The aim of this study was to document the perceptions of elders in six Caribbean countries about ‘active ageing’ and on the basis of their reports to make recommendations to improve their situation. Data were collected principally through 31 focus group discussions conducted in both urban and rural areas. Comparative analysis was carried out of the qualitative information, focusing on three components of ‘active ageing’: health and social services access and use, social support, and economic circumstances. Most of the participants were women, aged 60–79 years, of lower socio-economic status and from urban areas. Large disparities in the responses of Caribbean societies to population ageing were indicated, as well as unequal opportunities to obtain health care and social services, public transport, income and food by both socio-economic status and location. Home-care services are either insufficient or non-existent. Some elders receive social and financial support from relatives while others fear isolation and face deprivation. Social participation varies by place, physical condition, financial situation, association membership, and transport opportunities. Social protection benefits do not provide adequate income and some older people face food insecurity. It was concluded that a comprehensive and multi-sectoral approach using the ‘active ageing’ framework should be implemented to ensure a healthy ageing process.

This study examines both the motives for and the benefits of attending a university programme for older people (UPOP) in Spain, and how they vary with the type of UPOP. Two UPOP models were assessed: The ‘Older People's Classes’ of the University of Barcelona, which is organised as a lecture course, and the ‘University of Experience’ at the University of Valencia, which is a three- or four-year variant of regular university degrees. A sample of 321 older students (mean age 67.5 years) was gathered from the two UPOPs, 161 participants from the former and 157 from the latter. The findings suggest that expressive motives such as acquiring knowledge, expanding the mind or learning for the joy of learning were the most important reasons for joining a UPOP, and that among the perceived benefits from taking classes at university featured ‘gaining more friends’, ‘enhanced self or life-satisfaction’ and ‘joy in life’. Perceived benefits were particularly high among the less educated and the older students. While students participating in the Older People's Classes were older and included relatively more women, differences between the two models in motives and benefits did not exist or were slight. These results are discussed in the context of new strategies to improve university courses aimed at older students.

The purpose of this study was to explore musical taste patterns in old age. Having musical tastes, defined as individual preferences for certain musical genres, has been theorised as being a relational tool, something that can be used to negotiate social situations and interpersonal exchanges with others. Taste not only helps to make sense out of the endless array of products available on the cultural menu, but is also through consumption and display a way of signalling group membership, social location, identity and self. These concepts are important throughout the lifecourse, yet relatively unexplored in later life. What are the taste patterns of older adults and how do they compare to the musical preferences of other age groups? To address these questions we analysed data from the United States national Survey of Public Participation in the Arts (SPPA), a repeated cross-sectional survey, for the years 1982, 1992 and 2002. In each year, musical tastes displayed a positive relationship with age up to 55 years of age. The results indicate that across the three survey years, at older ages there was a negative relationship between tastes and age. We offer explanations for these results using theories from the sociology of culture and social gerontology.

Body-image research has focused on younger women and girls, and tended to ignore women in later life, although recent studies have called for more research into the body image of older women, particularly from a lifecourse perspective. The lifecourse perspective can address the complexity of body image by identifying personal and/or environmental factors that shape body image and the trajectories of body image across the lifecourse. Accordingly the purpose of the study reported in this paper was to explore older women's body image using a lifecourse perspective. We conducted individual interviews and follow-up focus groups with 13 women aged 60–69 years, all of them resident in a United States non-metropolitan county (its largest city having a population of 38,420) and having lived in the country for more than 30 years. The findings highlight the influence of inter-personal relationships (e.g. with a spouse or parent), the macro-environment (e.g. media or community attitudes) and key life events (e.g. physiological changes or educational experiences) that shaped body image at various life stages. In addition, the findings demonstrate that as women age, they de-prioritise appearance in favour of health or internal characteristics. Finally, the findings highlight the complexity of body image as a construct, which includes attitudes toward appearance, evaluations of health and physical ability, and assessments of appearance.

