Autonomy is important to persons, including when they are living in nursing homes. Especially the relational dimension of autonomy is crucial for older adults with physical impairments. They generally have the decisional capacity to make choices about how they want to live their lives, but are often unable, or only partially able, to exercise these decisions themselves. To execute decisions, older adults are dependent on those who support them or care for them. However, little is known about how nursing home residents maintain autonomy in daily life and how others are involved in the decisions and execution of the decisions. To examine how older adults with physical impairments living in nursing homes maintain autonomy in daily life, shadowing, a non-participative observational method, was used. Seventeen older adults were shadowed during the course of one day. The observation ended with a brief interview. After the shadowing, the detailed observation notes were typed out, combined with the verbatim transcript resulting in one extensive report per shadowee. All 17 reports were coded and analysed thematically. Six elements for how older adults maintain autonomy in relation with others were identified, i.e. ‘being able to decide and/or execute decisions’, ‘active involvement’, ‘transferring autonomy to others’, ‘using preferred spaces’, ‘choosing how to spend time in daily life’ and ‘deciding about important subjects’. For all six elements established in this study, it was found that older adults with physical impairments living in nursing homes could only maintain autonomy in daily life when others, such as staff, family and friends, were responsive to signals of the needs of older adults.

The continuing COVID-19 pandemic and social restrictions have impacted on the cognitive decline and mental health of people with dementia. Social isolation and loss of activities due to social restrictions may also have implications as to sense of identity for people with dementia. As part of the INCLUDE (Identifying and Mitigating the Individual and Dyadic Impact of COVID-19 and Life Under Physical Distancing on People with Dementia and Carers) component of the IDEAL (Improving the Experience of Dementia and Enhancing Active Life) cohort study, the overall aim of this subtle realist qualitative study was to explore the perspectives of people with dementia on living through the COVID-19 pandemic within the context of the ‘post-vaccine’ period and the national lockdowns in England and Wales; and to determine perceived challenges to and facilitators of ‘living well’ during the COVID-19 pandemic and beyond as restrictions were eased. In addition, the study findings are considered in relation to understandings of identity in dementia which the broader accounts of living through the pandemic have highlighted. Seven people with mild-to-moderate dementia were interviewed and themes were derived using framework analysis. Themes suggest interviewees' stoic acceptance of the pandemic and social restrictions but also fear of decline related to the temporality of their condition as well as loss of self-confidence to re-engage with the world. Interviewees managed threats to social identity by striving to maintain social and emotional connections, where the importance of a shared, social identity, particularly for people with young-onset dementia, was also apparent. Unlike in previous studies during the pandemic, the relevance of occupation for identity was observed, where maintaining previous or new activities or occupations was important to facilitate identity as well as to keep a sense of purpose. Therefore, as well as supporting people with dementia as the pandemic eases, future research into occupation and identity in dementia is of potential value.

Despite the recent policy impetus for age-friendly cities, there is still scope for more geographical insights into ageing in low- and middle-income countries (LMICs). Cities in LMICs, such as Bengaluru (India), are witnessing an increase in the size of the older population in their peripheral urban regions, but there is relatively little understanding of the risks of exclusion in later age in these liminal zones. This study, set in a peripheral ward of Bengaluru, focuses on the experiences of exclusion/inclusion of socio-economically marginalised older adults and their access to work, health care and leisure. The research uses a multidimensional old-age exclusion framework to highlight how the domains of neighbourhood, material resources, mobility infrastructure and social relations influence the risks for social exclusion. We use a qualitative approach by combining behavioural mapping and in-depth interviews. Our findings highlight some ways in which institutionalised exclusion from civic infrastructure accentuates the precariousness of ageing. The rigidity of traditional hierarchies in peri-urban regions has meant that older adults who were poor, women and belonged to marginalised castes experience constrained mobilities to access labour markets, health care and social life, compounding their place-based exclusion. Despite social networks and solidarities, older adults on the periphery faced individualisation of risks while trying to access the basic amenities, thereby falling between the gap of the urban–rural milieu and governance. Age-friendly cities need to accommodate such hybrid transitionary urban processes, in the absence of which, active ageing in these rising peripheries can be impeded.

