The extension of user involvement in different aspects of service delivery in health and social care has been a central element of care in the community policy. Purchasers and providers of such services for older people have been exploring ways of tailoring services to meet individual need and ensure that the quality of the service reflects user preference rather than service-provider requirements. This article describes a project involving residents from a random proportionate sample of nursing homes and residential homes for older people in the City of Manchester. The project was designed to bring user views about quality into the service contract specification for the purchase of residential and nursing home care. The process and the outcomes are described. Factors which appear to promote the movement of user involvement into the mainstream of service specification and service development are identified. The role of small-scale initiatives is discussed.

As people grow older in late life, their need for help with the activities of daily living increases. In Spain, those who need such help constitute about 20 per cent of the population aged 65 or more years. Support may be from formal care, informal care or both, and the type has different consequences for care receivers and their social networks. The aim of this paper is to examine the relationship between informal and formal care and the use of health services among older people in Spain. Using a sample of 1,148 respondents aged 65 or more years from the Spanish National Health Survey of 2003, we analysed the association between the sources of care (formal, informal, both, or no care) and the frequency of three types of health-care utilisation: hospitalisation, emergency services and medical consultations. After controlling for sex, age, level of difficulty in the activities of daily living, self-perceived health status, and social class, it was found that older people with disabilities who received neither informal nor formal care were more likely to consult physicians than those who received informal care, but that there were no significant relationships between the type of care and health-services utilisation. The findings provide new information about the consequences of the different types of care of older people with disabilities, and suggest specifically that informal care substitutes for some tasks usually done by health professionals.

A grounded theory approach, consistent with the work of Strauss and Corbin, was used to undertake semi-structured interviews with 17 older people, to explore their experiences of living in a care home, during the four- to six-week period following the move. Purposive sampling was initially adopted, thereafter, theoretical sampling was employed to recruit individuals identified by care managers within older peoples’ community teams and care home managers within a large Health and Social Care Trust in the United Kingdom. Consistent with grounded theory methodology, data collection and analysis occurred simultaneously. Constant comparative analysis underpinned data analysis and data management techniques. Data analysis revealed five distinct categories that captured these experiences. These were: (a) wanting to connect – ‘I am so lost here’, (b) wanting to adapt – ‘Well mentally you have to make the best of it’, (c) waiting for assistance – ‘it's a frustration for me’, (d) ‘waiting on the end’ – I am making no plans’ and (e) wanting to re-establish links with family and home – ‘I love getting home and I like getting out to the town’. Together these five categories formed the basis of the core category, ‘Waiting and Wanting’, which encapsulates the initial adaptation experiences of the men and women in the study. Findings indicate that individuals were dependent on others to create a sense of belonging, independence and wellbeing. Moreover, risk aversive practices were perceived as a threat to individuals’ independence and autonomy. Recommendations include the need to amend policy and practice for the development of a bespoke induction programme for each resident facilitated by a senior member of the care home staff working in partnership with individuals and families, in addition to the health and social care team, to support a more positive transition for new residents, relatives and care home staff.

This article provides information on the movements into and out of paid work by mid-life women. This is a group whose representation in the paid workforce is growing as population ageing proceeds and as educational qualifications expand. It is also a group that will be critical to any labour supply response to the economic challenges posed by population ageing. However, current understandings of the needs and circumstances of mid-life women in paid work are limited. To help address this knowledge gap we use data from the first five waves of the Household, Income and Labour Dynamics in Australia survey (2001–2005) to identify the causal influences of health, care and other factors on the ability of mid-life women to remain in and re-enter paid work. The results show that poor health and/or substantial care roles have a negative impact on the employment chances of this group. However, importantly, there is asymmetry in these health and care effects, in that improvements in health and/or reductions in care roles do not increase the chances of returning to paid work. This finding indicates that many mid-life women who experience poor health and/or undertake large care roles face substantial long-term negative consequences for their employment chances and, thus, their retirement and pre-retirement incomes.

