Evidence that immigrants tend to be underserved by the health-care system in the hosting country is well documented. While the impacts of im/migration on health-care utilisation patterns have been addressed to some extent in the existing literature, the conventional approach tends to homogenise the experience of racialised and White immigrants, and the intersecting power axes of racialisation, immigration and old age have been largely overlooked. This paper aims to consolidate three macro theories of health/behaviours, including Bronfenbrenner's ecological theory, the World Health Organization's paradigm of social determinants of health and Andersen's Behavioral Model of Health Service Use, to develop and validate an integrated multilevel framework of health-care access tailored for racialised older immigrants. Guided by this framework, a narrative review of 35 Canadian studies was conducted. Findings reveal that racial minority immigrants’ vulnerability in accessing health services are intrinsically linked to a complex interplay between racial-nativity status with numerous markers of power differences. These multilevel parameters range from socio-economic challenges, cross-cultural differences, labour and capital adequacy in the health sector, organisational accessibility and sensitivity, inter-sectoral policies, to societal values and ideology as forms of oppression. This review suggests that, counteracting a prevailing discourse of personal and cultural barriers to care, the multilevel framework is useful to inform upstream structural solutions to address power imbalances and to empower racialised immigrants in later life.

Family care-givers are the backbone of the long-term support system for care receivers at home. Care for stroke survivors after rehabilitation primarily rests on the shoulders of family members, often of older age themselves. We report the outcomes of a new complex support programme, the Care-givers’ Guide, on both individual and system levels. Psycho-social support and personalised information were the main ingredients of this intervention. A two-level multi-methodological approach was needed, with two concurrent interconnected studies. Family care-givers reflected on outcomes at an individual level in a quant-QUAL study with a pre–post quantitative questionnaire and a post-intervention qualitative semi-structured interview. Practitioners participated in a QUAL-QUAL study ex post interview, reflecting on the outcomes on the care-givers and on their own stroke care system. Individual family care-givers showed an increase in health literacy and level of psycho-social health. Qualitative analysis revealed improvement in knowledge, capability to act and individual empowerment; and stabilisation of sense of certainty, life balance and emotional wellbeing. Practitioners observed an optimisation of the stroke support system by improving professionals’ daily routine, augmenting the institutional support offer, securing the quality of patient care and increasing inter-institutional co-operation attempts. Positive outcomes of the support programme were observed on both evaluation levels: family care-givers showed improved health literacy and psycho-social health, whereas the professionals noticed an optimisation of the support system.

This paper examines how care home managers in England conceptualised the approach to delivering personalised care in the homes they managed. We conducted interviews with care home managers and mapped the approaches they described on two distinct characterisations of personalised care prominent in the research and practitioner literature: the importance of close care relationships and the degree of resident choice and decision-making promoted by the care home. We derived three ‘types’ of personalised care in care homes. These conceptualise the care home as an ‘institution’, a ‘family’ and a ‘hotel’. We have added a fourth type, the ‘co-operative’, to propose a type that merges proximate care relationships with an emphasis on resident choice and decision-making. We conclude that each approach involves trade-offs and that the ‘family’ model may be more suitable for people with advanced dementia, given its emphasis on relationships. While the presence of a range of diverse approaches to personalising care in a care home market may be desirable as a matter of choice, access to care homes in England is likely to be constrained by availability and cost.

The purpose of this study was to examine the effects of simplified reminiscence practice using olfactory stimuli on depression and cognitive function in community-dwelling older adults in Japan. Accordingly, 61 individuals were randomly divided into two groups. In the intervention group, 12 sessions of reminiscence were performed using olfactory cards. In the control group, reminiscence sessions were similarly performed, but with language cards. The Geriatric Depression Scale-15 (GDS-15) was used to measure mental health status and the Five Cognitive Test was used to measure cognitive function at baseline and after completion of the intervention. The final sample included 27 participants in the intervention group and 23 participants in the control group. Basic characteristics of the participants at baseline were compared and a significant difference was observed between the two groups in age (p = 0.029). Repeated-measures analysis of covariance with age as the covariate revealed a significant interaction between time and group on the GDS-15 (p = 0.04). Furthermore, a before and after comparison using a paired t-test showed a significant difference only in the intervention group (p = 0.01). The results of this study suggest that simplified reminiscence practice using olfactory cards could serve as an intervention to help maintain the mental health of community-dwelling older adults.

