This paper reports the evaluation of the effectiveness of incentives (viz. points and prizes) and of peer-group organisers (‘older people's champions') in the outcomes of a health-improvement programme for people aged 50+ years in a multi-ethnic district of the West Midlands, England. Health promotion activities were provided, and adherence, outcome variables and barriers to adherence were assessed over six months, using a ‘passport’ format. Those aged in the fifties and of Asian origin were under represented, but people of Afro-Caribbean origin were well represented and proportionately most likely to stay in the project. Those of greater age and with more illness were most likely to drop out. There were significant improvements in exercise, diet and the uptake of influenza vaccines and eyesight tests, but slighter improvements in wellbeing. Positive outcomes related to the incentives and to liking the format. The number of reported barriers was associated with lower involvement and lack of change, as was finding activities too difficult, the level of understanding, and transport and mobility problems, but when these were controlled, age did not predict involvement. Enjoying the scheme was related to positive changes, and this was associated with support from the older people's champions.

Personalisation of social care for adults is a key policy objective in the United Kingdom (UK), as in many other welfare states, having gained wide acceptance as essential for the empowerment of service users and as a means of managing increasing population demand. The system of personal budgets being established in the UK pursues twin objectives: aiming to ‘empower’ individuals to achieve ‘more for less’. However, there is mixed evidence that either objective is being achieved in practice. This is especially so in respect of older people who are less likely to accept a personal budget and more likely to be dissatisfied with their experience of using one. A qualitative study of eight cases in two local authority areas in England explored older people's experience of using a personal budget taken in the form of a direct payment. Data were elicited through a series of three in-depth interviews with each participant. The study was concerned with understanding the relationship between participants' experience of ‘Self’ and personalised services. Participants experienced personalisation when paid carers perceived and accommodated their ‘special requirements of Self’. In most cases this was achieved despite the consumerist aspects of personalisation rather than because of them, and often gave rise to risk and dilemma. The findings emphasise the importance of holistic assessment, and commissioning for quality over maximising choice.

The financial and social climate in which the residential-care sector operates in the United Kingdom has changed substantially over recent years. This paper examines the underlying motivations for providing residential-care services for older people. We focus on the motivations of a sample of managers and owners of care homes drawn from eight English local authorities, and explore the intrinsic aspects of their motivations, particularly professional achievement, recognition and job satisfaction. The majority of the respondents' primary motivations were to meet the needs of older people and to accomplish professional achievements. Their caring motivations had four principal components, which were labelled professional, financial, client-specific and client-generic, and as for their professional motivations, the interviewees reported high levels of job satisfaction. The respondents were satisfied with their career choice and felt that, through their work, they were contributing to society. The study identified several personal and external factors that influenced the providers' intrinsic motivations and professional aspirations. The presented evidence suggests that if future policies are to improve the quality of care-home services, it is essential that they also incorporate the professional needs of care-home providers.

The policy announcement in November 2018 by the Secretary of State for Health and Social Care that: ‘from today, let this be clear: tech transformation is coming’ indicates that confidence in care technologies, so apparent over the past decade in policy circles, remains unabated. This article suggests, based on evidence of significant limitations in technological solutions to care needs, that this confidence is misplaced. The focus is on remote care technologies – primarily telecare – which involve the passive or real-time monitoring of recipients, the majority of whom will be older people. These information and communication technologies (ICT) have been heralded by politicians, policy makers and industry interests alike as a solution to the challenges of demographic change and social care demand. While the research evidence suggests telecare works well for some people, in some circumstances, there are also significant complexities in its use, challenges presented to care relationships, and conflicting interpretations around its efficacy and cost-effectiveness. These critical issues have been marginalised in the mainstream discourse around telecare policy. This article explores the dissonance between this policy and the available evidence, drawing on a Multiple Streams Approach to analyse the emergence of, and continued confidence in, telecare policy based on a congruence of views across policy interests. To the extent that social care for older people is now in crisis, the article argues that the discourse around telecare represents an example of ‘silver bullet’ thinking: that is, too much focus on a single policy solution to address complex problems. Accordingly, the crisis in social care has deepened, without alternative policy proposals being available to address it. The renewed push for ICT-based solutions to this crisis in social care ought therefore to be viewed with some concern.

