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.

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.

Older people are increasingly being cared for in the community across Europe. Dependent care in Spain largely remains a private issue involving family carers and migrant women from developing countries. Qualitative research on respite care has contributed to our understanding of respite as a subjective experience. Nonetheless, how care-givers relieve the burden of care is still not fully understood. Migrant care-givers are present in family life but their need for rest remains unseen. The aim of the study presented in this paper was to contrast family care-givers and migrant care-givers' strategies for relief from their caring role. Care-givers rest by thinking, doing and being but in a different manner from that of care-giving, that is: when they are a different person. To leave the life of care-giving is the general strategy that family care-givers use to rest from their care-giving selves while turning to one's own world describes the way migrant care-givers seek to relieve the burden of care. The comparative analysis shows that both strategies have in common the necessity to disconnect from the care-giving identity and that both migrant and family care-givers employ strategies that are false exits to a care-giving identity: they apparently relieve the burden of care. Respite goes beyond places, times and activities; as family care itself, it requires identity.

This study challenges the persistent assumption behind research on intergenerational relationships, wondering: ‘can there be too much of a good thing’? The guiding hypothesis states that intergenerational solidarity, although beneficial for older parents' wellbeing at moderate levels, may be negatively associated with their individual sense of control at high levels. In contrast to previous studies, fixed-effects regression models on panel data from the English Longitudinal Study of Ageing control for selection in solidarity and changes in health. The analysis of 4,811 women and 3,847 men above the age of 50 also accounts for intergenerational conflict. Using multiple dimensions of intergenerational solidarity, our findings offer insight into the different roles of the various types of solidarity and can aid the design of formal and informal social support interventions.

Dementia is a source of growing concern globally, and often impacts on social and communicative functioning. INdependent LIving Support Functions for the Elderly (IN LIFE) was a project carried out within the European Commission Research and Innovation programme Horizon 2020 that resulted in the development of two digital communication aids for reminiscence intervention for elderly people with dementia and their communication partners. The purpose of this intervention study was to investigate the effects on quality of life for people with dementia when using these aids. People with dementia (N = 118) and their formal care-givers (N = 187) and relatives (N = 9) were given the communication aids for a period of 4–12 weeks. To assess a range of outcomes, questionnaires developed within the project were used along with the EQ-5D (European Quality of Life – 5 Dimensions) and QoL-AD (Quality of Life in Alzheimer's Disease) questionnaires. Quality of life improved among people with dementia when measured using EQ-5D (p < 0.05). There was also a correlation between the impact on the participants’ health and wellbeing, the carers’ rating of the usefulness of the digital communication aids and the care-givers’ satisfaction with using technology (p < 0.05). These results indicate that digital communication aids may be useful in social interaction where one partner has dementia.

Having a satisfying sex life is important to older adults. Thus, this study aimed to provide information about the sexual satisfaction of older adults in a relationship, using the Interpersonal Exchange Model of Sexual Satisfaction (IEMSS) as a theoretical framework. Participants were 187 sexually active individuals (98 men and 89 women) in a romantic relationship (age 65–75 years). They were recruited using Amazon's Mechanical-Turk, and completed the Interpersonal Exchange Model of Sexual Satisfaction Questionnaire and two open-ended questions asking what they enjoyed most and least about their sexual relationship. On average, participants were highly sexually satisfied. In keeping with the IEMSS, greater sexual satisfaction was predicted by a more favourable balance of sexual rewards to costs, greater equality of sexual costs and higher satisfaction with the non-sexual aspects of the relationship. Four themes emerged regarding what participants liked most and least about their sexual relationship: emotional aspects of the relationship, physical aspects of the relationship, dyadic aspects of the relationship and age-related aspects of being sexual. None of the four themes were specific to men or women, although some gender/sex differences were found. The results paint a positive picture of the sexual relationships of older adults and support the utility of the IEMSS as a framework to understand sexual satisfaction in older adults.

