Older male care-givers play an increasingly important role in informal care-giving, yet they have received little attention in the literature. The aim of this study was to explore the impact of care-giving on the experience of spousal intimacy for older male care-givers. Twenty-four older male care-givers, drawn from a region of the United Kingdom, participated in one-to-one interviews about their care-giving role. Thematic analysis was used to analyse data, and the study was underpinned by theories of masculinity. Three main themes were identified: (a) ‘Impact of care-giving on the experience of sexual intimacy’; (b) ‘Impact of care-giving on the experience of emotional intimacy’; and (c) ‘Not up for discussion’. When sexual intimacy declined, some older male care-givers prioritised emotional intimacy; some struggled with the decline; and some were reluctant to discuss the issue. Additionally, some care-givers reported that they had not received support from external support providers for declining sexual or emotional intimacy. Intimacy has been highlighted as important for care-givers given its link with care-giver wellbeing and quality of life. Results of this study suggest that sexual and emotional intimacy was an issue for older male care-givers, and that this issue should be considered by external support providers as part of a holistic assessment of need in order to tailor effective support.

The literature on socio-economic variations in the association between retirement timing and health is inconclusive and largely limited to the moderating role of occupation. By selecting the sample case of Mexico where a sizeable number of older adults have no or very little formal education, this study allows the moderating role of education to be tested properly. Drawing on panel data for 2,430 individuals age 50 and over from the Mexican Health and Aging Study (MHAS) and combining propensity score matching models with fixed-effects regressions, this article investigates differences in the health effects of retirement timing between older adults with varying years of education. Subjective health is measured using a self-reported assessment of respondents’ overall health and physical health as a reverse count of doctor-diagnosed chronic diseases. The results indicate that early transitions into retirement are associated with worse health outcomes, but education fully compensates for the detrimental association with subjective and physical health, while adjusting for baseline health, demographics and socio-economic characteristics. In conclusion, formal education during childhood and adolescence is associated with a long-term protective effect on health. It attenuates negative health consequences of early retirement transitions. Policies and programmes promoting healthy and active ageing would benefit from considering the influence of formal education in shaping older adults’ health after the transition into retirement.

It is known that the education of significant others may affect an individual's mortality. This paper extends an emerging body of research by investigating the effect of having highly educated adult children on the longevity of older parents in Europe, especially parents with low educational attainment. Using a sample of 15,015 individuals (6,620 fathers and 8,395 mothers) aged 50 and above, with 1,847 recorded deaths, over a mean follow-up period of 10.9 years from the Survey of Health, Ageing and Retirement in Europe (SHARE), we examine whether the well-established socio-economic gradient in mortality among parents is modified when their adult children have higher educational attainment than their parents. We find that having highly educated adult children is associated with reduced mortality risks for fathers and mothers with low educational attainment, compared to their counterparts whose adult children have only compulsory education. The association is stronger in early older age (ages 50–74) than in later older age (ages 75 and over). Part of the association appears to be explained by health behaviours (physical (in)activity) and health status (self-rated health). Our findings suggest that the socio-economic–mortality gradient among older parents might be better captured using an intergenerational approach that recognises the advantage of having highly educated adult children, especially for fathers and mothers with only compulsory education.

The article is based on a study of how social media and other types of online representations of nursing homes are described by staff. The study proceeds from a qualitative thematic analysis of 14 interviews with nursing-home representatives. The article addresses a key finding that was apparent in the interviews: the online representations’ form and content were adjusted to fit the demands of residents’ relatives. Given the peripheral role attributed to relatives in official Swedish eldercare policies, the motives for the online representations are systematically examined. Two motives are found to be central: marketing and assurance. Residents’ relatives, specified as adult children, were perceived pre-admission as customers in charge of the process of choice and placement; post-admission, relatives requested proof that social activities were provided for their parents. The article discusses how online representations strategically construct a version of ‘reality’ by adjusting to relatives’ unrealistic expectations, only showing residents as involved in social activities. Finally, the need to examine the actual role of relatives in Swedish eldercare is discussed.