The share of older migrants in Dutch cities is increasing. However, only limited knowledge has been gained about the urban conditions that older migrants live in and how these compare to those of their native Dutch counterparts. This paper contributes to filling this knowledge gap using detailed information on residential patterns, housing conditions and levels of neighbourhood deprivation in the city of Amsterdam in the Netherlands, and links this information to data about housing and neighbourhood satisfaction and perceived safety. Empirical evidence demonstrates that there is strong path dependence with regard to the places in which one finds different groups of older non-Western migrants. Older non-Western migrants in Amsterdam are highly concentrated in disadvantaged neighbourhoods. The number of concentrations has increased significantly over the past decade, as well as the concentration levels. Nevertheless, we did not find indications of social isolation. With regard to housing conditions, we found better conditions for socio-economically similar groups of native Dutch and Surinamese 55+ residents, compared to Turkish and Moroccan 55+ residents. These conditions correspond with levels of housing satisfaction. Surinamese older people are more positive about their neighbourhoods. We hypothesise that this is related to the restructuring of neighbourhoods where Surinamese 55+ residents are concentrated. Although the immediate environment of older non-Western people is characterised by high levels of social deprivation, this does not translate into dissatisfaction with social relations or feelings of lack of safety. This suggests that their residential concentration in particular urban neighbourhoods may also bring significant opportunities.

There is evidence that perceived health status is relevant for older adults' wellbeing, and at the same time perceived health status can be influenced by self-perceptions of ageing. There is a lack of studies on the relationship between these variables. The aim of this study was to explore attitudes towards ageing and self-perceptions of ageing among Spanish middle-aged and older people, and to identify possible mediators in the relationship between self-perceptions of ageing on perceived health status. The sample comprised 1,124 individuals from 50 to 98 years old (mean = 64.84, standard deviation = 10.12) from the Ageing in Spain Longitudinal Study database, Pilot Survey (ELES-PS). Almost 70 per cent of the participants stated that old age begins at a specific chronological age and half of them considered that society treats older people with indifference. Self-perceptions of ageing, physical activity, cognitive functioning and age were significant predictors, and together these variables explained 15.9 per cent in the variance of perceived health status. The multiple mediation analysis revealed that self-perceptions of ageing predicted cognitive functioning (B = 0.848, p < 0.01) and physical activity (B = 2.9046, p < 0.001), and mediated the association between self-perceptions of ageing and perceived health status (B = 0.1144, standard error = 0.0147, p < 0.01). Results from this study highlight the importance of perceptions and attitudes towards ageing for older adults' health and wellbeing, thus this study contributes to a better understanding of how these variables are related. In this sense, results from this study can be useful for designing interventions for fostering wellbeing. Addressing negative self-perceptions of ageing and negative attitudes towards ageing can be particularly useful because they are associated with more pessimistic expectancies about the ageing process.

This paper examines the relationship between age and training in the 15 European Union countries (EU-15) that were member states prior to the 2004 enlargement. The analysis is carried out using European Union Labour Force Survey data. We report cross-country comparisons of the training undertaken by older people (aged 50–64) and younger people (aged 20–49). We extend previous research by adding an analysis of the training undertaken by non-workers as well as that of workers. We also consider whether training is work-related, whether it is undertaken during normal work-hours and the time spent in training. Our results show that across the EU-15 not only are older people less likely to participate in training in general but, more importantly, they are less likely to participate in work-related training. Our evidence suggests that there is considerable scope for raising the training rates of older people and particularly older people who are out of work.

Sub-Saharan Africa's older population is projected to nearly double in size by 2030. At the same time, demographic changes have caused major shifts in the units primarily responsible for the care of older adults: the family and household. The purpose of this paper is to examine the relationship between household composition and health at older ages in rural Malawi. We use data from the Malawi Longitudinal Study of Families and Health, which contains detailed information on household and family structure, along with measures of mental and physical health (from the Short Form-12). We focus on several measures of living arrangements that are expected to be associated with health: overall household size, sex composition and kin structure (based on co-residence with offspring and grandchildren). Results show that: (a) older women who co-reside with offspring have better mental and physical health compared to those living only with grandchildren; (b) older men who live in larger households or in households with a higher proportion of females have better physical health.

Studies in various countries have reported that older people who are married have better health than older widows. This paper reports a replication of these analyses with Brazilian data. The main objective was to explore the relationships between marital status, individual and household income, and the health of men and women using ordered logistic regression with self-assessed health as the dependent variable. The explanatory variables of interest were gender, marital status, and individual and family income. The data are from a survey of 7,920 non-institutionalised older people resident in the southern state of Rio Grande do Sul in 1995. The survey used a structured, multi-disciplinary questionnaire, which collected information on demographic attributes, household composition, social relations, occupation, income and health status. The results show that widows were 20 per cent more likely to report better health than married women. The women without individual income had worse health than those who did, even after controlling for family income. For men, there were no significant differences in health by marital status. The main recommendation is that the health status and economic circumstances of married elderly women should be given more attention in both research and policy, certainly in Brazil and probably in other Latin American countries. Programmes of income support to the poorest households should include specific transfers to these elderly women. Brazil's Family Health and Older People's Health public programmes should place more emphasis on the health of elderly home-makers.

