There has been debate for some years as to whether the best model of care for people with dementia emphasises specialist facilities or integrated service provision. Although the United Kingdom National Service Framework for Older People recommended that local authority social services departments encourage the development of specialist residential care for people with dementia, uncertainty continues as to the benefits of particular care regimes, partly because research evidence is limited. This paper examines a large number of ‘performance measures’ from long-term care facilities in North West England that have residents with dementia. Of the 287 in the survey, 56 per cent described themselves as specialist services for elderly people with mental ill-health problems (known familiarly as ‘EMI homes’). It was envisaged that EMI homes would score higher than non-EMI homes on several measures of service quality for people with dementia that were developed from research evidence and policy documents. The analysis, however, found that EMI homes performed better than non-EMI homes on only a few measures. While both home types achieved good results on some standards, on others both performed poorly. Overall, EMI and non-EMI homes offered a similar service.

This paper examines UK and US primary care doctors' decision-making about older (aged 75 years) and midlife (aged 55 years) patients presenting with coronary heart disease (CHD). Using an analytic approach based on conceptualising clinical decision-making as a classification process, it explores the ways in which doctors' cognitive processes contribute to ageism in health-care at three key decision points during consultations. In each country, 56 randomly selected doctors were shown videotaped vignettes of actors portraying patients with CHD. The patients' ages (55 or 75 years), gender, ethnicity and social class were varied systematically. During the interviews, doctors gave free-recall accounts of their decision-making. The results do not establish that there was substantial ageism in the doctors' decisions, but rather suggest that diagnostic processes pay insufficient attention to the significance of older patients' age and its association with the likelihood of co-morbidity and atypical disease presentations. The doctors also demonstrated more limited use of ‘knowledge structures’ when diagnosing older than midlife patients. With respect to interventions, differences in the national health-care systems rather than patients' age accounted for the differences in doctors' decisions. US doctors were significantly more concerned about the potential for adverse outcomes if important diagnoses were untreated, while UK general practitioners cited greater difficulty in accessing diagnostic tests.

This article examines whether the different welfare states of the European Union member states engender different policy preferences and attitudes among the population. More specifically, it investigates variations in attitudes towards population ageing and pension reforms, and variations in people's retirement age preferences and expectations. It is shown that despite the different cultures and welfare traditions in the old and new member states, there are commonalities in people's value orientations and views about population ageing, not least that the vast majority are pessimistic about the consequences. In both Eastern and Western Europe, the most popular options for pensions reform are to raise taxes and to extend working life, and few favour reducing pension benefits. Despite these similarities, there are also marked attitudinal differences. Eastern Europeans rely more on their children for old-age care and are much more in favour of a pension structure in which benefits depend on the number of children. On personal expectations and preferences for retirement, it is shown that both Eastern and Western Europeans expect to retire from the labour market at an older age than the current actual retirement age.

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