This paper explores the concept of the completed life outlined in recent writing in the Netherlands on euthanasia and assisted suicide and its implications for ageing studies. Central to this theme is the basic right of people to self-determine the length of their later life, linked with the subsidiary right to assistance in achieving such self-determination. Although the notion of weariness with life has a long history, the recent advocacy of a self-limited life seems shaped by the new social movements presaged upon individual rights together with what might be called a distinctly third-age habitus, giving centre stage to autonomy over the nature and extent of a desired later life, including choice over the manner and timing of a person's ending. In exploring this concept, consideration is given to the notion of a ‘right to die’, ‘rational suicide’ and the inclusion of death as a lifestyle choice. While reservations are noted over the unequivocal good attached to such self-determination, including the limits to freedom imposed by the duty to avoid hurt to society, the article concludes by seeing the notion of a completed life as a challenge to traditional ideas about later life.

Much of the literature discusses filial piety in general and ambiguous terms. This study, in contrast, investigates specific perceptions of filial piety and parental expectations of filial duty among older Chinese immigrants in Canada. The study is based on thematic analysis of 46 Chinese immigrants in seven focus groups conducted in the Greater Toronto Area. Findings show the perceptions of filial piety varied, but almost all participants had reduced expectations of their children. Nevertheless, they still valued and expected emotional care from their children. The study argues that changes in institutional settings, social policies and welfare systems define parents’ support needs and affect their expectations in the host society, while norms and institutional settings in the place of origin influence their perceptions of filial piety.

We studied older people's perceptions of how they organise their out-of-home mobility and independent living when they face mobility restrictions, based on seven focus groups with older people (N = 28) from a suburb in Finland. This article provides an everyday life view of how the ability to move outside the home evolves through interdependencies between older people and their neighbourhoods, social relations and societal arrangements. Our findings show that supportive socio-material surroundings can provide older people with new ways to move outside their home despite mobility restrictions and new ways to organise their daily life with decreased mobility. In contrast, restrictive socio-material surroundings can lead to situations in which older people forgo certain out-of-home journeys and activities. The findings contribute to an understanding that organising one's daily life and out-of-home mobility is an act of interdependence. Policies promoting independent living in old age should recognise these fundamental interdependencies and support versatile ways of living rather than overemphasise activity and self-reliance. Based on older people's everyday life perspectives, both sides of the coin need to be considered: how to enable the out-of-home mobility of older people facing mobility restrictions and how to support them in managing and enjoying daily life with decreased mobility.

This article revisits a paper and from an autoethnographic/critical reflective biographical approach re-examines seven cultural notions or myths, which may encourage ageism. It is framed within my experiential knowledge of caring for my ageing parents, with the tensions and challenges around problematising the value of expertise based on experience, communication, grief, and autonomy and freedom versus safety. The commentary emphasises that by analysing the impact of our personal life experiences, we can start to understand both the intended and unintended consequences of policy and practice affecting those in the fourth age. As a social work educator, I wanted to reflect upon how my tacit experiential knowledge, if made explicit, could impact upon my own and others’ learning. The recent death of my father has allowed for a period of reflection on my own caring and indeed my professional social work experience, knowledge, skills and practice. It is argued that the ageing process is unequal as class and socio-economic factors, i.e. geography, age, gender, religion and ethnicity, all play parts in determining how someone ages, and indeed upon the care an individual older person receives. A fuller understanding of negotiating the role of one stakeholder, that of a family carer in the ageing process, is elicited in this paper.

The biomedical model has traditionally informed the dominant discourse on dementia and has significantly shaped practitioners’, policy makers’ and researchers’ responses. This model contextualises dementia as a progressive neuro-degenerative cognitive disorder and focuses on deficits and underlying pathology, often overlooking the fact that the person can and should be an active partner in the treatment process. Beginning in the late 1990s, the exclusive reliance on the bio-medical model has come under increasing scrutiny with a growing awareness that by recasting dementia in broader social and more humanitarian terms, much can be done to promote the individual's quality of life. Different frameworks and analytical tools have been forwarded to help us better understand dementia. These include personhood, citizenship, public health, disability and human rights. This review examines the merits of framing dementia as a disability, a citizenship concern and a human rights issue. It highlights some of the potential gains that can arise for the individual in using a human rights model to enhance practice, inform policy and create a more balanced research agenda. The article concludes by arguing that the complexities and magnitude of dementia are such that it requires multiple responses and a broad range of interpretative frameworks.

Lifecourse approaches to healthy ageing recognise that health in older age is affected by long-term cumulative inequalities between socio-economic status (SES), gender and ethnicity groups, which begin in childhood. Combining longitudinal survey data with lifecourse history interviews from 729 older New Zealanders aged 61–81 (mean = 72, standard deviation = 4.5), we tested a lifecourse model of predictors of physical, mental and social health in older age. Latent growth curve and mediation analysis showed that the link between childhood SES and late-life health (over 10 years) was mediated by education, occupation and adult wealth. To account for the moderating effects of gender and ethnicity, we modelled the effects for sub-groups separately (225 non-Māori women, 158 Māori women, 219 non-Māori men and 127 Māori men). Childhood SES was an important predictor of later-life health, mediated by education and adult SES for all participants and for non-Māori men. However, there were significantly different pathways for Māori men and for women. Māori men and women and non-Māori women did not attain the same health benefits from higher childhood SES and education as non-Māori men. Findings point to the importance of considering the mediators of lifelong impacts on health in older age, and recognition of how membership of different socially structured groups produces different pathways to late-life health.

