Since 1997 ageing research in the United Kingdom (UK) has been promoted through a series of research council special programmes with an emphasis on multi-disciplinary, collaborative, user-focused research. There has been notable progress and substantial setbacks, especially a major lull in activity, and strong disciplinary biases in later programmes. Skills, expertise and influence on policy and practice, developed through early programmes, have been lost. Two philosophies of programme management have emerged: a top-down approach to the development of priorities and activities, largely reflecting a linear model of research, development and diffusion; and, a bottom-up approach strongly influenced by the priorities of users including older people, which has emphasised the role of problem-solving and social interaction between researchers and users. A comparison of these two philosophies highlights factors which contribute to successful programme implementation and valuable outcomes for society at large. These emphasise: involvement of all potential users; encouragement of champions; supporting researchers at all stages in their careers; transparency in communicating intent, progress and achievements; varied and robust knowledge transfer; and, above all else, understanding the challenges faced by individuals as they grow older. Future programmes would be assured of making significant contributions to supporting older people and an ageing society if those commissioning the programmes recognised the importance of these factors and accepted the consequent challenges for the organisation of the programmes.

With the on-going ageing of the United States population, resolving health disparities continues to be a prominent and worthwhile goal, particularly in the areas of promoting minority health and reducing racial/ethnic disparities. This analysis employs the 2004 and 2005 Household Component records from the Medical Expenditures Panel Survey, which correspond to data files H89 and H97, to examine utilisation by race across the entire distribution function; more specifically, applying the behavioural model of health services utilisation and employing a Quantile Regression (QR) framework. This is a noteworthy contribution because the conditional mean may not be the best approximation for a skewed-location distribution. In contrast, QR is robust to outliers and scale effects since the estimation minimises least absolute deviation. The sample consists of 2,525 older adults at least 65 years of age with 303 corresponding to Black and 2,222 corresponding to White. Results suggest older Blacks continue to utilise health services (i.e. office or clinic visits with a physician or medical provider) at lower levels and this is more pronounced at and below the median quantile (i.e. below the 50th cut-off). Usual source of care (USC) continues to play an important role. Beliefs surrounding the need for insurance and medical intervention are also significant and explain some of the racial disparities. Although utilisation disparities persist for older Blacks, collaborative and flexible models of care can reach this group.

This study examined the cross-sectional association of bone and joint diseases with health-related quality of life (HRQoL) among 850 randomly sampled people aged 60 or more years in a rural area of Bangladesh. Information about arthritis, back and joint pain was collected through self-reports and two physicians' assessments at a health centre. Health-related quality of life was measured using a multi-dimensional generic instrument designed for older people that has questions on the construct's physical, psychological, social, economic, spiritual and environmental dimensions. Bivariate analyses showed that the most negative effects of bone and joint diseases were on the physical and psychological dimensions. Hierarchical linear regression analyses revealed that joint pain, whether doctor-diagnosed or self-reported, and self-reported back pain were all associated with lower HRQoL scores and accounted for almost 20 per cent of the variation (adjusted for age, sex, education, marital status, household size, income, expenditure and occupation). The analyses further revealed that women with self-reported back pain had significantly lower psychological, environmental and overall HRQoL scores than equivalent men, while self-reported joint pain was associated with significantly lower scores only for the environmental dimension. The strong association of bone and joint diseases with HRQoL underscores the importance of regarding these illnesses as public health problems.

