Although the association between falls and fear-of-falling has been established by previous studies, the temporal ordering of the two is uncertain. Moreover, the common and unique risk factors that contribute to falls and to fear-of-falling have not been investigated in either primary health-care settings or Asian societies. The aims of this study were to examine the temporal sequencing of fear-of-falling and a fall, and to identify the risk factors associated with the two. A prospective cohort study with three six-month measurement waves was conducted in primary-care settings in Hong Kong. The sample was derived from the waiting list control group of a randomised clinical trial, and 321 respondents participated in the three waves. They were evaluated with the Minimum Data Set for Home Care. It was found that falls and fear-of-falling at baseline were not independent predictors of respectively developing a fear-of-falling and becoming a faller, but that age was a common independent predictor for falls and the onset of a fear-of-falling. Individuals with a fear-of-falling were at risk of both falling and a fear-of-falling at 12 months. The good news is that no vicious cycle of falls and fear-of-falling was found, and modifiable risk factors, including IADL limitations, environmental hazards, and fear-of-falling were identified, so that effective prevention programmes for falls and for fear-of-falling can be designed.

Older prisoners are the fastest growing sub-group in the English and Welsh prison estate. They have complex health needs, in spite of which there is a dearth of literature concerning their access to prescribed medication. Literature relating to younger prisoners highlights common issues around maintaining continuity of medication upon reception into prison custody. The objective of the study was to explore the lived experience of older male prisoners regarding continuity of medication upon entry into prison. This paper presents findings from part of a large-scale research project regarding health and social care services for older male adult prisoners. Semi-structured interviews were conducted with male participants (N = 27) aged 60 years and over who had been newly received into prison. Interviews were conducted within the first ten weeks of custody. Participants were asked about their experience of accessing medication on entry into prison. Data were analysed using the constant comparison method. Eighty-five per cent of participants were in receipt of prescribed medication when committed to prison. Older prisoners’ experiences of receiving medication in prison were reflected in four key themes: delays in confirming medicines; changes to medication; communication difficulties; and enforced helplessness. Whilst these experiences mirrored those of prisoners of all ages reported in previous studies, these issues are especially relevant to older prisoners who are likely to have greater and more complex medication needs than their younger peers. In addition, older prisoners experienced unmet needs related to restricted mobility and functional skills that could have impaired their ability to maintain concordance with medication regimes. This study shows that there is need for increased awareness of prescribing issues specific to older prisoners to allay related feelings of anxiety and distress and to ensure they receive appropriate medication.

Long-term poverty, precarious employment, low pay, the increased pension age and real-term reductions in welfare benefits, including bereavement allowances, have brought into focus the financial vulnerability of many older women aged 55 years and older in the United Kingdom. In this article, survey data were analysed alongside evidence from observations of debt support meetings and interviews with older women who were receiving debt advice from a support charity. The findings suggest that older women were more likely to have financial problems than older men, particularly those women who were living on low incomes and who were separated or divorced. Following the breakdown of a relationship, many older women were at increased risk of more debt and bankruptcy, particularly those aged between 55 and 64 years and those in routine and semi-routine occupations. Many women had kept their financial problems hidden due to fear and shame whilst bringing up their children and some had been subject to coercive control and economic abuse by their former husbands or partners. It is important that any pension reforms, changes to minimum wage rates, and new divorce and domestic abuse legislation and welfare policies take account of the circumstances of separated, divorced and widowed older women. More financial support and advice needs to be provided to older women facing financial difficulties.

This study examined engagement in leisure activities among older adults, specifically focusing on how life transition factors in later life, including retirement and marital status, are associated with leisure activity engagement using a national sample of older American men and women. We conducted multiple regression analyses with a sample of 5,405 individuals (2,318 men; 3,087 women) from the Consumption and Activities Mail Survey, a supplementary sample of the Health and Retirement Study. We analysed activity engagement in each of four domains of leisure activities: mental, physical, social and religious. Retirement status was categorised into three groups: working (referent), completely retired and partly retired. Marital status was categorised into four groups: married (referent), divorced or separated, widowed and never married. We found an overall trend of a positive relationship between retirement and leisure activity engagement, which suggests that retirement provides a chance for older adults to participate in leisure activities after withdrawal from the labour force. The overall trend of a negative relationship between non-married status and leisure activity engagement suggests that the loss or absence of a spouse may serve as a barrier to participate in leisure activities. Nevertheless, variation among retirees and non-married individuals suggests future studies should compare completely and partly retired individuals or those who are widowed, divorced or separated, or never married to elucidate distinguishable leisure activity profiles.

