Meaningful engagement in activity is associated with the maintenance of health and wellbeing, but reduced activity participation is common among persons with dementia. Family care-givers play an important role in engaging their relatives with dementia in activities but little is known about their perception of occupational engagement. This study aimed to examine care-givers’ perception of occupational performance of their relatives from three aspects: person, occupation and environment. Adopting a qualitative methodology, semi-structured and in-depth interviews were conducted with 14 family care-givers. Care-givers were also asked to document the activity patterns of their relative, using the Activity Card Sort Hong Kong version (ACS-HK). The ACS-HK findings suggested that high-demand leisure activities were mostly retained (61%) while instrumental activities of daily living were the least retained (37%). Qualitative analysis revealed that care-givers’ perception of activity participation was intertwined with their motives and behaviours to get their relatives engaged in activities. Care-givers acknowledged occupational engagement as a means of maintaining wellness and used various strategies to encourage their relative's activity participation. Apathy and passivity, however, are difficult to deal with. Also, activity decisions appear to depend on the availability of support resources and a balance between safety concern and risk-taking. Clinical practitioners could assist care-givers by suggesting activity strategies and providing support resources for continued engagement of their relative in activities.

This article traces the development of residential care for elderly people in the period 1939 to 1948. It begins by looking at the nature of such institutions in the period just prior to the Second World War and then discusses the complex impact of war upon such provision. Particular attention is paid to how evacuation hostels, run by local authorities and voluntary organisations, changed notions about the role of the state in the care of elderly people. The paper concludes by looking at how such changed notions were incorporated into the 1948 National Assistance Act.

This study adopted mixed-methods research to explore the effects of reminiscing about nostalgic smells on the physiological and psychological responses of older people in long-term care facilities. A total of 60 participants were randomly divided into two groups and each participant was either interviewed regarding their reminiscence about nostalgic smells (experimental group) or were engaged in daily conversation (control group). The results indicated that anxiety and depression symptoms were more effectively relieved in the experimental group than in the control group. Moreover, most of the nostalgic smells recalled by the experimental group were associated with naturally occurring smells. Regarding heart rate variability, the normalised low-frequency of the experimental group decreased significantly. The results verified the utility of using reminiscence about olfactory memories in reminiscence therapy as this can calm anxiety and lessen depression, which can be very important for older adults living in long-term care facilities.

The dual demographic changes in massive rural-to-urban labour migration and population ageing have significantly impacted the lives of older adults, who have either been left behind in rural regions or migrated to urban areas. While many extant studies on migration and wellbeing of older adults have focused on either migrating or left-behind older adults, a very limited number of studies have directly compared these two groups. Utilising data from the China Longitudinal Ageing Social Survey, this study examines the impacts of different migration patterns (i.e. migrating older adults, left-behind older adults and non-migrating older adults) on the social networks and mental health of older adults in rural China. Structural equation modelling results showed that older adults who have been left behind reported weaker family ties and poorer mental health than the other older adults. Moreover, weakened family ties increased older adults’ risk of developing mental health problems. Older migrants reported the lowest level of depressive symptoms among the three groups of older adults. However, migration may be associated with poorer mental health among the older migrants due to the shrinking/weakening of family/friendship ties.

Sleep is vital for health and wellbeing across the lifecourse. Ethnic differences have been observed with regards to the prevalence and predictors of self-reported sleep problems. An understanding of sleep experiences with ageing and across ethnicities is required to better support older people. Open-ended interviews were conducted with 23 people living in Aotearoa/New Zealand aged 61–92 years (12 Māori and 11 non-Māori) concerning current sleep status, changes over their lifecourse and personal strategies for supporting good sleep. Participants typically expressed satisfaction with current sleep (usually pertaining to duration) or feelings that sleep was compromised (usually pertaining to waking function). Comparisons to a socially perceived ‘ideal’ sleep were common, with sleep transitions presented as a gradual and accepted part of ageing. Participants resisted medicalising sleep disruptions in older age. While participants were aware of ways to enhance their sleep, many acknowledged engaging in practices that undermined it. Unique insights from some Māori participants indicated that sleep disruptions were not so readily pathologised compared to Western views and that sleeplessness could provide opportunity for cultural or spiritual connection. Common narratives underpinning the themes were: ‘You don't need as much sleep when you're older’, ‘Sleep just fits in’ and ‘Having the time of my life’. Findings provide personal experiences and cultural interpretations relating to sleep and ageing. This provides the foundation for future participatory research to co-design sleep health messages which are meaningful for ageing well across ethnicities.