Care in Chile, as in most Latin American countries, remains largely the responsibility of female family members in informal arrangements with little government support. The analysis of caring for a dependent older person has commonly been approached from the burden of care perspective, focusing on the tasks carried out, the time spent providing care and the negative (burdensome) consequences for the care-giver. This study reveals the daily experiences of family care-givers of older people through a thematic data analysis of 42 interviews with main family carers of an older person as experienced by the carers themselves. Findings highlight the complex nature of care work. Tasks carried out do not necessarily relate to the intensity of the care experience or a negative experience. Care-givers can work long hours providing care and still feel comfortable and find the experience emotionally rewarding. Care-givers might also carry out only a few tasks and experience pressure. The broader social and economic context can generate constraints that make a specific set of tasks easier or harder on the carer, but these contextual factors do not fully explain the experience of care. Relations, and particularly those that carry an emotional component such as the carer-older person, carer-siblings and carer-spouse, must be considered alongside the tasks and the difficulties or potential constraints of the context to understand the care experience.

Much remains unknown about how the 2008 Great Recession, coupled with the ageing baby-boomer cohort, have shaped retirement expectations and realised retirement timing across diverse groups of older Americans. Using the Health and Retirement Study (1992–2016), we compared expectations about full-time work at age 62 (reported at ages 51–61) with realised labour force status at age 62. Of the 12,049 respondents, 34 per cent reported no chance of working full time at 62 (zero probability) and 21 per cent reported it was very likely (90–100 probability). Among those reporting no chance of working, there was a 0.111 probability of unmet expectations; among those with high expectations of working, there was a 0.430 probability of unmet expectations. Black and Hispanic Americans were more likely than white Americans to have unmet expectations of both types. Educational attainment was associated with higher probability of unexpectedly working and lower probability of unexpectedly not working. Baby-boomers experienced fewer unmet expectations than prior cohorts but more uncertainty about work status at 62. Our findings highlight the unpredictability of retirement timing for significant segments of the US population and the role of the Great Recession in contributing to uncertainty. Given the individual and societal benefits of long work lives, special attention should be paid to the high rates of unexpectedly not working at age 62.

Over the last two decades, the concept of resilience has become the focus of a growing body of gerontological research. However, there is a dearth of qualitative research that explores how socio-economic and socio-cultural factors shape older people's resilience. This study addresses this gap and explores the concept of resilience through the lens of 25 Australians from a variety of backgrounds, investigating the resilience strategies they employed in the face of different challenging life events. A qualitative narrative methodology involving one focus group and semi-structured interviews was employed. A stratified convenience sample of 34 people aged 60 and over participated in semi-structured interviews between 2009 and 2011. The study describes the meaning participants assigned to the term resilience, and focuses on the range of resilience responses and strategies they employed, bringing to light some key commonalities and differences. The study's findings suggest that access to economic and cultural resources and the nature of the adversity older people face can shape and limit their resilience strategies. The article outlines how the concept of resilience could be incorporated into aged care practice and argues that resilience-focused interventions that potentially broaden the resilience repertoire of older people should be explored within an aged care context.

Previous studies of the attitudes of nursing staff towards patients in hospitals have suggested that those who were mentally alert, young, acutely ill and in need of medical (not custodial) care, middle class, appreciative and co-operative were labelled ‘good’. Conversely the old, the poor, the chronically ill and the mentally disturbed were labelled ‘bad’. In the study reported here, of a single nursing home situated in the American midwest, these stereotypes are shown not to operate. A subset of these attitudes is none the less to be found which rewards cheerfulness, wittiness and appreciativeness. Favouritism amongst patients is examined as a significant influence on the care of residents who are all elderly and long-term sick.