Previous studies indicate that occupation might affect cognitive functioning in late life. As people in low- and middle-income countries often have to work until late life, we sought to investigate if there are cognitive benefits to working later into life and whether cognitive function deteriorates after exiting the labour force. We analysed longitudinal data from the Mexican Health and Aging Study (MHAS), a nationally representative sample of Mexican adults age 50+ (N = 7,375), that assessed cognitive functioning by verbal learning, delayed recall and visual scanning. Analyses were carried out using mixed-effects modelling corrected for the influence of gender, instrumental activities of daily living, diabetes, stroke, hypertension, depression, income and marital status. Results suggest that working actively, compared to exiting the workforce, was associated with cognitive performance only in context with occupation. Domestic workers had a faster decline in verbal learning (b = −0.02, p = 0.020) and delayed recall (b = −0.02, p = 0.036) if they continued working actively and people working in administration (b = 0.03, p = 0.007), sales (b = 0.02, p = 0.044) and educators (b = 0.03, p = 0.049) had a slower decline in visual scanning if they continued working in old age. Our findings indicate that continued participation in the labour force in old age does not necessarily come with cognitive benefits. Whether or not working actively in later life protects or even harms cognitive functioning is likely to depend on the type of job.

Recent research on young onset dementia (formal diagnosis at age <65) evidences emerging work around pre-diagnosis, diagnosis and the need to improve post-diagnostic support for this group. An increased awareness of young onset dementia has led to the establishment of peer-support groups, support networks and the involvement of people affected by dementia in research. However, the need to join up services at the systems level persists. Third-sector organisations that offer post-diagnostic support at the community level rely heavily on volunteers. Implications for policy and practice are that community-based commissioning of integrated services between health care, social care and the third sector would go a long way to providing the continuity and stability required in dementia support and care along the illness trajectory. This discussion document was written in collaboration with diagnostic services, the charity sector and conversations with people living with, and affected by, dementia.

Home equity represents a substantial share of retirement wealth for many older persons, particularly in Asia where national housing policies have encouraged home-ownership. This paper explored the potential for reverse mortgages to help ‘asset-rich and cash-poor’ older Singaporeans unlock their home equity while ageing in place. The empirical analysis was based on a nationally representative survey of home-owners age 50+ in the 2018 Singapore Life Panel (N = 6,258). Our analyses showed that the average older home-owner holds some 60 per cent of total net wealth in housing equity, suggestive of high demand potential for reverse mortgage products. Nevertheless, actual interest in such products was much below potential demand. Only one in four older home-owners indicated interest in commercial reverse mortgages if these were to become available; a larger majority had never heard of the financial product. Interest in reverse mortgages was positively associated with product awareness and self-rated product understanding. This implies that a critical step towards building consumer interest would be to enhance awareness of such products and simplify related contract terms. Having a mortgage, fewer children, financial literacy and preparedness for retirement were also positively associated with interest level. These results have implications for targeted interventions to enhance consumer awareness and spur interest in reverse mortgages, especially in ageing societies where older people have built up substantial equity through the housing market over time.

Adult children with siblings can share caring for older parents but adult only children face this responsibility alone. Given increased longevity and reliance on informal care-giving, as well as an increase in one-child families, there is a need to investigate only children's care-giving further. Using data from three large-scale British birth cohorts, this paper investigates patterns of parent-care, care intensity and wellbeing at ages 38 and 42 (N = 17,255, N = 16,703; born 1970), 50 and 55 (N = 12,775, N = 11,339; born 1958) and 63 (N = 2,364; born 1946), how sibling composition intersects with gender in relation to care-giving and whether different care-giving patterns are associated with wellbeing. Only children are more likely to provide parent-care and the pattern is consistent with an interpretation that differences by sibling status might increase with age. Provision is gendered, and the sibling group composition matters for involvement. Although care-giving is related to wellbeing, we found no evidence that this differs between only children and those with siblings. The literature on only children has hitherto focused largely on childhood, suggesting that on some outcomes they benefit from a concentration of parental resources. Our results suggest that in middle adulthood parental care needs may instead be concentrated for the only child without the ‘resource’ of siblings. This indicates a need to develop further our understanding of this growing demographic subgroup.