We describe the findings of a qualitative longitudinal interview study of a group of initially community-dwelling frail older people, and their informal and formal carers. We used a narrative approach to explore the role that narrative may have for people living with frailty. This has been less explored comparative to the experiences of those living with chronic illness. The frail older people told stories of their experiences that revealed three distinct shapes or typologies. These were either stable, unbalancing or overwhelmed, and related to how the person managed to adapt to increasing challenges and losses, and to reintegrate their sense of self into a cohesive narrative. Each is illustrated by an individual case story. Frailty is described as both biographically anticipated yet potentially biographically disruptive as older people may struggle to make sense of their circumstances without a clear single causative factor. Findings are discussed in relation to biographical disruption and reconstruction in chronic illness and the rhetoric around ‘successful ageing’. We conclude by drawing attention to the complex individual and social factors that contribute to the experience of living with frailty in later life.

The paper argues for a theoretical renewal of basic perspectives for ageing research. A longitudinal, ‘historical’ view of the personality is advocated as it is expected to permit a deeper understanding of needs as well as chances for renewal, re-training, prophylactic and rehabilitative measures of and for persons in later life. A psychosocial theory of cumulation of general life conditions and special events, interpreted and reacted to by the subjects, will supposedly enlarge the more static conceptions of ‘social factors of ageing’.

Western countries currently face pressing demands to transform the labour market participation of older workers, in order to address the pressing economic and social challenges of an ageing population. However, in this article we argue that our understanding of older workers is limited by a dominant discourse that emphasises individuals rather than organisations; and valorises youth as the performative aspiration for all workers, regardless of age. To see things differently, and to see different things, we offer a novel analytical synthesis that combines insights from post-foundational feminist theory, the 2007 film No Country for Old Men and an empirical study of older nurses working in the Norwegian public health-care system. Our aim is to provide the foundations for alternative interventions in the world of work that might underpin a more sustainable future for older workers.

The European Communities provide a contemporary naturally occurring laboratory for the comparative study of social policy formation and implementation. This is particularly the case regarding social policies for ageing populations. The substantive focus of this paper is long-term care policy and, more particularly, policy choices regarding relative emphasis on medical in contrast to social care of dependent older adults. The strategy of the paper is to discuss, first, the limits of comparative theories of social policy formation in predicting policies in a highly value-laden topic like long-term care. The paper then summarises factors which may explain the extraordinary but inconclusive attention given to long-term care policy in the United States. Finally, the paper outlines some questions about LTC policy in the EC which would benefit from comparative policy analysis. Particular attention will be directed to the balance of medical and social care for dependent elderly people, the role of housing policy in the context of general care policy, and the generic issue of public and private sector interaction in welfare states. Systematic exchange of LTC information among EC countries and between these countries and the US is encouraged.

Japan is the most rapidly ageing developed country in the world. Economic, political, and social changes will be necessary in the next 20 years as Japan attempts to adjust to the rapid ageing of its population. This paper examines survey responses by Japanese men and women regarding their attitudes toward the ageing of their country's population, concerns about the impact of anticipated demographic changes on their economic well-being in retirement, and preferences among alternative policy options for changes in the Japanese social security programme. Responses to a nationally representative survey, conducted by Mainichi Newspapers in 1992, were analysed. Key findings indicate that: (1) the Japanese are concerned about the impact of population ageing on their economic well-being in retirement, (2) most Japanese anticipate that earnings will be an important source of their retirement income, but they are worried about employment opportunities, (3) they favour increasing social security taxes instead of cutting retirement benefits, and (4) they favour raising the age of eligibility for social security benefits.

Those 85 years of age and older are the fastest growing subpopulation in the United States. Because they represent a very small proportion of the population (just 1% in 1980), the oldest old have not been studied until recently. Much of the interest in this group is related to their growth (over 50% per decade in the past 50 years) coupled with their disproportionate use of public resources, particularly health and social services. Women are strikingly overrepresented among the oldest old, with a gender ratio of approximately 44 males for every 100 females age 85 and older.

Existing tenure trends amongst middle-aged households mean that the next two decades will inevitably see significant increases in the numbers of older home owners in Britain. This paper applies estimates of trends in home ownership amongst older households in England, broken down by age group and household type, to official household projections to derive detailed estimates of the number of older home owners up to the year 2011. Additional data are used to derive estimates of the type and age of dwellings which older home owners will occupy and the amount of unmortgaged equity which they will have available. The paper goes on to discuss the implications of these estimates for a range of policies and academic debates. In future, fewer older home owners will experience poor housing conditions but significant minorities of single older people, many of them women and households headed by a person aged 75 and over, will continue to do so. The amount and effectiveness of investment undertaken in middle age is a key determinant of the conditions experienced in later old age, and factors such as right-to-buy and involuntary early retirement from the labour market in the 1980s and 1990s recessions, will lead to an increase in the number of very old home owners experiencing poor conditions. There will be more demand for mobility but limited equity and the lack of moving opportunities will restrict the extent to which older home owners' aspirations can be realised. The paper concludes that older home owners will face a varied future in the post-Keynesian welfare state, with many pressures to use the wealth tied up in their dwellings to meet welfare needs.

