Self-perceived health, a subjective assessment of health status, is influenced by state of economic independence and employment status after controlling for other demographic, social and health-related factors, particularly for elderly people as they tend to face discrimination in intra-household resource allocation. Being economically independent and employed increase the likelihood of elderly people rating their health as good/excellent compared to others and employment status came out as even more impactful. This study provides new insights by observing that across the expenditure quintile groups of the households, the importance of these variables varies as the bias in intra-household resource allocation against elderly people is supposed to increase with declining economic resources of the households. Economic independence improves the likelihood of rating one's health as good/excellent in the lowest expenditure quintile much more compared to those in the uppermost expenditure quintile. For employed too, the positive influence of employment status on self-perceived health of elderly people has been strictly increasing as we move down the expenditure quintiles of households.

Old age constitutes a vulnerable stage for developing gambling-related problems. The aims of the study were to identify patterns of gambling habits in elderly participants from the general population, and to assess socio-demographic and clinical variables related to the severity of the gambling behaviours. The sample included N = 361 participants aged in the 50–90 years range. A broad assessment included socio-demographic variables, gambling profile and psychopathological state. The percentage of participants who reported an absence of gambling activities was 35.5 per cent, while 46.0 per cent reported only non-strategic gambling, 2.2 per cent only strategic gambling and 16.3 per cent both non-strategic plus strategic gambling. Gambling form with highest prevalence was lotteries (60.4%), followed by pools (13.9%) and bingo (11.9%). The prevalence of gambling disorder was 1.4 per cent, and 8.0 per cent of participants were at a problematic gambling level. Onset of gambling activities was younger for men, and male participants also reached a higher mean for the bets per gambling-episode and the number of total gambling activities. Risk factors for gambling severity in the sample were not being born in Spain and a higher number of cumulative lifetime life events, and gambling severity was associated with a higher prevalence of tobacco and alcohol abuse and with worse psychopathological state. Results are particularly useful for the development of reliable screening tools and for the design of effective prevention programmes.

This study examined the association between adult children's achievements and ageing parents’ depressive symptoms in China. The research topic was examined within the contexts of one-child and multiple-children families in rural and urban China. Older adults (aged 60–113, N = 8,450; nested within 462 communities/villages) from the 2013 China Longitudinal Ageing Social Survey provided information about themselves and their adult children (N = 22,738). Adult children's achievements were assessed with educational attainment, financial status and occupational status; older parents’ depressive symptoms were assessed with nine items of the Chinese version of the Center for Epidemiological Studies Depression Scale. Multilevel linear regression models were estimated separately for older parents with one child only and multiple children. For older parents with multiple children, both having one or more children with any achievement and the total number of children's achievements were associated with fewer depressive symptoms. For parents with only one child, any achievement of the child and the total number of the child's achievements were associated with fewer depressive symptoms. Our results also indicated that the association between children's achievements and parents’ depressive symptoms varied by rural–urban residence and family type. Our findings contributed to the understanding of family dynamics underlying the emotional wellbeing of older adults in China.

China has faced challenges related to the rapid growth of its ageing population, and sleep is one of the public health challenges to this demographic group. This study examines the socio-demographic and behavioural factors associated with status change of sleeping patterns among Chinese older adults, using longitudinal data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Socio-demographic factors were selected from the 2012 wave of the CLHLS to examine the sleep status change in the 2014 wave. Multivariable logistic and multinomial regressions were used to study older adults’ changes of sleep quality and daily sleep duration. Older adults, 65 years old or above, were selected as study participants. A higher level of education was negatively associated with poor sleep quality and longer sleep duration (>8 hours). Increasing age was positively associated with both shorter and longer sleep duration. Being female was negatively associated with longer sleep duration. However, exercise status, smoking behaviour and alcohol use all were neither positively nor negatively associated with status change of sleeping patterns. Participants’ education, age and gender might be important factors associated with sleep status change. However, the effects of behavioural factors should be studied further. Policy implications and further research directions are discussed based on empirical results.

