Ideas of well-being in old age are often anchored in the successful ageing paradigm, foregrounding independence, activeness and autonomy. However, for those oldest old living in nursing homes, these goals are largely out of reach. In this article, we use the meta-ethnographic method to explore and reinterpret existing findings on the ways in which well-being is experienced (or not) by the oldest old in institutional care settings. We frame our findings in existential well-being theory, which understands wellbeing as a sense of ‘dwelling-mobility’. Our analysis resulted in the following themes: (a) institutionalisation as both restrictive and liberating; (b) reciprocity and mattering: the importance of being seen; (c) the need for kinship and the problem of ruptured sociality; (d) rethinking agency: situated, delegated and supported; and (e) lowered expectations: receiving care is not a passive act. We conclude that while institutional care environments are not always conducive to well-being, this does not have to be so. By shifting our focus from successful ageing ideals onto relationally situated care practices, a possibility for existential well-being opens up, even in situations of decline and care dependency.

Autonomy is important to persons, including when they are living in nursing homes. Especially the relational dimension of autonomy is crucial for older adults with physical impairments. They generally have the decisional capacity to make choices about how they want to live their lives, but are often unable, or only partially able, to exercise these decisions themselves. To execute decisions, older adults are dependent on those who support them or care for them. However, little is known about how nursing home residents maintain autonomy in daily life and how others are involved in the decisions and execution of the decisions. To examine how older adults with physical impairments living in nursing homes maintain autonomy in daily life, shadowing, a non-participative observational method, was used. Seventeen older adults were shadowed during the course of one day. The observation ended with a brief interview. After the shadowing, the detailed observation notes were typed out, combined with the verbatim transcript resulting in one extensive report per shadowee. All 17 reports were coded and analysed thematically. Six elements for how older adults maintain autonomy in relation with others were identified, i.e. ‘being able to decide and/or execute decisions’, ‘active involvement’, ‘transferring autonomy to others’, ‘using preferred spaces’, ‘choosing how to spend time in daily life’ and ‘deciding about important subjects’. For all six elements established in this study, it was found that older adults with physical impairments living in nursing homes could only maintain autonomy in daily life when others, such as staff, family and friends, were responsive to signals of the needs of older adults.

The continuing COVID-19 pandemic and social restrictions have impacted on the cognitive decline and mental health of people with dementia. Social isolation and loss of activities due to social restrictions may also have implications as to sense of identity for people with dementia. As part of the INCLUDE (Identifying and Mitigating the Individual and Dyadic Impact of COVID-19 and Life Under Physical Distancing on People with Dementia and Carers) component of the IDEAL (Improving the Experience of Dementia and Enhancing Active Life) cohort study, the overall aim of this subtle realist qualitative study was to explore the perspectives of people with dementia on living through the COVID-19 pandemic within the context of the ‘post-vaccine’ period and the national lockdowns in England and Wales; and to determine perceived challenges to and facilitators of ‘living well’ during the COVID-19 pandemic and beyond as restrictions were eased. In addition, the study findings are considered in relation to understandings of identity in dementia which the broader accounts of living through the pandemic have highlighted. Seven people with mild-to-moderate dementia were interviewed and themes were derived using framework analysis. Themes suggest interviewees' stoic acceptance of the pandemic and social restrictions but also fear of decline related to the temporality of their condition as well as loss of self-confidence to re-engage with the world. Interviewees managed threats to social identity by striving to maintain social and emotional connections, where the importance of a shared, social identity, particularly for people with young-onset dementia, was also apparent. Unlike in previous studies during the pandemic, the relevance of occupation for identity was observed, where maintaining previous or new activities or occupations was important to facilitate identity as well as to keep a sense of purpose. Therefore, as well as supporting people with dementia as the pandemic eases, future research into occupation and identity in dementia is of potential value.

