Substitution among the providers of old-age care has usually meant a process whereby the state ‘takes over’ what families used to do, but during the 1980s and 1990s, both home help and institutional care were cut back substantially in Sweden as elsewhere. Comparable, nationally representative surveys in Sweden of the provision of care for older people living in the community enable analysis of the effects of these cutbacks on the sources and patterns of care. It emerges that increased inputs from families match the decline of public services, that is, a ‘reverse’ substitution has recently been taking place. Local studies, of older people who have been followed over time as the provision of home help has changed, support these conclusions. Of the increased informal care, most has been provided by daughters, but sons have also contributed. A problematic aspect of these shifting patterns of care is that an increasing number of family carers with increasingly heavy care commitments are now without formal or informal support, whereas in the recent past many could expect their responsibilities to be shared with the state. The evidence from this study also calls into question common metaphors and assumptions about the assumed interdependence between informal care and public services for older people, and challenges the so-called substitution thesis.

Benevolent, long-term care can threaten older adults' sense of autonomy in a residential home environment. Increasing reliance on a hotel style of living has been seen to erode social identity, life satisfaction and even survival or lifespan. Drawing on evidence from both gerontological and social psychological literature, this paper examines the links between the empowerment of residents and their subsequent quality of life in the context of a move into a new care facility in a medium-sized town in South-West England. A longitudinal experiment was conducted during which 27 residents on one floor of a new facility were involved in decisions surrounding its décor, while those on another floor were not. The residents' attitudes and behaviour were monitored at three points over five months (four weeks pre-move, four weeks post-move, and four months post-move). Consistent with the social identity literature, members of the empowered group reported increased identification with staff and fellow residents in the new home, displayed enhanced citizenship, reported improved wellbeing, and made more use of the communal space. Moreover the staff found the empowered residents to be more engaged with their environment and the people around them, to be generally happier and to have better health. These patterns were observed one month after the move and remained four months later. Some implications for theory and practice are discussed.

For the older individual, leisure activities are a resource that helps to maintain health and engagement with life. This article investigates change over 10 years in the level of participation of older people in leisure activities in Sweden, and the factors associated with these changes. The data are from nationally representative samples of the Swedish population aged 77 or more years in 1992 and 2002. The level of participation was higher at the later date, and among four major groups of activities, social and cultural activities increased the most, while physical and intellectual activities increased only among women. Ordered logistic regressions enable variations in the level of participation by age, gender, level of education, disability and fatigue to be described. Participation in most kinds of activities, including the overall level, was more common at the younger ages (the late seventies and early eighties) and among those with full mobility and more education. Since average health was worse in 2002 than in 1992, it cannot explain the higher level of participation. Other possible explanations, such as cohort differences, improved accessibility, and changing gender roles, and the implications for health promotion programmes are discussed.

Ageing in rural areas has received less attention in the literature than the proportions of older people living in rural areas might suggest. This paper looks at rural ageing in the United Kingdom based on the existing literature and on research in country areas in which the author has been involved. It examines some of the common myths about ageing in rural communities and explores these in terms of their accuracy when compared with the reality of the situation of older people in these areas. The realities of rural lifestyles, family and community networks, life satisfaction, health and access to services are briefly discussed. It is concluded that ageing in rural Britain has advantages and disadvantages but that it is conclusively neither better nor worse than ageing in urban areas. However, it is suggested that rural service provision demands a different approach from that which is appropriate in urban areas.

This article examines the mounting pessimism of policy-makers concerning the implications of societal ageing. It is argued that underlying this pessimism are primarily macroeconomic worries about the economic ‘burden’ that older people are said to represent to the economy and, specifically, the working population. It is suggested that, in turn, these particular concerns are ideologically inspired; hence it is the public expenditure costs of pensions and health care rather than, for example, the economic costs of ageing for older people and their families, that are the chief causes of anxiety. Thus political ideology has distorted and amplified the macroeconomic consequences of population ageing in order to legitimate anti-welfare state policies.

While Britain and the US represent leading examples of this trend, there is a danger that, inspired to some extent by the leading international economic agencies, other countries will follow their lead. An unintended result of doing so may be the growth of inter-generational conflict. This concept has achieved quite wide currency in the US literature and has been influential in some policy circles. It is subjected to close scrutiny and found deficient as a basis for policy-making. In conclusion some lessons are drawn about the failure of orthodox social gerontology to counteract the pessimistic accounts emanating from economic and demographic analyses and the need for a more critical stance by the discipline.

Norwegian elderly people today are clearly more aware of public help and services compared to the late 1960s, and a growing number of them prefer public rather than family help. A study in Oslo found that a majority would turn to the public services when in need of long-term help, even when children were living close by. Children or other informal helpers were preferred over the public services only when there was a need for short-term assistance. The growing preference for public help is taken primarily as a response to increased availability of public services, and not as a reflection of weaker inter-generational solidarity.

