Autonomy is considered to be one of the central ethical principles of health care practice and as such is a significantly relevant concept for health care practitioners. With the many political and ideological drivers that challenge the way health care for older people is currently delivered, it is important to consider how the autonomy of older people is facilitated in everyday practice. In this paper I challenge the dominant understanding of autonomy as ‘individualism’. Through research undertaken with nurses who work with older people, it identifies the conflicts that arise between an individualistic understanding of autonomy set alongside an emphasis on ‘person-centred’ practice.

Data were collected by recording ‘naturally occurring’ conversations between nurses, patients and associated practitioners. Primary nurses recorded conversations occurring between them and four patients throughout their hospital stay. In addition, a recognised expert gerontological nurse and a community nurse specialist participated as a means of testing out initial themes generated by the primary nurses. A total of 14 case studies were recorded. The data were analysed using principles of conversation analysis and thematic analysis set within a hermeneutic interpretive framework. In order to illuminate presentations of autonomy in practice, focus group discussions with nurses and older people were used as part of the interpretative process. I discuss the factors that prevented the operationalisation of an individualised rights-based concept of autonomy for older people. Issues including information-giving, the conversation style of nurses, internal and external constraints and patients' competence to decide are considered. In addition, the role of families in decision-making is addressed. The paper ends with a discussion of an alternative view of autonomy based on ‘interconnectedness’ in the nurse-patient relationship. This perspective is not based on either the patient or nurse being the ‘final arbiter’ of decisions, but is instead set within a framework of negotiation.

This paper reviews recent research on care-giver networks and the concepts and approach that they apply, with particular reference to the support networks of the primary care-givers of older people with Alzheimer's disease. It makes the case for an integrated approach to the explanation of the various combinations of formal and informal support that are found. It argues that more attention needs to be given to transformations in care-giver networks over time, and that this will require more development of both theoretical perspectives and analytical tools. The stages of a care-giver's commitment towards an elderly relative are examined, to understand the associations between changes in the ailing person's needs, the structure of the support network and the primary care-giver's roles. This approach makes useful contributions to the understanding of the development, maintenance and dissolution of supportive ties. Following the work of Pescosolido (1991), we propose an integrated perspective that combines the ‘care-giver career’ approach and the methods of ‘social network’ analysis.

The workplace is one of the areas in which discrimination most frequently occurs. Despite increasing workforce participation among older adults and the adverse effects of workplace discrimination on the physical and psychological wellbeing of older adults, limited attention has been given to workplace discrimination against older workers. Based on a national survey of 420 older workers age 50 and above, this study first examined the prevalence of perceived workplace discrimination. Results indicated more than 81 per cent of the older workers encountered at least one workplace discriminatory treatment within a year. Prevalence of perceived workplace discrimination differed with age, gender, education, occupation and wage. The study further tested two competing hypotheses on the level of perceived workplace discrimination and found mixed support for both. As hypothesised (based on the social barriers theory), lower education and racial/ethnic minority status were positively associated with perceived workplace discrimination. As counter-hypothesised (based on the attribution-sensitivity theory), younger ages and being male were positively associated with perceived workplace discrimination. In examining the roles of supervisor and co-worker support, the study discovered that supervisor support was negatively associated with workplace discrimination. Finally, this study revealed a non-linear relationship between wages and perceived workplace discrimination, with the mid-range wage group experiencing the highest level of workplace discrimination.

There are at least four ways in which old age and migration cross each other's paths. First of all, there are people who migrated for economic reasons, usually at a relatively young age, and who have grown old in a foreign country. Secondly, there are older people who migrate when (or because) they are old: in Europe, they are mostly from the affluent northern countries and travel southward. Thirdly, there is increasing employment of, and demand for, immigrant workers in old-age institutions in the northern countries. Finally, there is the out-migration of young people, mainly from rural areas, that results in older people being left behind without children to look after them. In all these cases, migration has a profound effect on the wellbeing and care of older people. The authors of this article explore a fifth linkage between migration and old age, by focusing on the (mainly illegal) immigrants who take on roles as private carers and, in effect, replace the children who have emigrated. Two cases, from Greece and Ghana, are presented and viewed in the two countries' political, cultural and economic contexts, and are then compared to conditions in The Netherlands. In both cases, involving a ‘stranger’ in the care of an older parent is regarded as a good and respectable solution to the problem of absent children and grandchildren: it follows rules of reciprocity and normally provides a good quality of care. Ironically, hiring full-time private care for older people is feasible in low-income countries but a rare luxury in high-income societies.

