Recently, internet usage among elderly adults has been increasing and becoming more mainstream; with the ageing population in Taiwan, concerns over health are on the rise, and this is directly related to the products that people eat. The main objectives of this study were to develop an integrated extensibility model incorporating the technology acceptance model and to investigate the impact of health consciousness on elderly adults’ acceptance of technology in relation to traceability information websites in Taiwan. This study used structural equation modelling to analyse the data. The results revealed that elderly people with high health consciousness and high perceived usefulness had more positive attitudes towards products than those with low health consciousness and low perceived usefulness, and those with high health consciousness and high perceived ease of use had more positive attitudes than those with low health consciousness and low perceived ease of use in relation to the agricultural product traceability system.

The ordinary housing in which most old people live is a subject of growing concern in many countries. The idea of ‘staying put’ which has emerged recently in the UK from this growing concern is thus timely for it focuses specifically on housing assistance for elderly people who remain in conventional domestic housing. This paper attempts to identify a number of cross-national trends which suggest the relevance of ‘staying put’ to other countries, and presents a detailed study of the factors shaping the development of such policy in the UK. The present legislative framework for ‘staying put’, and the extent to which it is exploited are also discussed.

Population ageing and the global burden of dementia pose a major challenge for human societies and a priority for public health. Cognitive enhancement, i.e. the targeted amplification of core cognitive abilities, is raising increasing attention among researchers as an effective strategy to complement traditional therapeutic and assistive approaches, and reduce the impact of age-related cognitive disability. In this paper, we discuss the possible applicability of cognitive enhancement for public health purposes to mitigate the burden of population ageing and dementia. After discussing the promises and challenges associated with enhancing ageing citizens and people with cognitive disabilities, we argue that global societies have a moral obligation to consider the careful use of cognitive enhancement technologies as a possible strategy to improve individual and public health. In addition, we address a few primary normative issues and possible objections that could arise from the implementation of public health-oriented cognitive enhancement technologies.

With an increasing retirement age, more older adults are combining employment with informal care-giving responsibilities. However, little is known about how older workers experience care-giving activities next to their paid jobs. This study aims to fill this gap by examining how the work situation (i.e. working hours, occupational status and perceived access to human resources practices) is associated with feelings of gratification, burden and stress in care-giving. Using data from the NIDI Pension Panel Survey, we study care-giving experiences – in other words, the extent to which care-giving activities are gratifying, burdensome or stressful – of 1,651 Dutch older workers (age 60–65) who provide care at least once per week. Multivariate analyses reveal that the work situation plays an explanatory role next to socio-demographic factors and indicators of the care-giving situation. Working care-givers who feel they have access to phased retirement and organisational health support experience care-giving as relatively less burdensome and stressful. Moreover, those with access to phased retirement experience relatively higher levels of gratification in care-giving. Our findings suggest that the availability of organisational support relates to lower levels of care-giving burden and stress, and to some extent to higher levels of gratification. Organisations thus play an important role in facilitating the combination of work and care-giving obligations in a context of longer working lives.

Rapid fertility declines in Latin American and Caribbean countries since the 1960s have contributed to smaller family sizes among the current cohorts of older adults. This may have mental health implications in these societies as the family unit is highly valued as a source of social support. Utilising data from the 2000 Survey of Health, Well-being and Aging in Latin America and the Caribbean (SABE), this study examines the association between parental status, marital status and the likelihood of experiencing depressive symptoms among adults 60 years and older in seven cities within Latin America and the Caribbean (N = 9,756): Buenos Aires, Bridgetown, São Paulo, Santiago, Havana, Mexico City and Montevideo. Results from multivariate logistic regressions indicate that parental status is not significantly associated with depressive symptoms. Nonetheless, unmarried older adults, both those living alone and those living with others, are more vulnerable to experiencing depressive symptoms than their married counterparts. Marriage is especially protective for older adults in Havana and Montevideo. Older adults’ perceived income adequacy significantly moderates the relationship between marital status and depressive symptoms. Other significant covariates, such as experiencing disability and comorbidity, showed positive associations with depressive symptoms. While families may still represent a critical component for the mental health of older adults, broader investments in health across the lifespan are needed to improve individual psychological wellbeing.

With China's rapid urbanisation, many residents, especially older adults, are suffering from psychological problems induced by rural-to-urban relocation. This study examines the association between older adults’ rural place attachment and their depression after relocation, as well as the protective roles of neighbourhood social cohesion and sense of community in the relocation place. Chinese older adults (N = 224) who relocated from rural villages to urban communities completed a survey for this study. The results showed that older adults with stronger rural place attachment experienced more depressive symptoms and a lesser sense of community in the relocation place. In addition, the association between rural place attachment and depression was weakened by neighbourhood social cohesion. That is, compared with older adults perceiving low neighbourhood social cohesion, the positive association between rural place attachment and depression was weaker for older adults perceiving high neighbourhood social cohesion. Furthermore, neighbourhood social cohesion's protective role depended on sense of community. In particular, neighbourhood social cohesion buffered the association between rural place attachment and depression for older adults with a strong sense of community but not for older adults with a weak sense of community. These results have implications for developing resources within neighbourhoods and communities to promote relocation adjustment for older adults.

