Person-centred provision of long-term care (LTC) requires information on how individuals value respective LTC services. The literature on LTC preferences has not been comprehensively reviewed, existing summaries are contradictory. An explorative, scoping review was conducted to provide a thorough methodological description and results synthesis of studies that empirically investigated LTC preference outcomes based on respondents’ statements. A wide search strategy, with 18 key terms relating to ‘LTC’ and 31 to ‘preferences’, was developed. Database searches in PubMed, Ovid and ScienceDirect were conducted in February 2016. The 59 studies meeting the inclusion criteria were grouped and methodically described based on preference elicitation techniques and methods. Despite substantial methodological heterogeneity between studies, certain findings consistently emerged for the investigated LTC preference outcomes. The large majority of respondents preferred to receive LTC in their known physical and social environment when care needs were moderate, but residential care when care needs were extensive. Preferences were found to depend on a variety of personal, environmental, social and cultural aspects. Dependent individuals aspired to preserve their personal and social identity, self-image, independence, autonomy, control and dignity, which suggests that LTC preferences are a function of the perceived ability of a specific LTC arrangement to satisfy peoples’ basic physiological and mental/social needs. Research on LTC preferences would greatly profit from a standardisation of respective concepts and methods.

The impact of losing a limb in military service extends well beyond initial recovery and rehabilitation, with long-term consequences and challenges requiring health-care commitments across the lifecourse. This paper presents a systematic review of the current state of knowledge regarding the long-term impact of ageing and limb-loss in military veterans. Key databases were systematically searched including: ASSIA, CINAHL, Cochrane Library, Medline, Web of Science, PsycArticles/PsychInfo, ProQuest Psychology and ProQuest Sociology Journals, and SPORTSDiscus. Empirical studies which focused on the long-term impact of limb-loss and/or health-care requirements in veterans were included. The search process revealed 30 papers relevant for inclusion. These papers focused broadly on four themes: (a) long-term health outcomes, prosthetics use and quality of life; (b) long-term psycho-social adaptation and coping with limb-loss; (c) disability and identity; and (d) estimating the long-term costs of care and prosthetic provision. Findings present a compelling case for ensuring the long-term care needs and costs of rehabilitation for older limbless veterans are met. A dearth of information on the lived experience of limb-loss and the needs of veterans’ families calls for further research to address these important issues.

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.

Despite its benefits for prolonging careers, participation in training is far lower among older employees (age 50+) than among younger employees. This study analyses gender differences in older employees’ training participation. To investigate the predictors of training intensity, we examine two forms of training: formal educational programmes and on-the-job training. The study draws on a novel data-set, the European Sustainable Workforce Survey, carried out in nine European countries in 2015 and 2016, analysing 2,517 older employees and their managers, spread over 228 organisations. We concentrate on the interplay between employees’ gender, managers’ gender and managers’ ageism in shaping older employees’ training participation. Our findings indicate comparable training participation of older men and women in both forms of training, yet older women more often pay for enrolment in educational programmes themselves. Also, predictors of training participation are different. In line with the tenet of ‘gendered ageism’, we find that managerial ageism primarily targets older women, excluding female employees from the training opportunities available to their comparable male colleagues. Finally, female managers are associated with higher training participation rates for older employees, but only for older men. This result supports ‘queen bee’ arguments and runs counter to ‘homophily’ arguments. Overall, the study demonstrates that workplace dynamics and managerial decisions contribute to the reproduction of traditional gender divides in the late career.

Over the next 30 years, the number of people aged over 65 will exceed the number of children worldwide. Moreover, people at extreme old age will constitute a significant group of older adults. Undoubtedly, global ageing appears as a great challenge to the whole international community in relation to the protection of rights of older persons, including their right to health. The last one is recognised on international forums as one of the most current and complex issues. Therefore, in this paper, I discuss how the right of older adults to health is protected by international norms, and identify trends and perspectives for implementing this right effectively. Examining the degree of protection, I analyse existing international instruments and their interpretation provided by international bodies. I consider that the new international developments should fill in the existing loophole in international law and oblige States to focus on elimination of ageism, age discrimination in access to health care and various barriers to enjoying the right to health by older persons.

