Reflecting on sustained calls for patient-centredness and culture change in long-term care, we evaluated the relative importance of personal and organisational predictors of palliative care, hypothesising the former as weaker predictors than the latter. Health-care employees (N = 184) from four Canadian long-term care homes completed a survey of person-centred care, self-efficacy, employee wellbeing and occupational characteristics. Using backward stepwise regression models, we examined the relative contributions of these variables to person-centred palliative care. Specifically, blocks of variables representing personal, organisational and occupational characteristics; palliative care self-efficacy; and employee wellbeing were simultaneously regressed on variables representing aspects of person-centred care. The change in R2 associated with the removal of each block was examined to determine each block's overall contribution to the model. We found that occupational characteristics (involvement in care planning), employee wellbeing (compassion satisfaction) and self-efficacy were reliably associated with person-centred palliative care (p < 0.05). Facility size was not associated, and facility profit status was less consistently associated. Demographic characteristics (gender, work experience, education level) and some aspects of employee wellbeing (burnout, secondary trauma) were also not reliably associated. Overall, these results raise the possibility that humanistic care is less related to intrinsic characteristics of employees, and more related to workplace factors, or to personal qualities that can be cultivated in the workplace, including meaningful role engagement, compassion and self-efficacy.

This article critically examines the impact of the neoliberal university upon social work education, research and practice relating to older people. The article appraises market-led pedagogical reforms, including of the training of social workers who go on to work with older adults, such as in support of policies including personalisation. Influence is drawn from the work of Nancy Fraser: specifically, her understanding of ‘progressive neoliberalism’, or the improbable fusion of free market ideals with the politics of recognition to create a rejuvenated hegemonic bloc. This theoretical framework is utilised to analyse the prevalence of emancipatory constructs such as empowerment, participation, anti-oppression, equality, choice and independence within the acutely underfunded, bureaucratic and risk-averse fields of social care and social work. While benefiting some older ‘service users’, it is argued that personalisation policy regularly disadvantages or excludes older people within fragmented adult social care sectors. Progressive neoliberalism has helped to promote supplyled training and policies which envisage participative and asset-based self-care whilst more often excluding or objectifying older adults, especially those with higher-level needs.

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.

Whilst ageing in place is integral to international policy, there is less understanding of how individuals utilise formal services and informal supports in diverse rural environments to maintain their wellness and independence. Consequently, how older people negotiate their care within rural communities is subject to misconceptions. This paper draws on the convoy of care model to explore how older rural Australians negotiate their preferences and needs in the context of informal networks, availability of community resources, and the health and aged care system. The analysis draws on 60 in-depth interviews in six diverse rural communities across two Australian states. Three distinct care convoys are identified and demonstrate the interaction of multiple factors including individual preferences and needs, availability of family and community supports, and accessibility of local health and aged care services in the context of resource allocation. The findings highlight how families and communities compensate for a lack of accessible formal services. For older people without family and strong social networks, formal services are relied upon despite their inadequacy in some locales. This research has provided evidence that some Australian rural locales have limited resources resulting in challenges for older people to access home care and support. This results in many older people facing challenges to age in place. With aged care and health policy commonly designed for an urban context, our findings illustrate the importance of tailoring policy to respect the strengths and challenges existing in rural communities.

Across Europe a rising number of migrants are reaching higher ages. As old age is related to care dependency, care-giving within migrant families is becoming more important. To date, little research has focused on health outcomes for migrant care-givers. Theories and empirical evidence suggest differences in the relationship of care-giving and health between migrants and non-migrants due to differences in support, income, norms and values. Furthermore, across Europe the degree of formal care supply and the obligation to provide informal care vary considerably and presumably lead to different health outcomes of care-giving in different countries. Based on data from the Survey of Health, Ageing and Retirement in Europe (Waves 1, 2, 4, 5 and 6) and the English Longitudinal Study of Ageing (Waves 2–6), this paper studies the relationship between informal care-giving inside the household and health for migrant and non-migrant care-givers across Europe and analyses changes in health. In most countries migrant care-givers are in worse self-perceived and mental health compared to non-migrant care-givers. When controlling for important influences no differences in the relationship between health and care-giving for migrants and non-migrants can be found. Moreover, care-giving deteriorates mental health irrespective of origin. The country models showed that for non-migrants care-giving is most detrimental in Southern welfare states whereas for migrants care-giving is also burdening in Nordic welfare states.