In the context of worldwide ageing, increasing numbers of older people are lonely, isolated and excluded, with serious implications for health, and cognitive and physical functioning. Access to good public transport can improve mobility and social participation among older adults, and policies that improve access and promote use, such as concessionary travel schemes, are potentially important in promoting healthy and successful ageing. Concessionary travel schemes for older people are in place in many countries but are under threat following the global financial crisis. Evidence regarding their success in encouraging activity and social participation is generally positive but based largely on qualitative or observational associations and, in particular, is often limited by the lack of appropriate comparison groups. We use changes in the English statutory scheme, in particular the rising eligibility age from 2010 onwards, as a natural experiment to explore its impact on older people's travel. A difference-in-difference-in-difference analysis of National Travel Surveys (2002–2016) compares three age groups differentially affected by eligibility criteria: 50–59 years (consistently ineligible), 60–64 years (decreasing eligibility from 2010) and 65–74 years (consistently eligible). Compared with 50–59-year-olds, bus travel by 60–74-year-olds increased year-on-year from 2002 to 2010 then fell following rises in eligibility age (annual change in weekly bus travel: −2.9 per cent (−4.1%, −1.7%) in 60–74- versus 50–59-year-olds). Results were consistent across gender, occupation and rurality. Our results indicate that access to, specifically, free travel increases bus use and access to services among older people, potentially improving mobility, social participation and health. However, the rising eligibility age in England has led to a reduction in bus travel in older people, including those not directly affected by the change, demonstrating that the positive impact of the concession goes beyond those who are eligible. Future work should explore the cost–benefit trade-off of this and similar schemes worldwide.

Extra-care housing (ECH) has been hailed as a potential solution to some of the problems associated with traditional forms of social care, since it allows older people to live independently, while also having access to care and support if required. However, little longitudinal research has focused on the experiences of residents living in ECH, particularly in recent years. This paper reports on a longitudinal study of four ECH schemes in the United Kingdom. Older residents living in ECH were interviewed four times over a two-year period to examine how changes in their care needs were encountered and negotiated by care workers, managers and residents themselves. This paper focuses on how residents managed their own changing care needs within the context of ECH. Drawing upon theories of the third and fourth age, the paper makes two arguments. First, that transitions across the boundary between the third and fourth age are not always straightforward or irreversible and, moreover, can sometimes be resisted, planned-for and managed by older people. Second, that operational practices within ECH schemes can function to facilitate or impede residents’ attempts to manage this boundary.

This paper presents the experiences of formal carers working in technology-enriched supported accommodation for people living with dementia, examining their care-giving role from a person-centred care perspective. Within a qualitative study, 21 semi-structured interviews were conducted with formal carers and data were analysed following a thematic approach. Four main themes were identified that mapped to the attributes of the person-centred practice framework (PCPF): promoting choice and autonomy, staffing model, using assistive technology and feeling that ‘you're doing a good job’. Central to person-centred practice in these settings was the promotion of choice, autonomy and independence. The dichotomy between safety and independence was evident, curtailing the opportunities within the environmental enablers and associated embedded assistive technologies. Formal carers reported considerable job satisfaction working in these settings. The small-scale, home-like facilities seemed to have a positive effect on job satisfaction. These findings are relevant to policy makers, commissioners and service providers, highlighting the facilitators of person-centred care in community dwellings for people living with dementia and the role of formal carers in promoting this approach.

Social exclusion amongst rural-dwelling older adults and the role of the diversity of people and places in mediating the construction of that exclusion has not been adequately investigated or conceptualised in the international literature. Consequently, how ageing in a rural community can function to disadvantage or protect older people remains poorly understood. With the aim of advancing conceptual understanding on rural old-age social exclusion, this article explores how exclusion is manifest in the lifecourse experiences of rural-dwelling older adults and the role of mediating factors in the construction of exclusion in different kinds of rural places. The analysis draws on ten rural case-study sites across Ireland and Northern Ireland, encompassing five kinds of rural communities: dispersed rural; remote rural; island rural; village rural; and near-urban rural. Data come from 106 interviews with older people ranging in age from 59 to 93 years. Rural old-age social exclusion is confirmed as a multi-dimensional construct, involving: social relations; service infrastructure; transport and mobility; safety, security and crime; and financial and material resources. This analysis demonstrates that social exclusion for rural-dwelling older people is multi-layered, and its prevalence and form is shaped by four mediating factors: individual capacities; lifecourse trajectories; place; and macro-economic forces. The findings are used to present a conceptual framework that emphasises the role of mediating forces on rural old-age social exclusion.