The aim of this interdisciplinary study is to describe and analyse the meaning of love in relationships between couples living with Alzheimer's disease (AD). Despite the wealth of studies describing relationships in the face of AD, little is known about the experience and changing meaning of ‘love’ between spouses when one of them is suffering from AD. A qualitative narrative approach was used to capture what love means for couples when one spouse is living with AD. A combination of open discussion along with a semi-guided interview was conducted with N = 16 spouses of persons living with AD. Data were analysed using Thematic Analysis. A leading theme that emerges from the interviews is that AD provides a significant indicator of the meaning and understanding of the experience of love. Five major types of relationship developments occurred after the disease emerged: love died, love became weaker, love did not change, love was enhanced and the spouse fell in love again. The need for further research is discussed. The findings of this study offer an additional perspective to the existing literature, thereby providing a more comprehensive outlook on marital relationships within the context of AD.

Increasing longevity and the strain on state and occupational pensions have brought into question long-held assumptions about the age of retirement, and raised the prospect of a workplace populated by ageing workers. In the United Kingdom the default retirement age has gone, incremental increases in state pension age are being implemented and ageism has been added to workplace anti-discrimination laws. These changes are yet to bring about the anticipated transformation in workplace demographics, but it is coming, making it timely to ask if the workplace is ready for the ageing worker and how the extension of working life will be managed. We report findings from qualitative case studies of five large organisations located in the United Kingdom. Interviews and focus groups were conducted with employees, line managers, occupational health staff and human resources managers. Our findings reveal a high degree of uncertainty and ambivalence among workers and managers regarding the desirability and feasibility of extending working life; wide variations in how older workers are managed within workplaces; a gap between policies and practices; and evidence that while casualisation might be experienced negatively by younger workers, it may be viewed positively by financially secure older workers seeking flexibility. We conclude with a discussion of the challenges facing employers and policy makers in making the modern workplace fit for the ageing worker.

Although women's appearance is theorised as being central to their identity and social currency, much prior research has argued that as women age, other aspects of their lives assume a higher priority than their appearance. Nevertheless, they continue to invest time in appearance practices. In undertaking these various appearance practices, older women have to negotiate a range of conflicting social norms of age-appropriate appearance, such as managing the balancing act between ‘letting themselves go’, on the one hand, and looking like ‘mutton dressed as lamb’, on the other. This paper contributes to the growing literature on older women's attitudes to their appearance and related practices. Drawing on data from a two-year research project in a hair-salon catering primarily for older clients, I examine the question of the importance to women of their appearance through the lens of their hair-care practices. Focusing on a group of nine female clients aged 55–90 in a small hair-salon in southern England, I show how participants in their talk and embodied presentation display shifting orientations of investment/interest (or lack of interest) in their appearance. Comparing participants’ appearance practices, with their talk in two sequential environments in which a possible interest in appearance is made particularly salient, I argue that these shifting orientations reveal participants’ subtle negotiation of competing social norms of appearance for older women.

To cope with an increased proportion of older workers, organisations develop old-age adaptation policies. Two strategies underlie these policies: phasing out and activating. Although the existence of these strategies is widely recognised, the reasons for their presence have rarely been explored. We identify three arguments that explain the extent to which these strategies are present: profit, principles and pressures. We hypothesise that the intensity of the phasing out strategy is higher when it is profitable and easy to replace older workers, when employer's age norms support the principle of treating older workers differently, and when external pressures are high. We also hypothesise that the intensity of the activating strategy is higher when it is profitable but hard to replace older workers, when the employer's age norms reject the principle of treating older workers differently, and when external pressures are high. We use pooled regression analysis to study imputed managerial data from 5,410 organisations in seven European countries. Results confirm the importance of external pressures for the adaptation of both strategies, and of principles for activating. Although policy feasibility is important for the adaption of both strategies, the other profit variables showed mixed results. Net benefits of older workers to the organisation are only important for phasing out, and substitutability only for activating. This paper discusses the wider implications of the study.