This paper explores how people reason about Alzheimer's disease by telling stories about others who have the disease. More specifically, the paper is a cross-linguistic investigation of the narrative and linguistic devices used by African Americans in English, Mexican Americans in Spanish, and refugees/immigrants from the former Soviet Union (to the United States of America) in Russian in their oral productions of such stories. We examine the narratives as instances of case-based reasoning in which lay people (non-medical professionals) distinguish, represent and ‘perform’ symptomatic behaviours and construct a ‘case’ of the disease as a way of probing the difference between the normal and the pathological in conversational contexts. In particular, we examine situations in which stories are accepted and confirmed and situations in which stories are contested and negotiated. Common narrative and discursive devices across the three languages include concatenation, intertextuality, conjunction and conjunctive adverbs, lexical opposition, past progressive tenses, temporal adverbials, reported speech and prosodic cues. The fine-grained analysis of these narrative and discursive devices lays bare the inner-workings of case-based reasoning as a conversational task and suggests specific linguistic tools for intervening in lay narrative reasoning in clinical settings and in public health messaging about Alzheimer's disease.

To gain insights into vulnerable lifecourses and give a voice to those often underrepresented in quantitative research, this study examines the life stories (past, present and future) of 19 financially excluded older adults using an adapted version of McAdams’ life-story interview scheme. Although these life stories demonstrate an accumulation of many disadvantages and an uncertain future because of current financial situations, the stories also reflect the generativity, resilience, coping strategies and agency of financially excluded older adults. We demonstrate how the experienced lifecourse is built around both negative and positive turning points and transitions which go beyond the classical education–work–retirement triumvirate, and how socio-cultural life scripts are used as a framework to build one's own life story in order to achieve continuity. The discussion highlights the potential for deploying the life-story method as a qualitative resource for providing individualised care.

This paper studies the 2004 Spanish fictional novel by Andrés Barba, Ahora tocad música de baile, one of the first cultural texts dealing entirely with Alzheimer's disease to appear in Spain. It argues that the significance of Barba's fictional novel rests on two important issues: the ethics of representation of violence against vulnerable subjects and the ethics of care. The paper analyses how these two issues allow Barba to create a story in which the verbal and physical abuse to which the person living with Alzheimer's disease is subjected places the reader, on the one hand, as voyeur/witness of the abuse; and, on the other, as interpreter, and ultimately judge, of the fine line that separates euthanasia, assisted suicide and murder. The open ending of the novel defers all ethical and moral judgement to the reader. It examines how the novel offers a monolithic perspective about Alzheimer's disease, in which care is presented as a burden. In fact, this study shows that the novel's multi-layered structure and polyphonic nature places the emphasis on stigmas, stereotypes and negative metaphors around Alzheimer's disease, as found in contemporary social discourses.

As we approach 1992, it is likely that elderly people in Britain will increasingly compare themselves with elderly Europeans. In Britain, recent government statements suggest that, for most pensioners, old age is no longer associated with being poor. The purpose of this paper is to compare poverty among elderly people in Britain and other European Community countries. The paper draws upon data from an EC-sponsored study on ‘new poverty’ in the European Community. ‘New poverty’ is not a term commonly used in Britain to describe the changes in poverty that have occurred in the last decade. It is suggested that one of the reasons for this could be because poverty in Britain, more so than in many other EC countries, is still strongly associated with the ‘old poor’. The paper shows that elderly people in the UK are much more dependent on means-tested social assistance (income support) than elderly people in other EC countries.

In the study of ageing, community has increasingly become a topic of interest. Ageing studies are certainly not alone in this, for the same is widely true in the contemporary American social sciences. More and more research, often quite theoretical, suggests that we must raise the sense of community to achieve improvements in the quality of life. In gerontology, over the past decade studies of nursing homes and housing settings have burgeoned. For the most part, however, analyses have focused on the need for community through social integration, while the underlying question, of how community is formed through social interaction, has been neglected. Community, as discussed here, grows out of interaction in a local setting. The interaction is based on a shared or common knowledge of the site's occupants. In essence, community is not so much a site or location per se, but rather the activity of converting a site into a shared collectivity. In this article, the specific mechanisms through which community is formed in a senior, government-supported housing complex are documented. Using data from fieldwork in the neighbourhood, it is argued that, at this site, community is formed through talk about the neighbourhood's commonly recognised troubles. An important component of this ‘troubles talk’ is the celebrity status of two residents. Talk about them is an important component of the elaboration and elucidation of the commonalities that bind the residents together.