Ageism is a widely used term that is not (yet) well understood. We propose a redefinition of ageism and to separate it from ableism. We believe this to be important as remedies may depend on whether someone is experiencing ageism or ableism. While focusing the discussion on older workers as a sub-group of older people who (can) experience ageism, we assess the usefulness of critical (feminist) disability studies for ageism research. We hope that redefining ageism and analytically separating it from ableism (without suggesting that both concepts should be studied independently from one another) will provide guidance for researchers who study ageism and will allow for more specific policy guidance on how to solve difficulties experienced by older workers.

Participatory action research (PAR) advocates end-user involvement in various societal domains. This paper aims to identify and analyse impacts of PAR involving older persons as co-researchers, and how these impacts spread and are enhanced throughout the research process and after its completion. By impact we mean transformational change throughout and after a PAR study. We present a qualitative community-based research project involving older people who live in sparsely populated areas in the Netherlands, and explore three types of PAR impact: personal, interpersonal and community impacts. We demonstrate how these impacts unfold through expanding circles, from a personal to a community level, and how these circles enhance each other. The project was conducted by a PAR team consisting of one researcher and seven co-researchers. The data were collected from observations, interviews and minutes of meetings, which the team subsequently analysed. The results are presented as a narrative account, whereby four project stages are followed by reflection on the impact it made. The discussion addresses the circles of impact, and whether and how they can strengthen each other in community-based projects involving older people. The concluding remarks address the influence of group dynamics on PAR, whether frail older adults can be expected to take an active part in PAR projects and the extent to which the results from such community-based PAR projects can be generalised.

Women's magazines are widely read in Canada. The popularity of such magazines is significant because critical gerontologists, primarily drawing on content analyses of the magazines, often argue that these publications convey problematic messages about ageing. This article broaches the subject of women's magazines and ageing from a different vantage point, that of the older woman reader herself. This audience-centred research draws on 21 semi-structured interviews with Canadian women over the age of 55. The study examines what older women say about the ageing-related content of women's magazines, along with what they say about how, when and why they read these magazines. Findings illustrate that participants are aware of the inadequate and unrealistic representations of older women in women's magazines. Nonetheless, they value the publications as a source of practical information on a variety of topics and as a light and undemanding source of entertainment and relaxation. The study reveals how participants assess and deploy magazine contents and characteristics in ways that contribute to, and are informed by, their lives and identities as older women. Against the broader cultural context of ageism, using and talking about women's magazines enables the participants to position themselves as knowledgeable and informed on a variety of topics and in multiple interactions, both in explicit reference to the magazines themselves and more generally in their lives.

The ageing population has been rapidly growing over recent years. Theoretically, religion seemingly plays an important role in improving older people's health. This study examines whether believing in religion is related to better health conditions among Chinese older adults through a meta-analysis. Two researchers independently extracted the studies from a comprehensive database and grey literature search and evaluated their scientific quality. From the 3,777 potentially eligible papers, just 76 were selected. The pooled effect size detected no significant difference between Chinese religious and non-religious older adults’ overall health and wellbeing. Dividing the outcomes into different categories, religious older adults reported both a higher level of anxiety (Hedge's g = −0.392, 95% confidence interval (CI) = −0.494, −0.290; p = 0.004) and yet a higher level of happiness (Hedge's g = 0.342, 95% CI = 0.074, 0.610; p = 0.018). Having a higher proportion of females in the sample is related to a smaller effect size in overall health outcomes (β = −2.205, 95% CI = −3.800, −0.613; p = 0.007) and social support specifically (β = −4.660, 95% CI = −6.261, −3.058; p < 0.0001). This study is among the first to synthesise the quantitative evidence regarding health differences between older religion believers and non-believers in China. It calls for future studies investigating the pathways underlying the religion–health relationship.

A growing number of older men are living alone. They are often referred to as an at-risk group in health-care systems. The purpose of this article is to establish an overview of these men's health and health-care utilisation. We do so by drawing on three sources: an online survey with health-care professionals, data from a national self-report health study and register-based data on health-care utilisation. The results show that older men living alone generally have lower health scores than older men co-habiting and that, among older men living alone, lower educational level is associated with lower health scores but also a greater use of free-of-charge health-care services. Health-care professionals conducting preventive home visits consider older men's social needs the most pronounced problem for the men's wellbeing and call for new services to be custom made for them. In this article, we discuss differences between older men living in rural and urban areas and between those who are single, divorced or widowed. We conclude that health and social care systems must differentiate between sub-groups of older men living alone when developing new services and that free-of-charge services, such as general practitioners and home care, should be considered as vehicles for addressing health inequities.

