In this article, we use clothes as a tool for exploring the life stories and narratives of people with dementia, eliciting memories through the sensory and material dimensions of dress. The article draws on an Economic and Social Research Council-funded study, ‘Dementia and Dress’, which explored everyday experiences of clothing for carers, care workers and people with dementia, using qualitative and ethnographic methods including: ‘wardrobe interviews’, observations, and visual and sensory approaches. In our analysis, we use three dimensions of dress as a device for exploring the experiences of people with dementia: kept clothes, as a way of retaining connections to memories and identity; discarded clothes, and their implications for understanding change and loss in relation to the ‘dementia journey’; and absent clothes, invoked through the sensory imagination, recalling images of former selves, and carrying identity forward into the context of care. The article contributes to understandings of narrative, identity and dementia, drawing attention to the potential of material objects for evoking narratives, and maintaining biographical continuity for both men and women. The paper has larger implications for understandings of ageing and care practice; as well as contributing to the wider Material Turn in gerontology, showing how cultural analyses can be applied even to frail older groups who are often excluded from such approaches.

Public policies that provide incentives for higher middle-income people to purchase private long-term care insurance (LTCI) have been proposed as a way to shield large numbers of middle-income people from the risk of needing costly long-term care. A proposal to promote purchases of private LTCI that has gained modest traction in the United States of America is the Partnership Program. The structure and public–private nature of the Partnership Programs are reviewed along with the trends in sales of both regular private LTCI policies and Partnership LTCI policies to show that both experienced low purchase rates. Implementation efforts for the Partnership Programs were very modest, in part because many were launched when the Affordable Care Act was passed. At the same time, several well-known insurers withdrew from selling private LTCI. Understanding why the Partnership Program is not a success provides lessons for other counties interested in creating similar public–private ventures.

This article offers a theoretical framework for studying loneliness among older people from a social problems perspective. The framework combines the constructionist approach to social problems (Spector and Kitsuse) and systems theory (Luhmann). Based on the first approach, we understand the social problem of loneliness among older people to be the result of claims-making activities by different key actors. These activities are guided by underlying moralities, causalities and solutions. With the second approach, we can explain how social problems are framed differently within different social systems. The proposed framework is primarily aimed at researchers studying social (in contrast to bio-medical or psychological) aspects of loneliness among older people. It helps not only to guide research designs in order to address conflicting perspectives, rationalities and interests but also to enable researchers to grasp fully how ‘loneliness among older people’ is attributed (potentially shifting) meanings through communicative acts by influential stakeholders in the ‘social problems industry‘. Combining constructionism and Luhmann's theory also helps to interpret and explain concrete claims-making concerning loneliness as a social problem. The argument in this article is illustrated via three different social systems: medicine, religion and economy. Loneliness among older people appears to be something different from each of these perspectives: as a matter of health and illness, of spirituality, and of incentives and commodities, respectively.

Finding ways of improving the health and wellbeing of older men is an important challenge for public health. This review aimed to assess evidence for the effects of Men's Sheds and other gendered social activities on the health and wellbeing of older men, and to consider their effective components and theoretical frameworks. A scoping review using standardised search criteria and terms identified 31 relevant papers of sufficient quality for inclusion. Analysis was informed by guidance on interpretative and narrative synthesis and a quality assessment tool designed for reviewing disparate data from different disciplines and research paradigms applied. The review found some limited evidence that Men's Sheds and other gendered social activities may have impact on the mental health and wellbeing of older men, but little evidence of the impact on physical health. Qualitative data provided valuable insights into how and why complex psycho-social activities can affect participants, but there was a lack of longitudinal evidence drawing on validated health and wellbeing measures. Key components of successful interventions included accessibility, range of activities, local support and skilled co-ordination. A variety of theoretical frameworks were employed. As yet, there is no conclusive evidence that Men's Sheds and other gendered interventions confer health and wellbeing benefits on older men. Studies in this field to date are few and of variable quality. Larger and more robust mixed-methods studies, including randomised designs, are needed.

Given increases in childlessness, we ask if and how the permanently childless substitute for adult children in their later-life support networks. Previous research finds that they are disadvantaged on several network and support indicators. Yet, the role of different substitution mechanisms remains unclear. We examine two substitution mechanisms: substitution through adjustments of network size/composition and through higher efficiency of personal ties. Data are from the German Ageing Survey (childless: N = 1,886; parents without/with residentially proximate children: N = 4,437/8,337). Our descriptive and regression results on network size/composition and the number of potential informational and emotional supporters show that both mechanisms play a role: the childless have more friends and extended kin, and they are more likely to consider them as potential supporters, than parents. Across cohorts or age groups, the relative effect size of network size/composition versus tie efficiency changes. Parents with no children nearby constitute a mixed type that shows similarities to the childless on some indicators of social support and to parents with at least one child nearby on other indicators. Our findings provide a foundation for better predicting how current demographic trends affect future scenarios of social support in later life and for identifying the future need for formal care services. Thus, they are relevant for social scientists and policy makers alike.