Park homes are a small, niche sector of the United Kingdom housing market. This paper reports a study of 40 residents of park-homes that focused on their motivations for choosing this form of accommodation, and on their views about and experiences of park-home living. Whilst the sector has long provided a low-cost housing option for people of all ages, in recent years it has increasingly aligned itself as a lifestyle choice for older people. Despite their diverse reasons for moving to park homes, most respondents reported very positive experiences of park-home living and shared similar views about the benefits, but there were a few dissenting voices. Two conceptual frameworks are used to help understand the experiences of the respondents. ‘Elective belonging’ offers a way of contextualising the narratives that people articulate about their lifestyle choices and that affirm their sense of biographical continuity even having moved to new locations. This notion also helps frame some of the tensions that arise among the residents. The second framework, ‘biographical disruption’, is a way of framing the stories that the respondents told when their lives had not followed the anticipated trajectory and by which they coped and made sense of the circumstances which soured their chosen lifestyle.

Frailty is increasingly used in clinical settings to describe a physiological state resulting from a combination of age-related co-morbidities. Frailty also has a strong ‘lay’ meaning that conjures a particular way of being. Recent studies have reported how frail older people perceive the term frailty, showing that frailty is often an unwanted and resisted label. While there are many scores and measures that clinicians can use to determine frailty, little has been published regarding how health-care professionals use and make sense of the term. This paper reports the findings of a qualitative study that explored how health professionals perceive frailty. Forty situated interviews were conducted with health-care professionals working in an emergency department in the English Midlands. The interview talk was analysed using discourse analysis. The findings show that the health professionals negotiate an ‘ideological dilemma’ – a tension between contradictory sets of meanings and consequences for action – based on their ‘lay’ and clinical experience of the term frailty. It is concluded that this dilemma could have a negative impact on the assessment of frailty depending on the system of assessment used.

The persistence of greater life expectancy among women than men means that widowhood on a large scale is a feature of both pre-industrial and subsequent societies. This paper examines the changing structure of widowhood along with the familial and economic support afforded to women in this category, in the 17th and 18th centuries by contrast with the present day. It indicates, by drawing on parish data for England, that the incidence of the widowed status is today lower in each age group than two hundred years previously, but higher as a proportion of total population. Current widows are however twice as likely to be over 55 and to be heads of households. Further comparisons over time are used to make observations about the relative effectiveness of the parish, kin, and the Welfare State in providing material support.

Over the last 15 years, frailty has become a dominant discourse on late life. Taken-for-granted knowledge and practice can be seen in initiatives such as the International Association of Gerontology and Geriatrics’ White Book on Frailty. This paper begins with an overview of key themes on frailty from the biomedical literature, followed by critical literature in the social sciences and humanities. It discusses the tensions within the biomedical field, frailty as a social construction and ‘social imaginary’, practices of frailty as historically linked to political systems of care, and frailty as an emotional and relational experience. It then draws on a critical discourse analysis to assess the 2016 White Book on Frailty. Drawing on the idea of ‘significant absences’, the paper highlights the gaps that exist where the social and emotional understandings and political readings of frailty are concerned. The paper concludes by outlining the need to recognise the ‘politics of frailty’ including the power relations that are deeply embedded in the knowledge and practices surrounding frailty, and to incorporate older people's experience and ideas of vulnerability into research, policy and care practice.

Returning home or moving to a more supportive setting upon discharge from inpatient health-care services can have a tremendous impact on the lives of older adults and their families. Institutional concerns with patient safety and expedience can overshadow health-care professionals' commitments to collaborative discharge planning. In light of many competing demands and agendas, it can be unclear what is driving discharge-planning processes and outcomes. This paper presents the results of a study examining discharge planning in an older adult rehabilitation unit in a Canadian urban setting. Using microethnographic case studies, we explored the perspectives of older adults, family members and health-care professionals. Drawing on concepts of relational autonomy to guide the analysis, we found that discourses of ageing-as-decline, beliefs privileging health-care professionals' expertise and conventions guiding discharge planning intersected to marginalise older adult patients in discharge-planning decision making. Discharge planning in the research setting was driven by norms of ‘protecting physical safety’ at the expense of older adults’ self-declared interests and values. Such practices resulted in frequent recommendations of 24-hour care, which have significant personal, social and financial implications for older adults and their families, and ultimately might undermine clients' or health-care systems' aims. The analysis revealed social, political and institutional biases that diminish the rights and autonomy of older adults.