Evidence on post-diagnostic support for people with young onset dementia is scarce. Previous studies have employed a problem-focused approach; however, evidence on ‘what works’ in real-life practice is essential to develop recommendations for service design and delivery. This study aimed to provide insight into ‘what works’ from the perspectives of people with young onset dementia and their supporters. We gathered free-text responses on positive service experiences via a UK cross-sectional survey. Inductive thematic analysis was used to identify the objectives of positive services and the needs these met. Follow-up interviews enabled in-depth insights from people with diverse diagnoses, ages and social situations. These were analysed using a template drawn from the survey. The 233 survey respondents gave 856 examples of positive support. Analysis of 24 follow-up interviews led to 16 themes clustered under three superordinate themes: ‘maintaining autonomy’, ‘being myself’ and ‘togetherness’. We found that positive services address the disruptions to sense of agency, selfhood and meaningful relationships that are experienced by those with young onset dementia. The study provides an in-depth understanding of the needs met by positive services for younger people with dementia. Our nuanced findings on good practice can inform age-specific guidelines for young onset dementia and indicate how personalisation can work in practice to help people with young onset dementia to maintain identity, autonomy and connections.

Immigrants commonly report difficulties with developing social connections post-transition, which can lead to social isolation as they age. Understanding what factors promote/hinder the social integration of immigrants is an important public health objective. We tested the public health model of social integration of Berkman et al. in a sample of older immigrants. This model calls for considering both the social conditions in which social networks are embedded (upstream influences) and the levels of social support offered by different types of networks (downstream influences). First, we derived an empirical typology of social networks of older immigrants. Next, we tested associations of social networks with upstream and downstream influences. Data came from the New Zealand Health, Work and Retirement Study. The sample included 568 older adults (54% male) who immigrated as adults (mean length of stay = 28.5 years, standard deviation = 12.5). Latent profile analysis was employed on responses to the Practitioner Assessment of Network Type to identify social networks. Associations with upstream and downstream correlates were tested using logistic and multiple regression. Four network configurations emerged: ‘private-restricted’ (43.4%), ‘family-dependent’ (35.8%), ‘locally integrated’ (10.9%) and ‘wider community-based’ (9%). Having shorter length of residence and individualistic cultural background was predictive of being in a restricted network (private-restricted, family-dependent). Being in a restricted network was associated with lower levels of social support. Network type interacted with partner status: having a partner buffered the negative impact of having a restricted network on social support. Although restricted networks are common among older immigrants, they do not necessarily result in compromised social support. While we may see differences across countries regarding the impact of specific upstream and downstream influences, our findings highlight that both contextual and individual-level resources need to be considered alongside network structure to promote social integration of immigrants as they age.

Recent public and policy interventions aim to recognise formally the contributions of family care-givers to long-term residential care in Canada, with some arguing family carers are more than visitors and should be recognised as essential care-givers. These developments call for reconsidering how family care roles are understood and operationalised. Drawing on ethnographic research conducted in three care homes in Ontario, Canada, we present an in-depth feminist rhetorical analysis of the narrated lives and work practices of 12 unpaid family carers. Specifically, we explore how unpaid family carers themselves draw on broader discursive ‘ruling metaphors’ to interpret their roles and activities (e.g. as essential care-givers, visitors, team members), and how these metaphors invoke, organise and/or give rise to particular practices, responsibilities and relations. We contrast the stories of a family member who positioned herself as an essential care-giver and expressed a more onerous sense of individual responsibility with the stories of people who enjoyed the pleasures of visiting, who contributed as team members in ways that went beyond caring for their own relatives' care needs, and who embraced the possibilities that came with volunteering and with being able to influence change. Our analysis situates and contextualises participants' stories of their involvement and unpaid work in relation to their everyday material conditions and circumstances. We elaborate how different ways of understanding caring roles shape the nature of carers' unpaid work, as well as their options to share responsibility or set limits on that work. We also raise questions about the organisational conditions needed to help enact care as a shared collective responsibility.

