals to seek their experience and details of service delivery to grey nomads. In March 2020 [prior to state border closures due to the COVID-19 pandemic] a field study was conducted to identify the impact of grey nomads on healthcare services in remote New South Wales and Queensland. A qualitative approach was taken to explore the perspectives of nursing healthcare managers working in remote towns along a popular travel route. With appropriate Research Ethics Committee approval, managers were purposively sampled and sample size was determined by data saturation. Thirteen managers were contacted and twelve interviews were scheduled to take place face to face in the healthcare facilities (small hospitals with acute care and aged care services) at mutually convenient times. A semi-structured interview schedule was developed in line with the research aim. The interviews were audio-recorded, transcribed and thematic analysis was undertaken concurrently with data collection for ongoing refinement of questions and to address emerging issues. RESULTS: These nursing managers described a strong service and community ethos. They regarded travellers' healthcare needs no differently to those of local people and described their strong commitment to the provision of healthcare services for their local communities, applying an inclusive definition of community. Traveller presentations were described as predominantly exacerbations of chronic illness such as chest pain, medication-related attendances, and accidents and injuries. No hospital activity data for traveller presentations were available as no reports were routinely generated. Travellers were reported as not always having realistic expectations about what healthcare is available in remote areas and arriving with mixed levels of preparedness. Most travellers were said to be well-prepared for their travel and self-management of their health. However, the healthcare services that can be provided in rural and remote areas needed to be better understood by travellers from metropolitan areas and their urban healthcare providers. CONCLUSION: Participants did not perceive travellers as a burden on health services but recommendations were made regarding their expectations and preparedness. Australia's national transition to electronic health records including a patient-held record was identified as a future support for continuity of care for travellers and to facilitate treatment planning. With no current information to characterise traveller presentations, routinely collected hospital data could be extracted to characterise this patient population, their presentations and the resources required to meet their care needs.

Exploring the 'grey nomad' travelling population of Australia and its health: an integrative literature review.

With increasing numbers of baby boomers retiring and taking to the road in rural and remote Australia, often for extended periods, this review aimed to identify the characteristics of these 'grey nomads' travelling across Australia, their experiences in relation to their health and social needs and their access to health care. To this end, an integrative literature review with narrative analysis was conducted. Studies of Australian grey nomad travellers published from 1999 to January 2020 were sourced from Ovid Emcare, Medline/PreMedline, Embase, PsychINFO, Academic Search Complete and Google Scholar. Fourteen records based on 11 studies described grey nomads as predominantly older heterosexual couples who defied the conventional view of aging by seeking adventure and new experiences. Many planned for their health needs while travelling, and their health was overwhelmingly reported to improve with the nomadic lifestyle. This review demonstrates the paucity of data about grey nomads. Information on travellers' health care needs and service usage is a significant gap, undermining regional and rural service planning and the provision of healthcare services, and represents a considerable challenge for healthcare providers such as GPs, pharmacies and emergency departments.

The Conversion of Social Capital into Community Development: an intervention in Australia's outback.

The research presented in this article employed a deliberate intervention to mobilize social capital and then studied the dynamics of the way in which it influenced community development. Whether or not social capital is able to facilitate development depends on the specific context in which it occurs. Although the general context of this study was that of small rural towns in Australia's outback that are experiencing decline, each of the four towns studied had unique features which could influence the mobilization of social capital. Rural communities have the willingness and capacity to mobilize but whether this capacity is actualized may well depend on the presence of other mobilizing factors. Specifically the intervention study found that a structure needs to be in place which can take the initiative and work across the community - engaging a range of organizations. Second, the structure needs to be supported, but not controlled, by local government. Third, it needs the kind of social entrepreneurship that can sustain a community-wide vision and bring together the diverse groups within the community.

The Grey Nomad phenomenon: changing the script of aging.

This article explores a relatively new and little understood phenomenon, that of the Australian Grey Nomads. Every year increasing numbers of older Australians take to the road. This article explores the phenomenon both empirically and theoretically. A grounded approach is used by which the experience is explored from an ethnographic account involving interviews with some 400 travelers, including in-depth taped interviews with 26 traveling groups. The data is analyzed and discussed in terms of "Ulyssean" aging. The Ulyssean lifestyle requires the freedom to pursue personal choice and new, personally risky experience. Issues of health, personal development, and social networks are discussed in relation to the literature on aging. In particular, it is argued that the Grey Nomad phenomenon fundamentally challenges the dominant decline model of aging. It presents a picture instead of these older Australians taking active and very positive control of their lives, regardless of financial and health conditions. In doing so, they are rewriting the dominant social script for aging.