Evidence on post-diagnostic support for people with young onset dementia is scarce. Previous studies have employed a problem-focused approach; however, evidence on ‘what works’ in real-life practice is essential to develop recommendations for service design and delivery. This study aimed to provide insight into ‘what works’ from the perspectives of people with young onset dementia and their supporters. We gathered free-text responses on positive service experiences via a UK cross-sectional survey. Inductive thematic analysis was used to identify the objectives of positive services and the needs these met. Follow-up interviews enabled in-depth insights from people with diverse diagnoses, ages and social situations. These were analysed using a template drawn from the survey. The 233 survey respondents gave 856 examples of positive support. Analysis of 24 follow-up interviews led to 16 themes clustered under three superordinate themes: ‘maintaining autonomy’, ‘being myself’ and ‘togetherness’. We found that positive services address the disruptions to sense of agency, selfhood and meaningful relationships that are experienced by those with young onset dementia. The study provides an in-depth understanding of the needs met by positive services for younger people with dementia. Our nuanced findings on good practice can inform age-specific guidelines for young onset dementia and indicate how personalisation can work in practice to help people with young onset dementia to maintain identity, autonomy and connections.

Despite the recent policy impetus for age-friendly cities, there is still scope for more geographical insights into ageing in low- and middle-income countries (LMICs). Cities in LMICs, such as Bengaluru (India), are witnessing an increase in the size of the older population in their peripheral urban regions, but there is relatively little understanding of the risks of exclusion in later age in these liminal zones. This study, set in a peripheral ward of Bengaluru, focuses on the experiences of exclusion/inclusion of socio-economically marginalised older adults and their access to work, health care and leisure. The research uses a multidimensional old-age exclusion framework to highlight how the domains of neighbourhood, material resources, mobility infrastructure and social relations influence the risks for social exclusion. We use a qualitative approach by combining behavioural mapping and in-depth interviews. Our findings highlight some ways in which institutionalised exclusion from civic infrastructure accentuates the precariousness of ageing. The rigidity of traditional hierarchies in peri-urban regions has meant that older adults who were poor, women and belonged to marginalised castes experience constrained mobilities to access labour markets, health care and social life, compounding their place-based exclusion. Despite social networks and solidarities, older adults on the periphery faced individualisation of risks while trying to access the basic amenities, thereby falling between the gap of the urban–rural milieu and governance. Age-friendly cities need to accommodate such hybrid transitionary urban processes, in the absence of which, active ageing in these rising peripheries can be impeded.

Home environment is essential to older adults. While existing studies have investigated the positive implications of home modification strategies for older adults and proposed relevant policies and programmes, literature has remained relatively silent on how older adults perceive their needs for their home environment and its modification, especially during and after they go through home modification projects. This study investigated community-dwelling older adults' perceptions of needs for home modification in Shanghai. Informed by theories in environmental gerontology and tenets of awareness of age-related change, we conceptualised two intertwined, evolving processes of person–environment (P-E) interactions: older adults' interactions with their home environment, and the interactions between their perceptions of needs for home modification and the ageing process. Taking a qualitative approach, we interviewed community-dwelling older adults who were among the first to have received a pilot government-sponsored home modification project in Shanghai (N = 15). Our findings suggest that older adults' P-E dynamics evolved in response to their perception of their home environment and ageing process. Most participants initially were unaware of their underlying needs for home modification even when they had encountered challenges in their apartments. As the home modification project took place, participants gradually gained knowledge of their home environment and the following modification, which enabled them to better identify and articulate their needs to improve their daily living. After the project, participants' understandings of their home environments continued to evolve, expanding to their neighbourhood. This study informs policy and practice to focus on recognising the evolving aspects of older adults' needs in their home environment and better engaging older adults in the process of home modification.

Critical and feminist ageing scholarship has drawn attention to how dominant discourses of ageing negatively impact older women's identities and social lives. While research intersecting migration and ageing has broadly focused on older immigrants' settlement experiences, very little is known about the discursive influences over older immigrant women's sense of agency and social relations. To address this knowledge gap, this study explores the subjectivity-formations of older South Asian Muslim women engaged in transnational migration. Narrative and discourse analysis principles were used to conduct and analyse life story-based interviews with 15 South Asian Muslim older women who recently migrated to Toronto, Canada. Findings indicate that participant subjectivity-formations are shaped by: (a) discourses of ageing; (b) socio-cultural–religious discourses; and (c) discourses of transnational migration. In response, participants engaged in dynamic strategies including conforming, negotiating, creating alternative narratives and/or resisting these discourses to organise their lives. These findings reinforce the continued need to trace the governmentality of structural conditions over ageing migrant women's lives and their responsive strategies to manage these impacts.