The ability to use the internet frequently is likely to provide a useful means of engaging with society and using services in later life, yet older people are the most likely to suffer digital exclusion, with those of the oldest ages at the greatest risk. Using six waves (2002–2012) of the English Longitudinal Study of Ageing, we model cohort-specific patterns of frequent internet use for people aged 50 and over. Multi-level growth models are used to observe trajectories of internet use over the ten-year period. Firstly, analyses are stratified by gender and wealth, and secondly we additionally test for health effects. The study finds cohort-specific differences in patterns of internet use. Rates of internet use increase faster among younger cohorts yet, despite initially increasing, begin to decline among older cohorts. Poor health is shown to be a key factor in shaping the trajectory of internet use over time. Rates of internet use are consistently lower for women than men and for those in poorer financial circumstances, independently of age cohort. The findings demonstrate the importance of ensuring older people can remain digitally included throughout later life, including after the onset of poorer health, especially as some of these individuals might benefit the most from some of the services the internet can provide.

Civic society voluntary associations promote healthy ageing by increasing older adults’ social and physical activity levels and through the co-production of services aimed at other senior citizens. Local governments are increasingly interested in collaborating with such associations as a policy response to an expanding ageing population. Co-production requires a flexible, network-based governance approach, which has not been examined from the voluntary associations’ point of view. This study explores how voluntary associations perceive the relevance and usefulness of public policies aimed at promoting co-production of services for ageing citizens. The study is based on quantitative data collected through a survey sent to 1,060 voluntary associations (N = 571) in three Danish municipalities. We also studied municipalities’ policies relevant to co-production of services aimed at senior citizens. We found that all of these policies included the explicit ambition of network governance of co-production of services targeted to address healthy ageing issues. However, our study indicates that the voluntary associations perceive the actual network governance to be somewhat fragmented and the corresponding scope of co-production was limited, which indicates the failure of municipalities to implement policy goals. Accordingly, municipal co-production in this area could probably benefit from the use of relevant key performance indicators that can enable political-administrative monitoring in order to secure deeper implementation and political accountability that promotes healthy ageing at the local level.

This article aims to encourage critical reflection about the limitations of the rational choice approach as an explanatory insight to understanding older people's choice-making about their health or social care requirements. It develops an interpretive framework examining how older people engage in the process of choice-making when selecting a care option. Choice-making is conceptualised as a temporal, processual phenomenon, influenced by others, and characterised by an individual's behavioural responses to changing circumstance and lifecourse events. Data are from qualitative interviews with 29 older adults whose choice of care option involved moving to an extra-care setting in Wales (United Kingdom). Transcripts were coded using in-case and constant-comparison approaches, and analysis was undertaken using concepts of engagement and temporality as elements of the choice-making process. Using an inductive approach, a typology of six different ‘pathways to choice’ of care setting was identified; these findings suggest that choosing a care option in later life is a diverse, interactive and time-bound social phenomenon, inadequately captured by the rational choice approach where it is understood more as an individualised, linear and logical process. Recognising that choice-making evolves through time as part of a process shaped by others means service providers will be better positioned to offer opportunities for more preventative-focused interventions which empower older consumers to make planned and informed choices about care options.

The population of Australia is ageing, with women being the primary beneficiaries of this increase in longevity. Increasingly older individuals are being diagnosed with different chronic illnesses such as peripheral arterial disease (PAD) which causes blockages of the blood vessels in the legs resulting in pain, non-healing ulcers, immobility and the potential amputation of the threatened limb. PAD has been traditionally thought to affect men more than women. Resultingly, women have been under-represented in clinical trials of PAD and under-diagnosed in the health-care setting. However, it has recently been acknowledged that women are indeed more likely to suffer from PAD than men due to increased presence of disease and survival advantage. As such, very little is known about women's understanding of and the meaning they create of their experiences of PAD. Therefore, how older women with PAD experience the ageing process is the focus of this qualitative research project. Interviews were conducted with 11 women from Sydney, Australia aged over 65 years who had been diagnosed with PAD. The interviews were analysed using an inductive thematic analysis. Three manifest themes were constructed: independence and control, active and involved, and the acceptance of ageing. These findings emphasised the idea that despite the presence of a chronic illness and increased age, remaining independent and engaged with life was vital to these women's wellbeing. Their subjective experiences of ageing reflect the fact that by adapting to the physical, mental and social changes that come with growing older, the focus does not need to be on loss and decline but rather can be about the continuation of life that can be both positive and meaningful.