The aim of the study was to assess the prevalence of abuse among the residents of long-term care facilities in Israel, and its associations with risk indicators. Seventy-one such residents aged 70 or more years were assessed in the internal and orthopaedic departments of two university medical centres for possible abuse by carers at the long-term facilities from which they were admitted. The study collected socio-demographic and health profiles and a list of maltreatment or abusive acts, and administered the Signs of Abuse Inventory and the Expanded Indicators of Abuse Questionnaire. Among the 71 residents, 31 per cent reported some form of maltreatment, most being instances of disrespectful behaviour. Signs of abuse, mostly of neglect, were detected in 22.5 per cent of the sample. Hierarchical regression analysis revealed that higher scores on risk indicators and higher dependence on others for the activities of daily living significantly associated with reported abuse, while age, gender, risk indicators and lower blood albumin level (being an indicator of worse nutritional and health status) significantly associated with identified signs of abuse. It is concluded that direct questioning mainly discloses instances of disrespectful behaviours and humiliation, while the assessment of signs of abuse is more sensitive to cases of neglect. Risk indicators were found to be reliable indicators of abuse. Routine screening for these indicators is recommended to improve detection and thereby to prevent abuse in long-term care facilities.

This paper reports a United States study of the factors that influence the turnover of older adult volunteers. Based on a parent study of programmes that use older adult volunteers, the follow-up study examined the experience for 207 older volunteers who served in ten programmes in 2005 and 2006, respectively. Telephone interviews and mail surveys were used to collect programme and personal information. The findings indicated that aspects of the volunteer experience, like duration of involvement, volunteering in other programme(s), type of activity, the adequacy of on-going support, and the availability of stipends influenced volunteering retention and turnover. Respondents who volunteered for a longer period were committed in other programmes, felt better supported, and received a stipend were less likely to quit volunteering in a designated programme. Also those volunteering in public safety programmes were least likely to quit. As reported by older adult volunteers themselves, the primary reasons for volunteer withdrawal included a higher priority of another productive activity or commitment, declining health, and problems with the programme administration. Volunteers with extensive experience were least likely to withdraw. The findings suggest that organisations with volunteer programmes can promote older adults' long-term engagement as volunteers by providing on-going support and stipends. Changes in programme characteristics would impact positively on volunteer retention, especially among low-income older Americans.

Payments for care, by which people in need of long-term care directly employ care workers, have been introduced in many European countries. In The Netherlands, care dependants are allowed to use these payments to hire relatives to perform care tasks. Care-givers who are employed by their relatives are in a hybrid position, because they are contracted as employees in the informal setting of a family home and its affective care relationships. This paper reports a qualitative study of relatives' experiences of payments for care and how these affect their care-giving. In-depth interviews were undertaken with 17 paid carers: they were asked to respond to three fictional vignettes of contrasting care trajectories. It was found that the cash nexus had mixed and partly contradictory implications for the paid care-givers. On the one hand, the care-givers were satisfied with the arrangement, as the payments recognised and raised their status as carers, and were seen as reward and reciprocation for their care work. Some carers had found that the contract helped manage strained relationships, by enabling a clearer differentiation of care tasks from affection. On the other hand, some who regarded themselves as employees and saw their role as equivalent to formal carers felt a greater obligation to provide high-quality care, and found that they were thanked less often and received fewer tokens of gratitude.

Dependent older people are predominantly cared for by family members, mostly partners and children, but not every parent in need is cared for by a child, and intergenerational care varies widely across Europe. Previous studies have used care regimes to explain these differences, but because of the lack of large comparative surveys, the prevalence of intergenerational care has rarely been related directly to the institutional and cultural context, including state care provision, legal obligations between family members, and societal opinion about the role of the state in elderly care. This paper reports an analysis of variations in intergenerational care among European countries and the reasons for these differences using data from the Survey of Health, Ageing and Retirement in Europe for Austria, Belgium, Denmark, France, Germany, Greece, Italy, The Netherlands, Spain, Sweden and Switzerland. Results from logistic multilevel models show that care by children is influenced by the individual characteristics of both parents and children, and by family structures, welfare-state institutions and cultural norms. Intergenerational care is more prevalent in southern and central European countries, where children are legally obligated to support parents in need, and care is perceived as a responsibility of the family, whereas in northern Europe, the wider availability of formal care services enable adult children, particularly daughters, have more choice about their activities and use of time.