An inclusive neighbourhood is a key facilitator enabling older adults to age in place. Neighbourhoods have been identified as a dimension of social exclusion important to older adults, and it has been argued that older adults are particularly vulnerable to neighbourhood change. The aim of this study was to explore older adults’ experiences of neighbourhood exclusion within the context of neighbourhood change. Focus groups were undertaken in the urban and rural areas of a metropolitan borough in England involving a total of 41 older adults, with data analysed via thematic analysis. Urban areas in the borough studied have transformed following the closure of the mining industry, with a high level of deprivation in many areas, while some rural areas have undergone gentrification. Within the context of structural neighbourhood change, four themes were identified: community cohesion, political agency, feelings of safety and the physical environment. The themes were interlinked, which calls for collaboration across traditional lines of professional responsibility, and for research that encompasses different aspects of neighbourhood exclusion. This study contributes with knowledge on older adults’ experiences of exclusion, including novel findings on the importance of political agency and collective memory, and identifies actions to combat exclusion. An active involvement of older adults in the development of initiatives to tackle social exclusion is recommended.

Scientific research has made great progress towards a better understanding of the determinants and consequences of working after retirement. However, working conditions in post-retirement jobs remain largely unexplored. Therefore, using information on working conditions such as job demands, job control and work hours, we investigate whether working retirees can be categorised by the quality of their jobs. Using data from the Survey of Health, Ageing and Retirement in Europe, we perform latent class analysis on a sample of 2,926 working retirees in 11 European countries. The results point to the existence of two sub-groups of working retirees. The first is confronted with high-strain jobs, while the second sub-group participates in low-strain jobs. Subsequent (multi-level) logit analysis undertaken to describe the two classes further suggests that classification in either group is predicted by the socio-economic status of working retirees and by the context of poverty in old age in the countries in question. We conclude that working after retirement in a high-strain job may be conceptually different from working in a low-strain job.

With increasing life expectancy, changes in family structure and, most recently, the relaxation of the hitherto strict family planning policies, understanding how mid-life individuals support multiple generations, particularly their older parents and younger grandchildren, is of increasing research and policy significance in China. This paper analyses data from the 2011 China Health and Retirement Longitudinal Study (CHARLS) to examine the characteristics of Chinese mid-life individuals aged 45–64 who are potentially being ‘sandwiched’ between providing care to older parents/parents-in-law and/or younger grandchildren (under age 16). Binary logistic and multinomial regression models shed light on the factors associated with providing support to one generation or multiple generations. The results highlight that amongst the Chinese mid-life sandwich generation, 58 per cent only provide care to their young grandchildren, 23 per cent only provide care to their parents/parents-in-law, whilst 15 per cent are simultaneously supporting both generations. Rather than acting as competing demands upon the mid-lifers’ time, the multivariate analysis provides evidence that the provision of intergenerational care is complementary, with caring for grandchildren increasing the probability of also supporting one's parents/parents-in-law, and vice versa. However, an increase in the number of younger grandchildren has a negative impact on the care provided to older parents/parents-in-law, indicating that at higher care intensities there may be competing demands across the generations.