Healthy ageing is a public health problem globally. In Europe, the dependency ratio of the elderly is expected to increase by 21.6 per cent to 51.2 per cent in 2070. The World Health Organization (WHO) study on healthy ageing started in 2002 as a concept whereby all people of all ages should be able to live in a healthy, safe and socially inclusive way. The aim of this study is to present preliminary results of the project Identification of Determinants of Healthy Ageing in Italy (IDAGIT) that aimed to collect data on the active and healthy ageing of the Italian population aged over 18 using the conceptual framework of the WHO's ageing model. To link the determinants of the IDAGIT studies to those of the WHO model, we performed a confirmatory factor analysis which reported these variables as significant (in order of factor loading): smoking, cognition score, comorbidity, outdoor built environment, participation, working expertise and income. Considering comorbidity, 83.8 per cent of the sample declared not having any chronic diseases or to have only one, and regarding neurological diseases, only nine people had received a diagnosis of stroke. Regarding gender, the personal determinants and physical and social environments did not result in statistically significant differences, whereas we found statistical differences between the aged groups in all variables analysed. These results provide a first bio-psycho-social perspective on ageing in the Italian population.

Research has demonstrated that holding a young subjective age (i.e. feeling younger than one's chronological age) has been associated with various positive aspects of physical and psychological health. However, little is known about how such associations differ between cultural sub-groups within a given society. Accordingly, the current study focused on the Israeli component of the Survey of Health, Ageing and Retirement in Europe (SHARE-Israel) and aimed to explore the moderating role of culture on the association between subjective age and objective physical health, subjective physical health and psychological health. Data were collected from 1,793 respondents, who were classified into three groups: veteran Israeli Jews, immigrants from the former Soviet Union and Israeli Arab citizens. Age ranged from 50 to 105 (mean = 69.65, standard deviation = 9.49). All participants rated their subjective age and filled out scales examining six dimensions covering psychological health, as well as objective and subjective physical health. Across all examined dimensions, an older subjective age was associated with unfavourable health outcomes. For the majority of health dimensions, the subjective age–health links were most prominent among Israeli Arabs. Results are discussed from both a general societal standpoint (i.e. group differences in access to health services), as well as from the individual's specific role in his or her culture and society.

Emotion concepts are representations that enable people to make sense of their own and others’ emotions. The present study, theoretically driven by the conceptual act theory, explores the overall spectrum of emotion concepts in older adults and compares them with the emotion concepts of younger adults. Data from 178 older adults (⩾55 years) and 176 younger adults (20–30 years) were collected using the Semantic Emotion Space Assessment task. The arousal and valence of 16 discrete emotions – anger, fear, sadness, happiness, disgust, hope, love, hate, contempt, guilt, compassion, shame, gratefulness, envy, disappointment, and jealousy – were rated by the participants on a graphic scale bar. The results show that (a) older and younger adults did not differ in the mean valence ratings of emotion concepts, which indicates that older adults do not differ from younger adults in the way they conceptualise how pleasant or unpleasant emotions are. Furthermore, (b) older men rated emotion concepts as more arousing than younger men, (c) older adults rated sadness, disgust, contempt, guilt, and compassion as more arousing and (d) jealousy as less arousing than younger adults. The results of the present study indicate that age-related differentiation of conceptual knowledge seems to proceed more in the way that individuals understand how arousing their subjective representations of emotions are rather than how pleasant they are.

Age has become an increasingly contested form of division within contemporary society, with some writers suggesting age has become ‘the new class’ while others point to increasing ‘ageism’ in society. In exploring such competing claims, this paper examines the basis for considering age as a social class, category or group. Drawing upon Bourdieu's writings on classification and the criteria for what constitutes a social class or category and the ‘objective’ and ‘symbolic’ criteria defining it, the paper argues that the material criteria for distinguishing between ‘retired’ and ‘working-age’ households have almost disappeared. At the same time, the symbolic representation of age is no longer confined to the parameters of poverty. Shorn of its objective distinction, the symbolic representation of old age seems to have bifurcated, between a generational identity where older people are represented as an advantaged group and an aged identity still essentialised as old and weak. The dissolution of an objective material basis for framing age has taken away much of the underlying basis for a coherent symbolic categorisation of age. Later life might better be seen as a contested symbolic space, framed by the dual axes of socio-historical generation and corporeal, chronological agedness.