Research suggests that adult children are less likely to provide care to community-dwelling parents when beds in residential care settings are more widely available. The underlying mechanisms are not well understood. Drawing on data from the Survey of Health, Ageing and Retirement in Europe (SHARE) on 1,214 impaired parent–child dyads from 12 countries, we find that adult children are less likely to provide care in countries where beds in residential care settings are more widely available because (a) parents’ care needs are less severe in such countries (out-selection hypothesis) and (b) adult children and impaired parents are less likely to share a household in such countries (in-selection hypothesis). Finally (c), after taking these two factors into account, adult children remain less likely to provide care in countries where beds in residential care settings are more widely available (diffusion of responsibility hypothesis). Plausibly, being able to rely on residential care undermines adult children's sense of urgency to step in and provide care to their parents.

This article calls for a sociological understanding of the importance of trust to aged care. It connects existing theories of trust to empirical evidence from gerontology and nursing research. Trust is defined as a response to and management of social vulnerability. It is argued this makes trust a fundamental concept for understanding human service and social care institutions, including aged care. In light of Australia's Royal Commission into Aged Care Quality and Safety, as well as generational shifts in consumer expectations and care ethics, the article highlights four distinct yet interrelated forms of trust: interpersonal, institutional, organisational and public trust. All of these forms are shown to be critical in conceptualising and evaluating the perceived trust deficit facing contemporary aged-care systems, and existing evidence shows how these forms of trust can reinforce, conflict and misalign with each other. Efforts to rebuild trust in aged care at an organisational and institutional level should ensure mechanisms facilitate rather than hinder the formation of interpersonal trust relations between individual service users, their families and aged care staff. Broader social policy reforms must also consider and address the way cultural understandings of ageing, and media representations of aged care, have diminished the public's trust in the sector, and how the cycle of scandals, reviews and piecemeal reforms contributes to this.

The aims of this paper are to investigate both older people's views about ways in which to finance health-care costs and their willingness to pay for treatment themselves, along with variations in these views by age and gender. The data are from the Good Ageing in Skåne (GAS) prospective longitudinal cohort study in Sweden, which involved medical examinations and a survey of living arrangements and socio-economic conditions. For the analysis reported in this paper, 930 GAS respondents aged 60–93 years were invited to participate in an additional structured interview, and 902 (97%) accepted. The sample was divided into the ‘young-old’ (aged 60–72 years), ‘old-old’ (78–84 years) and ‘oldest-old’ (87–93 years). It was found that the participants recommended increasing health-care funding by higher taxes and that they were willing to pay themselves for specific treatments, e.g. cosmetic surgery and medication to combat impotence and obesity. Many were also willing to pay privately for cataract surgery, to shorten the wait, although the respondent's financial circumstances associated with this willingness. Significantly more men than women, and of the ‘young-old’ than of the other two age groups, would pay for cataract surgery. The views of people aged 85 or more years differed from those of the young-old, e.g. significantly fewer believed that older people's health care received too little resource. Views about how to finance health care thus differed among the age groups and between men and women.

Day care centres intend to improve the quality of life of disabled older adults. The aims of the paper are to: (a) examine the extent to which users of day care centres experience higher levels of quality of life compared to their peers who are non-users; and (b) to explore the relationships between the length of use and frequency of weekly attendance at day care centres and quality of life. This is a case-control study with a sample of 817 respondents, of whom 417 were users of day care centres and 400 were non-users, matched by age, gender and family physician. The study was conducted in 12 day care centres in the southern region of Israel. Data collection included face-to-face interviews using a structured questionnaire. Quality of life was found to be significantly related to the use of day care centres, but length and frequency of attendance were insignificant in explaining quality of life among users of day care centres. The study demonstrated that users of day care centres have a higher quality of life, but in a cross-sectional study we cannot prove causality. Therefore, more research using quasi-experimental and longitudinal research designs is necessary to assess causality between use and attendance at day care centres on users' quality of life.