The aim of the study reported here was to investigate the relationship between health and household composition among older people. The 1 per cent and 2 per cent SARs (Samples of Anonymised Records) drawn from 1991 British Census data were used to examine the frequency of a limiting long-term illness among older people according to different types of living arrangements. These data include the population in institutions and our results show that previous studies based only on the private household population have underestimated the prevalence of illness among older people. Long-term illness rates vary across family and household types, with higher frequencies found for those individuals not living in families (either alone or with others) or in lone parent families, compared with those living as part of a couple. Importantly, our results show a previously unreported clustering of long-term illness in households. Those over 45 suffering from a limiting long-term illness were more likely than those without such an illness, to live in households including others with long-term illness. These results indicate that health should be considered from a household, rather than just an individual, perspective. Our findings support those who have argued that families including an older ill member need more help from formal services. However, it is unlikely that this can be achieved solely by redeploying services from those living alone as long-term illness rates were also high in this group.

Techniques of possession research among older people tend to accentuate their prizing of things and their use of special dispositions to achieve the protection or ‘safe passage’ of things as they transfer to a new owner. Such efforts on behalf of possessions may also be undertaken to perpetuate the self. To study the care of things and self in a wider context, we examined older people's repertoire of disposition strategies during episodes of household relocation and downsizing. We analysed the narratives of persons in 75 households in the Midwestern United States of America. People indeed told stories about the safe passage of cherished possessions – their initiative to place things, appreciation by new owners, and attempts to project the values or memory of the giver. Such accounts of special placements, however, dotted rather than dominated recollections of the move. More commonly, large quantities of items were passed via non-specific offers of possessions to others who may volunteer to take them. This allowed people to nonetheless express satisfaction that their possessions had found appreciative owners. Even though our interviews did not disclose extensive attempts at self-transmission, whole-house downsizing may affirm the self in another way: as conscientious about the care of things. Such affirmation of the present self as accomplished and responsible can be seen as a positive adaptation to the narrowing life world.

Much contemporary theory suggests that, unlike works of biography or autobiography, human life itself is fundamentally comprised of disconnected moments and is thus devoid of literary form. People may seek to bind these moments together as narratives in the course of their efforts at self-understanding; but these narratives, it is often held, are little more than fictions or myths, impositions of form and order upon the flux of experience. In Tolstoy's Death of Ivan Ilych, we find a powerful refutation of this view. For what we see in Tolstoy's story are the grave consequences of a life lived moment to moment, without any sense of the whole. Only in the face of death could Ivan Ilych gain the requisite distance to behold the true meaning of his dismal life and only upon beholding this meaning could he see the contours of the life well-lived, that is, the life possessed of narrative integrity. By exploring the relationship between death, narrative integrity, and the radical challenge of self-understanding via the story of Ivan Ilych, the present essay seeks ultimately to identify ways in which the study of ageing might contribute to our identifying the good and virtuous life.

Walking is an essential component of outdoor mobility, and recognised as one of the best forms of physical activity for older adults. The purpose of this study is to examine the relationships between socio-demographic factors, coping resources, self-esteem and health status with the outdoor walking ability of people aged 55–79 years living in the community. The hypothesis is that there is a positive association between outdoor walking ability and coping, self-esteem and health status. A nationally-representative sample of 3,069 women and men answered questions regarding socio-demographic attributes, coping resources, self-esteem, health status and outdoor walking ability. The mean age of the respondents was 65.6 years. Around one-half of the sample were women, and around one-half were aged 65 or more years. One-third (32.3%) of the sample were married or cohabiting. Regarding outdoor walking ability, only 0.7 per cent of the respondents were not able to walk at all, and 80.8 per cent could walk at least one kilometre without a pause. Binary logistic multivariate regression analyses showed that those who had good outdoor walking ability (one kilometre or more) were significantly younger than those who did not, and that they were predominantly men, partnered or married, not in paid work, experienced significantly little pain, had better self-reported health and higher perceived coping.