Independent mobility is an important component of healthy ageing. Public transit may be an affordable way to achieve independent mobility, and yet little is known about older adults’ transition to public transit. This paper addresses this research gap by providing an exploration of older adults’ experiences transitioning to public transit use, and by comparing these experiences to those of older people who have always travelled using transit. Twenty-four older adults (65+) living in Hamilton, Canada, who use public transit completed semi-structured interviews during which they discussed their experiences when they first began to use transit. These experiences are framed herein with the concept self-efficacy, i.e. how one's belief in their ability to complete a task shapes their ability to complete said task. Results indicate that most older adults acquire skills to transition to public transit, such as trip planning, boarding, knowing where to sit and exiting the bus. These skills are developed through practice. As one gains experience, one becomes more confident in their ability to meet their daily travel needs using transit. Therefore, the transition to public transit as an older adult can be more challenging for those with little experience using public transit. This paper highlights the danger of assuming all older adults will effortlessly take up transit and stresses the importance of older adults gaining experience using public transit.

Financial abuse is a significant form of elder maltreatment and is frequently ranked in the top two most common forms of abuse perpetration. Despite this, it is under-identified, under-reported and under-prosecuted. Financial institutions, such as banks, are important environments for identifying and responding to the financial abuse of older people. Traditionally, banks have not always been part of inter-sectorial responses to financial abuse, yet are important stakeholders. The aim of this study is to explore perceptions and experiences of financial abuse in five national banks. Data were collected from 20 bank managers and five members of the National Safeguarding Committee in the Republic of Ireland. Using thematic analysis, four themes were identified: defining a vulnerable adult; cases of financial abuse of vulnerable adults; case responses to financial abuse of vulnerable adults; and contextual issues. The data demonstrate the multiplicity of manifestations and the complexity of case investigation and management. Findings point to the need to enhance banks’ responses, through additional education and training, and promote integrated inter-sectorial collaboration. In addition, a change in societal beliefs is needed regarding financial entitlement, responding to ageism, public awareness of the consequences of financial decisions and types of financial abuse, as well as ensuring such crimes are addressed within the legal system.

We present a meta-evaluation of the literature on the impacts of active labour market policies for unemployed people over 50, extracting 82 impacts for analysis. The meta-evaluation includes only impact evaluations that examine both a group of beneficiaries and a control group of comparable non-beneficiaries. On average, we find that active policies have a slightly negative effect (−0.8 percentage points) on the probability of unemployed people over 50 finding a job and that this negative effect disappears 24 months after policy implementation. However, this effect is very different when disaggregated by policy type. Direct job creation policies have a clear negative effect (−3.9 percentage points), and training policies have a positive average effect, either in isolation (2.4 percentage points) or when combined with search assistance or counselling (1.7 percentage points). We also find slight differences by gender, with the effect of active policies being greater for women than for men. These results have important implications, given that the European Commission and the Organisation for Economic Co-operation and Development have made active policies the cornerstone of their efforts to improve the re-employment of older people. Our results support training policies, either in isolation or in combination with search assistance and counselling. The greatest impacts are obtained after 12 months of policy implementation.

In response to the rising financial pressure on old-age pension systems in industrialised economies, many European countries plan to increase the eligibility age for retirement pensions. We used data from Sweden to examine whether (and if so, how) retirement after age 65 – the eligibility age for basic pension – compared to retiring earlier affects older adults’ (between ages 70 and 85) cognitive functioning. Using a propensity score matching (PSM) approach, we addressed the selection bias potentially introduced by non-random selection into either early or late retirement. We also examined average and heterogeneous treatment effects (HTEs). HTEs were evaluated for different levels of cognitive stimulation from occupational activities before retirement and from leisure activities after retirement. We drew from a rich longitudinal data-set linking two nationally representative Swedish surveys with a register data-set and found that, on average, individuals who retire after age 65 do not have a higher level of cognitive functioning than those who retire earlier. Similarly, we did not observe HTEs from occupational activities. With respect to leisure activities, we found no systematic effects on cognitive functioning among those working beyond age 65. We conclude that, in general, retirement age does not seem to affect cognitive functioning in old age. Yet, the rising retirement age may put substantial pressure on individuals who suffer from poor health at the end of their occupational career, potentially exacerbating social- and health-related inequalities among older people.