Health services research has been dominated by the biomedical paradigm and positivism, and the funding cultures of biomedicine have dictated the choice of method used by researchers. Social science paradigms, however, have been recognised as increasingly important within health services research and both quantitative and qualitative methods are accepted as appropriate. Older people with dementia have usually been excluded from or marginalised in studies about dementia because of traditional assumptions about the ability or appropriateness of people with dementia to act as participants or respondents. The choice of research method should be driven by theory and not by ideological or political prescription. Theory-driven pluralistic approaches to method will facilitate participation of people with dementia in research through the valuing of personhood. There are no unique methodological challenges in researching dementia. Rather, the complex nature of dementia and dementia care highlight the methodological challenges of investigating complex social phenomena.

This article describes and evaluates cash-for-care programmes for older people in four European countries, namely Home-Care Grants in Ireland, Direct Payments in the United Kingdom (England), Service Vouchers in Finland and Personal Budgets in The Netherlands. The purpose is to raise understanding of the background and reasons for the introduction of cash-for-care programmes and their impact on the countries' care regimes. It is argued that while the motives for introducing cash-for-care programmes in the four countries are similar, namely to promote choice and autonomy, to plug gaps in existing provision, to create jobs, and to promote efficiency, cost savings and domiciliary care, the relative importance of these goals varies. Current cash-for-care programmes have comparatively modest coverage as compared with direct service provision and provide no more than an optional, supplementary source of care in three of the studied countries. Cash-for-care schemes have not radically transformed the care regimes in Finland, The Netherlands or the United Kingdom. In Ireland, however, the restricted availability of alternative forms of formal service provision means that the expansion of cash-for-care might shift care provision significantly towards private provision and financing.

This study examines the personal meaning and importance of music in the lives of older people, paying particular attention to the ways in which music contributes to self-identity and the quality of life. The data derive from qualitative interviews with a sample of older Australians aged 65 years and over who live in rural and urban settings. The findings reveal that music provides people with ways of understanding and developing their self-identity, of connecting with other people, of maintaining wellbeing and of experiencing and expressing spirituality, and that it provides strong associations with and memories of a person's life. Specifically, the results show how music is used as a source of entertainment as well as a forum to share and interact with others. Music was described as a personal experience to which people assigned meaning and emotions. The informants also described how music allowed them to engage in imaginative play and to escape from some of the hardships experienced in later life. The results reveal that music promotes quality of life by contributing to positive self-esteem, by helping people feel competent and independent, and by lessening feelings of isolation and loneliness. The paper argues that music can be used to maintain and promote a better quality of life for older people.

This paper uses an intersectionality theoretical lens to interrogate selected findings of a scoping review of published and grey literature on the health and health-care access of ethnocultural minority older adults. Our focus was on Canada and countries with similar immigrant populations and health-care systems. Approximately 3,300 source documents were reviewed covering the period 1980–2010: 816 met the eligibility criteria; 183 were Canadian. Summarised findings were presented to groups of older adults and care providers for critical review and discussion. Here we discuss the extent to which the literature accounts for the complexity of categories such as culture and ethnicity, recognises the compounding effects of multiple intersections of inequity that include social determinants of health as well as the specificities of immigration, and places the experience of those inequities within the context of systemic oppression. We found that Canada's two largest immigrant groups – Chinese and South Asians – had the highest representation in Canadian literature but, even for these groups, many topics remain unexplored and the heterogeneity within them is inadequately captured. Some qualitative literature, particularly in the health promotion and cultural competency domains, essentialises culture at the expense of other determinants and barriers, whereas the quantitative literature suffers from oversimplification of variables and their effects often due to the absence of proportionally representative data that captures the complexity of experience in minority groups.

Research shows that contact with nature plays a vital role in our psychological wellbeing. Domestic gardening is common among older adults who spend more leisure hours gardening than any other age group. Despite this, few studies have systematically explored the significance of domestic gardens in relation to older adults' health and wellbeing. This study examined the perceived therapeutic benefits of gardening, and the effect of ageing in relation to older gardeners' continued participation in gardening, using quantitative and qualitative data from a survey of Australian older adult gardeners (N=331). The quantitative data, which included frequencies, were analysed using the PASW Statistics 18.0 package. The qualitative data, which included participants' responses to open questions, were analysed by deriving themes via Leximancer, an innovative text analytics software that uses word association information to elicit concepts, extracting the most important and grouping these according to themes. In relation to the reasons for gardening, several themes were identified including valuing the aesthetics of gardens, connecting with nature, achievement, and physical and mental activity. The benefits of gardening, and the variety of ways that respondents had adapted or modified their gardening activities in order to continue, are also reported. Gardening was more than a casual leisure pursuit for these participants, who saw it as critical to their physical and psychological wellbeing.