This paper assesses the feasibility and welfare-improving potential of an insurance market for aged care expenses in Australia. As in many other countries, demographic dynamics coupled with an upward trend in costs of personal care result in consumer co-contributions imposing a risk of expenses that could constitute a significant proportion of lifetime savings, in spite of the presence of a government-run aged care scheme. We explore issues around the development of an insurance market in this particular setting, considering adverse selection, moral hazard, timing of purchase, transaction costs and correlation of risks, as well as such contextual factors as longevity and aged care cost determinants. The analysis indicates aged care insurance is both feasible and welfare-enhancing, thus providing a gainful alternative to the aged care reform proposed by the Productivity Commission in 2011. However, while the insurance market would benefit the ageing Australian population, it is unlikely to emerge spontaneously because of the problem of myopic individual perceptions of long-term goals. Consequently, we recommend regulatory action to trigger the market development.

A continuous rise of female life expectancy above that of males among older adults in India and China may give the impression that the relative gender gap in health in these countries is decreasing. However, given the systemic gender bias against older females in these countries across multiple dimensions of health, a fuller understanding of the gender gap in health calls for a multi-dimensional perspective. We estimate a multi-dimensional old-age threshold (MOAT) that specifies different old-age thresholds for female and male populations which accommodates multiple dimensions related to physical, intellectual and general health. We use the MOAT to evaluate the multi-dimensional gender gap in India and China by differencing the MOAT for females with that of males. Females in both countries have a lower MOAT than their male counterparts, indicating an earlier advent of ‘old age’ for females. The multi-dimensional estimates of the gender gap are also higher than the estimates based on only one dimension of health. A considerable level of variation is also observed in the gender gap across provinces. The study illustrates the need to understand the gender gap in health in India and China from a multi-dimensional perspective and provides an innovative way to quantify such a gap. Province-specific as well as health dimension-specific interventions are vital in reducing the gender gap among older adults in these countries.

The ageing population of Turkey has brought later-life care into question. Family care remains most prevalent, but institutional, paid and professional care are increasing. Literature in Turkey has focused on the medical or social policy aspects but not care-givers’ experiences, nor how the care is performed. This study aims to illuminate care-givers’ experiences using qualitative methods, through in-depth interviews in Ankara with 19 care-givers providing home care for people aged 65 and over. Commonalities and differences were revealed among unpaid family care-givers, paid care-givers and professional care-givers. First, whether paid or unpaid, the bodily and emotional aspects of care work are intertwined. To cope with the ‘negativities’ involved in the work, nurses usually medicalised bodily tasks, unpaid care-givers cited traditional responsibilities and employed infantilisation, while paid care-givers mostly informalised the relationship, infantilised the person cared for and underlined their asexuality. Secondly, care work is gendered; silenced, invisible and ambivalent; related to intimacy with older bodies; and performed in the home space, which blurs the distinction between the private and public field for paid care. Finally, it involves emotional work regarding managing the bodily aspects and navigating the relationships surrounding the older person; and it is labour-intensive with an exploitative character.

Suicide in later life is a pressing public health concern, which has likely been exacerbated by the COVID-19 pandemic. Many older adults who need mental health treatment do not have access to necessary services and training for mental health providers to support older adults experiencing suicidality is limited. One solution is developing interventions based in a public health approach to suicide prevention, whereby natural helpers who provide community services are mobilised to respond to older persons-at-risk. Home-delivered meal (HDM) services, for example, are one effective means to reach older adults who are isolated due to being homebound and may be instrumental in preventing suicide. This study examined the experiences of 20 HDM volunteers who received Applied Suicide Intervention Skills Training (ASIST), an evidence-based suicide intervention programme. Phenomenological analysis yielded findings centred on three areas demonstrating the impact of the ASIST training on HDM volunteers: putting asist skills into practice; response to ASIST skills; and role transformation. Implications for integrating suicide prevention efforts with HDM services and directions for future research are discussed.