The concurrent ageing of parental care-givers and people with intellectual disabilities is driving academic and social welfare concern for a post-parental care ‘crisis’. The ‘crisis’ typically pertains to a transition from primary care in the family home precipitated by the death or incapacity of older parents without a pre-planned pathway to post-parental care. This crisis is amplified in rural communities given low service engagement with families and a deficit of disability-supported accommodation and services. Academics, service providers and policy makers have responded through a problematisation of post-parental care planning. This focus continues to normalise informal care, burdens families with responsibility for planning, and diverts attention from structural deficits in the socio-political carescape. This paper attends to the Australian policy landscape in which long-term care-giving for families living with intellectual disability is enmeshed. It contends that the dyadic and didactic model of informal long-term care has profound implications for social service support and post-parental care planning. Problematisation of carers’ ‘need’ to relinquish primary care and for people with intellectual disabilities to transition to independent and supported living is necessary to unsettle the dominant policy and service discourse around the provision of services to sustain informal care-giving. Innovation is then needed to forge pathways of support for families in rural communities planning on continuing, transitioning and transforming care arrangements across the lifespan.

A global ageing population presents opportunities and challenges to designing urban environments that support ageing in place. The World Health Organization's Global Age-Friendly Cities movement has identified the need to develop communities that optimise health, participation and security in order to enhance quality of life as people age. Ensuring that age-friendly urban environments create the conditions for active ageing requires cities and communities to support older adults’ rights to access and move around the city (‘appropriation’) and for them to be actively involved in the transformation (‘making and remaking’) of the city. These opportunities raise important questions: What are older adults’ everyday experiences in exercising their rights to the city? What are the challenges and opportunities in supporting a rights to the city approach? How can the delivery of age-friendly cities support rights to the city for older adults? This paper aims to respond to these questions by examining the lived experiences of older adults across three cities and nine neighbourhoods in the United Kingdom. Drawing on 104 semi-structured interviews with older adults between the ages of 51 and 94, the discussion centres on the themes of: right to use urban space; respect and visibility; and the right to participate in planning and decision-making. These themes are illustrated as areas in which older adults’ rights to access and shape urban environments need to be addressed, along with recommendations for age-friendly cities that support a rights-based approach.

Population ageing combined with physical inactivity has critical implications for the public health of communities in the twenty-first century. In the last decade, the World Health Organization launched the age-friendly cities agenda, aiming to address population ageing through whole-systems, rights-based, health equity-focused approaches. An important intervention for age-friendly communities is modifying built environments to support population-level physical activity. Physical activity can help mitigate impacts of chronic diseases and social isolation on older adults. Need for advocacy and action in this area raises questions of how to develop supportive environments for physical activity across age-friendly community types. In Canada, a substantial proportion of older adults live outside large urban municipalities, for which scant research exists on fostering age-friendly built environments. To this end, we conducted qualitative research involving semi-structured interviews with 21 municipal policy influencers in Alberta, Canada to gather perspectives on development and early implementation of an age-friendly policy framework in the small urban and rural context. Our findings are organised by three main themes providing key lessons for advocacy and action, namely pursuing comprehensive planning, promoting public engagement and prioritising the needs of older adults. This research informs advocacy and action priorities in promoting built environment modification for routine physical activity as part of an age-friendliness agenda for small urban and rural regions of Canada and other countries.