There is lack of research on old indigenous women's experiences. The aim of this study was to explore how old women narrate their experiences of wellbeing and lack of wellbeing using the salutogenetic concept of resilience. Interviews from nine old Sami women were analysed according to grounded theory with the following themes identified: contributing to resilience and wellbeing built up from the categories feeling connected, feeling independent and creating meaning; and contributing to lack of lack of resilience and wellbeing built up from the category experiencing lack of connectedness. The old Sami women's narratives showed that they were to a high extent resilient and experienced wellbeing. They felt both connected and independent and they were able to create meaning of being an old Sami woman. Having access to economic and cultural capital were for the old Sami women valuable for experiencing resilience. Lack of resilience was expressed as experiences of discrimination, lack of connectedness and living on the border of the dominant society. Analysis of the Sami women's narratives can give wider perspectives on women's health and deepen the perspectives on human resilience and increase the understanding of minority groups in a multicultural world.

Much research is conducted to evaluate digital-based solutions for health-care services, but little is known about how such evaluations acknowledge diversity in later life. This study helps fill this gap and analyses participation in the evaluation of a web-based mobile phone system for monitoring the post-operative progress of patients after day surgery. Participation is conceptualised as resulting from three processes: pre-screening, recruitment and self-selection. Based on field information and survey data, this study models (a) the (non-)participation in a sample of 498 individuals aged 60 and older that includes non-screened, non-recruited, decliners and participants in the evaluation, and (b) the individual decision to participate in a sample of 210 individuals aged 60 and older who were invited to take part in the evaluation. Increasing age enhances the likelihood of not being screened, not being recruited or declining the invitation. Those not recruited were most often ineligible because of technology-related barriers. Decliners and participants differed by age, gender, job, health status, digital skills, but not by social participation. Results suggest that highly specific groups of older people are more likely to be involved than others. Old-age diversity is not properly represented in digital health research, with implications for the inclusivity of new digital health technologies. This has implications for increased risks of old-age exclusion and exacerbation of social and digital inequalities in ageing societies.

This paper reports the findings of research funded by The Nuffield Foundation on older people paying the full cost of their long-term residential or nursing home care in England. The research had three stages; a national postal survey directed at the senior finance officer in social services departments, follow-up telephone interviews with a sample of them, and interviews in five case study areas. Those interviewed included social services staff (including a legal adviser), care home providers, self-funding residents and relatives. These self-funding residents were commonly relatively physically independent on admission to the care home. Despite central government directives that needs assessments should be available regardless of a person's means, it is a common policy to encourage older people in this situation to admit themselves directly to care homes without a needs assessment. Wide variation was found in local authority practice in respect to being prepared to make a contract with a care-home provider for older people able to meet the full costs of care.

The number of elderly Commonwealth South Asian immigrants in Britain originating from the Indian sub-continent will grow substantially in the next few years, yet there has been little consideration of this group in terms of academic social research. Indeed, welfare agencies are only beginning to become aware of the possible needs of this group. A survey of the scanty British literature on elderly ethnic minorities reveals the paucity of existing knowledge. However, studies from other countries, notably Japan and the U.S.A., suggest a number of illuminating areas for research. The presence of a culturally distinct Asian ethnic minority group experiencing ageing in British conditions appears to afford a good opportunity to throw further light on an important aspect of gerontological theory: namely the respective weight to be attached to cultural factors, social structure and the degree of societal modernisation in shaping the ageing process of individuals and groups.

Residents of care homes across the globe are affected by the spread of SARS-CoV-2 as they have been identified as a high-risk group and because they experienced strict social isolation regulations during the first wave of the pandemic. Social isolation of older people with poor physical and mental health is strongly associated with mental health problems and decreased life expectancy. Other research has shown that older people managed to adapt to the changes brought about by the pandemic and have linked this to the concept of resilience. The aim of this research project was to investigate how this applied to residents in care home settings during the first phases of the contact ban in Germany from sociology, developmental psychology and environmental gerontology perspectives, and to gain in-depth understanding of residents’ experiences. This paper draws on structured interview data collected from residents in two care homes during early June 2020 in Frankfurt am Main, Germany. The findings show that their experiences were shaped by three factors: care home settings and the approach of staff to handling the contact ban; biographical sense of resilience; and a hierarchy of life issues. The findings highlight the importance of locally specific response mechanisms in care homes, agency and belonging of residents despite health-related limitations and the importance of a critical (gendered) lens on understanding their experiences.