A minority of older people who move into long-term institutional care are married and have spouses who continue living in the community. The financial complexities and consequences for a couple in this situation deserve to be more widely recognised. Data from the Family Expenditure Survey on the incomes of older married couples are used to examine the financial implications for couples of one spouse entering residential or nursing home care, taking into account local authority procedures for assessing residents' contributions to charges and Income Support rules as they apply to both spouses. We look in particular at the consequences of alternative ways couples might share their incomes, and alternative treatments of such sharing by local authorities and the Department of Social Security. We demonstrate that wives remaining at home are more likely to have low incomes and have recourse to means-tested state benefits if their husbands enter residential care than husbands who remain at home when their wives enter care. Local authorities are likely to be able to require larger contributions to their care costs from husbands than wives. On average, wives whose husbands enter residential care are best off financially when their combined income and savings are shared equally, but this leaves husbands with the least money to contribute to their care costs. If it is the wife who enters care the situation is reversed.

The focus in the United States on ‘setting limits’ to the provision of such services as health care for old people may be spreading to Europe. This article points up the empirical deficiencies in some of the unexamined assumptions in such proposals, especially the belief that an inordinate share of medical expenditures occur in the final weeks or months of elderly patients. The setting-limits doctrine is viewed as a subset of broader socio-political-ideological thrusts aimed at (or resulting in) anti-elderly, intergenerational-conflict policy proposals. Such proposals should be evaluated in terms of their social constructionist, partially contrived, and historically distorted bases. Apocalyptic gerontology needs to be weighed in terms of its moral implications.

The purpose of this paper is to explore the difficulties elderly taxpayers experience when complying with the tax system operated in the United Kingdom. Some of these problems arise from particular characteristics of the UK system, which are difficult for taxpayers to understand. Results from the survey reported here point to disproportionately high compliance costs experienced by elderly and recently retired taxpayers. The policy implications of these findings are discussed in terms of such matters as the improved distribution of explanatory leaflets and the need for simplification and improved comprehensibility of tax and other bureaucratic literature. Throughout the paper comparisons are drawn particularly between Britain and the USA.

Health authorities worldwide address older adults as a risk group for more serious illness and health complications associated with COVID-19, while social gerontologists have warned that addressing older adults as a risk group of COVID-19 bears the risk of reinforcing ageism. This paper empirically explores to what extent older adults perceive themselves as part of a COVID-19 risk group and how these perceptions influence their everyday lives and experiences of age and ageing. This paper draws upon data from a mixed-methods study on older adults' risk perceptions during COVID-19 in Lower Austria, including a representative survey on 521 adults (60+ years) and data from 20 semi-structured interviews. Approximately two-thirds of the respondents consider themselves at risk of COVID-19 and name age, in addition to pre-existing illness, as a contributing factor in this risk perception. Older adults with health constraints, and especially older men, have a higher probability of perceiving risk due to COVID-19. Additionally, older adults report that they experience being ‘suddenly seen as old’ or ‘being put into a box’ during the pandemic, which influenced their experiences and images of ageing. Our study provides insights into how perceived COVID-19 risk affects the everyday lives of older adults. Age-based categorisations of risk contribute to a shift in images of age and ageing, drawing on insecurity and risk, rather than successful and active ageing, to conceptualise later life.

Considering the important role that paid support workers play in care of older people with dementia, it is vital that researchers and relevant organisations understand the factors that lead to them feeling valued for the work that they do, and the consequences of such valuing (or lack thereof). The current study employed semi-structured interviews to understand the individual experiences of 15 support workers based both in residential care homes and private homes. The General Inductive Approach was used to analyse the interview transcriptions and to develop a conceptual model that describes the conditions that lead to support workers feeling valued for the work that they do. This model consists of organisational or individual strategies, the context in which support work takes place, and various interactions, actions and intervening conditions that facilitate or prevent support workers feeling valued. A significant finding in this research was the role of interpersonal relationships and interactions which underlie all other aspects of the conceptual model developed here. By understanding the importance of how employers, families of older adults with dementia and peers interact with support workers, we may promote not only the quality of work that support workers deliver, but also the wellbeing of the support workers themselves.