Immigrants commonly report difficulties with developing social connections post-transition, which can lead to social isolation as they age. Understanding what factors promote/hinder the social integration of immigrants is an important public health objective. We tested the public health model of social integration of Berkman et al. in a sample of older immigrants. This model calls for considering both the social conditions in which social networks are embedded (upstream influences) and the levels of social support offered by different types of networks (downstream influences). First, we derived an empirical typology of social networks of older immigrants. Next, we tested associations of social networks with upstream and downstream influences. Data came from the New Zealand Health, Work and Retirement Study. The sample included 568 older adults (54% male) who immigrated as adults (mean length of stay = 28.5 years, standard deviation = 12.5). Latent profile analysis was employed on responses to the Practitioner Assessment of Network Type to identify social networks. Associations with upstream and downstream correlates were tested using logistic and multiple regression. Four network configurations emerged: ‘private-restricted’ (43.4%), ‘family-dependent’ (35.8%), ‘locally integrated’ (10.9%) and ‘wider community-based’ (9%). Having shorter length of residence and individualistic cultural background was predictive of being in a restricted network (private-restricted, family-dependent). Being in a restricted network was associated with lower levels of social support. Network type interacted with partner status: having a partner buffered the negative impact of having a restricted network on social support. Although restricted networks are common among older immigrants, they do not necessarily result in compromised social support. While we may see differences across countries regarding the impact of specific upstream and downstream influences, our findings highlight that both contextual and individual-level resources need to be considered alongside network structure to promote social integration of immigrants as they age.

Recent public and policy interventions aim to recognise formally the contributions of family care-givers to long-term residential care in Canada, with some arguing family carers are more than visitors and should be recognised as essential care-givers. These developments call for reconsidering how family care roles are understood and operationalised. Drawing on ethnographic research conducted in three care homes in Ontario, Canada, we present an in-depth feminist rhetorical analysis of the narrated lives and work practices of 12 unpaid family carers. Specifically, we explore how unpaid family carers themselves draw on broader discursive ‘ruling metaphors’ to interpret their roles and activities (e.g. as essential care-givers, visitors, team members), and how these metaphors invoke, organise and/or give rise to particular practices, responsibilities and relations. We contrast the stories of a family member who positioned herself as an essential care-giver and expressed a more onerous sense of individual responsibility with the stories of people who enjoyed the pleasures of visiting, who contributed as team members in ways that went beyond caring for their own relatives' care needs, and who embraced the possibilities that came with volunteering and with being able to influence change. Our analysis situates and contextualises participants' stories of their involvement and unpaid work in relation to their everyday material conditions and circumstances. We elaborate how different ways of understanding caring roles shape the nature of carers' unpaid work, as well as their options to share responsibility or set limits on that work. We also raise questions about the organisational conditions needed to help enact care as a shared collective responsibility.

In recent years, various authorities launched projects that aim to make their cities more age-friendly. Designing age-friendly cities is a complex and context-dependent process that requires clear implementation guidelines for policy makers. As one of the eight domains of age-friendly cities, transportation is a critical component of making our cities more liveable for older adults and their families. This paper contributes to the literature by exploring the travel behaviour of older adults with a focus on the factors that lead to sustainable mobility patterns. Our empirical analysis is based on survey data collected from 1,221 older adults as part of the Age-Friendly Columbus project in Columbus, Ohio in the United States of America. We develop multinomial logistic regression models to investigate the travel mode choices of older adults (auto only, non-auto options only and multimodal (auto and at least one non-auto option)). We include age and built environment characteristics as the key variables, with lifestyle-related factors and socio-demographics as controls in our analysis. We find older respondents were more likely to use autos only compared to younger respondents. Our analysis also reveals significant associations between built environment characteristics and travel mode choices. Interaction effects show that the relationships between built environment characteristics and travel preferences differed by age cohorts among older individuals. The primary contribution of this study is that it provides evidence on what built environmental improvements help to promote sustainable travel among older adults in mid-sized and auto-dependent metropolitan cities. We argue that these improvements contribute to older adults' sustainable mobility, as well as out-of-home activity behaviour, social engagement and individual health. The results of this study may especially benefit non-driver older adults who lack reliable non-auto alternatives for their daily travel.