Most private-sector employees in the United Kingdom (UK) are automatically enrolled into individualised defined contribution (DC) pension accounts. In a DC environment, income adequacy in retirement is highly dependent on the decisions that individuals make earlier in their lives. The ease with which they move into employment, and the pension support that they then receive from their employer, can be critical in determining outcomes. This paper discusses how employees respond to workplace pension schemes and the circumstances under which they assess the suitability of their contributions. The findings are based on an embedded case study comprising qualitative interviews with 25 employees of a large UK utility company. Participants were selected on the basis of socio-economic similarity. The research concluded that fixed-term employment negatively impacted on saving for retirement, both with respect to scheme membership and to the level of saving. Furthermore, it was found that the employment context had an influence upon retirement savings behaviour. The proactive approach of the employer in providing retirement benefits, and the trust that employees had in their employer, positively influenced membership and contribution levels. In addition to employer endorsement effects, both the encouragement of older work colleagues and workplace norms had a role to play in influencing how successfully individuals prepared for retirement.

There are many definitions of social isolation which draw on structural indicators (e.g. living alone), functional indicators (e.g. social support) or both. This makes comparing prevalence rates across studies difficult and provides little guidance for practitioners and service providers to identify and target socially isolated clients. The purpose of the present study was to compare, within one large population-based data-set of Canadians aged 45–85, single-item and composite indicators of social isolation, by total sample and by socio-demographics (age, sex) and health. Data were from the Canadian Longitudinal Study on Aging (CLSA) which assessed features of social network, social support and social participation. Two composite scales were created to compare prevalence rates based on structural only or both structural and functional indicators. Results indicated overall low prevalence rates of social isolation, regardless of the measure used. A composite scale using only structural features identified 5.8 per cent socially isolated adults aged 45–85. This compared with a structural and functional scale that identified 9.8 per cent socially isolated adults. The composite measures showed less variation across socio-demographics than single-item measures. Results shed light on different ways in which social isolation can be defined and how single-item and composite definitions impact our understanding of identifying socially isolated adults in a given population. Results add to discussion of measures that can be used by researchers, services providers and practitioners.

Access to health care should be determined by clinical need and not by age. Older people form an increasing proportion of the general population and of those with coronary heart disease, but compared with younger people they are less likely to be invited for cardiac rehabilitation programmes and more likely not to complete them. This study examined the factors that contribute to these trends in Scotland. A national survey of rehabilitation centres (n = 30) found that the majority of their programme co-ordinators believe that age does influence access to rehabilitation. While only one programme used an overt age criterion, age was widely perceived to influence access, both during initial assessment and in assessments for exercise components; and while the respondents acknowledged that other criteria influenced selection, the factors cited most often were all more common during old age, e.g. the presence of other medical ailments, lower initial exercise tolerance, and poor access to private or public transport. Focus groups undertaken with a sub-sample of the co-ordinators revealed that staff appeared to have knowledge of the benefits of cardiac rehabilitation for older people, but that the scarcity of resources prevented them from offering more accessible and appropriate services.

Finch and Mason (1990) have recently referred to various articles, by myself and others, concerning the hierarchy of obligations among network members, in relation to decision-making about the provision of practical help to elderly people. In their fascinating and informative case study, Finch and Mason argue that this hierarchy is best viewed as a normative belief which influences negotiation within families, rather than as a way of predicting people's behaviour in practice. I would argue that the question of the relationship between ‘statistical’ norms of behaviour (i.e. what most people do), and normative beliefs (i.e. what people think is the right thing to do), is a question open to empirical investigation. Certainly, it would be a misuse of case study methodology to suggest that failure to adhere to the hierarchy in one particular instance could be advanced as proof that it did not reflect a norm of behaviour. Statistical norms are never deterministic in individual cases, but it may still be possible to predict what the majority of people will do.