This paper examines the impact of childhood and adulthood socio-economic status (SES) on personal network characteristics in later life. Data are derived from 2,285 married older adults (born between 1903 and 1937) who participated in face-to-face interviews for the Dutch survey on ‘Living arrangements and social networks of older adults’ conducted in 1992. Childhood and adulthood SES were indicated by the father's and own level of education and occupation. Multivariate analyses showed that SES in adulthood has more impact on network features in old age than father's SES. People with low lifetime SES or with downward SES mobility had small networks, low instrumental and emotional support from non-kin, but high instrumental support from kin, when compared with the upwardly mobile or those with high lifetime SES. The level of education was a better indicator of network differences than occupational prestige. It is concluded that obtaining a high SES during life pays off in terms of having more supportive non-kin relationships in old age. The small networks and less supportive non-kin relationships of low-status older adults make them more vulnerable to situations in which kin are unavailable or less willing to provide support. This study underscores the distinction between types of support and types of relationships in the SES–network association. Further research on the social pathways of socio-economic inequality in health and wellbeing should take these distinctions into account.

Despite the growing awareness of the significance of helping a relative to relocate to a care home as a key phase in the care-giving career, relatively few British studies have explored this experience in depth. Informed by a constructivist perspective, this study sought a better understanding of nursing home placements from the viewpoint of relatives. Data were collected in 37 semi-structured interviews involving 48 people who had assisted a close relative to move into a nursing home. Analysis revealed three perceived phases to the transition: ‘making the best of it’, ‘making the move’ and ‘making it better’. The relatives' experiences through these phases had five perceived elements, all of which were continua, from absent to very strong, reflecting the extent to which they were felt. They were: operating ‘under pressure’ or not; ‘in the know’ or ‘working in the dark’; ‘working together’ or ‘working alone’; ‘in control of events’ or not, and ‘supported’ or ‘unsupported’ both practically and emotionally. This paper reports findings about the first phase of the transition, ‘making the best of it’, and documents the experiences of decision-making about nursing home placements. It is argued that health and social care practitioners have enormous potential to influence whether or not helping a relative to move into a nursing home is perceived as a positive choice.

Sensory loss (visual and/or hearing loss) is prevalent in older adults. Decreased vision and/or hearing acuity often result in poor communication and psychosocial functioning. This qualitative study explores the communication and psychosocial perceptions of a group of older adults with single or dual sensory loss. The aims were to identify the communication difficulties and conversational strategies used by the subjects, and to explore their perceptions of their social adjustment, quality of life and physical and mental well-being. The participants were all older adults with sensory loss who attended the Vision Australia Foundation. In-depth interviews revealed that the participants experienced frequent communication difficulties. They identified the personal, situational and environmental triggers responsible for communication breakdown, and they described the compensation and avoidance strategies that they used. The participants acknowledged that frequent communication breakdown resulted in decreased socialisation. The problems of adjusting to sensory loss, depression, anxiety, lethargy and social dissatisfaction were cited as factors that affected their physical and mental well-being, while being optimistic, coping with their sensory loss, and maintaining social contact contributed to an improved quality of life. All participants expressed interest in being involved in further communication intervention programmes.

In 2004 in Europe, more than two-thirds of those born during 1945–54 had a parent or parent-in-law alive, and the rates of co-residence with their ascendants ranged from less than four per cent in Sweden, Denmark and The Netherlands, to between 17 and 24 per cent in Italy, Spain and Greece. The proportions that had provided practical help to their parents during the previous 12 months had a north-south gradient, from approximately one-in-three in the northern countries to 15 per cent or less in the southern countries. In contrast, the proportions of the helpers that provided regular and almost daily help had an inverse pattern, being low in Sweden and Denmark and much higher in the south. Some of these differences may be attributable to variations among the countries in the interpretation of ‘help’. Help to elderly parents tends to be most associated with the gender of givers and receivers, the living arrangements, geographical proximity and needs of the parents, and the availability of adult children who can help. There is little evidence of a specific ‘baby-boomer generation’ effect on the probability of giving help.

This article reports research funded as part of the recent ESRC Growing Older initiative. The project ‘Family, Work and Quality of Life’ explored changes in economic and social roles across four birth cohorts passing through mid-life (45–59/64 years) in Britain. The relationship between multiple role responsibilities and a range of indicators of quality of life, including material resources, health and engagement in social activities were investigated. The research was based upon secondary analysis of four different surveys: the 2000 British Household Panel Study, the 1994–95 Family and Working Lives Survey, the 1985, 1990, 1995, and 2000 General Household Surveys, and the longitudinal Retirement Survey (1988/89 and 1994). A particularly interesting finding is that being ‘caught in the middle’, in terms of having simultaneous care-giving responsibilities to dependent children and frail parents whilst in paid work, has been atypical. Only one-in-nine British women, and one-in-ten British men, aged 45–49 years (born in 1941–45) occupy all three roles concurrently, but multiple role occupancy is increasing across cohorts, particularly the combination of caring and paid work. Role occupancy significantly affects the accumulation of pension entitlements (particularly second-tier pensions), with the effect that many women who have fulfilled the important social roles of carer and parent will face a low income in old age. Where adverse health outcomes were found, parental role in mid-life was most frequently associated with such poor health, suggesting that continued parental demands in mid-life may have negative health consequences.