This paper draws attention to the need for further understanding of the fine details of routine and taken-for-granted daily activities and mobility. It argues that such understanding is critical if technologies designed to mitigate the negative impacts of falls and fear-of-falling are to provide unobtrusive support for independent living. The reported research was part of a large, multidisciplinary, multi-site research programme into responses to population ageing in Ireland, Technologies for Independent Living (TRIL). A small, exploratory, qualitative life-space diary study was conducted. Working with eight community-dwelling older adults with different experiences of falls or of fear-of-falls, data were collected through weekly life-space diaries, daily-activity logs, two-dimensional house plans and a pedometer. For some participants, self-recording of their daily activities and movements revealed routine, potentially risky behaviour about which they had been unaware, which may have implications for falls-prevention advice. The findings are presented and discussed around four key themes: ‘being pragmatic’, ‘not just a faller’, ‘heightened awareness and blind spots’ and ‘working with technology’. The findings suggest a need to think creatively about how technological and other solutions best fit with people's everyday challenges and needs and of critical importance, that their installation does not reduce an older adult to ‘just a faller’ or a person with a fear-of-falls.

Centres for seniors offering leisure-time activities currently represent significant actors that translate the idea of active ageing into a particular approach to seniors. Despite the fact that active ageing is now represented by the state and providers of social services as the universally desirable way of ageing, the significantly smaller numbers of male clients was identified as a marked feature of such organisations. A three-year ethnographic study was conducted at two centres in the Czech Republic which offer seniors-only leisure-time activities strongly grounded in the idea of active ageing. The method of participant observation was used, and 47 in-depth interviews were conducted with the centres' clients and employees. The higher participation by women in the centres and the role they attribute to such organisations in their lives is analysed in the context of their previous gendered biographies. Gender patterns embedded in the way daily activities at the senior centres are organised, as well as in the idea of active ageing itself, are highlighted. Despite the seeming invisibility of gender as a principle that structures the way these centres are run, they are in fact gendered organisations, where gender emerges as a basic principle affecting the chances of participating in active ageing as presented by the centres.

The lifestyle of the baby boomers as retirees has been assumed to differ from older cohorts due to them being financially more stable and having grown up during the welfare state expansion. Many baby boomers live in large houses with gardens that require maintenance and labour. Recent studies have indicated that a growing share of those born in the 1940s in Sweden express a wish to change residence at retirement or in old age. A need to verify such results statistically was identified to confirm whether there has been an increase in residential mobility among older people. As a result, moves that took place during 2001–06 of the total cohort born in the 1940s were compared to similar moves by those born in the 1930s, ten years earlier during 1991–96, i.e. those aged 57–66 in 1996 and 2006. The study used a register database, Geoswede, containing the entire Swedish population. The study showed increased residential mobility rates among the 1940s cohort compared to the cohort born in the 1930s. However, explanations for the differences between the cohorts were not evident.

China has seen a rapid decline of the traditional multi-generational household and an increase in rural-to-urban migration, raising concerns about a possible breakdown of the informal support system. Against this background, the paper looks at family care-giving (or the absence thereof) to parents in three different living arrangements: with any child or child-in-law (co-resident); independent with at least one child living in the same community (networked); and without any children in either the household or the community (isolated). It also compares the care-giving arrangements of single elders to those living with a spouse. The sample, which is derived from the comprehensive China Health and Retirement Longitudinal Study (CHARLS), contains data on 887 functionally impaired individuals aged 60 and above. The findings suggest that married parents are mostly cared for by their spouse, even if they co-reside with adult children. Proximity to children is particularly important for single elders, who are more likely to lack a care-giver when living independently. There appears to be a hierarchy in family care responsibilities, where children step in as care-givers only when the spouse is no longer able to fulfil this role. While these findings imply a significant deviation from traditional practices and norms of ‘filial piety’, they can be interpreted as a rational adaptation to the changed economic circumstances in rural China.