This study examined which of the identified health, psychological, social and environmental mediators could most effectively explain the socio-economic status (SES)-based differences in participation in exercise among elderly Japanese. The candidates for mediators were composed based on the socio-ecological model. A representative sample of people 65 years and older living in two areas with different residential SES in Tokyo, Japan produced 739 effective participants. The intensity of exercise was evaluated based on whether the participants exercise for 30 minutes or longer twice a week, or for 20 minutes or longer three times a week. SES was evaluated by education and income. Mediators were assessed through four dimensions: (a) health, (b) psychological status, (c) social relations and (d) environmental context. As a result, SES's indirect effect through the mediators was evaluated using a multiple mediator model. The influence of both education and income on exercise was mediated by self-efficacy for exercise and social support for exercise. Self-efficacy for exercise had the strongest effect, while social support for exercise explained more of the income differences affecting participation in exercise than it did regarding educational differences. Self-efficacy for exercise may have the strongest effect as a mediator, which would explain the differences in participation in exercise among elderly Japanese based on education and income.

Ethnic inequalities in health and wellbeing across the early and mid-lifecourse have been well-documented in the United Kingdom. What is less known is the prevalence and persistence of ethnic inequalities in health in later life. There is a large empirical gap focusing on older ethnic minority people in ethnicity and ageing research. In this paper, we take a novel approach to address data limitations by harmonising six nationally representative social survey datasets that span more than two decades. We investigate ethnic inequalities in health in later life, and we examine the effects of socio-economic position and racial discrimination in explaining health inequalities. The central finding is the persistence of stark and significant ethnic inequalities in limiting long-term illness and self-rated health between 1993 and 2017. These inequalities tend to be greater in older ages, and are partially explained by contemporaneous measures of socio-economic position, racism, and discrimination. Future data collection endeavours must better represent older ethnic minority populations and enable more detailed analyses of the accumulation of socio-economic disadvantage and exposure to racism over the lifecourse, and its effects on poorer health outcomes in later life.

The purpose of this study was to conduct a descriptive analysis of multiple dimensions of religious belief and practice among older people in Japan with data from a nationwide sample. Six dimensions were evaluated: religious affiliation, involvement in formal religious organisations, private religious practices, the functions of prayer, belief in punishment by supernatural forces, and beliefs about the afterlife. In addition to describing these dimensions for the sample as a whole, tests were performed to see if they varied by age, sex, marital status, education and for those living in rural or urban areas. The findings suggest that even though older people in Japan are not highly involved in formal religious institutions, they engage frequently in private religious practices, and that while many older people in Japan do not endorse some religious beliefs (e.g. about the quality of the afterlife), there is strong adherence to others (e.g. beliefs about punishment by supernatural forces). It was found that older women are more deeply involved in religion than older men, and that levels of religious involvement appear to be higher in rural than in urban areas. Less pronounced differences were found with respect to age, but compared to the ‘young-old’, the ‘oldest-old’ aged 75 or more years were more deeply involved in those aspects of religion that take place outside formal institutions.

Population ageing and discourses on healthy ageing have led to a growing interest in social dancing for seniors. While senior dance has been described as both common and contributing to good health, the fundamental connection between bodily and temporal dimensions has been fairly neglected. As a result, there is a risk of portraying dance among older adults as a general practice, while at the same time the senior dance's potential to shed light on relations between temporality and ageing is not utilised. Based on qualitative interviews with 25 women and eight men, aged 52–81, in Sweden, whose main leisure activity was dancing, this article sheds light on this knowledge gap by illustrating the pleasurable experiences of senior dance. The results illustrate that the pleasurable experiences of dancing can be understood as three different experiences of temporality: embodied experience of extended present, an interaction with synchronised transcending subjectivities and age identities with unbroken temporality. The results also highlight the central role that temporal aspects play in processes around subjectivities in later life, as well as the close connection between ageing embodiment and temporality. They also illustrate the ability of dance to create wellbeing, not only through its physical elements, but also through the sociality that constitutes the core of dancing. In light of these results, the article argues that the temporal processes relate to individuals’ diverse relationship with the world and that they therefore play a central role in subjective experiences of ageing.