Person-centred care requires improved documentation of nursing home resident wellbeing, e.g. by nursing staff proxy assessments. Previous studies mainly focused on proxy self-report agreement of quality of life of people with dementia, using lengthy questionnaires. This is the first study to investigate how well nursing staff assess residents’ wellbeing after training, using a single-question assessment method of happiness and engagement. We conducted a cross-sectional mixed-method study, including proxy assessments from 49 nursing staff, and self-reports from 49 nursing home residents without dementia (mean age 85). We explored agreement between colleagues, and between proxy assessments and self-reports, and potential nursing staff characteristics associated to this (age, experience, hours worked per week). Brief written motivations were evaluated on nursing staffs’ understanding of the happiness and engagement concepts. The results showed low agreement between colleagues, and low agreement between proxy assessments and self-reports. Nursing staff assessed happiness and engagement substantially higher than residents’ self-reports. Hours worked per week was related to happiness proxy assessments, but none of the included nursing staff characteristics were related to proxy self-report agreement. Nursing staff interpreted the concepts in diverse ways. Overestimating resident wellbeing when using this single-assessment method may undermine subsequent efforts to improve wellbeing. We could not identify which nursing staff could best provide wellbeing assessments. For now, proxy wellbeing assessments should always be combined with regular self-reports whenever possible.

There is some evidence in the literature of increased demand on health services by adults with psychiatric morbidity. Among people over retirement age these associations appear weaker. Results from three independent, but comparable, surveys of elderly people living in London and Essex are presented in relation to their use of health and social services. Psychiatric morbidity was found to be a poor predictor of service use. Level of functional ability and, in some cases, age were both stronger predictors of use of a selection of these services among the two samples from the urban area. Age was a stronger predictor of use of home help and meals on wheels services among the younger urban sample aged 65–85. The model had little explanatory power in relation to use of general practitioner services. The study also indicated that the semi-rural sample had better reported health status and functional ability than the samples in the urban area. Use of health and social services was also lower in the semi-rural areas.

Educational gerontology is a comparatively new field of study. In British terminology, it concerns learning in the later years and the methodology relating to this. This special issue of the American journal Educational Gerontology provides an opportunity for reflection on the current state of the art on both sides of the Atlantic. Huey B. Long of the University of Oklahoma, as Guest Editor, invited contributors (eight American and one British) to speculate on likely developments in the field of educational gerontology during the period 1990 to 2010. Not all the authors accepted the challenge and four of the nine papers are considered here.

This paper discusses several changes in mother-daughter relationships in Turkey and their association with changing social conditions. It is based on in-depth interviews with 30 older mothers and their adult daughters. As a country experiencing rapid urbanisation, westernisation, military coups and economic crises, Turkey provides an increasingly changing setting for the investigation of inter-cohort changes in inter-generational relationships. Most of the mothers in the study were born during the 1930s, soon after the foundation of the Turkish Republic. They grew up during an era of material scarcity, restrictive social norms and few opportunities for advancement, and lived in a relatively homogeneous and stable social context. Most of the daughters were born during the 1950s; they grew up at a time of rapid social change and political turmoil but relative material abundance, and were exposed to consumerism and individualistic values that emphasised personal achievement and independence. The ideals and opportunities of the mothers’ youth conflicted with those presented to their children, and the goals of and approaches to parenting became unstable and a source of anxiety. The daughters were caught between their parents’ and their children's demands, which produced conflicts between their ideals and reality, and many experienced internal and inter-personal conflicts. Both mothers and daughters attributed differences in their personalities and parenting styles to the changing times.