Secure, affordable housing is strongly linked to wellbeing in older age. This paper reports on a study of childless and poor older Malaysians who are potentially a vulnerable group in relation to accumulating such housing resources for older age. Childless is defined as a person without biological, step or adopted children, and poverty is defined following the national guideline. The research explores the cumulative advantages and disadvantages over the lifecourse that may influence their routes to attaining, or failing to attain, secure and stable housing in older age. Semi-structured interviews with a purposive sample of 34 childless and poor older Malaysians in Kuala Lumpur, Malaysia, were analysed using a lifecourse perspective to identify the events/experiences that had shaped their housing arrangements in old age. Housing arrangements are hierarchical in structure and can be categorised into four types: home-ownership, public-rental, private-rental and informal housing arrangements. The capacity to afford secure housing (i.e. public rental or ownership) decreased with ill-health and reduced opportunities to work. Structural and policy factors such as eligibility for public housing had also contributed to shaping current housing arrangements. Family poverty, low levels of education and, consequently, reduced employment opportunities affected the ability to accumulate the financial resources needed to afford housing in older age. Some individual decisions and situational disadvantages also contributed to reductions in housing choice. From the social and cultural context, some participants with greater networks had more choices and advantages in the accumulation of housing resources. Initiatives to provide retirement entitlements for workers have not favoured those in low-level informal employment or have come too late to assist those who are now older people. In conclusion, more disadvantages than advantages were accumulated earlier in their life, impacting on their ability to have affordable, secure and stable housing in older age.

Caring for one's grandchildren has become a more common experience for individuals partly as a result of a longer overlap between the lives of grandparents and their grandchildren. Existing research shows that around 50 per cent of grandparents engage in some grandparental child care in most European countries, however, this proportion is higher among older people with a migrant background, partly due to greater economic necessity among migrant families. Research has also highlighted ethnic differences in parents’ child-care selection, even after controlling for their socio-economic status. Building on these strands of work, this paper investigates the differences in the use of (grandparental) child care among parents from different Black and Minority Ethnic (BME) groups in the United Kingdom, using data from Understanding Society. The results show that parents from Other White, Indian, Pakistani, Bangladeshi and African communities are less likely to use child care than White British parents, while the opposite is true for Caribbean parents. However, among parents using child care, individuals from the Other White, Caribbean and African groups are less likely than the White British majority to be using grandparental child care as a supplement to other child-care types, or on its own. Ethnic differentials in the use of child care per se and grandparental child care in particular, have significant policy implications, and may mask other kinds of ethnic differences.

Intergenerational transfers measured in several currencies (e.g. co-residence, contact, proximity and support) have been always considered important indicators for family solidarity. Most of the studies on intergenerational transfers examine the structural characteristics of such exchanges (as distance, frequency, type, motives), emphasising the potential positive association between the structure and the quality of parent–child relationships. Additionally, while most surveys include questions on the structural indicators of family exchanges, it is still uncommon for them to contain assessments of the relationships between parents and their adult children as well. Using the Italian 2009 Family Survey, this study analyses the satisfaction of parent–child relationships for parents aged 65 and older. After examining the association of such a variable with the structural indicators of intergenerational exchanges (frequency of contact), we explored the individual factors associated with satisfaction of relationships with a child using multilevel multinomial models. Overall, older Italian parents report high satisfaction in their relationships with their adult children. Additionally, a not strong, but statistically significant association between structure (contact) and satisfaction was found. This study shows how high satisfaction of relationships with children is positively associated with being a mother and being married and negatively associated with bad health status. Some of the variables considered have different impacts between the sexes of parents. Additionally, a better appreciation of relationships with daughters compared to sons was found, especially for fathers.