Gerontologists have emphasised that older adults are not only recipients of support but also important support providers. Using data from the first wave of the Netherlands Kinship Panel Study of 727 middle-generation adults aged 45 to 79 years, we examined the associations between loneliness and giving support up, across and down family lineages. Overall, the findings were consistent more with an altruism perspective, that giving brings rewards, than with an exchange perspective, which emphasises the costs of giving support. The results showed an inverse relationship between the number of generations supported and loneliness, and that those engaged in balanced exchanges with family members in three generations (parents, siblings and children) were generally the least lonely. As regards the direction of support giving, the findings showed that the association between giving support and loneliness was insignificant if the support was for parents, negative for support to siblings, and positive for support to children. Imbalanced support exchanges were differentially associated with loneliness, and depended on the type of family relationship involved. Non-reciprocated support made parents more vulnerable to loneliness, whereas non-reciprocated giving in sibling ties was associated with low levels of loneliness. Imbalanced support giving in relationships with parents was not associated with loneliness.

Photovoice is a qualitative research technique in which participants record and reflect on their community through photography. The technique is gaining popularity as a participatory research methodology. Few studies, however, have described the use of photovoice with older adults. This paper examines the application of photovoice in a qualitative, participatory research study examining age-friendly community characteristics in four communities in Manitoba, Canada. Thirty older adults were provided with cameras and took photographs to illustrate how age-friendly their communities are and participated in group discussions to identify priorities in becoming more age-friendly. The research process and results were analysed in order to assess the application of the methodology with older adults. Photovoice is an effective tool for eliciting older persons’ perceptions of their communities, giving voice to the unique concerns of older adults, and identifying strategies for change. If adapted to accommodate the needs of seniors, this methodology provides an innovative approach to community-based gerontological research. On the other hand, there are a number of challenges to be overcome if photovoice is to be a truly effective research instrument, including recruitment, photography training, retrieving consent forms, and issues of time and distance.

This paper reports a systematic review of 28 evaluations of interventions that aimed to describe the benefits of the use of the life story for nursing-home residents with dementia, particularly with reference to their sense of identity. The 28 studies were published during 1990–2003. The review focuses on the methodology of the evaluations, and on how the studies contributed to our understanding of the value of using a resident's life story in care interactions. The studies were divided into three groups by the purpose of the intervention: to raise self-esteem and self-integration; to improve life quality; and to change behaviour. The features of the interventions that were associated with enhanced sense of identity were a thorough and encompassing treatment of the individual's life story, the translation of the life story into care interactions, and active encouragement of the residents' initiatives. Only one intervention had all of these features. The diverse aims and forms of the interventions were mirrored by the diverse methodologies of the evaluation studies. Recently the trend has been towards more rigorous designs that measure a few precisely-defined quantitative outcomes but at the cost of a narrower appreciation of the impacts. Given that there is still a great deal to learn about how best to deliver sensitive, individualised and effective support and care to people with dementia, it is argued that qualitative assessments have been too hastily discontinued.

Few studies have investigated how outdoor environments might disable people with dementia. The issue is rarely considered in planning and design guidelines and not at all in regulations, despite dementia being within the scope of disability discrimination legislation in the United Kingdom and other countries. This article reports a study that involved older people with mild to moderate dementias taking two walks, one in a real town centre and one in a virtual reality (VR) simulation. Adaptations were made to the VR simulation to test possible design improvements. Overall, the town centre posed relatively few problems for the 38 older people with dementia who participated, although more difficulty was evident with greater impairment. Some features of particular places were liked more than others, particularly the segregation of spaces from motor traffic. There were measurable benefits from using clear textual signs to support wayfinding and to identify objects and places in the environment. Diminished outdoor activity is likely to be experienced as a decrease in quality of life and may accelerate the progression of dementia. We conclude that older people with mild to moderate dementia should be encouraged to be active outdoors and that this can be facilitated by small environmental modifications. Some limitations of the VR technology used for the study are also reported.

Some 50 years after the creation of the welfare state and at the start of the new millennium, this paper considers the current and future status of older people in Britain. It argues that as the population ages, the situation of older people is becoming an increasingly important element in social policy debates. The first half of the paper critically reviews developments over the last five decades, emphasising the salience of accommodation issues during this period. In the light of recent initiatives such as ‘Better Government for Older People’, the second half of the paper outlines a policy agenda for the early years of the 21st century. We argue unequivocally for an integrated social policy which addresses the broad needs of an ageing society as opposed to narrow age-based interests, or the interests of specific problematised or stigmatised groups. The creation and delivery of such an integrated policy for tomorrow's Britain rests, we contend, on three crucial dimensions: an explicitly articulated value base; a consideration of the educational, technological and spatial aspects of policy; and harmonisation of action at both local and national levels.

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.

With an ageing society, the demand for health and social care is increasing. Traditionally, staff provide care for their clients rather than with them. In contrast, reablement aims to support people to maximise their competences to manage their everyday life as independently as possible. There is considerable variation between and within countries regarding the conceptual understanding of the approach. This variation affects the ability to evaluate reablement approaches systematically, compare and aggregate findings from different studies, and hinders the development of a robust evidence. Therefore, a Delphi study was conducted in 2018/9 with the aim of reaching agreement on the characteristics, components, aims and target groups of reablement, leading towards an internationally accepted definition of reablement. The study consisted of four Web-based survey rounds. In total, 82 reablement experts from 11 countries participated, reaching agreement on five characteristics (e.g. person-centred), seven components (e.g. goal-oriented treatment plan) and five aims (e.g. increase clients’ independency). Furthermore, most experts agreed that reablement is an inclusive approach irrespective of the person's age, capacity, diagnosis or setting. Based on these features, a definition of reablement was developed, which was accepted by 79 per cent of participating experts. This study is a significant step towards providing conceptual clarity about reablement. Future research should focus on evaluating the implementation of agreed reablement components to inform practice, education and policy.