This study estimates the effect of increases in age on 16 health problems that affect paid work for men and women in the United Kingdom. The analysis is based on a sample of the United Kingdom household population from the Office for National Statistics Labour Force Survey of 2007. Using multinomial logit regressions, the results reveal considerable diversity in the relationships between age and the reported prevalence of health problems that affect work. In particular, problems with heart, blood and circulation, arms and hands, legs and feet were strongly related to age, while difficulties in seeing and hearing, skin conditions and allergies appeared not to be more prevalent among older workers than younger employees. Regarding gender differences, it was found that, in general, women's health-related ability to participate in work was less affected by age, but that they suffered particular problems with arms and hands, skin conditions, allergies and depression. Finally, the study analyses the non-linear effects of unit increases in age. Such analysis may usefully identify the ages (or inflection points) at which ageing intensifies its effects on occupational health. These findings point to the importance of intervention at the appropriate time, when preventive measures may avoid the exacerbation of the health problem.

Using interview data from 30 Tibetan elders living in India and Switzerland, the paper explores the support they received, their perception of intergenerational relationships, and their acceptance of different levels of intergenerational exchange. All of the sample had aged in either India or Switzerland and so provide excellent comparison groups, from respectively a developing and a developed country, by which to study changing filial piety with time, context and socio-economic conditions. With limited resources in old age, most of the participants in India needed financial support. Among them, parents with many children and children in developed countries received better financial support and collective care than those with one child or all children living in India. In contrast, the participants in Switzerland were entitled to state old-age benefits, and so required mainly affirmation and emotional support. A consequence of living in a developed nation was dissatisfaction when the children adopted western values and the family's cultural continuity was threatened. The findings support two recommendations: in developing countries, the provision of old-age benefits to ensure a minimum level of financial security and independence among older adults; and in developed countries, the promotion of a mutual understanding of filial piety among different generations of older refugees and immigrants to help ameliorate intergenerational differences.

This paper reports findings from a three-year study which integrated Kitwood's (1997) person-centred and Sabat's (2001) selfhood approaches in the design, fieldwork and analysis of a multi-method observational study that explored the social worlds of 14 people with dementia in continuing-care. The types of interactions that participants experienced in everyday ward life and during creative sessions were identified by observing, video-recording and engaging with them and by Dementia Care Mapping. The participants' responses to such interactions in terms of their well- or ill-being and expressions of self were identified and documented. The findings indicate that in the wards, staff interactions were often limited and sometimes abusive and that participants experienced ill-being, whereas during creative sessions, interactions were generally facilitatory and celebratory with the participants experiencing wellbeing. By developing the selfhood approach and integrating it with the person-centred approach, I argue that recognising and supporting selfhood (or not) during interactions can lead to qualitatively different staff behaviours, with consequences for the well- or ill-being of people with dementia. There is scope for incorporating this developed selfhood framework into staff training, for it has the potential to transform practice and the experiences of people with dementia in receipt of care.

There is increasing use of electric mobility-scooters by older people in South Australia, the fourth largest state in Australia. Although various issues about their use have been raised by users, carers, urban planners and legislators, to date they have received little research attention. The purpose of the study reported in this paper was to explore the factors that influence and impact upon older people who use mobility-scooters, particularly from their own perspectives. Data were collected through a survey of 67 current electric mobility-scooter older users, and through two focus groups with other older South Australian people who were users. The data showed that more than 71 per cent of the participants had owned their scooter for more than two years, most had purchased the scooter as new, and 80 per cent owned a four-wheel scooter. The scooter was used predominantly for getting to and from shops, visiting friends and family, and to go for rides. Most respondents used their scooters three to five times each week and travelled between two and five kilometres from their home. The key findings from the focus groups were categorised into three major themes of ‘obtaining a scooter’, ‘the meaning of mobility’ and ‘issues around sharing spaces’. Each is exemplified. The implications for environmental and building design, for the better training of users, and for public education are discussed.