This paper investigates the association between accumulated major lifecourse adversities and later-life depressive symptoms among older people in England, both at a single point in time (prevalence) and the onset over time during later life (incidence), using data from the English Longitudinal Study of Ageing. Using retrospective data on the experience of major life adversities from childhood onwards, five latent classes were identified: no/few lifecourse adversities (58.6%), lost relationship (27.0%), chained adversities (2.4%), childhood adversities (6.3%) and war-related adversities (5.7%). Older people who had experienced ‘chained adversities’, ‘childhood adversities’ and ‘a lost relationship’ had higher odds of presenting current depressive symptoms in 2006, even after controlling for socio-demographic characteristics, health-risk behaviours and social resources. Longitudinal analysis indicated that amongst respondents who were clear of depression in 2006, those older people who had experienced childhood adversities, a lost relationship and war-related adversities experienced a higher risk of having a new case of depressive symptoms. Results further indicate that women's mental health in later life is more sensitive to earlier life adversities than men's. The study shows that intervention earlier in the lifecourse may have benefits for the individual both contemporaneously and over the longer term.

The paper focuses on temporal aspects of informal caring for older people. Limitations of large-scale surveys in capturing such data are noted and time-use methodology, despite its own limitations, is proposed as a promising alternative. Adopting a critical perspective on time that includes carers’ own conceptualisations, we report the findings of a qualitative study of carers’ time use. Sixty-two interviews with carers, male/female, co-resident/not co-resident, employed/not employed, and located across Great Britain were conducted. Analysis considered people's own diverse and ambiguous views of their care activities. Carers’ accounts of their time revealed non-linear experiences and a sense of being permanently on call. Interviewees often travelled distances to engage in support activities with or for older people. Changes over time were pervasive, increasing or reducing care requirements. Unanticipated events could precipitate radical changes in time use. Managing time, exercising temporal agency, was particularly apparent in accounts of care, employment, other family responsibilities and choices about friendship. Measurement of carers’ time use which draws on the conceptual foundation of carers’ own perspectives on time may provide more effective quantitative understanding of the temporal aspects of caring. It should not pre-define time, must grasp a variety of tasks, take account of intermittent activity, incorporate the 24–7 experience of many carers and demonstrate how caring time interacts with other time.

Understanding how social experiences throughout life shape later loneliness levels may help to identify how to alleviate loneliness at later lifestages. This study investigates the association between social relationship adversities throughout the lifecourse and loneliness in later life. Using prospective data from the Medical Research Council National Survey of Health and Development (N = 2,453), we conducted multivariable analyses to investigate independent, cumulative and moderated effects between the number of social relationship adversities experienced in childhood, mid-adulthood and later adulthood and the feeling of loneliness at age 68. We examined interactions between social relationship adversities and current quantity and quality aspects of social relationships. We found evidence of a step-dose response where greater exposure to social relationship adversities experienced at three earlier lifestages predicted higher loneliness levels in later life with more recent social relationship adversities more strongly related to loneliness. The results also demonstrated support for exacerbation and amelioration of earlier adverse social relationship experiences by current social isolation and relationship quality, respectively. This study suggests that social relationship adversities experienced throughout the lifecourse continue to influence loneliness levels much later in life. A key finding is that adverse social relationship experiences in earlier life may explain why otherwise socially similar individuals differ in their levels of loneliness. Implications for policy and research are discussed.

With a large baby-boomer generation entering mid-later life in the United Kingdom, and families spanning across multiple generations, understanding how individuals support multiple generations is of increasing research and policy significance. Data from the British 1958 National Child Development Study, collected when respondents were aged 55, are used to examine how mid-life women and men allocate their time to support elderly parents/parents-in-law and their own adult children in terms of providing grandchild care, and whether there is a trade-off in caring for different generations. Binary logistic and multinomial regression models distinguish between individuals supporting multiple generations, only one generation or none. One-third of mid-life individuals are ‘sandwiched’ between multiple generations, by having at least one parent/parent-in-law and one grandchild alive. Among them, half are simultaneously supporting both generations. Caring for grandchildren increases the probability of also supporting one's parents/parents-in-law, and vice versa. More intense support for one generation is associated with a higher likelihood of supporting the other generation. Good health is associated with caring for multiple generations for men and women, while working part-time or not at all is associated with such care provision for women only. Facilitating mid-life men and women in responding to family support demands whilst maintaining paid employment will be critical in fostering future intergenerational support.