It has been argued that lifecourse transitions are transformative moments for individuals when lifestyles, habits and behaviours are potentially open to contemplation and change. Within sustainability research such ‘moments of change’ are regarded as offering potential to encourage less environmentally damaging consumption patterns. Research on consumption indicates that orientations to material goods and their affective significance are complex. Whilst sociological work understands attachment to things as integral to maintaining kinship relations, this is hard to reconcile with long-standing moral concerns about materialism and psychological research which indicates a negative relationship between the acquisition of material objects and wellbeing, and the environmental implications of acquiring and divesting ‘stuff’. Yet there has been little engagement with how older people orient to their material possessions and divestment, the implications of this for later-life wellbeing and for environmental sustainability. In this paper, we draw these different strands of work together to understand how retirees relate to their material possessions and their divestment. Drawing on serial interviews with individuals in the United Kingdom, we explore how the transition to retirement highlights the complexity of participants’ attachment to things. While some items had profound relational significance, others were experienced as troublesome. Decisions on what to divest were shaped by pragmatic considerations and levels of attachment, whilst modes of divestment were aligned with values of thrift.

This study investigates the dynamics of policy reforms pertaining to care for older adults in post-socialist Lithuania. In the Soviet era social services in Lithuania were in a rudimentary stage of development. By the early 1990s a combination of long-term demographic trends such as ageing, a decline in fertility rates and an increase in divorce rates, and the impact of radical neo-liberal reforms significantly increased the number of older individuals living alone and in poverty. In response, a number of measures were undertaken to reform older-age care, resulting in decentralisation, institutional layering and institutional recalibration of social services. It is argued that the historical legacy has proved to be especially significant in the institutional development of social services by reproducing a State-centred system, although with a growing trend towards the privatisation and marketisation of social care. The role of various organised interests and civic groups, policy makers and international organisations, as well as ideologies and broader sets of cultural values in shaping social services pertaining to the care of older adults are discussed.

Loneliness and social isolation among older adults are emerging public health concerns. Older adults from ethnic minority communities or with immigration backgrounds may be particularly vulnerable when encountering loneliness and social isolation due to the double jeopardy of their old age and minority status. The goal of this study is to conduct a scoping review of published journal articles on ethnic minority/immigrant older adults' loneliness and social isolation experiences to show the extent, range and nature of empirical studies in this area across several high-income countries (i.e. European countries, United States of America (USA), Canada, Australia and New Zealand). This review uses Arksey and O'Malley's five-state framework, a well-established scoping review method. We identify and analyse 76 articles published between 1983 and 2021. This evidence base is largely US-focused (54%) with the vast majority (76%) having a quantitative design. We summarise and map factors of loneliness and social isolation into a multi-dimensional socio-ecological model. By doing so, we show how ethnicity/immigration-specific factors and general factors intersect in multiple dimensions across places and time, shaping ethnic minority/immigrant older adults' heterogeneous experiences of loneliness and social isolation. Several critical gaps that should be at the forefront of future research are highlighted and discussed.

Analysis of intergenerational contact and solidarity patterns has generally focused on the family. However, the unprecedented co-existence of a high number of different generations raises the challenge to delve into how such patterns may develop inside and outside the family. To understand better intrafamilial and extrafamilial intergenerational contact and solidarity in Spain, three national surveys were initially studied using cross-tabulation tables and measures of association. Then, factor analysis and logistic regression of most recent data focused on explanatory variables behind two dimensions of intergenerational solidarity. Regarding intergenerational co-residence, the results point to a highly relevant difference between intrafamilial and extrafamilial habits. As regards regular, but non-residential, contact between the generations, two gaps have been identified. The first gap appears between family practices and non-family practices, with a significant and progressive reduction of the latter being detected. According to the second gap, while intergenerational contact drops outside the family, levels of intragenerational contact are comparable in both settings. In this context, patterns of associational and functional intergenerational solidarity towards older relatives and non-relatives have been identified, with age, distance, civil status and especially gender being the key explanatory variables. The paper argues that there is good reason to pay combined attention to both intrafamilial and extrafamilial forms of intergenerational contact and solidarity, something that has been done very little to date.