Studies designed to evaluate the services of a health or welfare institution face the major difficulty of selecting evaluative criteria to serve as measures of successful performance. This paper explores that difficulty in the context of a study of a new psychogeriatric day hospital. The study and its methods of data collection are described. ‘Patient turnover’ features prominently as a measure of success within the hospital. Consultants, nurses, general practitioners, social workers, staff of a related hospital and patients’ relatives interpret this measure in different ways and adopt different strategies to pursue ‘success’ in their own interests. These differences are described. The paper concludes that a ‘pluralistic evaluation’ has several advantages as compared to other approaches.

Population ageing occurs in all industrialised societies and is the demographic phenomenon that currently gets the highest attention from scientists, policy makers and the general public. The main aim of this paper is to broaden our understanding of its societal consequences, such as ageism and intergenerational solidarity. Our study is based on the 2008 investigation of attitudes towards population ageing and older people in seven European countries of Schoenmaeckers et al. We replicate their analysis in a specific human subpopulation in which the process of population ageing started earlier and is much more advanced than in the general societies: the members of Catholic orders. The study compares the attitudes of 148 nuns and monks from three Bavarian monasteries to those of the western German general population using descriptive and multivariate analyses in the context of the debate around population ageing in Germany. We discuss the specific characteristics of order members that might influence their attitudes and also take a brief look at their views on possible political strategies to solve the problems connected with the demographic changes. Our results confirm the findings of Schoenmaeckers et al. and reveal that worldly and monastic populations show an identical basic pattern of a positive attitude towards older people while at the same time considering population ageing a worrisome development. However, order members evaluate older people's abilities and their role in society more positively. This result gives rise to the optimistic perspective that in an aged population the younger and older generations can build a well-functioning society.

Leisure research among the elderly has not kept pace with its significance in their lives. While the centrality of work is often discussed, a comparable role for leisure is seldom acknowledged. Through a blending of life-course and structural-level perspectives this paper discusses the need for conceptual innovation in leisure research. A broader perspective on the nature of leisure, its structure and the emerging need to address leisure as a form of consumption is advocated. Recognition of the identity-affirming nature of leisure and consumption will greatly enhance the focus of leisure research.

Based on previous community research, we prioritise the need to understand better how experiences and feelings of invisibility could be shaped by relational dynamics, interfacing with service provision, and social forces, with the overarching view of understanding better the experiences of participants living with Parkinson's disease. A photovoice methodology was employed. A discussion of one case study of Bindy and Volta leads to a better understanding of how strong spousal support can significantly alter how one individual experiences and defines living with Parkinson's.

The aim of this study was to examine the prevalence of loneliness among older people and to identify risk factors for loneliness in a Nordic regional context over a six-year period. Longitudinal data from the Gerontological Regional Database (GERDA) study of 4,269 older adults living in northern Sweden and western Finland, aged 65, 70, 75 and 80 at baseline in 2010, were analysed. Logistic regressions were used to analyse socio-demographic, social and health-related risk factors at baseline and changes in these for experiences of loneliness at follow-up. The results showed that most older adults (85%) did not experience loneliness at baseline or at follow-up in our study region. However, 3 per cent of the sample reported loneliness in both study years, indicating enduring and chronic loneliness. Analyses revealed that being widowed and becoming a widow/er as well as poor self-rated health at baseline and the onset of depression were risk factors for loneliness. Finally, the risk of loneliness was higher in older people living in Sweden. Further work is needed to explore changes and stability in loneliness as well as to increase our understanding of between-country differences in loneliness.

Using the 1994 Canadian General Social Survey, this study examines the economic effects of retiring because of poor health. When men and women who have retired for reasons of poor health are compared to those who have retired for other reasons, the health retirees are disadvantaged on measures of their health, on human capital variables, in terms of their work history, and ultimately, in their retirement income whether personal or household. The men who retired because of ill health were less likely to receive income from a private pension or from interest and dividends. Almost half of the men reported that their financial situation was worse since their retirement. The women retirees suffered from the same disadvantages as the men although their incomes in retirement were much lower. In the multivariate analyses, health had a significant and negative effect on men's household and personal incomes but there was no effect on the incomes of women. For them, any effect that poor health might have had on household income was offset by factors associated with marriage, and the women's own socio-demographic characteristics. The findings suggest reason for policy-makers to be cautious when contemplating blanket reductions in disability/invalidity and pension rates.