In recent years, various authorities launched projects that aim to make their cities more age-friendly. Designing age-friendly cities is a complex and context-dependent process that requires clear implementation guidelines for policy makers. As one of the eight domains of age-friendly cities, transportation is a critical component of making our cities more liveable for older adults and their families. This paper contributes to the literature by exploring the travel behaviour of older adults with a focus on the factors that lead to sustainable mobility patterns. Our empirical analysis is based on survey data collected from 1,221 older adults as part of the Age-Friendly Columbus project in Columbus, Ohio in the United States of America. We develop multinomial logistic regression models to investigate the travel mode choices of older adults (auto only, non-auto options only and multimodal (auto and at least one non-auto option)). We include age and built environment characteristics as the key variables, with lifestyle-related factors and socio-demographics as controls in our analysis. We find older respondents were more likely to use autos only compared to younger respondents. Our analysis also reveals significant associations between built environment characteristics and travel mode choices. Interaction effects show that the relationships between built environment characteristics and travel preferences differed by age cohorts among older individuals. The primary contribution of this study is that it provides evidence on what built environmental improvements help to promote sustainable travel among older adults in mid-sized and auto-dependent metropolitan cities. We argue that these improvements contribute to older adults' sustainable mobility, as well as out-of-home activity behaviour, social engagement and individual health. The results of this study may especially benefit non-driver older adults who lack reliable non-auto alternatives for their daily travel.

Mobility research tends to focus on physical movement and experiences in later life; however, changes in older adult mobility over time remains underexplored. Furthermore, older adults typically experience many life events, some of which result from cognitive and physical decline, and many of which impact mobility. This article aims to explore how life events affect the mobility of older adults over time. We conducted in-depth interviews with 22 older adults aged 55 years and over from Lancashire, United Kingdom. Of these participants, eight lived with memory problems. The findings show that both anticipated and unexpected life events play a profound role in the participants' mobility over time. Retirement, long-term illness and age-related illness were examples of anticipated life events, while the death of a loved one and developing memory problems were examples of unexpected life events. In both cases, participants' made external adaptations, such as moving home, or internal adaptations, such as self-awareness. The findings also emphasise the layered nature of life events and adaptations playing a role in the participants' mobility. Additionally, life events such as developing memory problems showed a domino effect, triggering further life events and adaptations which impacted the participants' mobility. This article emphasises how transition periods can occur before or after a life event, showing that adaptations can be pre-emptive to a life event. Our article contributes to calls for internal adaptations to be fully incorporated into age-related policy and also for age-related policy to be more inclusive for older adults who experience memory problems and dementia.

Medical assistance in dying (MAID) is legal in Canada but cannot be accessed through an advance request. Some data suggest that informal care-givers of persons with dementia support the legalisation of advance requests for MAID. Opponents argue that care-givers' support is due to society's failure to address their well-documented burden and unmet needs. To our knowledge, this assumption has never been tested. To fill this knowledge gap, we conducted a survey among 204 Canadian informal care-givers of persons with dementia to (a) elicit their attitudes towards allowing no longer competent adults to access MAID through an advance request, and (b) test the hypothesis that attitudes are in part driven by the level of burden experienced by care-givers and unmet needs for support. Attitudes were elicited with a clinical vignette involving a woman with Alzheimer's disease who requests MAID while still competent, or through an advance request for the time after she would lose decisional capacity. Informal care-givers' support for MAID ranged from 60 per cent in the scenario where the person is still competent and likely has several more years to live, to 87 per cent when she is depicted as no longer competent, in severe distress and close to death. Quality-of-life considerations and the value of self-determination were key arguments in support of legalising advance requests for MAID. Using multivariable logistic regression, we found no evidence that burden and unmet support needs influence attitudes towards advance requests for MAID, after controlling for other determinants. These findings contribute new insights into people's attitudes towards the sensitive issue of whether MAID should be extended to persons with dementia-induced decisional incapacity.

Older adults' participation in gambling is increasing internationally. Due to their lifestage, older adults may be vulnerable to gambling-related harm. When investigating older adults' gambling, researchers have mostly focused on the individual characteristics of ‘problem gamblers’. Less is known about the socio-cultural, environmental and commercial factors that may influence older adults' gambling behaviours. Utilising Social Practice Theory, this critical qualitative inquiry of N = 40 Australian older adults (aged 55 and over) explored how social practices influenced gambling participation. Using a Constructivist Grounded Theory approach, data were interpreted using a reflexive thematic analysis. Theme 1 identified how gambling practices fulfilled older adults' social needs. Gambling was embedded in social activities and created a sense of belonging. Theme 2 highlighted how gambling became an everyday part of some participants' lives, with a range of routines constructed around gambling. While social factors influenced routinised gambling behaviours, the accessibility of gambling products in everyday settings contributed to engagement with gambling. This study demonstrates that a range of social, environmental and commercial factors may influence and routinise the gambling practices of older adults. Interventions aimed at preventing and reducing routine gambling participation among older adults should acknowledge the interplay between agency and social structure. Public health responses should aim to disrupt routine behaviours associated with gambling for older adults.