The overall aim of this grounded theory study was to explore the context of a nursing home as ‘home’ from the perspective of residents and staff. Sixteen focus group interviews were used to collect qualitative data from nursing home residents (N = 48) and staff (N = 44). Five distinct categories captured the views and experiences of participating residents and staff. These were: (a) Starting off on the right foot, ‘First impressions can be the lasting ones; (b) Making new and maintaining existing connections, ‘There is great unity between staff and residents’; (c) The nursing home as home, ‘It's a bit like home from home for me’; (d) Intuitive knowing, ‘I don't even have to speak, she just knows’; and (e) Feeling at home in a regulated environment, ‘It takes the home away from nursing home’. Together these five categories formed the basis of the core category ‘Knowing me, knowing you’, which captures the experiences of participants who repeatedly highlighted the importance of relationships and feelings of mutuality and respect between and among staff and residents as central to feeling at home in a nursing home. The reciprocity and mutuality associated with the core category, ‘Knowing me, knowing you’, was at times challenged by staff shortages, time constraints, and conflicting priorities associated with the co-existence of a regulated and homely environment.

As detailed knowledge on multigenerational migrant families is sparse, this paper draws on quantitative and qualitative data to investigate intergenerational co-residence for older Turkish immigrants in Denmark. Registry data show that 23 per cent of Turkish immigrants in the 65–74 years age group live in intergenerational households – a level halfway between levels in Denmark and Turkey. These extended households are predominantly of the ‘culturally ideal’ type – formed by sons, sons’ wives and often the couple's children. One in five extended households, however, includes unwed sons and hence do not provide access to the labour power of daughters-in-law. Many factors seem to contribute to the observed pattern, including variable meanings of intergenerational co-habitation, high levels of poverty and limited housing options for extended families. Interviews with older Turkish immigrants point to another contributing factor, namely men's difficulties finding wives willing to live with parents-in-law. The sons’ hardships in this regard can be tied to a Danish immigration regime that bars marriage migrants from entering into extended households. While Turkish women raised in Denmark do not face such legal restrictions, such young women may reject marriage proposals entailing in-law co-habitation. The study thus adds new nuances to our understanding of how the dynamics of age, gender and immigration experience may shape the ways in which older immigrants live in Europe today.

This study investigates the impact of non-intensive and intensive supplementary grandparental child care on grandparents’ involvement in leisure activities. Three aspects of leisure activities are investigated: the number/frequency of activities, with whom they are carried out and the subjective satisfaction with them. Beside the possibility of a cumulation effect, the literature suggests that providing grandparental child care might compete with other activities, especially for women. Thus, we consider role enhancement and role strain theories to derive our hypotheses. We use longitudinal data from the German Ageing Survey (DEAS) which contains rich information on the leisure activities of people aged 40 and older. To account for selection into the provision of grandparental child care, we use a within-unit estimation approach (fixed-effects panel models). Our results show that both grandfathers and grandmothers tend to engage in more leisure activities when they provide grandparental child care. While care-giving grandfathers become more likely to engage in activities with family members without changing their engagement outside the family, we found no effect for women in this respect. Nevertheless, grandparental child-care provision modifies satisfaction with leisure activities only for women, reducing it, independently from with whom leisure activities are carried out. These findings suggest that a higher quantity of leisure activities does not necessarily imply higher quality.

Life expectancy in China has increased. This paper explores the age when older adults (aged 60 and above) consider themselves to be an ‘older person’ and how age-related loss of resources (five dimensions: early cumulative factors, decline and loss of health resources, reduction and loss of economic resources, weakening and loss of social support resources, and personal role transition and experiences of losing family members) could impact their perceived old age. Using two waves of data from the China Longitudinal Ageing Social Survey (CLASS) in 2014 and 2016 (6,244 participants in 2014 and 2,989 participants in both 2014 and 2016), we found that the mean perceived old age is around 70 years at baseline (2014). Higher level of educational attainment and occupational types (early cumulative factors), better health condition, receiving support from friends and taking care of grandchildren are significantly associated with the perception that old age begins at an older age at baseline, while being Han-Chinese, being an urban resident (early cumulative factors) and reporting better health condition have significant positive effects on the perception that old age begins at an older age in the later wave. Our findings suggest that the age standard of older adults should be adjusted dynamically in response to social development and longevity, and also highlight the importance of early cumulative factors in shaping the ageing process besides age-related factors.