Maintaining good wellbeing in older age is seen to have a positive effect on health, including cognitive and physiological functioning. This paper explores experiences of wellbeing in a particular older adult community: those who have served in the military. It aims to identify the specific challenges that ex-service personnel may have, reporting findings from a qualitative study focused on how older veterans told stories of military service and what these stories revealed about wellbeing. We used a qualitative approach; data are drawn from 30 individual interviews, and from engagement with veterans in workshops. Analysis was conducted using a data-driven constant comparison approach. Three themes are presented: how loneliness affects older adult veterans; how they draw on fictive kinship; and the role of military visual culture. Although participants had diverse experiences of military service, they felt that being a veteran connected them to a community that went beyond association with specific experiences. Using narratives of military experience to connect, both in telling stories and by stories being listened to, was vital. As veterans, older adults were able to access each other as a resource for listening and sharing. However, it was also exclusionary: civilians, because they lacked military service experience, could not empathise and be used as a resource.

Global policy places emphasis on the implementation and usage of advance care planning (ACP) to inform decision making at the end of life. For people with dementia, where its use is encouraged at the point of diagnosis, utilisation of ACP is relatively poor, particularly in parts of Europe. Using a constructivist grounded theory methodology, this study explores the ways in which co-residing couples considered ACP. Specifically, it seeks to understand the ways in which people with dementia and their long-term co-residing partners consider and plan, or do not plan, for future medical and social care. Sixteen participants were interviewed. They identified the importance of relationships in the process of planning alongside an absence of formal service support and as a result few engaged in ACP. The study recognises the fundamental challenges for couples in being obliged to consider end-of-life issues whilst making efforts to ‘live well’. Importantly, the paper identifies features of the ACP experience of a relational and biographical nature. The paper challenges the relevance of current global policy and practice, concluding that what is evident is a process of ‘emergent planning’ through which couples build upon their knowledge of dementia, their networks and relationships, and a number of ‘tipping points’ leading them to ACP. The relational and collective nature of future planning is also emphasised.

The use of age as a criterion for the allocation of medical resources has been extensively debated internationally. This paper describes a study of the significance of age for the quality of life (QoL) of older and younger people with end-stage renal failure (ESRF) and in receipt of renal replacement therapy (RRT). The study has two components: a structured literature review to characterise the QoL and health-status measurement instruments that have been developed for use with all or specifically older RRT patients; and a longitudinal survey of the QoL domains nominated by older RRT patients by their age and duration of treatment. The literature review found that no validated QoL instrument had been developed specifically for use with older RRT patients. Moreover, there was little correspondence between the QoL domains used in the instruments described in the published literature and those mentioned by the survey participants. Older and younger patients nominated different domains, and their nominations changed with the duration of treatment. No significant differences in QoL scores were found between older and younger patients, but the scores improved significantly between 6–12 and 18–24 months of treatment. The findings suggest that using older age as a criterion for refusing full access to healthcare resources in ESRF is a simplistic and potentially erroneous strategy.

This paper has re-analysed and compared data between three studies conducted in the United Kingdom and in Sweden (the OPUS ‘Older People's Use of Unfamiliar Space’ study in the United Kingdom and the Swedish studies ‘Let's Go for a Walk’ and ‘Walking in Old Age’) to provide a comprehensive account of the issues facing older people in the outdoor environment. All three studies draw on the ‘fit’ between the person and their environment as a guiding conceptual base – capturing the dynamics of the relationship between older people's personal needs and their wider environmental context. This common conceptual base allowed us to test theory against practice, and to explore the utility of this concept across different geographical contexts. Participatory research was also applied, highlighting the importance of the voice of older people and involving older people in research. The studies also used a mixed-method approach involving both quantitative and qualitative methods. The paper highlights that although not generalisable, you can compare cross-locales and cross-nationally using different methodology; it investigates the challenges of cross-national comparative analysis and draws on findings from the three studies to illustrate the different challenges and solutions and finally looks at lessons that are transferable.