This study of recent pension reforms in Hong Kong and urban China particularly addressed three questions. What are the causes of the pension reforms in these two economies? What are their key features? What difficulties have been faced by the Hong Kong and Beijing governments during their implementation? As well as enhancing our understanding of the pension schemes in these two countries, the paper makes a contribution to the debate on whether government welfare reforms in responses to economic globalisation are converging on one pattern, an ideal mix of pension schemes. This paper shows that both convergent and path-dependent processes explain the forms of the measures introduced by the Hong Kong and Beijing governments. They have responded not only to the challenges brought by economic globalisation but also to the legacy of previous policies. Moreover, the welfare effectiveness of the new schemes has been undermined both by the two governments' non-welfare policies, particularly to promote economic growth, and by the constraints created by the previous welfare measures. The paper also argues that to develop only a non-contributory comprehensive pension scheme is not the solution to the problem of how best to provide old-age income security, but that this welfare goal principle should be more strongly upheld in pensions reforms.

In this study we examine patterns of change and stability in loneliness among 108 women who had participated in a friendship enrichment programme during the year after the programme. We distinguished seven groups of participants in which different levels of loneliness significantly declined, remained stable or increased. These were reduced to the following groups: those recovered, significantly improved and not improved. We then examined whether resources such as age, education, partner status, health, initially available friendships and developments in friendships were related to these loneliness patterns. The data were collected using face-to-face semi-structured interviews, a loneliness scale and the personal convoy model. The results indicate that none of the demographic characteristics, nor health, were associated with the patterns of loneliness. Friendship availability and development did differ among the groups. Recovery from loneliness after a year was associated with the presence of a friend in the outer circle of the convoy and having more variation in one's friendships initially and one year later. It was also associated with the presence of a friend in the inner circle and reporting improvement in friendship later. The absence of these qualities initially or subsequently was more characteristic of those whose loneliness was stable or increased. Thus, the maintenance of companionate friendship and the development of intimacy in one's friendships seem advantageous for recovery from loneliness. While this study illustrates that recovery from, and significant reduction of loneliness are possible, we are not yet able to predict who will benefit and who will not benefit from a friendship enrichment programme.

Research to-date has examined the impact of intergenerational support in terms of isolated types of support, or at one point in time, failing to provide strong evidence of the complex effect of support on older persons’ wellbeing. Using the Harmonised China Health and Retirement Longitudinal Study (2011, 2013 and 2015), this paper investigates the impact of older people's living arrangements and intergenerational support provision/receipt on their physical and psychological wellbeing, focusing on rural–urban differences. The results show that receiving economic support from one's adult children was a stronger predictor for higher life satisfaction among rural residents compared to urban residents, while grandchild care provision was an important determinant for poor life satisfaction only for urban residents. Having weekly in-person and distant contact with one's adult children reduced the risk of depression in both rural and urban residents. Older women were more likely than men to receive support and to have contact with adult children, but also to report poor functional status and depression. The paper shows that it is important to improve the level of public economic transfers and public social care towards vulnerable older people in rural areas, and more emphasis should be placed on improving the psychological wellbeing of urban older residents, such as with the early diagnosis of depression.

Loneliness among older people is perceived as a global public health concern, although assumptions that old age is a particularly lonely time for everyone are not accurate. While there is accumulating quantitative and qualitative evidence on the experience and impact of loneliness amongst older adults, there is little exploration of methodological issues that arise in engaging with older adults particularly through research-oriented conversations. The sensitivity and stigma often attached to loneliness means that interviewing research participants presents ethical challenges for researchers navigating complex emotional responses. This paper presents reflections from three research projects that used research interviews to explore accounts of loneliness experienced by older people. The everyday methodological decisions of research teams are often hidden from view, but through a critical examination of reflexive accounts of fieldwork, this paper makes visible the internal and external negotiations of researchers responding to ethical complexity. The paper explores the key decisions that researchers make during interviews about loneliness: how to introduce the topic; how to phrase questions about loneliness; when to ask the questions; how to deal with the stigma of loneliness and respond to ageism; and how to manage the participant–researcher relationship post-interview. The paper concludes with recommendations for appropriately navigating ethical complexity in loneliness research, thus contributing to an effective qualitative methodological approach to researching loneliness in later life.