Nursing homes have been criticised for restricting the lifestyle of older people in need of care. As concepts of elder care have changed and services in formal care have developed further, efforts towards deinstitutionalisation have led to the enhancement of community care models. This paper discusses how ideas of community care can also influence reform within institutional care. The study focuses on the challenges and obstacles of practice change arising in German nursing homes by opening up to civil society principles. Applying the model of organisational hybridisation, the concept of 12 German nursing homes regarding family and community partners' involvement were analysed through explorative qualitative interviews with nursing home directors. The nursing homes have conceived various forms of co-operation with community actors. Nevertheless, emerging tensions between state, market and civil society conceptions of the nursing homes limit practical change. The ‘organisational hybridisation’ has generated two general problems to be discussed here: first, the difficulty nursing homes have in opening their doors to new perceptions of care as well as to the interests of their community partners. Second, the fact that the nursing homes tend either to strive for an integration in community life or for the maintenance of a ‘sheltered zone’ for their residents implies that nursing homes' definition of ‘normality’ has a strong influence on their chosen concept of care.

In this paper, we examine the injunction issued by the prominent politician, broadcaster and older people's advocate, Baroness Joan Bakewell, to engage in ‘death talk’. We see positive ethical potential in this injunction, insofar as it serves as a call to confront more directly the prospects of death and dying, thereby releasing creative energies with which to change our outlook on life and ageing more generally. However, when set against a culture that valorises choice, independence and control, the positive ethical potential of such injunctions is invariably thwarted. We illustrate this with reference to one of Bakewell's interventions in a debate on scientific innovation and population ageing. In examining the context of her intervention, we affirm her intuition about its positive ethical potential, but we also point to an ambivalence that accompanies the formulation of the injunction – one that ultimately blunts the force and significance of her intuition. We suggest that Gilleard and Higgs' idea of the third age/fourth age dialectic, combined with the psycho-analytic concepts of fantasy and mourning, allow us to express this intuition better. In particular, we argue that the expression ‘loss talk’ (rather than ‘death talk’) better captures the ethical negotiations that should ultimately underpin the transformation processes associated with ageing, and that our theoretical contextualisation of her remarks can help us see this more clearly. In this view, deteriorations in our physical and mental capacities are best understood as involving changes in how we see ourselves, i.e. in our identifications, and so what is at stake are losses of identity and the conditions under which we can engage in new processes of identification.

There is a growing body of literature documenting the positive effects of both religiousness and spirituality on human health, particularly among those who are ageing or diagnosed with a life-limiting illness. These positive effects provide buffers to life's stressors such as those associated with mental illness, care-giver burden, substance abuse and social disruption resulting from war. An important aspect of health care for individuals of all ages involves completion of a spiritual assessment. This paper explores the concept of spirituality and spiritual assessment, which has many definitions in the literature, and also provides examples of assessment tools from theology, nursing, social work and medicine.

By 2050, the number of people in Australia aged over 85 is expected to quadruple. Yet, from a socio-psychological research perspective, little is known about the experiences of people who continue to live at home during late old age (85 years and over), a period when challenging problems associated with ageing escalate and threaten to compromise independence. Utilising a qualitative methodology, the subjective lived experience of 23 very old adults (19 women, four men, with a mean age of 90.7 years, range 85–101 years) who live independently in rural Australia were elicited. The aims of the research were to understand their thoughts and feelings about ageing in place at home, and what psychological, social and practical adaptive strategies they employ to cope with difficulties encountered during very old age. In-depth interviews were analysed in an interpretive phenomenological tradition of thematic analysis, interpretation of paradigm cases and interpretation of exemplars. Participants described how historical, cultural and environmental contexts shaped their everyday thoughts, activities and what was meaningful for them. The findings add to our understanding of the largely unnarrated lives of the very old, suggest a need for person-centred home-care assessment processes and aid significant others (family, friends and neighbours) to understand better what very old adults need to live independently.

Falls among community-dwelling seniors constitute a major public health concern because of the potential morbidity and mortality associated with the fall. This study examined the informal care networks accessed by Canadian seniors who had visited the Emergency Department as a result of a fall, and considered the implications of the processes of asking for and receiving help on the senior's identity. Four themes were identified. The first was valuing independence. The remaining three themes concerned threats to the participants' identities linked to the need to ask for or receive help from family and friends. They were: becoming indebted, feeling devalued and becoming a burden to others. Seniors were noted to excuse family members from the expectation of helping because of work and family commitments, and illness. Participants described a mutually beneficial relationship with friends wherein both parties valued their independence and provided assistance to the other when needed. Their comments suggested that assistance was viewed as a good to be traded among peers. Our findings indicate that seniors value their independence and may not seek help even when it appears to be available, if asking threatens valued identities. Health and social care practitioners and policy makers responsible for planning and delivery of services should take this into account in order to ensure the best possible care for injured community-dwelling seniors.