In this paper, relationships between old age, retirement and social inequalities, as marked by participation in leisure activities, are examined. Two issues are tackled: first, whether old age and particularly the transition into retirement have an effect on participation in three selected activities; and second, whether the social inequalities underlying these activities change with older age and retirement. The empirical investigation uses data from the first two waves of the English Longitudinal Study of Ageing (ELSA), which included variables on having a hobby, being a member of a club, and an index of participation in cultural events (cinema, theatre/opera/classical music performances, museums and galleries). The different socio-economic backgrounds of different age groups explain a considerable part of the observed age differences in these activities. Longitudinal analyses show that respondents tended to continue their activities regardless of changes in work and age, with two exceptions, namely that retirement was positively related to having a hobby, and those who stopped working because of an illness experienced a significant decline in all three of the examined categories of activity. The pattern of continuity also applied to socio-economic differences in patterns of participation in leisure activities. Some indications of slightly growing inequalities with age require further investigation.

How older women cope with challenges and losses in later life influences not only their physical health but also their psychological wellbeing and quality of life. The purpose of the analysis reported in this paper was to understand how participation in a women's leisure-based social group – the Red Hat Society® – serves as a coping resource for older women. The Society is an international organisation of women aged 50 or more years and has the mission to ‘celebrate the silliness of life’. The Society currently has an estimated one million members in 30 countries. To understand the ways that social group participation may contribute to older women's health and wellbeing, this paper examines the dynamics of leisure-based coping with positive emotions as the focus. Based on an analysis of responses to an open-ended question about meaningful experiences associated with being involved in the Red Hat Society, the sample of 272 members identified the main reasons for their involvement as chronic and acute stressors, challenging life transitions and daily hassles. In addition, they described four ways that participation helped them to manage these stressors: as a context for social support, emotional regulation, sustaining coping efforts, and meaning-focused coping. The results are discussed in relation to theory and previous evidence on the role of positive emotions and leisure in coping.

Dementia studies are currently dominated by biomedical and psychological models that focus on the individual without regard to their socio-cultural context (Bond 1992, 1999; Lyman 1989; Harding and Palfry 1997; Whitehouse et al. 2000). There is now a growing interest in how socio-cultural factors may mediate the experience of, and response to, dementia (Holstein 1998). The purpose of this review is to examine this growing interest in the socio-cultural context of dementia with reference to earlier developments in disability studies (Oliver 1990; Thomas 1999) and ageing research in general (Estes et al. 1984). The implications of placing dementia in a socio-cultural context for research, policy and practice will be discussed.

Most of the theoretical work on dementia has been devoted to pointing out the inadequacies of biomedical and psychological models in which problems are attributed solely to an individual's neuropathology with a simultaneous neglect of socio-cultural factors (Binney and Swan 1991; Lyman 1989; Harding and Palfry 1998; Kitwood 1998). The study of dementia, it is argued, has been limited by the broader ‘biomedicalisation of ageing’ whereby problems of ageing have been attributed to the ‘tragedy’ of the individual's pathology rather than as a function of an inadequate societal response. Robertson (1991) describes how people so labelled are referred to as ‘victims’ or ‘sufferers’. All difficulties in the person's life are attributed to their underlying disease with a consequent neglect of social and environmental factors that may ameliorate or prevent such ‘symptoms’.

Research indicates that friendship contributes to wellbeing in later life in various ways: through the provision of companionship in daily life, support during stressful transitions, sustainment of identity under changing circumstances and adaptation to old age. However not all older people have friends available who fulfil these different functions. In order to promote wellbeing and reduce loneliness, an educational programme on friendship enrichment for older women has been developed and implemented in the Netherlands. The friendship programme's main goal is empowerment; it helps women clarify their needs in friendship, analyse their current social network, set goals in friendship and develop strategies to achieve goals. Reduction of loneliness, when present, is also an important goal of the programme. A study that followed 40 participants during the year after the programme demonstrates that a majority succeeded in developing new, or improving existing, friendships and in significantly reducing their loneliness. They also reported changes related to the self and social behaviour. Limitations of the research design, reflection on the feasibility of reducing loneliness through a single type of intervention, and possible applications of the programme's design to other areas, are presented in the discussion.