In most Organisation for Economic Co-operation and Development (OECD) countries, the government has to manage tension between growth in the need for long-term care (LTC) services for older people and significant public budget constraints. Not surprisingly, therefore, cost-containment policies are of increasing relevance. Nevertheless, despite the flourishing interest in the comparative literature in reforms and the sustainability of LTC policies, a scoping review of these measures has so far not been produced. This article aims to contribute to filling this gap. We present a typology of LTC cost-containment policies across the OECD. Cost-containment policies cluster in two areas according to their focus: demand-side policies, which reduce the actual chances of receiving LTC services and/or make them more expensive for users; and supply-side ones, which modify the provision of services. Furthermore, an indirect outcome of the review is that it allows an overview of potential negative implications of these policies. These negative implications can be grouped in two macro spheres relating to a worsening of the care arrangements for beneficiaries and to increased demand for individual/family resources, in both economic and time and effort terms. In the light of the expected profound impacts of the COVID-19 outbreak on all social security sectors in the medium and long term, this article provides a valuable tool for both academic and policy-making debate. It allows an analytical comprehension of cost-containment strategies adopted in LTC sectors linking them with the related impacts on beneficiaries and their families.

Quizzes are a ubiquitous part of the dementia social care landscape. This article explores why. Using an ethnographic approach which draws on close analysis of communication, we examine dementia quizzes as a ‘social practice’, and what such a lens can tell us about their popularity in social care settings. Vignettes of real interactions drawn from ten different quizzes recorded in four different group settings attended by 28 people living with dementia and 15 staff members are presented to highlight particular issues. We show that the conditions of post-diagnosis dementia social care are uniquely well suited to an activity such as quizzes which are malleable, requiring little preparation or materials, and impose a communication framework which can help to organise the interactional space. Quizzes also draw on previously forged interactional competences, such as turn-taking and question–answer sequences, a skill that has been shown to persist even as dementia progresses. Finally, we argue that the meaning of quizzes with people with dementia feeds into wider societal values and associations attached to memory, dementia and personhood. The extent to which quizzes are akin to a ‘test’ or a fun and enjoyable social activity rests in how they are enacted. We suggest that practice can be adapted, developed and made more inclusive through input from people living with dementia themselves.

Whilst ageing in place is integral to international policy, there is less understanding of how individuals utilise formal services and informal supports in diverse rural environments to maintain their wellness and independence. Consequently, how older people negotiate their care within rural communities is subject to misconceptions. This paper draws on the convoy of care model to explore how older rural Australians negotiate their preferences and needs in the context of informal networks, availability of community resources, and the health and aged care system. The analysis draws on 60 in-depth interviews in six diverse rural communities across two Australian states. Three distinct care convoys are identified and demonstrate the interaction of multiple factors including individual preferences and needs, availability of family and community supports, and accessibility of local health and aged care services in the context of resource allocation. The findings highlight how families and communities compensate for a lack of accessible formal services. For older people without family and strong social networks, formal services are relied upon despite their inadequacy in some locales. This research has provided evidence that some Australian rural locales have limited resources resulting in challenges for older people to access home care and support. This results in many older people facing challenges to age in place. With aged care and health policy commonly designed for an urban context, our findings illustrate the importance of tailoring policy to respect the strengths and challenges existing in rural communities.