This article contributes to our understanding of transnational family relationships and the circulation of care. We are interested in understanding how large-scale emigration affects the support and care of older people in the origin country. Using in-depth interviews and participant observation, we examine the significance of transnational family support for older people, and the ways in which migrant children and other kin care for elderly relatives from afar. Our case study is of the Transylvanian Saxons, a German-speaking minority in Romania, who experienced mass-exodus to Germany following the end of socialism in 1990. The lapse of time since the exodus allows us to examine how transnational family practices evolve, and what the challenges are to maintaining family-hood over time and distance. Contrary to expectations, we find that material family support from Germany to Romania is not significant and has declined. Care, by contrast, remains an important part of what most transnational families provide, although practices of ‘caring about’ are more prevalent than hands-on ‘caring for’. Counter to optimistic accounts of transnational family care in the literature, we argue that the difficulties and challenges for older people of being cared for by distant family members are fundamental, and strong transnational family ties are not an inevitable outcome of migration.

This investigation examines the association of four measures of poverty (income-based, expenditure-based and asset-based poverty, and material deprivation) with life satisfaction. Perceived life satisfaction was measured among 1,410 older Chinese persons aged 65 and over. Besides life satisfaction and measures of poverty, the study assessed socio-demographic variables, financial strain, health indicators, and social and community resources. Those who faced expenditure-based poverty, material deprivation and asset-based poverty reported a significantly lower level of perceived life satisfaction, while the association between expenditure-based poverty and life satisfaction was found to be the strongest. Other factors that had an impact on life satisfaction included gender, education and marital status; financial strain; social support; the number of close family members and friends; self-rated health; functional capacity; perceived memory; pain; sleep quality; neighbourhood collective efficacy; and engagement in cultural and entertainment activities. From the theoretical perspective, the findings have strong implications for the understanding of the factors that shape the perception of quality of life in old age. Our results also have important policy implications for the official measurement of poverty, monitoring of the poverty situation and the development of anti-poverty measures to help older persons living in poverty to improve the quality of their lives.

Policies to extend working life (EWL) assume homogeneous workers face similar choices about working longer: this may be difficult for women, workers in physically onerous jobs or in low-paid precarious employment. Work-life trajectories are gendered; women interrupt employment and pension-building to provide care. There is occupational variation in capacities to prolong working lives: physically demanding jobs cause work-related health deficits. The precariously employed cannot contribute regularly to pensions and may face age discrimination. This research provides an inter-occupational and cross-national dimension to EWL research, comparing women teachers and health-care workers in the United States of America (USA) and Republic of Ireland. It documents intra-cohort distinctions that emerge among women when considering educational opportunities and occupational tracks expressed in lifecourse trajectories and accumulated capacities for extended work. Analysis draws on interview data from ten teachers and ten health-care workers in each country, comparing the implications of EWL policies for women workers: in precarious versus secure occupations and occupations with different physical demands. It reveals work-life trajectories leading to poorer financial and health outcomes for older health-care workers, especially in the USA. Most women (regardless of occupation or country) opposed extending working life, with concerns ranging from health status and ability to work to the desire to have healthy years in retirement. The most important distinctions are between the occupational categories considered, rather than cross-national differences. Implications for national and work-place policy and research are considered.