Research regarding quality of life among older people has predominantly focused on functional elements experienced at individual or dyadic level despite the complex interplay of factors that contribute to quality of life. Perspectives which explore interdependencies within communities and the intersecting environments in which older people exercise agency have seen less study. They do, however, play an important role in influencing quality of life as experienced by older people across community settings. Qualitative data from a co-produced study of dimensions influencing quality of life in older people was subjected to secondary analysis using a critical human ecological approach. Findings demonstrate the importance of community interdependencies in supporting individual quality of life, the expression of active agency to foster quality of life within and across communities, and the importance of state infrastructures and service provision within these interdependencies. This article argues for a movement beyond functional conceptualisations of quality of life towards the inclusion of perspectives regarding communal wellbeing, alongside the role differing types of community play in influencing quality of life. Through developing conceptions of quality of life in social relations and community cohesion, in particular how quality of life is influenced by perceptions of solidarity and social justice including across generations, assessing quality of life at community level will assist in driving cultural change in policy making and practice.

Pakistan is a lower middle-income country, which to date has had very little research and policy making to address the challenge of dementia. This study aims to explore the perceptions of dementia in a group of Pakistani adults. A series of focus group discussions were completed during 2017 with men and women in two metropolitan centres in Pakistan (Lahore and Karachi) (N = 40). Two vignettes, depicting someone with mild dementia and someone with severe dementia, were used to facilitate discussions. An induction-led thematic analysis was completed. Five themes were identified, reflecting (a) dementia awareness, (b) responsibility, (c) barriers to health care, (d) identified support needs, and (e) religion. Most participants had little awareness and knowledge about dementia, commonly understood to be a disease of forgetting or just normal ageing. Thus, there is an urgent need of a nation-wide campaign to raise dementia awareness in Pakistan, though this needs to be accompanied by improved, accessible health and social care services.

Guided by Sörensen and Pinquart's model of preparation for future care, this study investigated the relationship between familism and intended care arrangements. Ordinal logistic regression was performed on a sample of 516 urban Chinese one-child parents aged 45–65 with an equal gender ratio to examine the associations between five care expectations, familism (filial obligation and child gender) and future care planning constructs (awareness, information gathering and avoidance). Awareness and information gathering were positively associated with service-focused care arrangements. Avoidant planners were more inclined to rely on adult children. Participants with a stronger filial obligation had greater expectations for ageing at home with the aid of a spouse, siblings or helper. Child gender was not significantly associated with intended care arrangements. The model of preparation for future care was useful when predicting service-focused care arrangements. Familism was a powerful predictor of family-focused care arrangements. Females were more likely to rely on children regardless of child gender but less likely to rely on spouses and siblings. The study enriches researchers' understanding of urban Chinese older adults' intended care arrangements in the context of fading familism and single-child families.

Ever more people are in paid work following the age of state pension availability, and yet the experience of working in this phase of the late career has been little studied. We interviewed a purposive sample of 25 Swedish people in their mid- to late sixties and early seventies, many of whom were or had recently been working while claiming an old-age pension. The data were analysed with constant comparative analysis in which we described and refined categories through the writing of analytic memos and diagramming. We observed that paid work took place within a particular material, normative and emotional landscape: a stable and secure pension income decommodifying these workers from the labour market, a social norm of a retired lifestyle and a looming sense of contraction of the future. This landscape made paid work in these years distinctive: characterised by immediate intrinsic rewards and processes of containing and reaffirming commitments to jobs. The oldest workers were able to craft assertively the temporal flexibility of their jobs in order to protect the autonomy and freedom that retirement represented and retain favoured job characteristics. Employed on short-term (hourly) contracts or self-employed, participants continually reassessed their decision to work. Participation in paid work in the retirement years is a distinctive second stage in the late career which blends the second and third ages.

For older people mobility and participation in activities can be restricted both by individual factors and by the environment. The aim of this paper was to examine the longitudinal impact of measures taken in the outdoor environment on an ageing population. The following factors were examined on three occasions over a nine-year period: frequency of walking; differences in report on environmental barriers; and reported valuation of the outdoor environment; and how these relate to different characteristics. At the second follow-up, the respondents experienced more functional limitations and more were using mobility devices than at baseline. At the first and second follow-up, the respondents did not experience as many environmental barriers in their outdoor environment compared to baseline. However, frequency of walking and evaluation of the outdoor environment decreased in general between baseline and first- and second follow-up. A quite promising result from the study is that compared to people not using mobility devices, mobility device users were more likely to be frequent walkers at first- and second follow-up than at baseline. Likewise, at second follow-up respondents having functional limitations were less likely to experience traffic barriers than at baseline. In terms of accessibility, usability and mobility for an ageing population, the results are promising, showing that measures in the outdoor environment can possibly facilitate walking for those who are more fragile, even in a longitudinal perspective.