Older adults are more susceptible to adverse health outcomes during and after a disaster compared with their younger counterparts. Ageing-in-place organisations such as senior centres and Villages provide social services and programming for older adults and may support older adults’ resilience to disasters. This study examines the role of ageing-in-place organisations in building disaster resilience for older adults. Semi-structured interviews were conducted with a purposive sample of 14 ageing-in-place organisation leaders in King County, Washington in the United States of America. The sample included representatives of five government-run senior centres, seven non-profit senior centres and two Villages. Interviews were audio-recorded and professionally transcribed. We used a combined inductive and deductive approach to code and thematically analyse the data. Ageing-in-place organisation leadership recognise disasters as a threat to older adults’ health and safety, and they see opportunities to provide disaster-related support for older adults, though the type and extent of participation in resilience-building activities reflected each organisation's unique local context. Organisations participate in a variety of disaster-related activities, though respondents emphasised the importance of collaborative and communication-focused efforts. Findings suggest that ageing-in-place organisations may be best equipped to support older adults’ disaster resilience by serving as a trusted source of disaster-related information and providing input on the appropriateness of disaster plans and messages for the unique needs of older adults ageing-in-place.

This paper develops knowledge of the logistics of moving house amongst older people living in insecure housing. These people typically do not move once and settle into a new house, but face ongoing moves driven by factors including housing affordability, tenure conditions and eviction. The paper identifies four domains of experience faced by people undergoing cumulative, involuntary residential moves: the material (process of relocating oneself and possessions), economic (costs of moving house), embodied (physical experience) and affective (how relocation is experienced and felt). The logistics of relocation are examined through the experiences of single older women living in insecure housing in the greater Sydney region of Australia. The accounts of these women foreground the costs and challenges of insecure housing that are a consequence of relocation. Conceptually this work contributes to understandings of mobility-based disadvantage in older age through drawing out the ways that the logistics of moving house – of relocating oneself and possessions – contribute in distinct ways to mobility-based disadvantage through risks to identity and senses of home. Empirically it addresses gaps in gerontological and housing scholarship through developing knowledge of the logistics and experiences of ongoing, involuntary residential moves.

Services providing practical support are a key component in the spectrum of social care assisting older people to age in place. Te Puāwaitanga o Ngā Tapuwae Kia Ora Tonu/Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ), a longitudinal study of Māori and non-Māori in advanced age, aims to determine predictors of successful ageing and to understand trajectories of health and wellbeing. This paper investigates whether household living arrangements (living alone or with others) might explain previously reported gender and ethnic differences in support service utilisation. We had shown that women and non-Māori received more services than men and Māori despite better health. The results of analyses in this paper show that, as expected, poorer physical function led to increased service use. After controlling for functional status, household living arrangements (living alone) were the next strongest driver of service use. In a fully adjusted model, previously observed differences around gender and ethnicity were no longer significant predictors of support service use. However, gender and ethnicity do shape living arrangements in advanced age. Women in advanced age are more likely to live alone, consequently needing more outside support, whereas men are more likely to have a spouse/partner able to provide care. Māori are more likely to live in multigenerational households, the care available at home meaning they are less likely to qualify for formal support. This study points to a need for understanding how gender and ethnicity interact with living arrangements and suggests that inequities may not be absent when the presence of others in a household renders an older person ineligible for formal care.

Food insecurity among elderly people is a major public health concern due to its association with several health conditions. Despite growing research and implementation of diverse income-based policy measures, food insecurity among elderly people remains a major policy issue in Canada. Additional research could inform food policy beyond strategies that target improving the financial resources of elderly people. Drawing data from the Canadian Community Health Survey (N = 24,930), we explored the correlates of food insecurity among older adults using negative log-log logistic regression techniques. Our findings show that certain categories of elderly people are more prone to food insecurity. These segments include seniors who are visible minorities (OR = 1.29, p < 0.01), live alone (OR = 1.13, p < 0.05), have a very weak sense of community belonging (OR = 1.40, p < 0.001), in poor physical health (OR = 1.20, p < 0.01), and those in lower age and income categories. These findings corroborate previous studies that demonstrate that food insecurity among elderly people is a complex phenomenon influenced by diverse socio-economic factors. In Canada, food security policies targeted at elderly people have largely prioritised poverty alleviation through income support programmes. While these programmes can improve the purchasing power of elderly people, they may not be sufficient in ensuring food security. There is a need to embrace and further investigate an integrated approach that pays attention to other contextual socio-economic dynamics.