Economists typically argue population ageing generates fiscal pressures by restricting the tax base while increasing demands for social spending. Alongside other economic pressures associated with neoliberalism, this dynamic contributes to a politics of ‘enduring austerity’ that limits governments’ fiscal discretion. The politics of population ageing reflects modelling techniques, such as generational accounting (GA), which, anticipating future deficits, create demands for policy action today to address projected intergenerational inequalities. Taking Australia as a case study, this paper explores the politics of GA in public budgetary processes. While existing critiques reject GA by arguing it relies on ‘apocalyptic’ or unreliable demography, we focus on a different kind of contestation, which applies the techniques and even the categories of GA to frame different problems and promote different solutions. We identify three sites of partisan contest that refocus fiscal modelling: including the tax side of the budget equation; comparing the cost of public provision to public subsidies for private programmes; and including the costs of environmental damage. At each site, the future-orientated logic of GA is mobilised to contest the policy implications of austerity. This complicates analysis that financialisation and neoliberalism necessarily ‘de-politicise’ policy by removing state discretion. Instead, we identify an increasingly important, if technocratic, form of political contestation that offers the possibility to promote more egalitarian responses to population ageing.

The gender gap in family care-giving is an established research finding: men dedicate less time to care-giving and provide specific gendered types of help. This article argues that in order to grasp men's contribution to care arrangements one should recognise the multifaceted nature of care and examine care networks beyond the ‘care receiver–primary care-giver’ dyad with a dynamic perspective. A qualitative analysis of the care networks of three large Dutch families with an older parent in need of care confirms the greater involvement of women in care-giving and men's tendency to provide specific types of care. However, men also contribute to the elasticity and stability of the care arrangement by filling temporary gaps and supporting the female care-givers. This article puts forward the idea that men's contribution is in turn a factor in the perpetuation of the gendered structure of care-giving.

This study examined the causal relationship between knowledge, attitudes and discriminatory behaviour towards older people and further explored age-group differences using multi-group analysis. Data were collected from 1,500 Korean adults aged 20 and older in 2011 using the multi-stage quota sampling method. Trained investigators collected data with a developed survey questionnaire in person and a structural equation modelling method was used for data analysis. Attitudes towards older people was measured using two variables: ‘image of older people’ and ‘prejudice against older people’. The findings revealed that the younger and older generations demonstrated differences regarding the causal relationship between knowledge, attitudes and discriminatory behaviour towards older people. The paths model between independent and dependent variables in the structural equation modelling was non-equivalent in younger and older groups. For both groups, knowledge about ageing and older people led to a positive influence on their image of and prejudice against older people. The effect of prejudice on discriminatory behaviour was significant in the younger group, but not in the older group. Further implications for practice and future research to reduce ageism were discussed.

The older population is particularly susceptible to malnutrition, which currently affects 1.3 million people aged 65+ in the United Kingdom. Malnutrition is an outcome of food insecurity and despite demographic changes that have led to a rise in numbers of older people, we know very little about how older people become vulnerable to food insecurity. The aim of this study was therefore to explore older people's everyday food practices in order to expose the strengths and challenges within local and national food systems, and better understand how food insecurity might arise in later life. This empirical study operationalised practice theory using a multi-method ethnographic approach with 25 households aged 60–94 years, comprising interviews, observation, visual methods and food logs. A model of vulnerability developed by Schröder-Butterfill and Marianti framed data collection and analysis. Analysis revealed the assets and adaptations older households used to protect themselves from threats to food security. Factors ranging from changes to physical and mental health, and structural factors such as supermarket design, moved households towards food insecurity. Smaller everyday ‘trivia’, e.g. lack of seating and accessible toilets in supermarkets, accumulated to shift people towards vulnerability. Vulnerability is structured by the habitus but is a fluid, relational, temporal and socially constructed state, and people moved towards and away from vulnerability. We have developed a model that accommodates this fluidity, incorporates the concept of ‘cumulative trivia’ and suggests how the ‘aggregation of marginal gains’ could counter-balance and address trivial threats. This model demonstrates to policy makers and those working in public health how vulnerability to food insecurity operates and where interventions could be applied to support households to achieve food security and avoid becoming malnourished.