In this paper, we examine the injunction issued by the prominent politician, broadcaster and older people's advocate, Baroness Joan Bakewell, to engage in ‘death talk’. We see positive ethical potential in this injunction, insofar as it serves as a call to confront more directly the prospects of death and dying, thereby releasing creative energies with which to change our outlook on life and ageing more generally. However, when set against a culture that valorises choice, independence and control, the positive ethical potential of such injunctions is invariably thwarted. We illustrate this with reference to one of Bakewell's interventions in a debate on scientific innovation and population ageing. In examining the context of her intervention, we affirm her intuition about its positive ethical potential, but we also point to an ambivalence that accompanies the formulation of the injunction – one that ultimately blunts the force and significance of her intuition. We suggest that Gilleard and Higgs' idea of the third age/fourth age dialectic, combined with the psycho-analytic concepts of fantasy and mourning, allow us to express this intuition better. In particular, we argue that the expression ‘loss talk’ (rather than ‘death talk’) better captures the ethical negotiations that should ultimately underpin the transformation processes associated with ageing, and that our theoretical contextualisation of her remarks can help us see this more clearly. In this view, deteriorations in our physical and mental capacities are best understood as involving changes in how we see ourselves, i.e. in our identifications, and so what is at stake are losses of identity and the conditions under which we can engage in new processes of identification.

Semantic dementia causes progressive communication difficulties that significantly impact on the person and their family. There is a paucity of research examining conversation skills in this condition and associated interventions to support interaction, such as life-story work. This study used a multiple case study design to: (a) explore the everyday conversation experiences of five individuals with semantic dementia and their spouses; and (b) examine how intervention using interaction-focused life-story work could support communication needs. A total of 74 home visits were conducted over a longitudinal period. An innovative combination of conversation analysis of video and audio data alongside biographical interviewing was used. Information derived from these strands was utilised to design an individually tailored life-story intervention. Cross-case analysis examined the contribution of life-story work to interaction and other aspects of care. Results showed that a range of challenges and skills were present within conversation. Life-story work was delivered in all cases using a variety of formats and the work could be conceptualised under various points of connection: interactional, emotional, new, practical and future. Detailed assessment was important to define aims for intervention and appropriate format(s) for life-story work for the individual concerned. Outcomes for communication in this study were not solely about supporting the telling of facts about the person's life but represented a broader focus to facilitate embodied and emotional connections. This study demonstrates that creativity within life-story work is important to foster social interaction, beyond information exchange, using both verbal and non-verbal behaviours. In addition, video data show promise for exploring in-the-moment outcomes for research and practice, particularly to capture the non-verbal dimensions of this work.

As the population ages, older adults are increasingly expected to play multiple productive roles. This study examined how hours of paid or unpaid work were associated with volunteering among older Japanese. Data came from the 2012 National Survey of the Japanese Elderly, a nationwide survey of Japanese aged 60 and older (N = 1,324). We performed multinominal logistic regression analyses to predict volunteering (regular or occasional versus non-volunteer) based on hours of paid work and unpaid work for family consisting of sick/disabled care, grandchild care and household chores. Those who worked moderate hours were most likely to be a regular volunteer while working 150 hours or more per month had a lower probability of volunteering, regardless of whether the work was paid or unpaid. Thus, full-time level work competed with volunteering for both paid and unpaid work for family, but it was more so for paid work. By types of activities, doing household chores and substantial grandchild care were positively associated with volunteering, and the latter complementary relationship was explained by a larger community network among grandparents. Our findings indicate that delaying retirement from full-time paid work may reduce the supply of regular volunteers in the community. Thus, policies to increase part-time work for older adults as well as the types of volunteer work in which paid workers can participate are necessary.