Using data from the Cebu Longitudinal Health and Nutrition Survey (1994, 1998, 2002, 2005, 2007, 2012), we utilise latent class analysis to develop time-use class membership to characterise the degree to which women in Cebu are subject to the double burden of work and family responsibilities in mid- and later life. Results suggest that close to a third of the sample are engaged in high-intensity work for pay (either outside or home-based), while combining it with a substantial amount of household chores and with a low level of personal time in a span of 18 years. Our latent transition analysis also shows that, with the addition of grandchildren into the household, some women experience a shift in time-use class membership by becoming high-intensity care-givers or by completely transitioning out of the work arena, while others remain double-burdened with active involvement in both work and family responsibilities.

Rural areas tend to be inhabited by more older people and thus have a higher prevalence of dementia. Combined with lower population densities and more sparse geography, rural areas pose numerous barriers and costs relating to support and resource provision. This may leave people with dementia in rural places at a significant disadvantage, leading to a heavy reliance on informal support networks. The present study explores the personal experiences of people living with dementia and carers living in rural areas, seeking to discover both benefits and challenges, as well as recommendations within the literature for improving the lives of those affected by dementia in rural areas. A scoping review following the framework of Arksey and O'Malley identified 60 studies that describe or discuss the personal experience of dementia (either by the person with dementia or carer), in relation to living in rural or remote geographical areas. Four overarching themes were derived, namely the possible benefits of living in a rural community (supportive rural communities), sources of strength described by people affected by dementia in rural areas (managing and coping), detrimental aspects of living in a rural community (rural community challenges) and difficulties with dementia care services. Three further themes yielded recommendations for improving the experience of dementia in rural areas. This review highlights some potential opportunities related to living in rural areas for people living with dementia. These often come with parallel challenges, reflecting a delicate balance between being well-supported and being in crisis for those living in rural areas. Given the limited access to formal services, supporting people with dementia in rural areas requires input and innovation from the people, organisations and services local to those communities.

The paper focuses on temporal aspects of informal caring for older people. Limitations of large-scale surveys in capturing such data are noted and time-use methodology, despite its own limitations, is proposed as a promising alternative. Adopting a critical perspective on time that includes carers’ own conceptualisations, we report the findings of a qualitative study of carers’ time use. Sixty-two interviews with carers, male/female, co-resident/not co-resident, employed/not employed, and located across Great Britain were conducted. Analysis considered people's own diverse and ambiguous views of their care activities. Carers’ accounts of their time revealed non-linear experiences and a sense of being permanently on call. Interviewees often travelled distances to engage in support activities with or for older people. Changes over time were pervasive, increasing or reducing care requirements. Unanticipated events could precipitate radical changes in time use. Managing time, exercising temporal agency, was particularly apparent in accounts of care, employment, other family responsibilities and choices about friendship. Measurement of carers’ time use which draws on the conceptual foundation of carers’ own perspectives on time may provide more effective quantitative understanding of the temporal aspects of caring. It should not pre-define time, must grasp a variety of tasks, take account of intermittent activity, incorporate the 24–7 experience of many carers and demonstrate how caring time interacts with other time.

This article analyses the strategies that older widowers used to assert their masculinity during in-depth research interviews by the author, a middle-aged woman. Twenty-six widowers living in Atlantic Canada and Florida in the United States and who were aged from 56 to 91 years participated in the study. The author analysed the interviews from a symbolic-interactionist perspective that looks at the world from the perspective of those being studied. The widowers used various strategies of impression management to reinforce their identity as ‘real men’ during the interviews. These strategies included taking charge of the interview, using personal diminutives and endearments to assert control, lecturing the interviewer about various topics including differences between men and women, and bringing attention to their heterosexuality by referring to themselves as bachelors and commenting on increased attention from women. The paper chronicles the process of discovery of the importance to the study participants of portraying themselves as men. It was found that older widowers' identity as ‘real men’ is precarious because they lack three essential components of masculinity: being in a heterosexual relationship, being employed, and being young. The article makes extensive use of the participants' quotations to demonstrate their attempts, through impression management, to maintain a masculine identity while discussing the very topics that threatened it.