This article aims to provide an initial account of the life circumstances of older people in 11 continental European countries during the year prior to their deaths. It focuses on regional variations in functional limitations and sources of support. Using logistic regression we analyse data from 523 end-of-life interviews in 2006–07, collected for the Survey of Health, Ageing and Retirement in Europe (Wave 2) about the respondents who had died since the baseline data collection in 2004–05. The prevalence of functional limitations was found to be fairly consistent across Northern, Central and Southern Europe. Significant regional differences existed, however, with regard to the deceased respondents' main sources of support and the locations of their deaths. Northern Europeans were the least likely to receive help from their family only and the most likely to be supported by non-kin. They also exhibited the highest risk of dying in a nursing home. In Mediterranean countries, a pattern of exclusive family support and dying at home prevailed. The findings support the notion of a ‘mixed responsibility’ of families and welfare states as providers of support for older people in the last year of life.

The purpose of this study was to conduct a descriptive analysis of multiple dimensions of religious belief and practice among older people in Japan with data from a nationwide sample. Six dimensions were evaluated: religious affiliation, involvement in formal religious organisations, private religious practices, the functions of prayer, belief in punishment by supernatural forces, and beliefs about the afterlife. In addition to describing these dimensions for the sample as a whole, tests were performed to see if they varied by age, sex, marital status, education and for those living in rural or urban areas. The findings suggest that even though older people in Japan are not highly involved in formal religious institutions, they engage frequently in private religious practices, and that while many older people in Japan do not endorse some religious beliefs (e.g. about the quality of the afterlife), there is strong adherence to others (e.g. beliefs about punishment by supernatural forces). It was found that older women are more deeply involved in religion than older men, and that levels of religious involvement appear to be higher in rural than in urban areas. Less pronounced differences were found with respect to age, but compared to the ‘young-old’, the ‘oldest-old’ aged 75 or more years were more deeply involved in those aspects of religion that take place outside formal institutions.

The aim of this study is to specify the concept of ‘healthy ageing’ from both western and non-western cultural perspectives, and to compare the views of academics and lay older people. Thirty-four published peer-reviewed full papers in English and Chinese (traditional characters) were identified using electronic database searches. The key components of their definitions of healthy ageing were extracted and categorised into 12 domains. The results show that, in general, lay definitions (as described in 11 studies) included more domains (independency, family, adaptation, financial security, personal growth, and spirituality) and more diversity in the healthy ageing concept than academic views (which tend to focus more on physical and mental health and social functioning in later life). Certain domains were valued differently across cultures. As shown in previous studies, the findings affirm that healthy ageing is a multi-dimensional and complex concept and that there are substantial differences in different cultures. Moreover, we found that there are pronounced variations in the conceptualisation of healthy ageing as between academic and older lay people. Generally, older lay people perceive healthy ageing more broadly than the maintenance of physical, mental and social functioning. We suggest that academic researchers should integrate the more holistic perspectives of older lay people and cultural diversity into the classical ‘physical–mental–social’ healthy ageing concept.

Psychological distress in cancer patients is inversely related to age, although the reasons are unclear. The adult development literature suggests that ageing may be associated with the development of adaptive capacities, specifically greater attachment security (the sense that others will be available and supportive when needed) and spirituality (the capacity to view one's life as having meaning, purpose and value), that enable older people to cope better with disease. We examined whether age-related patterns in attachment security and spiritual wellbeing account for the protective effect of age against distress. Measures of depression, attachment security, spiritual wellbeing and disease burden were collected from 342 patients aged from 21 to 88 years with advanced, metastatic cancer. Attachment security and spiritual wellbeing were tested as mediators of the effect of age on depression, controlling for disease burden. It was found that age was associated inversely with depression and positively with spiritual wellbeing and attachment security. Depression was inversely related to attachment security and spiritual wellbeing, and the effect of age on depression was fully mediated by attachment security and spiritual wellbeing. The relative protection from psychological distress among older cancer patients may be the result of age-related developmental accomplishments and/or differences in the response to adverse life-events.