China has been undergoing dramatic socio-economic and demographic changes in the last few decades. The rapid growth of the ageing population will pose tremendous challenges to its public health and social welfare system. This study aims to examine how urbanisation has impacted cardiovascular disease (CVD) risks among middle-aged and older Chinese in two decades, from 1991 to 2011. Data were drawn from a nationwide longitudinal data-set of the China Health and Nutrition Survey (CHNS) (sweeps 1991, 1993, 1997, 2000, 2004, 2006, 2009 and 2011). Participants aged ⩾45 years old were included. A dynamic urbanisation index was created for each community (village or neighbourhood) based on community-level data that can reveal the heterogeneity within and across places and capture dimensions of social, economic and physical characteristics of urban living over time and space. Multi-level modelling analyses (level 1: occasions; level 2: individuals; level 3: households; level 4: communities) were performed on outcomes of CVD risks such as body mass index, waist circumference, and systolic and diastolic blood pressure. The results show upward trends in all CVD risks for both genders over 20 years of urbanisation after adjustment for socio-economic and demographic confounders. Urbanisation in China is associated with absolute increases in CVD risks over time among its middle-aged and older people, despite its contribution to relative reduction of the rural–urban gap over time. This is particularly true for women from the least urbanised areas. It is relevant to inform policy-making processes to target the most vulnerable groups of older people in China during its rapid urbanisation process. There is a possibility for policy intervention to reduce inequality during the process of China's planned urbanisation.

The average expected lifespan in Canadian long-term care (LTC) homes is now less than two years post-admission, making LTC a palliative care setting. As little is known about the readiness of LTC staff in Canada to embrace a palliative care mandate, the main objective of this study was to assess qualities relevant to palliative care, including personal emotional wellbeing, palliative care self-efficacy and person-centred practices (e.g. knowing the person, comfort care). A convenience sample of 228 professional and non-professional staff (e.g. nurses and nursing assistants) across four Canadian LTC homes participated in a survey. Burnout, secondary traumatic stress and poor job satisfaction were well below accepted thresholds, e.g. burnout: mean = 20.49 (standard deviation (SD) = 5.39) for professionals; mean = 22.09 (SD = 4.98) for non-professionals; cut score = 42. Furthermore, only 0–1 per cent of each group showed a score above cut-off for any of these variables. Reported self-efficacy was moderate, e.g. efficacy in delivery: mean = 18.63 (SD = 6.29) for professionals; mean = 15.33 (SD = 7.52) for non-professionals; maximum = 32. The same was true of self-reported person-centred care, e.g. knowing the person; mean = 22.05 (SD = 6.55) for professionals; mean = 22.91 (SD = 6.16) for non-professionals; maximum = 35. t-Tests showed that non-professional staff reported relatively higher levels of burnout, while professional staff reported greater job satisfaction and self-efficacy (p < 0.05). There was no difference in secondary traumatic stress or person-centred care (p > 0.05). Overall, these results suggest that the emotional wellbeing of the Canadian LTC workforce is unlikely to impede effective palliative care. However, palliative care self-efficacy and person-centred care can be further cultivated in this context.

The impact that providing care to ageing parents has on adult children's lives may depend on the long-term care (LTC) context. A common approach to test this is to compare whether the impact of care-giving varies between countries with different LTC coverage. However, this approach leaves considerable room for omitted variable bias. We use individual fixed-effects analyses to reduce bias in the estimates of the effects of informal care-giving on quality of life, and combine this with a difference-in-difference approach to reduce bias in the estimated moderating impact of LTC coverage on these effects. We draw on longitudinal data for Sweden and Denmark from the Survey of Health, Ageing and Retirement in Europe (SHARE) collected between 2004 and 2015. Both countries traditionally had generous LTC coverage, but cutbacks were implemented at the end of the 20th century in Sweden and more recently in Denmark. We use this country difference in the timing of the cutbacks to shed light on effects of LTC coverage on the impact care-giving has on quality of life. Our analyses show that care-giving was more detrimental for quality of life in Sweden than in Denmark, and this difference weakened significantly when LTC coverage was reduced in Denmark, but not in Sweden. This suggests that LTC coverage shapes the impact of care-giving on quality of life.

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.