In many parts of the world, grandparents live with their grandchildren in ‘skipped-generation households’ in which no parent resides. In Thailand, this living arrangement is more common in rural areas where parents often migrate to find employment. The focus of this article is on how grandparents make the decision to live in skipped-generation households. Our study is based upon open-ended interviews with 48 grandparents who lived in three rural areas of Thailand. Using an interpretative phenomenological approach, the analysis uncovers several factors that contribute to grandparents’ decisions about their living arrangements. These factors include: norms about care-giving and family obligation, inadequate child-care options, the need for financial support, problematic relationships within the family and a desire for companionship. We also identify three different decision-making patterns: grandparents initiating the decision to provide grandchild care, adult children asking grandparents to assume this role and adult children abandoning grandchildren to the grandparents. Based upon these findings, we provide implications for practice that address the conditions of grandparents and their family members.

Having a fall and then lying on the floor for an hour or more is known as a ‘long lie’, which is associated with serious injury and an elevated risk of admission to hospital, long-term care and death. Personal call alarms are designed to prevent long lies, although little is known about their use. Using cross-sectional data from the English Longitudinal Study on Ageing, this study investigated the proportion of self-reported users of personal call alarms among 3,091 community-dwelling adults aged 65+ who reported difficulties of mobility or activities of daily living. The characteristics of users were then explored through logistic regressions comparing those living alone with those living with others. One hundred and eighty people self-reported using a personal call alarm (6%). Multivariate regression found the following to significantly predict personal call alarm use among both those living alone and with others: greater difficulty with activities/instrumental activities of daily living, older age, and for those living with others only: lower score on the quality of life subscale for control. Personal call alarm use may be markedly lower than the 30 per cent annual incidence of falls among community-dwelling older people. Better understanding is needed of the reasons for low usage, even amongst those at highest falls risk for whom such alarms are most likely to be beneficial.

The extent of social isolation experienced by people living with dementia who reside in the community has been well acknowledged, yet little is known about how people living alone with dementia maintain neighbourhood-based connections. The purpose of this study is to examine the experiences of people with dementia who live alone, focusing upon how they establish social networks and relationships in a neighbourhood context, and how they are supported to maintain this social context within everyday life. Multiple data collection methods were used including, semi-structured interviews, walking interviews, guided home tours and social network mapping, which were conducted with 14 community-dwelling people living alone with dementia (11 women and three men) situated across the three international study sites in England, Scotland and Sweden. Data were analysed using thematic analysis. The analysis revealed four main themes: (a) making the effort to stay connected; (b) befriending by organisations and facilitated friendships; (c) the quiet neighbourhood atmosphere; and (d) changing social connections. The analysis suggests that people with dementia who live alone were active agents who took control to find and maintain relationships and social networks in the neighbourhood. Our findings indicate the need to raise awareness about this specific group in both policy and practice, and to find creative ways to help people connect through everyday activities and by spontaneous encounters in the neighbourhood.

South Korea's old-age poverty rate is among the highest in the developed world. Confronted with the increasing demand for a social safety net for older people, the South Korean government introduced the Basic Old-Age Pension (BOAP) in 2008. The BOAP is a non-contributory, means-tested pension covering 70 per cent of the elderly population, with monthly benefits amounting to 84 kW (thousand Korean won, approximately equivalent to US $1) for singles and 139 kW for couples. Little empirical research has been conducted, however, to evaluate the effectiveness of the new pension programme in supporting the financial wellbeing of older people. Using data from the 2008–2010 Korea Welfare Panel Study, a panel data analysis is conducted to estimate the effects of the BOAP on three sets of financial wellbeing measures: financial difficulty, monthly consumption and overall financial satisfaction. The results suggest that the BOAP has beneficial effects on the financial wellbeing of older people by improving affordability of basic subsistence items such as heating and nutritious meals, particularly among the older-old group. However, the effects are limited to these few outcomes only; overall financial wellbeing and other important indicators remain unchanged.