Benevolent, long-term care can threaten older adults' sense of autonomy in a residential home environment. Increasing reliance on a hotel style of living has been seen to erode social identity, life satisfaction and even survival or lifespan. Drawing on evidence from both gerontological and social psychological literature, this paper examines the links between the empowerment of residents and their subsequent quality of life in the context of a move into a new care facility in a medium-sized town in South-West England. A longitudinal experiment was conducted during which 27 residents on one floor of a new facility were involved in decisions surrounding its décor, while those on another floor were not. The residents' attitudes and behaviour were monitored at three points over five months (four weeks pre-move, four weeks post-move, and four months post-move). Consistent with the social identity literature, members of the empowered group reported increased identification with staff and fellow residents in the new home, displayed enhanced citizenship, reported improved wellbeing, and made more use of the communal space. Moreover the staff found the empowered residents to be more engaged with their environment and the people around them, to be generally happier and to have better health. These patterns were observed one month after the move and remained four months later. Some implications for theory and practice are discussed.

Although a variety of research projects have been conducted on the benefits of religious coping in older adults, no direct comparison between atheism and religious faith has been published. The study reported in this paper tackled this issue by interviewing two matched groups of people aged over 60 years living in southern England, one of 11 informants with strong atheistic beliefs, and the other of eight informants with strong religious beliefs. Five paired comparisons were undertaken to examine the role of the content of the belief system itself in coping with different negative stresses and losses commonly associated with ageing and old age. The pairs were matched for the nature of the loss or stress that the two people had experienced, but the two individuals had opposed atheistic and religious beliefs. The analyses showed that all the study participants – regardless of their beliefs – were coping well, and suggested that a strong atheistic belief system can fulfil the same role as a strong religious belief system in providing support, explanation, consolation and inspiration. It is postulated that the strength of people's beliefs and how those beliefs are used might have more influence on the efficacy of coping than the specific nature of the beliefs. Further research into the strength of belief systems, including atheism, is required to test and elaborate this hypothesis.

The ability to perform the instrumental activities of daily living (IADLs) is an important focus for the promotion of independent living in old age. If strategies to enable older people to remain in their own homes are to be developed, advances must be made in understanding the demands associated with IADLs. This paper reports on a study of how activity demands – the body postures, actions and hand functions involved in cooking, housework, laundering and shopping – relate to the capabilities of a sample of older people in Great Britain. Task data were analysed for 4,886 community-dwelling 55–93-year-olds who were enrolled in a follow-up survey to the 1996/97 Family Resources Survey. Logistic regression models were used to calculate adjusted odds ratios for associations between functional limitations and IADL difficulty. Attributable fraction estimates were also used to assess the population impact of the functional limitations. Comparable effect sizes were observed across activities for limitations in body postures (standing, reaching and bending/stooping), actions (lifting/lowering and holding/carrying) and hand functions. Most of the difficulties were attributable to limitations in body postures, primarily bending/stooping, whereas actions and hand functions accounted for much less difficulty. We present a matrix of the potential impact that design changes to alleviate each limitation would have on the ability to perform the activities studied. This can help to prioritise interventions aimed at supporting continued independent living.

This paper presents a structured literature review that focused on comprehensive case management by nurses for adults with long-term conditions living in the community. The emphases of the review are the implementation of case-management approaches, including its roles, core tasks and components, and the coverage and quality of the reported implementation data. Twenty-nine studies were included: the majority were concerned with case management for frail older people, and others focused on people with multiple chronic diseases, high-cost patients, or those at high risk of hospital admissions. All the studies reported that case managers undertook the core tasks of assessment, care planning and the implementation of the care plan, but there was more variation in who carried out case finding, monitoring, review and case closure. Few studies provided adequate implementation information. On the basis of the reviewed evidence, three issues were identified as key to the coherent and sustainable implementation of case management for people with long-term conditions: fidelity to the core elements of case management; size of caseload; and case-management practice, incorporating matters relating to the continuity of care, the intensity and breadth of involvement, and control over resources. It is recommended that future evaluations of case-management interventions include a comprehensive process component or, at the very least, that interventions should be more fully described.