Late-life divorce is increasingly common in many Western countries, however, studies on this transition remain scarce. The purpose of this article is to study attributed reasons for late-life divorce, and if any life phase-typical aspects can be identified in these attributions. Qualitative interviews were carried out with Swedish men and women aged 62–82, who after the age of 60 had divorced from a cross-gender marital or non-marital co-habiting union (N = 37). The results, analysed using principles from Grounded Theory, revealed four different types of narratives: (a) incompatible goals for the third age, (b) personality change caused by age-related disease, (c) a last chance for romance, and (d) enough of inequality and abuse. A central insight and an original contribution generated by the study was the importance grey divorcees attributed to the existential conditions of later life in their divorce decisions. The results are discussed in relation to theories of late modern intimacy and the third age.

Daniel Callahan has maintained that a common understanding of the meaning of old age and the proper role of old people in society is a prerequisite for decisions on the distribution of health-care resources to the elderly. The call for such a common understanding is traced to the writings of Thomas Cole and Harry Moody. A discussion of their ideas is followed by a philosophical analysis of communitarian accounts of meaning and the good life in general. It is concluded that viable interpretations of the meaning of old age should comply with the values of liberal individualism. Meaning should be localised less at the level of global ideas and images and more at the level of local and heterogeneous practices. The practice of distributing health-care resources cannot and should not be regulated by communitarian interpretations of the value of old age. It would seem to be sufficiently infused by liberal individualist interpretations of meaning and justice.

The post-war history of hospital care for older people in Britain in the first phase of its National Health Service (NHS) emphasises a detrimental Poor Law legacy. This article presents a regional study, based on the South West of England, of the processes by which Victorian workhouses became the basis of geriatric hospital provision under the NHS. Its premise is that legislative and medical developments provided opportunities for local actors to discard the ‘legacy’, and their limited success in doing so requires explanation. Theoretical perspectives from the literature are introduced including political economy approaches; historical sociology of the medical profession; and path dependence. Analysis of resource allocation decisions shows a persistent tendency to disadvantage these institutions by comparison with acute care hospitals and services for mothers and children, although new ideas about geriatric medicine had some impact locally. Quantitative and qualitative data are used to examine policies towards organisation, staffing and infrastructural improvements, suggesting early momentum was not maintained. Explanations lie partly with national financial constraints and partly with the regional administrative arrangements following the NHS settlement which perpetuated existing divisions between agencies.

Scholars and policy makers have expressed concern that social and economic changes occurring throughout Asia are threatening the wellbeing of older adults by undercutting their systems of family support. Using a sample of 1,654 men and women aged 45 and above from the Chitwan Valley Family Study in Nepal, we evaluated the relationship between individuals' non-family experiences, such as education, travel and non-family living, and their likelihood of receiving personal care in older adulthood. Overall, we found that among individuals in poor health, those who had received more education, travelled to the capital city, or lived away from their families were less likely to have received personal care in the previous two weeks than adults who had not had these experiences. Our findings provide evidence that although familial connections remain strong in Nepal, experiences in new non-family social contexts are tied to lower levels of care receipt.

The objective of the study was to discover what fairly independent residents living in long-term residential care think about home care as an alternative. A stratified systematic sample was drawn from a one-day census of patients in all residential homes in Finland on 2 December, 1991. A postal survey was used for data collection in December, 1992. Respondents who preferred home care were compared with respondents preferring residential care according to length of stay, health, functional ability and health-related quality of life. Most respondents preferred institutional care. Preference for home care was explained most strongly by emotional factors, unwillingness for residential care at admission, and still having a home to return to. Shorter length of stay also predicted preference for home care. Those who preferred home care admitted they would need much formal care after discharge. People living in residential homes are rarely ready for discharge home, because of limitations in their physical ability or of their unwillingness to change their site of care.