Being dependent on homecare potentially threatens a person's integrity and autonomy, particularly when people are dependent on help to manage basic bodily functions that involve intimacy and nudity, making the person vulnerable despite being in his or her own home. As the population continues to age and live longer, more people are expected to be dependent on homecare. The aim of this study was to investigate the phenomenon of dependence on homecare among people ageing at home. Individual in-depth interviews were used to explore 15 Danish and Norwegian homecare receivers’ experiences of dependence on homecare. Interview records were transcribed and analysed in a hermeneutical phenomenological process described by van Manen. First and foremost, the experience of dependence on homecare is a question of adaption. The older people in this study struggled to get used to their deteriorating body and at the same time they continuously had to negotiate to get care in accordance with their values. Being dependent on care could be experienced as being reduced to a task or a problem to be solved though the participants had a significant need for undivided mental attention. The presence of homecare staff in the participants’ homes could entail a change where the participants experienced that they lost control over the surroundings. According to the voices of the older people in this study, future homecare should be accommodated in an organisational set-up that gives priority to stability and continuity in the relation between the homecare receiver and the homecare staff. Also it is significant that homecare staff do not have a task-oriented approach to their job and are sensitive to the values of the homecare receivers.

The benefits of exercise are well documented, nevertheless, physical activity decreases progressively with age, a trend exacerbated in those who have fallen. An important predictor of exercise behaviour is the extent to which motivation for exercise has been internalised into one's identity, however, we know little about changing health behaviours in older people, with calls for longitudinal studies to aid understanding. Grounded in self-determination theory, the present study explored the role of self-talk in the process of identity change during the initial ten weeks of an exercise referral falls prevention programme. Six participants identified at risk of falling completed weekly measures of their physical activity-related cognition and identity; in-depth interviews were completed at course commencement and ten weeks later. During this initial phase of the behaviour change programme, participants developed stronger physical activity identities, with themes reflecting a transition from a physically impaired and negative self to a more future-orientated, capable and integrated self-identity. Concurrently, autonomy-supportive and competence-reinforcing self-talk significantly increased, with non-significant increases and decreases in controlling and amotivational self-talk, respectively. The data suggest that self-talk may be usefully conceptualised as a process through which social messages are interpreted and internalised to integrate a new behaviour into one's existing self-concept.

The global population is ageing and the likelihood of living alone increases with age. Services are necessary to help older people living alone to optimise health and wellbeing. This systematic review aimed to summarise the effectiveness and accessibility of interventions to improve the health and wellbeing of older people living alone. Relevant electronic databases (CINAHL, MEDLINE, PsycINFO and Scopus) were searched for all years up to August 2018. Studies were included if they involved older people (aged ⩾55 years) living alone, and an intervention with measured health and wellbeing outcomes. All study types were included. The Theory of Access was used to assess interventions across dimensions of accessibility, availability, acceptability, affordability, adequacy and awareness. Twenty-eight studies met the eligibility criteria; 17 studies focused on ageing safely in place and 11 on psychological and social wellbeing. Studies comprised quantitative (N = 19), qualitative (N = 4) and mixed-methods (N = 5) approaches. Dimensions from the Theory of Access were poorly addressed in the studies, particularly those of higher-quality methodology. Studies were heterogeneous, preliminary in scope and lacked consistent study design, methodology or measurement. Services that do not address user accessibility in design or evaluation may be limited in their uptake and impact. It is recommended that dimensions of access and co-creation principles be integrated into service design processes and be evaluated alongside clinical effectiveness.