This paper examines immigrant poverty at an older age in Sweden with an emphasis on late-in-life immigrants. We analyse tax data for the entire Swedish-born and non-Swedish-born population. The poverty status of a household is assessed using two criteria. First, the disposable income of the household in which the person lived in 2007 must be below 60 per cent of the median equivalent income in Sweden as a whole. Second, to be classified as ‘twice poor’ a household's net assets must be below SEK 10,000. The results indicate that three out of four Swedish-born older persons were not classified as poor by either of the criteria, and only 1 per cent by both criteria. In contrast, among older persons born in low-income countries almost three out of four were classified as poor according to one of the criteria and not fewer than one in three according to both. Results of estimating logistic models indicate that the risk of being considered poor according to both criteria is strongly positively related to one's age at immigration. Our results indicate that it is crucial that migrants, particularly those who arrive after age 40, be better integrated into the Swedish labour market. To alleviate poverty among those migrants who are already of older age, increased transfers are probably the only possible alternative.

Population ageing combined with physical inactivity has critical implications for the public health of communities in the twenty-first century. In the last decade, the World Health Organization launched the age-friendly cities agenda, aiming to address population ageing through whole-systems, rights-based, health equity-focused approaches. An important intervention for age-friendly communities is modifying built environments to support population-level physical activity. Physical activity can help mitigate impacts of chronic diseases and social isolation on older adults. Need for advocacy and action in this area raises questions of how to develop supportive environments for physical activity across age-friendly community types. In Canada, a substantial proportion of older adults live outside large urban municipalities, for which scant research exists on fostering age-friendly built environments. To this end, we conducted qualitative research involving semi-structured interviews with 21 municipal policy influencers in Alberta, Canada to gather perspectives on development and early implementation of an age-friendly policy framework in the small urban and rural context. Our findings are organised by three main themes providing key lessons for advocacy and action, namely pursuing comprehensive planning, promoting public engagement and prioritising the needs of older adults. This research informs advocacy and action priorities in promoting built environment modification for routine physical activity as part of an age-friendliness agenda for small urban and rural regions of Canada and other countries.

Social exclusion is a dynamic multi-dimensional process that is interactive in nature. The complex interplay between domains, whereby each domain can act as a determinant, indicator and/or outcome of social exclusion, hinders understanding of the process and the mechanisms through which social exclusion exists. This article highlights the need to disentangle these pathways and move beyond descriptive accounts of social exclusion, presenting a new working framework that allows direct hypothesis testing of these between-domain relationships. Whilst this working framework can be applied to any population, this article focuses on older adults. Life events that can drive social exclusion such as bereavement and changes in health are more likely to occur in later life, and occur more frequently, increasing the risk of social exclusion for this population. Rooted in the new working framework, this article presents the construction of later life social exclusion measures for use with Understanding Society – the United Kingdom Household Longitudinal Study. The validity of these measures are considered by examining the characteristics of those aged 65 years and over who score the highest, and therefore experience the greatest level of exclusion. This new working framework and developed social exclusion measures provide a platform from which to explore the complex relationships between domains of social exclusion and ultimately provide a clearer understanding of this intricate multi-dimensional process.

Later life care practices are closely entangled with the ideals of independence and dependence. Based on an interpretive analysis of qualitative interviews with 34 people aged 65–100 receiving home care in Ontario, Canada, this article explores older people's subjective interpretations of caring for themselves (i.e. independence) and receiving support from others (i.e. dependence). Findings suggest that individuals construct subjective meanings of independence in relation to their changing physical capacities, and in the context of their relationships with family members, friends and formal care providers. First, participants considered their care activities to be a way of maintaining independence when they undertook certain practices with the intention of staving off dependency and future decline. Second, when they accepted assistance, many engaged in care relations that allowed them to preserve an independent identity in the face of limits to physical self-sufficiency. Third, participants reached the limits of independence when they lacked adequate assistance, and were unable to care for themselves in desirable ways. Findings illustrate how objective circumstances related to social and financial resources as well as access to formal services shape subjective interpretations, allowing some older people to hold on to independent identities while exacerbating feelings of dependency among others.