This article examines how older adults experience the physical and social realities of having multiple chronic conditions in later life. Drawing on data from in-depth interviews with 16 men and 19 women aged 73+ who had between three and 14 chronic conditions, we address the following research questions: (a) What is it like to have multiple chronic conditions in later life? (b) How do older men and women ‘learn to live’ with the physical and social realities of multiple morbidities? (c) How are older adults’ experiences of illness influenced by age and gender norms? Our participants experienced their physical symptoms and the concomitant limitations to their activities to be a source of personal disruption. However, they normalised their illnesses and made social comparisons in order to achieve a sense of biographical flow in distinctly gendered ways. Forthright in their frustration over their loss of autonomy and physicality but resigned and stoic, the men's stories reflected masculine norms of control, invulnerability, physical prowess, self-reliance and toughness. The women were dismayed by their bodies’ altered appearances and concerned about how their illnesses might affect their significant others, thereby responding to feminine norms of selflessness, sensitivity to others and nurturance. We discuss the findings in relation to the competing concepts of biographical disruption and biographical flow, as well as successful ageing discourses.

This critique of the term ‘carer’ argues that, although developed as a result of well-intentioned and socially-engaged research, it fails the people with whom it is most concerned, that is ‘carers’ and those who are cared for. The paper considers the historical and political development of the term ‘carer’ before examining research in various ‘carer’-related settings in the United Kingdom, namely mental health, physical and intellectual impairment, cancer and palliative care and older adulthood and dementia. The article concludes that the term ‘carer’ is ineffective and that its continued use should be reconsidered. This conclusion is based on the consistent failure of the term ‘carer’ as a recognisable and valid description of the relationship between ‘carers’ and those for whom they care. Furthermore, use of the term may imply burden and therefore devalue the individual who is cared for and in this way polarises two individuals who would otherwise work together. Consequently, this commentary suggests that descriptions of the caring relationship that focus on the relationship from which it arose would be both more acceptable and useful to those it concerns. Furthermore, a more accessible term may increase uptake of support services currently aimed at ‘carers’, therefore inadvertently meeting the original aims of the term, that is, to increase support for ‘carers’.

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.

The globalisation of international migration has increased the ethnic diversity of most ageing populations across the Western world. This has implications for gerontological research, policy and practice, and puts our understandings of ethnicity to the test. This paper presents the different perspectives that inform ethnicity scholarship (the essentialist/primordial perspective, the structuralist/circumstantialist perspective and social constructionism) and suggests that the way in which we regard ethnicity has implications for how gerontological research is designed, how policies for old age are formulated and how gerontological practice is shaped. Through a review of contemporary gerontological research on ethnicity published in some of gerontology's main journals, the paper discusses some of the trends observed and concludes that most research seems to be informed by essentialism and structuralism. This suggests that the gerontological imagination on ethnicity has yet to be informed by the latest developments in ethnicity scholarship. The paper therefore urges gerontologists to broaden their understanding of ethnicity and suggests that much could be gained if we were to let the social constructionist perspective on ethnicity and the notion of intersectionality be sources of inspiration for the gerontological imagination on ethnicity.

Cognitive impairment manifests in changed out-of-home mobility. Until recently, the assessment of outdoor mobility relied on the reports of family care-givers and institutional staff and used observational approaches, activity monitoring or behavioural checklists. This article presents data for 41 mildly demented, mildly cognitively impaired and healthy men and women aged 64–90 years in Tel-Aviv (Israel) who took part in an interdisciplinary project, SenTra, that is studying the outdoor activities of elderly people using advanced tracking technologies and that involves researchers from geography, social work, gerontology, psychology and medicine. The participants were tracked for 28 consecutive days using a location kit that combined a global positioning system (GPS) with radio frequency identification. The high-resolution spatial and temporal data enabled detailed analysis of the differences in the timing and distance of the participants' daily outdoor mobility patterns. It was found that the spatial range of the mobility of elderly people with cognitive impairment is severely restricted, with most out-of-home time spent in close proximity to their residences. We conclude that GPS is an advanced research tool able to understand out-of-home behaviour better than was possible with previous methods.

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.

Personal relationships are an integral part of living, working and visiting in care homes, but little research has made relationships the main focus of enquiry, and there have been few studies of the perspectives of residents, staff and family members. The study reported here sought to redress this neglect. Using a constructivist approach, the nature and types of relationships between residents, staff and family members were explored in three care homes in England using combined methods including participant observation, interviews and focus groups. The data collection and analysis occurred iteratively over 21 months and three types of relationships were identified: ‘pragmatic relationships’ that primarily focus on the instrumental aspects of care; ‘personal and responsive relationships’ that engage more fully with the particular needs of individual residents; and ‘reciprocal relationships’ that recognise the roles of residents, staff and family members in creating a sense of community within the home. This paper explores the contributions made by staff, residents and family members in the development of these relationships. The findings enhance our understanding of the role of inter-personal relationships in care home settings and of the factors that condition them. The implications for developing improved practice in care homes are also considered.

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.

Migrant care workers make a substantial contribution to older adult care in Ireland and the United Kingdom (UK). However, little is known about the relational aspects of care involving migrant care workers and older people. Given that the care relationship is closely linked to quality of care, and that the Irish and UK sectors are increasingly restricted by economic austerity measures, this lack of information is a concern for care practice and policy. Our paper explores the relationship between migrant care workers and older people in Ireland and the UK and draws on data collected in both countries, including focus groups with older people (N = 41), interviews with migrant care workers (N = 90) and data from a survey of and interviews with employers. The findings illustrate the complexity of the migrant care worker–older person relationship; the prevalence of need orientated, friendship and familial-like, reciprocal, and discriminatory interlinking themes; and the role of individual, structural and temporal factors in shaping these relationships.

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’.

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.

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.

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 study has systematically examined the use of health and social services among non-institutionalized elderly people according to the Andersen model which groups factors influencing use into predisposing, enabling and need variables. Need for service as evidenced by physical and psychological functioning was the most important predictor of use of physician services and hospitalization. Predisposing factors had the most effect on use of dental services. On the other hand, knowledge of services, an enabling factor, was most relevant to use of social services. Since this factor is manipulable to planned change, several program strategies were suggested for increasing awareness of social services particularly among the impaired elderly.

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.

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.

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.

Several recent studies have documented a negative relationship between informal care-giving and labour market attachment in Great Britain. This paper examines the relationship from a longitudinal perspective using data from the Great Britain 1994–95 Family and Working Lives Survey. The first part of the paper studies the timing of informal care-giving to a sick, disabled or elderly person. This information is used in the second part to examine the effects of caring on employment. The results show that most carers look after only one dependant during their lives, and only around one-fifth to one-third look after a second dependant before the age of 65 years. Of all informal carers, about one-third had not been employed when they started caring for the first time in their lives, another third said that caring had no effect on their work arrangements, and about one-third reported one or several effects on their work arrangements, most commonly that they stopped working. Multivariate analyses show that semi-routine and routine manual workers report the strongest effects of care-giving. Part-time workers were more likely than full-time workers to reduce their hours of paid employment when they started caring.

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.

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.