It is well known that negative ageing perceptions have various detrimental effects on indicators of successful ageing, but less is known about the role of social support networks and loneliness in ageing perceptions. The objective of this study was therefore to assess the association of social networks, relationship quality and loneliness with negative ageing perceptions in late life. Cross-sectional data on 6,912 adults aged ⩾50 years from the first wave of the Irish Longitudinal Study on Ageing (TILDA) were analysed. Ageing perceptions were assessed with the Brief Ageing Perceptions Questionnaire. Information on social support networks, loneliness and socio-demographics were obtained using standard questions. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression scale. Multivariable linear regression was conducted to assess the associations. Social isolation, poor relationship quality (with spouse, children, other family members or friends) and loneliness were all significantly associated with negative ageing perceptions even after adjustment for all potential confounders including depressive symptoms. Our study indicates that targeting integration into social support networks and improving relationship quality may potentially reduce the extent to which older individuals adopt negative ageing perceptions. Future studies with prospective design are warranted to understand the temporal direction and causal association of social support networks and loneliness with negative ageing perceptions.

The assumption that social and economic transitions in a country pose a threat to the provision of support to older people is questioned in this study. The study investigates the availability and sources of such material, practical and emotional support in urban and rural areas of Bangladesh. The support provided by older people towards household functioning is also explored. It was found from an interview survey of 701 individuals aged 60 years and older that the propensity to receive support was greater among rural older people than their urban counterparts. Gender differences were also observed, in that men were mainly providers of material support, and women of practical and emotional support. Among married older people, spouses were reported as important sources of emotional support for both elderly men and women, and some regional differences were observed. The data show mutuality in the provision of support between older people and their family members. It is evident that support to elderly people from their families is strong in Bangladesh, and that the socio-cultural dynamics of the society influence its provision.

In the United States of America (USA), older adults in rural areas are at increased risk for adverse outcomes of disasters, partly due to medical needs, limited or long geographic distances from community resources, and less knowledge and motivation about preparedness steps. Older residents and ageing service providers in a rural community in the USA were interviewed regarding their perceptions about disasters and preparedness, and their reactions to the preparedness training programme using the concepts of the Extended Parallel Process Model. Participants generally indicated low motivation to engage in preparedness behaviours despite perceptions of personal risk and beliefs that preparedness behaviours were easy and could improve disaster outcomes. A theme of social relationships emerged from the data, with participants identifying social relationships as resources, barriers and motivators. People surrounding older adults can support or deter their preparedness behaviours, and sometimes elicit a desire to protect the wellbeing of others. Findings suggest two potential strategies to facilitate preparedness behaviours by moving beyond personal benefits: highlighting older adults' increased ability to protect the wellbeing of younger generations and their community by being prepared themselves, and engaging family, friends and neighbours in preparedness programmes to enhance the resilience of their social groups. Older adults in many cultures have a desire to contribute to their society. Novel and effective approaches to increase preparedness could target their social groups.

Mealtimes in residential care homes are fundamentally social occasions, providing temporal structure to the day and opportunities for conversation and companionship. Food and drink are imbued with social meanings and used to express and create relationships between people. There is a dearth of research exploring care home residents' mealtime experiences in the United Kingdom. This paper reports on particular findings from a qualitative study which investigated factors influencing nutritional care provided to residents in two different types of residential care settings in South Wales, UK. Data were generated through focus group interviews with relevant staff members (N = 15), individual interviews with managers (N = 4) and residents (N = 16) of the care homes and their informal carers (N = 10), observation of food preparation and mealtimes throughout the day, and analysis of appropriate documents. Data were analysed using thematic analysis. This paper's focus is on the ways in which care home residents' experiences and understandings of mealtimes were influenced by various environmental factors, such as the home's geographical location, physical lay-out and ambience. Moreover, the shared meaning of mealtimes for residents, informal carers and staff was constructed from each group's socio-cultural background, family experiences and memories, and was integral to residents' sense of normality, community and identity.