Research concerning the reciprocal influence of relationships and dementia largely focuses on dyadic relationships despite evidence that whole families are affected. Furthermore, such research generally considers more common forms of dementia such as Alzheimer's disease. Behavioural variant fronto-temporal dementia (bvFTD) primarily although not exclusively affects people below the age of 65 and is distinctly different in its impact from more common forms of dementia, affecting social cognition and therefore relational functioning. We aimed to develop a detailed understanding of intergenerational family experiences of bvFTD over time. We adopted a social constructivist and pluralist approach, using Narrative Thematic Analysis and Grounded Theory. We interviewed seven families in their own homes, including the person with bvFTD, at up to three time-points every six to nine months from 2012 to 2014, resulting in 46 interviews with 19 family members. Three super-ordinate themes were identified: Theme 1: We before bvFTD: cohesive and connected – disconnected and distant; Theme 2: Challenges experienced by us; and Theme 3: Relational outcomes: a changing we – an entrenched we. Results emphasise bvFTD brought early and significant disruption to family relationships. The interplay of prior relational functioning, involving the nature of the relationship for family members, the specific impact of bvFTD on these relationships and family member's understanding of bvFTD was critical to how each family fared over the duration of the research, and the relational outcomes they experienced. These findings suggest health-care practice could enhance its support for families living with bvFTD, through the development of tailored, family-oriented approaches to assessment and practice. Such approaches are necessary to understand how families work together and identify interventions that address the family-specific challenges bvFTD brings. The provision of tailored, relational-focused and specialised information concerning the experience of living with bvFTD is needed to flexibly address families' needs and expectations.

Organisational priorities for health care focus on efficiency as the health and care needs of populations increase. But evidence suggests that excessive planning can be counterproductive, leading to resistance from staff and patients, particularly those living with cognitive impairment. The current paper adds to this debate reporting an Institutional Ethnography of staff delivering care for older patients with cognitive impairment on acute orthopaedic wards in three National Health Service hospitals in the United Kingdom. A key problematic identified in this study is the point of disjuncture seen between the actualities of staff experience and intentions of protocols and policies. We identified three forms of disjuncture typified as: ‘disruptions’, where sequenced care was interrupted by patient events; ‘discontinuities’, where divisions in professional culture, space or time interrupted sequenced tasks; and ‘dispersions’, where displaced objects or people interrupted sequenced care flow. Arguably disruption is an integral characteristic of care work; it follows that to enable staff to flourish, organisations need to confer staff the autonomy to address systemic disruptions rather than attempt to eradicate them. Ultimately, organisational representations of ‘good practice’ as readily joined up, impose a care standard ‘stereotype’ that obscures rather than clarifies the interactional problems encountered by staff.

Although volunteering is considered a good strategy for successful ageing, not many older adults are engaged in voluntary work and those who are do so mainly sporadically. This study focuses on time invested in volunteering rather than on doing voluntary work or not, as is often done in studies so far. By combining the theory of resources for volunteering with a functional and structural approach to volunteering, this cross-sectional study seeks to shed light on a wide range of factors associated with the intensity of volunteering. The study is based on a sample of 1,599 volunteers aged 50 and older participating in the Norwegian study on Life Course, Ageing and Generation Study (NorLAG). The survey includes, among others, detailed information about demographics and time invested in voluntary work and questions about attitudes, motivations, structural and other potential barriers to volunteering. Multivariate linear regression analyses indicate that a religious attitude is associated with elevated hours spent on voluntary work, while co-habitation is associated with a decreased engagement in voluntary work. In addition, people who are motivated to volunteer because they find it interesting and because volunteering allows them to use their competence spend more time volunteering. Human capital, i.e. education, income and subjective health, are not associated with the number of hours invested in voluntary work. The likelihood of contributing more volunteering hours of older men is 17.5 per cent higher than that of older women. We found no indication of a relation between work status, functional limitations, urbanisation or ethnicity and voluntary work engagement. Policies aiming to increase time investment of volunteers should strive for an optimal fit between the nature of the voluntary work and the interests and skills of the volunteers. In designing interventions to stimulate higher engagement in voluntary work, one should further promote strategies for flexible time commitment.