We examined structures of (trans)national mother–child relationships in adulthood among non-Western immigrants in the Netherlands and assessed how acculturation impacted these intergenerational ties. From the Netherlands Kinship Panel Study, Turkish, Moroccan, Surinamese and Antillean respondents were selected whose mother lived in the Netherlands (N = 360) or abroad (N = 316). First, extending a previous typology of immigrant mother–child relations in the Netherlands, Latent Class Analysis was conducted for transnational relations. As expected, combining information about given and/or received emotional and financial support resulted in an emotional-interdependent and detached transnational mother–child relationship. Second, acculturation effects were estimated by using relationship assignment as a dependent variable, performing Logistic Regressions on our uni-national and transnational sample. Findings were mixed, suggesting acculturation impacts differently on family relations within and across borders. Overall, our results demonstrate the importance of reciprocal affective ties in a transnational context, also in the absence of financial or practical support, and show the relevance of distinguishing different facets of acculturation.

Financial welfare in later life is of prime concern as the funding of pensions and care rises up policy agendas. In this context, work and family histories are well known to impact on late-life income, generally reducing state and private pensions for women. In a political context where benefits are under threat as part of the retrenchment of the welfare state, we consider two key questions. First, how do state pension and benefit transfers interact with work and family histories to reduce poverty risks in later life? Second, who is kept out of poverty by state benefits and transfers? Using data from the English Longitudinal Study of Ageing, we examine how work, family and health histories are associated with poverty in later life and estimate how far and in what ways state pensions, income support and disability benefits play a mediating role. We conclude that state support is key to maintaining incomes above official poverty lines for substantial numbers whose work, family and health histories would otherwise have led to their incomes falling below these lines. While disability benefits are designed to compensate for the additional costs of disability, it is likely that many in receipt experience poverty (even though they are not captured in official poverty statistics); even more so for those incurring the costs of disability but not in receipt of these benefits.

Interpersonal financial abuse of older people is well documented but the potential role of financial institutions is rarely examined. Financial institution mistreatment describes direct and indirect practices by financial institutions that threaten the financial wellbeing of older people. This analysis was based on a survey of community-dwelling older people (N = 2,021) aged 65 years and older, and examined self-reports of interpersonal and financial institution mistreatment. The prevalence of interpersonal financial abuse was reported by nearly 2 per cent of respondents compared to 1 per cent for financial institution mistreatment. The socio-demographic and health characteristics of the group who experienced interpersonal financial mistreatment were different from those who reported financial institution mistreatment. The boundaries between the two phenomena were explored using a social ecology framework that reflects the influences of ageism and normative practices on elder abuse. The study confirms previous international evidence on interpersonal financial abuse and provides preliminary data on financial mistreatment by financial institutions. The evidence has implications for policy and current preventative strategies that tend to ignore the influence of macro-contextual factors such as legislative and institutional normative practices, government policies and societal attitudes that can act as permissors of some types of financial mistreatment.

Social engagement has powerful effects on wellbeing, but variation in individual engagement throughout the lifecourse is wide. The trajectories may differ by gender and be affected by socio-economic status (SES). However, long-term development of social engagement is little studied and the effect of childhood SES on later-life social engagement remains obscure. We aimed to describe the social engagement development from childhood to middle age by gender and test the effect of childhood SES on middle age social engagement. Data (N=16,440, 51.3% male) are drawn from the on-going National Child Development Study, following British babies born in 1958. Social engagement was measured by social activities, voluntary work and social contacts, with follow-ups at age 11, 16, 23 and 50. SES was measured by father's occupational social class and tenure status. Structural equation modelling suggested inter-individual stability in social engagement, showing that development of social engagement started in childhood and increased social engagement in middle age through adolescence and early adulthood. Longitudinal effects were detected within and across the social engagement domains. Lower childhood SES was significantly related to a lower level of voluntary work and social activity in middle age, but to higher levels of social contacts. Although stability in social engagement is moderate over the lifecourse, variation within and across the different social engagement domains is shaped by differences in childhood SES.

