Chapters 3 to 7 intersect. Each chapter explores and offers analysis of a group of, often connected, issues that contribute to deepening understanding of, and explaining, mental health outcomes in later life.

Chapter 3 will explore three key issues. Firstly, it will foreground the importance of taking a life course approach to understanding health outcomes and the contribution of social gerontology to extending this perspective. Secondly, it will explore the nature of health inequalities, their implications for older people and how inequalities impact on health outcomes, particularly mental health outcomes. A part of this makes visible the intersection between health and risks associated with belonging to an unequal society. Its third focus relates to links between later life health and experiences, and exposure to adversity earlier in the life course particularly childhood. In attempting to bring these perspectives together my aim is to: illuminate the different ways in which life course inequality and adversity create and/or amplify risks to mental health in later life; draw out mental health issues from the broader category of ‘health’; and expose the embedded and structural nature of causative mechanisms.

Experiences common to later life (such as bereavement, ill health), their intersection with age-related inequalities and their impact on mental health is the focus of Chapter 4. Chapters 5 to 7 explore the impact of age-related risks that are relevant to particular subpopulations of older people: Socio-economic disadvantage and poverty; Abuse, mistreatment and neglect; and The fourth age, frailty and transitions. As these are risks that have powerful implications for mental health they warrant exploration in their own right.

All five chapters focus on functional mental health issues; issues relating to the mental health of people living with dementia and links between mental health and how we conceptualise dementia are explored in Chapters 8 and 9.

The life course approach

There is growing evidence that later life health is a product of the life course. A life course perspective seeks to identify how health outcomes are shaped ‘independently, cumulatively and interactively’ by biological, psychological, social, historical and environmental factors throughout a person's life, as well as those that impact on it in old age (Kuh et al, 2002; Whalley et al, 2006).