Cowgill's modernisation theory stipulates that older people's social status is lower in societies with higher societal modernisation. The few existing studies reveal conflicting results showing either negative or positive associations. The current study follows up seminal cross-national research on the perceived social status of people in their seventies (PSS70) in a diverse set of countries. PSS70 was defined as the relative status of people in their seventies compared to people in their forties. Data were obtained by the World Values Survey (2010–2014) and included 78,904 respondents from 58 countries. Multilevel regressions showed that the level of modernisation had a strong and negative association with the PSS70 but mostly due to one component, namely the share of older people in society. The associations were more complex when considering cultural zones of which two stood out. Irrespective of level of modernisation, Muslim countries showed higher and post-communist countries showed lower levels of PSS70. In Muslim countries, modernisation had a near-zero association with PSS70, whereas it was strongly negatively associated with PSS70 in post-communist countries. This study generally supports Cowgill's theory in a large and diverse cross-sectional sample of countries, yet it also illustrates its cultural boundary conditions.

Over the past 40 years, positive ageing discourses that speak to an expectation of continued productivity have gained prominence within research and policy. Such discourses have been critiqued as placing disproportionate value on the extension of older adults' working lives, while obscuring other valuable forms of work performed by older adults. Despite the emergence of theoretical conversations about the expansion of conceptions of work, few studies have adopted an explicit focus on the work performed by older adults within their neighbourhoods. Informed by conceptions of work positioned at the intersection of critical gerontology and critical feminism, we drew upon qualitative data from a larger ethnographic study, generated from 17 participants aged 65 and older, to examine: (a) the various forms and contributions of unpaid work that older adults carry out at the neighbourhood level, and (b) the ways in which older adults' representations of this work relate to dominant notions of productivity. Specifically, each participant engaged in three types of qualitative interviews, including additional spatial and visual data generation: (a) completing a narrative interview; (b) carrying a small Global Positioning System (GPS) device to automatically log locations, completing an activity diary and a follow-up interview; and (c) participating in a go-along interview or a photo elicitation interview. Our findings highlight a range of unpaid work performed by participants in their neighbourhood, including formal volunteering, informal caring and informal civic participation. Although these forms of work were, at times, discussed by participants as enabling social inclusion, significant tensions arose from the general lack of discursive and social value assigned to them. In particular, participants described being subject to overwhelming expectations placed on older adults, and women in particular, to carry out this work, with little recognition or acknowledgement of their contributions to the neighbourhood. Taken together, our findings suggest the need not only to diversify understandings of the forms of work perceived as aligning with productive contributions to society in older age, but also to attend to the invisible work performed by older adults within their neighbourhoods. Additionally, we propose a variety of ways organisations and communities that benefit from older adults' unpaid labour may enhance accessibility, thereby reducing the work done by older adults to negotiate tensions between ableist expectations for productivity and their ageing bodies.

Mobility research tends to focus on physical movement and experiences in later life; however, changes in older adult mobility over time remains underexplored. Furthermore, older adults typically experience many life events, some of which result from cognitive and physical decline, and many of which impact mobility. This article aims to explore how life events affect the mobility of older adults over time. We conducted in-depth interviews with 22 older adults aged 55 years and over from Lancashire, United Kingdom. Of these participants, eight lived with memory problems. The findings show that both anticipated and unexpected life events play a profound role in the participants' mobility over time. Retirement, long-term illness and age-related illness were examples of anticipated life events, while the death of a loved one and developing memory problems were examples of unexpected life events. In both cases, participants' made external adaptations, such as moving home, or internal adaptations, such as self-awareness. The findings also emphasise the layered nature of life events and adaptations playing a role in the participants' mobility. Additionally, life events such as developing memory problems showed a domino effect, triggering further life events and adaptations which impacted the participants' mobility. This article emphasises how transition periods can occur before or after a life event, showing that adaptations can be pre-emptive to a life event. Our article contributes to calls for internal adaptations to be fully incorporated into age-related policy and also for age-related policy to be more inclusive for older adults who experience memory problems and dementia.