National surveys show that people from minority ethnic groups tend to be less satisfied with social care services compared with the white population, but do not show why. Research indicates that barriers to accessing services include lack of information, perceptions of cultural inappropriateness and normative expectations of care. Less research has examined the experience of minority ethnic service users after they access services. This study conducted in-depth interviews with 82 South Asian and White British service users and family carers, the majority of whom were older people. Thematic analysis was used. The key theme was understanding the social care system. Participants with a good understanding of the system were more able to adapt and achieve control over their care. Participants with a poor understanding were uncertain about how to access further care, or why a service had been refused. More White British than South Asian participants had a good understanding of the system. There was more in common between the South Asian and White British participants' experiences than might have been expected. Language was an important facilitator of care for South Asian participants, but ethnic matching with staff was less important. Recommendations include better communication throughout the care process to ensure service users and carers have a clear understanding of social care services and hence a better experience.

Lifelong learning is believed to have physical, social and emotional benefits for older adults. In recognition of this, numerous programmes encouraging learning in later life exist worldwide. One example is the University of the Third Age (U3A) – a lifelong learning co-operative rooted in peer-support and knowledge sharing. This article is based on a collaborative study conducted by university researchers and members of a U3A in North-East England (United Kingdom) investigating the social inclusivity of the group in light of low attendance levels among those from social housing and non-professional backgrounds. A qualitative approach comprising semi-structured interviews and focus groups was adopted to explore knowledge and experience of lifelong learning and the U3A. Sixty individuals aged 50+ were interviewed. The demographic profile of participants largely reflected the socio-economic make-up of the area, with the majority living in areas of high socio-economic deprivation. Several barriers to lifelong learning were revealed, including: poor health, insufficient transport and caring responsibilities. Regarding U3A participation, three exclusionary factors were outlined: lack of knowledge, organisational name and location. Poor comprehension of the purpose and remit of the U3A can result in the development of ‘middle-class' myths regarding membership, perpetuating poor participation rates among lower socio-economic groups. Such perceptions must be dispelled to allow the U3A to fulfil its potential as a highly inclusive organisation.

The objectives were to determine whether women always fare more poorly in terms of physical function and disability across countries that vary widely in terms of their level of development, epidemiologic context and level of gender equality. Sex differences in self-reported and objective measures of disability and physical function were compared among older adults aged 55–85 in the United States of America, Taiwan, Korea, Mexico, China, Indonesia and among the Tsimane of Bolivia using population-based studies collected between 2001 and 2011. Data were analysed using logistic and ordinary least-squares regression. Confidence intervals were examined to see whether the effect of being female differed significantly between countries. In all countries, women had consistently worse physical functioning (both self-reported and objectively measured). Women also tended to report more difficulty with activities of daily living (ADL), although differences were not always significant. In general, sex differences across measures were less pronounced in China. In Korea, women had significantly lower grip strength, but sex differences in ADL difficulty were non-significant or even reversed. Education and marital status helped explain sex differences. Overall, there was striking similarity in the magnitude and direction of sex differences across countries despite considerable differences in context, although modest variations in the effect of sex were observed.

The benefits of engagement with social activities on health and wellbeing are widely reported by gerontologists. Less is known, however, about what drives withdrawal from and re-engagement with social activities in later life. This is an important area of research which has direct implications for public policies that aim to ensure equitable outcomes among older adults. Much of the existing literature supports continuity theory which assumes people will not alter their level of social engagement as they age or after life-changing events. This paper uses data from the English Longitudinal Study of Ageing over an eight-year period (2002–2010) to determine the effect of short-term changes in marital, employment and health status over an initial four-year period on the dynamics of social detachment over the following four years. We control for underlying socio-economic disadvantages built up during the lifecourse and find that these effects, including poor education, wealth and health, are the most important determinants of persistent detachment from social activities as well as movement into and out of social detachment. The effects are consistent in men and women. The effects of short-term changes in marital and employment status have little effect on social detachment. Recent deterioration in health, however, predicted movement into social detachment, which implies the relationship between health and social detachment is reciprocal.

The media shape both what people consider significant and how people think about key issues. This paper explored the cultural beliefs and stereotypes that underlie media portrayals of nursing homes. The analysis of texts of 157 articles about nursing homes published from 1999 to 2008 on the front pages of four major-market American newspapers (The New York Times, Chicago Tribune, Los Angeles Times and The Washington Post) was conducted using a qualitative approach inspired by comparative narrative and critical discourse analysis. Results suggest two major themes, each with several narrative components: (a) managing disposable lives (bodies outliving bank accounts; making frailty affordable; and the economics of triage); and (b) retaining purchasing power as successful ageing (consumption as a sign of market participation, spending money as an indicator of autonomy; and financial planning as preparation for future decline). Thus, the results indicate that nursing home residency in-and-of-itself is not a marker of unsuccessful ageing. This, instead, depends, in part, on the extent of choice available as a result of the level of financial solvency. This study shines light on the betwixt and between zone that distinguishes the Third and Fourth Ages; that is, independence versus dependence in old age. If individuals in a nursing home retain control over the management of their lives through the maintenance of financial independence, even if physically frail, association of nursing home residence with the Fourth Age may be ameliorated.