Emphasis placed on Xiao (孝; filial piety) in Chinese culture highlights parents' investment in their children with the expectation of being cared for when older. An increasing number of Chinese students come to the United Kingdom (UK) to study, with the majority returning home and likely to become future care-givers for their parents. Little attention has been paid to the implications of transnational mobility of Chinese students on the reciprocal aspects of future care responsibility. With the uniquely changing family structure due to consequences of the One-Child Policy, we conducted proactive research on the opportunities and challenges that Chinese transnational students anticipate they may face in future care-giving for elderly parents. Hence, this study's aim was to make a novel contribution to knowledge through exploration of the perspectives of Chinese students in England on intergenerational ties and filial obligations. Adopting a social constructivist philosophical position, we conducted three focus groups with 19 UK-based Chinese students, using a semi-structured topic guide with informed consent. Interviews were translated, transcribed and analysed using reflective thematic analysis, capturing semantic and latent meanings, and employed a descriptive and interpretative approach. Six themes were discovered, revealing a ‘culture of duty’ where familial obligation and societal expectations were prominent. Prospective care-givers anticipated a future dilemma between balancing work commitments and providing care as mandated by Xiao. Furthermore, it appeared that lack of preparedness might further exacerbate barriers faced when accessing support. We surmised that the changing demographics and absence of formal support could compound stressors over time, especially if cognitive dissonance arises as realities of life do not fit with societal expectations. Our findings imply that policy makers, practitioners and the government will need to adequately support prospective family care-givers who are returnees in caring for older generations.

Technological interventions are increasingly popular methods of targeting and preventing loneliness in older adults. Research has identified various factors that influence the willingness and propensity of older adults to integrate technology into their social lives and the ways in which this may enhance their social connectedness. Given prevalence rates and negative outcomes associated with loneliness for this population, further research is warranted to clarify the mechanisms through which technological interventions may decrease loneliness. This study aimed to better understand the perspectives of older adults on the role of technology in their social relationships in later life. Four focus groups were conducted with 27 older adults, aged 65–80 years. Transcripts were analysed using thematic analysis, and results were validated via written participant feedback. Participants reported technology as one of many tools used to maintain their social relationships. Their choice to use technology for social interaction was influenced by their estimation of effort required, likely quality of the interaction, and the privacy and security provided. These factors were the same as those that influenced decisions to use other methods (e.g. face-to-face meetings). Based on the results, we recommend that loneliness interventions should be technology-agnostic and multifaceted, providing a wide range of tools that recognise the technological competencies of older adults and supporting different interaction types to meet the preferences of the individual.

Older adults' engagement in various prosocial activities is a salient question in present-day societies that aim to promote active ageing. However, there are only a few studies focusing on associations between several types of prosocial activities, and they have rarely considered help to relatives and friends separately. Moreover, there is lack of studies considering informal monetary help and charity donations when analysing multiple prosocial activities. Using population-based data of older Finns (N = 2,184), we examined whether providing informal help (i.e. practical help, financial support or personal care) to relatives and friends is associated with participation in volunteering and charity, respectively. Overall, 5 per cent of the participants provided all examined forms of informal help and volunteered, 16 per cent provided two types of help and volunteered, and 23 per cent provided one type of help and volunteered. In addition, 9 per cent of the participants provided all types of informal help and made charitable donations, 33 per cent provided two types of help and made charitable donations, and 54 per cent provided one type of help and made charitable donations. Practical help and care channelled outside the household were associated with an increased probability of volunteering, although they were not associated with the probability of making charitable donations. Practical help, financial support and personal care provided to friends were particularly important predictors of volunteering and charity. These results are discussed in the context of the role overload and role extension hypotheses.

Quantitative research on how grandparents fare when looking after grandchildren has mainly focused on general wellbeing indicators, showing that grandparenting is linked to higher wellbeing. However, global assessments of wellbeing reveal little about activity-specific experiences and only indirectly provide insights about how grandparents experience grandchild care. Whereas qualitative studies have observed diversity in grandparenting experiences, quantitative insights regarding potential strains of grandparenting are scarce. This study examines directly to what extent grandparents experience supplementary grandchild care as burdensome and obligatory, and tests – building on role strain theory – how differences in grandparents' characteristics can explain these experiences. Analyses are based on data collected in 2015 and 2018 among 3,429 Dutch grandparents who look after grandchildren. Descriptive findings show that 20 per cent of the studied grandparents experienced grandparenting as fairly/very burdensome and 8 per cent as fairly/very obligatory. Ordinal logistic regression models with random effects show that more-intense grandparenting situations were linked to higher levels of burden and obligation. Moreover, grandparents in poor health, higher education and those with other responsibilities (e.g. paid work) were relatively more likely to experience higher levels of burden and obligation. Our findings imply that the understanding of non-custodial grandparenting as only rewarding might be one-sided, as positive and negative experiences can go together. There appears to be substantial heterogeneity in how grandparents experience looking after their grandchildren.