During the period of economic and political transformations in Poland, considerable changes occurred in large housing estates, while demographic transformation and housing-stock ageing starting to aggravate social and spatial problems. The serious issue currently dominating such estates concerns the process of natural ageing of the housing stock and residential ageing which is associated with the reduction of residential mobility and demographic ageing of people living in the large housing estates. This paper intends to identify ageing of the estates’ population in the context of the evaluation of residential life quality. The authors concentrated on analysis of 2002 and 2011 statistical data, as well as data collected during their field surveys conducted in 2010–2012. Detailed studies were carried out on seven estates in five cities and towns in Poland (Kraków, Poznań, Tarnów, Żyrardów and Dzierżoniów). To identify the residential standard and quality of life, surveys were conducted on housing estates which allowed the researchers to establish the essential factors which determined the level of satisfaction of older people with regard to their place of residence. The authors also determined the course of changes in the perception of particular aspects of life quality in the process of residents’ ageing in the selected places of residence.

This paper provides a brief introduction to demography and population science and the newly emerged subfield of the demography of ageing. Links with gerontology are explored. Recent work on mortality at very high ages and on the black-white mortality ‘cross-over’ reported from the United States is then reviewed. These topics are important substantively and theoretically and also serve to illustrate demographic approaches to data and data analysis. Analytic approaches to the topics reviewed have had to be imaginative as there are major problems with data on very old people. Recent work indicates that the mortality of very old people, including centenarians, has fallen considerably, at least in those countries where good data exist. The mortality ‘cross-over’, however, appears to be artefactual, at least at ages under 95 years.

Involvement in sports is considered a powerful way to generate social capital. However, the role of sport engagement in the development of social relationships of older adults has not received much attention. Remarkably, there is a lack of empirical evidence on the quality and diversity of social relations built through active sport participation and spectatorship. This paper attempts to assess the relationship between sport engagement and various measures of network social capital, including the extension and quality of social networks and the heterogeneity of personal relationships. Also, it proposes new and more informative measurements of an individual's quantity and quality of social ties. By analysing data from a survey in Spain (N = 600) and applying logistic regressions, the results show that sport participation and attendance at sporting events are closely related to different dimensions of network social capital. Concerning people who are not actively engaged in sports, more extensive social networks characterise those who frequently attend sporting events. In contrast, active sport participation is associated with the extensity and quality measures of social connectedness, the level of satisfaction with friends and the opportunity to enjoy close relationships. Therefore, this paper provides new evidence on how sport engagement may result in tighter and extensive networks for older adults and serve as support for emphasising sports, physical activity and leisure as strategies for maintaining and boosting older people's social and psychological health.

Drawing upon a variety of research data and national statistics, this paper presents a detailed analysis of the contribution made by family and informal care to the support of elderly Scandinavians. Comparative data from other countries are employed to highlight some similarities with other European, American and Far Eastern societies. Formal help is directed at the childless and those who live alone, but the conclusions draw attention to the dangers of this concentration if it excludes essential support to overburdened carers.

Falls among community-dwelling seniors constitute a major public health concern because of the potential morbidity and mortality associated with the fall. This study examined the informal care networks accessed by Canadian seniors who had visited the Emergency Department as a result of a fall, and considered the implications of the processes of asking for and receiving help on the senior's identity. Four themes were identified. The first was valuing independence. The remaining three themes concerned threats to the participants' identities linked to the need to ask for or receive help from family and friends. They were: becoming indebted, feeling devalued and becoming a burden to others. Seniors were noted to excuse family members from the expectation of helping because of work and family commitments, and illness. Participants described a mutually beneficial relationship with friends wherein both parties valued their independence and provided assistance to the other when needed. Their comments suggested that assistance was viewed as a good to be traded among peers. Our findings indicate that seniors value their independence and may not seek help even when it appears to be available, if asking threatens valued identities. Health and social care practitioners and policy makers responsible for planning and delivery of services should take this into account in order to ensure the best possible care for injured community-dwelling seniors.

The growing number of oldest old has increased the need for social services and medical care in many countries during the last decade. These needs have been met with various strategies to make more effective and efficient use of resources. In many ways these changes have been successful, but at the same time the amount of success correlates negatively to the potential for further gains. That is, when the slack in the system has been drawn in, it is doubtful whether further gains can be made with these strategies. So what can be done if the public resources are restricted and needs continue to increase? Adequate solutions will require a wide perspective encompassing all the various services needed by elderly people. Decisions made in one sector necessarily have repercussions in other service areas. It is also essential to recognize the differences between sectors; guidelines and strategies developed within the medical sector are not always applicable in the social services sector. With Sweden as an example, the organizational and administrative changes that have occurred during the last decades are presented along with arguments for extending the discussion of strategies and priorities to include all kinds of service to the elderly population.