Singapore has an age-based mandatory retirement policy for taxi drivers. In 2006, the upper age limit of mandatory retirement was raised from 70 to 73 years for healthy, older taxi drivers. Retirement from taxi driving in Singapore often results in simultaneous retirement from work and forced driving cessation due to limited private vehicle ownership. While both retirement from work and driving cessation have been found to have negative implications for health and wellbeing in Western countries, little is known about the effects of mandatory retirement and driving cessation for healthy professional drivers in an Asian context. This study aimed to explore the mandatory retirement experience of older Singaporean taxi drivers, aged 70–73 years. In-depth interviews were conducted within a descriptive phenomenological approach with 23 older Singaporean taxi drivers who were retired or retiring drivers. Findings showed the experience to be dominated by retirement from work issues rather than by driving cessation. Three themes described the experiences: ‘stories of taxi driving’, ‘feeling lost in retirement’ and ‘contradictions of growing old in Singapore’. Taxi driving was a valued role. Despite an expected retirement, most participants were not prepared for the retirement transition. They struggled with emotional adjustment, financial vulnerability, identity, reduction in life-space and meaningful activity participation. Participants felt under-valued despite having personal achievements and support from family and ‘successful ageing’ policies. Work remained a preferred activity despite limited re-employment opportunities. The unique context of expected but forced retirement, financial need in a non-welfare system, high cultural value on work, and limited options for productive or meaningful activities and roles, predisposed this sub-group of older Singaporean men to be vulnerable retirees in terms of identity and wellbeing issues. Support for a stressful late-life transition is indicated for continued health and wellbeing.

Fifty elders, 61–91 years of age, identified and evaluated the important people in their lives. Characteristics which typified good relationships in general were reciprocity, trustworthiness, friendliness and responsibility. Highest mean scores on the semantic differential scale were found for friends, lowest for neighbours. Significant differences between these two groups indicates that they cannot be combined. Grandchildren did not appear to play a central role in the lives of this group of elders. Spouses gave each other low ratings relative to other groups of supporters. If replicated in a larger sample, the possibility should be investigated that respondents may evaluate intimate relationships on a different ‘psychological yardstick’ than other relationships and relatively low evaluations may not indicate marital dissatisfaction.

The main purpose of this paper is to evaluate the innovative nursing home voucher scheme that was introduced by the Valencia Autonomous Region of Spain in the early 1990s to implement targets laid down by the national plan for the development of older people's services. The article begins with a review of the evolution of Spanish social services, and especially the nursing home sector, and then summarises the genesis, objectives and characteristics of the voucher scheme. The main part of the paper reports a performance analysis and economic evaluation of the programme. On the basis of detailed information over four years, it is concluded that nursing home vouchers have contributed to the increased supply of publicly-financed rooms, have promoted equality of access to the service, and have increased user choice. It is also shown, however, that while vouchers can lead to an increase in the quality of inputs, they increase utilisation and expenditure. In the absence of the monitoring or reporting data that would be required, it is not possible to determine whether the scheme has increased efficiency, in the sense of improving the quality of life of frail older people at reasonable and containable cost.

Optimal mobility is fundamental for healthy ageing and quality of life. This study is part of a cross-sectional population-based study of 85-year-old people residing in Linköping municipality, Sweden. The purpose was to describe 85-year-old peoples' health-related quality of life (HRQoL) in relation to mobility and fall risk while adjusting for gender and body mass index. Data collection included a postal questionnaire, a home visit and a reception visit. HRQoL was assessed with EQ-5D-3L, mobility with the Timed Up and Go test (TUG) and fall risk with the Downton Fall Risk Index (DFRI). All those who completed the DFRI, TUG and EQ-5D-3L were included in the present study (N = 327). Lower HRQoL was associated with longer time taken to complete TUG and higher fall risk in both genders but not with body mass index. Women had higher risk of falling, took a longer time to complete TUG and reported less physical activity compared with men. Health-care professionals should address mobility capacity and fall risk in order to maintain quality of life in elderly people. This is of utmost importance, especially for elderly women because impaired mobility, high risk of falling and occurrence of pain are common among women, and related to lower HRQoL.