Medical assistance in dying (MAID) is legal in Canada but cannot be accessed through an advance request. Some data suggest that informal care-givers of persons with dementia support the legalisation of advance requests for MAID. Opponents argue that care-givers' support is due to society's failure to address their well-documented burden and unmet needs. To our knowledge, this assumption has never been tested. To fill this knowledge gap, we conducted a survey among 204 Canadian informal care-givers of persons with dementia to (a) elicit their attitudes towards allowing no longer competent adults to access MAID through an advance request, and (b) test the hypothesis that attitudes are in part driven by the level of burden experienced by care-givers and unmet needs for support. Attitudes were elicited with a clinical vignette involving a woman with Alzheimer's disease who requests MAID while still competent, or through an advance request for the time after she would lose decisional capacity. Informal care-givers' support for MAID ranged from 60 per cent in the scenario where the person is still competent and likely has several more years to live, to 87 per cent when she is depicted as no longer competent, in severe distress and close to death. Quality-of-life considerations and the value of self-determination were key arguments in support of legalising advance requests for MAID. Using multivariable logistic regression, we found no evidence that burden and unmet support needs influence attitudes towards advance requests for MAID, after controlling for other determinants. These findings contribute new insights into people's attitudes towards the sensitive issue of whether MAID should be extended to persons with dementia-induced decisional incapacity.

Falls in older adulthood can have serious consequences. It is therefore important to identify ways to prevent falls, particularly from the voice of older adults. Bottom-up qualitative exploration of the perspectives of older adults can provide rich insights that can help inform the development of effective fall prevention programmes. However, currently there is a dearth of such empirical data, especially among urban-dwelling older adults in high-density cities where fall rates are high. The current study aimed to examine qualitatively perceptions of neighbourhood physical environment in relation to falls, perceived risks and fear of falling, and strategies and behaviours for fall prevention in a sample of urban-dwelling older adults in the high-density city of Hong Kong. Face-to-face semi-structured in-depth interviews were conducted with 50 community-dwelling older adults. Interviews were transcribed verbatim and analysed using thematic analysis techniques. Five general themes were revealed: risks and circumstances of falls, consequences of falls, fear of falling and its consequences, neighbourhood environment, and strategies and behaviours of fall prevention. While older adults discussed the risks of falling and held a fear of falling, these beliefs were mixed. In addition to fall prevention strategies (e.g. keep balance), current findings highlighted the importance of establishing protective factors (e.g. flat and even walking paths) and reducing risk factors (e.g. neighbourhood clutter) in neighbourhood environments. For urban-dwelling older adults in high-density cities, current findings highlight the importance of focusing efforts at the built environment level in addition to strategies and behaviours of fall prevention at the individual level.

Older adults' participation in gambling is increasing internationally. Due to their lifestage, older adults may be vulnerable to gambling-related harm. When investigating older adults' gambling, researchers have mostly focused on the individual characteristics of ‘problem gamblers’. Less is known about the socio-cultural, environmental and commercial factors that may influence older adults' gambling behaviours. Utilising Social Practice Theory, this critical qualitative inquiry of N = 40 Australian older adults (aged 55 and over) explored how social practices influenced gambling participation. Using a Constructivist Grounded Theory approach, data were interpreted using a reflexive thematic analysis. Theme 1 identified how gambling practices fulfilled older adults' social needs. Gambling was embedded in social activities and created a sense of belonging. Theme 2 highlighted how gambling became an everyday part of some participants' lives, with a range of routines constructed around gambling. While social factors influenced routinised gambling behaviours, the accessibility of gambling products in everyday settings contributed to engagement with gambling. This study demonstrates that a range of social, environmental and commercial factors may influence and routinise the gambling practices of older adults. Interventions aimed at preventing and reducing routine gambling participation among older adults should acknowledge the interplay between agency and social structure. Public health responses should aim to disrupt routine behaviours associated with gambling for older adults.