‘Caring for carers’ is high on the United Kingdom policy agenda for community care. Although recent policy advocates the provision of services directly to the carer, research suggests that an alternative way of helping carers is through targeting enhanced services towards the cared-for person. This paper reports a randomised controlled trial of the effects on carer distress of an additional specialist clinical assessment for vulnerable older people at risk of residential or nursing home placement. The sample was composed of 142 informal carers of older people, randomly assigned to receive either the additional specialist assessment or the usual social services assessment. Carers were assessed using the modified Social Behaviour Assessment Schedule (SBAS), and data were also collected on older peoples' service use throughout the study period. Regression analyses indicated that changes in older peoples' behaviour, as opposed to carer or service-related factors, predicted changes in carer distress, and that the carers of the older people who experienced depressive symptoms received the greatest benefit from the specialist assessment. The study suggests that an effective means of improving outcomes for carers may be to target services towards the distressing behaviours of the person for whom they care, with symptoms of depression being particularly important.

Nursing homes have been criticised for restricting the lifestyle of older people in need of care. As concepts of elder care have changed and services in formal care have developed further, efforts towards deinstitutionalisation have led to the enhancement of community care models. This paper discusses how ideas of community care can also influence reform within institutional care. The study focuses on the challenges and obstacles of practice change arising in German nursing homes by opening up to civil society principles. Applying the model of organisational hybridisation, the concept of 12 German nursing homes regarding family and community partners' involvement were analysed through explorative qualitative interviews with nursing home directors. The nursing homes have conceived various forms of co-operation with community actors. Nevertheless, emerging tensions between state, market and civil society conceptions of the nursing homes limit practical change. The ‘organisational hybridisation’ has generated two general problems to be discussed here: first, the difficulty nursing homes have in opening their doors to new perceptions of care as well as to the interests of their community partners. Second, the fact that the nursing homes tend either to strive for an integration in community life or for the maintenance of a ‘sheltered zone’ for their residents implies that nursing homes' definition of ‘normality’ has a strong influence on their chosen concept of care.

In Canadian residential long-term care, paid companion services are increasingly viewed as helping to meet older adults’ psycho-social needs. Complementing the critique of these services from a political economy perspective, analyses of companions’ talk about their work can illuminate not only why companions stay in devalued and often invisible work, but also how social assumptions and circulating narratives about nursing homes and older adults are implicated in this process. In this article, we draw on in-depth analyses of interviews with both companions and organisational representatives. We interpret companions’ accounts in relation to their need to justify the necessity for their work to their employers (families), to nurture good relationships with the facilities in which they work, and to maintain a sense of identity as a responsible, conscientious and ‘caring self’. In this way, these precarious workers inadvertently reproduce dominant narratives, including those that stigmatise dementia and residential care, and facilitate the privatisation of person-centred, relational care. Organisational representatives generally reproduce similar assumptions about care responsibilities, in a context in which facilities are increasingly challenged to meet a range of resident needs. Discussion highlights tensions around responsibility for psycho-social care in nursing homes, highlighting organisational vested interests in avoiding risk and downloading responsibilities to families and to private, independent and temporary workers.

The North American post-war generation, known as the baby-boomers, has challenged traditional family relations and the sexual division of labour. How do these challenges play out in the face of frail, ill or disabled family members? A study undertaken in Montreal, Quebec, with baby-boomer care-givers aimed to raise understanding of the realities of this group. We met with 40 care-givers for a one and a half-hour qualitative interview to discuss their identification with their social generation, their relationship to care-giving, their values regarding care-giving, and the reality of the care-giving they offer. The findings indicate that women, in particular, no longer identify themselves mainly in terms of family. For most, care-giving is not their only or even their dominant identity. They are actively trying to maintain multiple identities: worker, wife, mother, friend and social activist, alongside that of care-giver. They are also participating in the very North American process of individualisation, leading to what we call the ‘denaturalisation’ of care-giving. Notably, the women we met with call themselves ‘care-givers’ and not simply wives, daughters or mothers, denoting that the work of care-giving no longer falls within the realm of ‘normal’ family responsibilities. These care-givers thus set limits to their caring commitments and have high expectations as to services and public support, while still adhering to norms of family responsibility for care-giving.

European welfare states used to be based on the principle of the family. Since the 1990s, however, ‘individual responsibility’ has been promoted, which fundamentally alters the traditional welfare-institutional framing of the family and the corresponding construction of the social citizen. One policy field that has been heavily influenced by this development is old-age security. The literature assumes a convergence towards institutional individualisation. We show this however to be incorrect. We empirically analyse and classify welfare-institutional change in old-age security with regard to individualisation. An innovative methodological approach for institutional analysis allows a nuanced identification of the welfare-institutional trends towards individualisation of the social citizen above pension age both within and between welfare states. We conclude that there has been no general and no partial convergence towards individualisation. Instead, on average, family elements in old-age security have either increased or persisted. Also, our analysis suggests that welfare-institutional change with regard to family is far from being a linear process and in part even displays contradictions.