Sleep is an integral part of individuals' health and wellbeing. Despite evidence showing that social stressors are important contributors to older adults' sleep problems, how the accumulative stressful life events (SLEs) and ageing attitudes independently and jointly affect sleep quality among older adults in developing countries remains unclear. This study examined the effects of SLEs on subjectively rated sleep quality among older adults in China, and explored the potential mediating and moderating roles of positive and negative ageing attitudes on the above association. Using data from the 2014 China Longitudinal Ageing Social Survey, we had complete data for 7,780 older adults aged 60 and older. We employed logistic regression models and the Karlson–Holm–Breen decomposition method. Our findings indicated that SLEs significantly increased the risk of poor sleep quality, especially for those who had experienced two or more SLEs during the past year. Positive ageing attitudes were associated with lower odds of poor sleep quality, whereas negative ageing attitudes were related to higher odds of poor sleep quality. Moreover, the mediation analyses suggested that SLEs were associated with poor sleep quality via negative ageing attitudes. The moderating effects further documented that higher levels of positive ageing attitudes can significantly attenuate the deleterious impact of SLEs on sleep quality. The findings highlight the significance of SLEs for older adults' sleep quality and shed light on the importance of ageing attitudes to improve older adults' sleep in China as well as other low- and middle-income countries, where the social safety nets are still underdeveloped.

In most Organisation for Economic Co-operation and Development (OECD) countries, the government has to manage tension between growth in the need for long-term care (LTC) services for older people and significant public budget constraints. Not surprisingly, therefore, cost-containment policies are of increasing relevance. Nevertheless, despite the flourishing interest in the comparative literature in reforms and the sustainability of LTC policies, a scoping review of these measures has so far not been produced. This article aims to contribute to filling this gap. We present a typology of LTC cost-containment policies across the OECD. Cost-containment policies cluster in two areas according to their focus: demand-side policies, which reduce the actual chances of receiving LTC services and/or make them more expensive for users; and supply-side ones, which modify the provision of services. Furthermore, an indirect outcome of the review is that it allows an overview of potential negative implications of these policies. These negative implications can be grouped in two macro spheres relating to a worsening of the care arrangements for beneficiaries and to increased demand for individual/family resources, in both economic and time and effort terms. In the light of the expected profound impacts of the COVID-19 outbreak on all social security sectors in the medium and long term, this article provides a valuable tool for both academic and policy-making debate. It allows an analytical comprehension of cost-containment strategies adopted in LTC sectors linking them with the related impacts on beneficiaries and their families.

Driving is the preferred mode of transport for many older drivers, providing mobility to maintain independence and quality of life. The loss of driving privilege has negative psychosocial consequences, including depression. Early discussions and planning for driving retirement are therefore essential. Driving retirement, however, is typically a taboo topic for older drivers and their support networks. To understand why discussions and planning about driving retirement are avoided, 43 semi-structured interviews were conducted with older drivers in New South Wales, Australia. Drawing on Löckenhoff's ageing and decision-making framework, thematic analysis of transcripts offers insights into why discussions and planning for driving retirement are avoided or facilitated. The findings reveal most older drivers had not discussed or planned for driving retirement. Barriers to discussing and planning for driving retirement included: perceptions of loss, change, death and denial. Facilitators to discussing or planning for driving retirement included: declining health and driving confidence, medical advice, age or car accident. Driving retirement in car-dependent societies is a major life event, symbolising an end-of-life stage for many older people. This paper calls for strategies to encourage early and regular discussions about driving retirement with older drivers. To support older drivers’ transition to driving retirement, an understanding of the value and meaning placed on driving in the context of the individuals' identity and lifestyle is recommended.

Quizzes are a ubiquitous part of the dementia social care landscape. This article explores why. Using an ethnographic approach which draws on close analysis of communication, we examine dementia quizzes as a ‘social practice’, and what such a lens can tell us about their popularity in social care settings. Vignettes of real interactions drawn from ten different quizzes recorded in four different group settings attended by 28 people living with dementia and 15 staff members are presented to highlight particular issues. We show that the conditions of post-diagnosis dementia social care are uniquely well suited to an activity such as quizzes which are malleable, requiring little preparation or materials, and impose a communication framework which can help to organise the interactional space. Quizzes also draw on previously forged interactional competences, such as turn-taking and question–answer sequences, a skill that has been shown to persist even as dementia progresses. Finally, we argue that the meaning of quizzes with people with dementia feeds into wider societal values and associations attached to memory, dementia and personhood. The extent to which quizzes are akin to a ‘test’ or a fun and enjoyable social activity rests in how they are enacted. We suggest that practice can be adapted, developed and made more inclusive through input from people living with dementia themselves.