Sexuality and intimacy in care homes for older people are overshadowed by concern with prolonging physical and/or psychological autonomy. When sexuality and intimacy have been addressed in scholarship, this can reflect a sexological focus concerned with how to continue sexual activity with reduced capacity. We review the (Anglophone) academic and practitioner literatures bearing on sexuality and intimacy in relation to older care home residents (though much of this applies to older people generally). We highlight how ageism (or ageist erotophobia), which defines older people as post-sexual, restricts opportunities for the expression of sexuality and intimacy. In doing so, we draw attention to more critical writing that recognises constraints on sexuality and intimacy and indicates solutions to some of the problems identified. We also highlight problems faced by lesbian, gay, bisexual and trans (LGB&T) residents who are doubly excluded from sexual/intimate citizenship because of ageism combined with the heterosexual assumption. Older LGB&T residents/individuals can feel obliged to deny or disguise their identity. We conclude by outlining an agenda for research based on more sociologically informed practitioner-led work.

With the development of possible therapeutic interventions for people with dementia there is an increasing realisation among clinical and health service researchers of the paucity of appropriate outcome measures for people with dementia and their informal caregivers. The different perspectives on dementia within the biomedical, psychological and social models of disability lead to radically different meanings of the concept ‘quality of life’ and approaches to its assessment. This paper examines these different approaches and proposes a broad research agenda which is underpinned by two key principles. First, people with dementia and their informal caregivers should be involved in the development of usable outcome measures relevant to their needs and circumstances. Second, the scientific community in partnership with those directly affected should develop a pluralistic approach to the assessment of outcome taking account of both the meaning of the condition to people with dementia and their informal caregivers and cost utility from a societal perspective.

Increasing numbers of people are using complementary therapies, and many are in older age groups. Although recent empirical research has considered the demands for complementary medicine, and in particular its recent consumer boom, little acknowledgement is given in research to the different social categories of users, and to the intricacies of their different motivations and consumer behaviours. In the context of a relative paucity of dedicated research investigations, the paper highlights the relevance of social gerontological perspectives. Based on a questionnaire survey of 144 older users, and in-depth interviews with 20 older users in southern England, it considers trends in local use and user actions, attitudes and opinions. From a disciplinary perspective, the paper also contributes to a growing body of research which focuses on older peoples’ self-implemented health and health care strategies. There is a substantial degree of user satisfaction with the therapies used, and many respondents claimed to have benefited in terms of their physical and mental health. Older users are also empowered by their treatment decisions and negotiations, many of which are made either independently, or jointly between themselves and their therapists. Treatment solutions are typically constructed with combinations of complementary therapies, or combinations of complementary therapies and orthodox health services.

Demographic change and policy changes in social care provision can affect the type of social care support received by older people, whether through informal, formal state or formal paid-for sources. This paper analyses the English Longitudinal Study of Ageing data (wave 4) in order to examine the relationship between demographic and socio-economic characteristics, and the receipt of support from different sources by older people who report difficulty with daily activities. The research outlines three key results with implications for the future organisation of social care for older people. Firstly, the number of instrumental activities of daily living (IADLs) an older person reports having difficulty with, followed by the number of activities of daily living (ADLs) are the strongest determinants of receiving support from any source. Secondly, there are significant gender differences in the factors associated with receiving support from different sources; for example, physical health is a strong determinant of informal support receipt by men, while mental health status is a strong determinant of informal support receipt by women. Finally, the research shows that different kinds of impediments in everyday life are associated with receiving support from different sources. This ‘link’ between particular types of difficulties and support receipt from particular sources raises questions about the way social care provision can or should be organised in the future.

Employing a political economy analysis of need as it relates to the ageing of the population in the context of the postmodern welfare state, this paper attempts to go beyond the narrow confines of the apocalyptic demography argument that an increasing dependent older population represents social and fiscal catastrophe. Older people are caught between a social ethic which values independence on the one hand, and, on the other, a service ethic which constructs them as dependent. This paper argues that this dichotomy between dependence and independence results from a depoliticisation of need, in part the legacy of a radical individualism combined with a postmodern therapeutic ethic. The deeper issues which lie at the heart of the apocalyptic demography argument have to do with issues of need, reciprocity, and community. This paper argues further that a moral economy of interdependence, based on the notion of reciprocity, transcends the dependency/independency dichotomy, repoliticises need, and thereby creates the possibility of a revitalisation of civil society.

Older age is one stage of the lifecourse where dignity maybe threatened due to the vulnerability created by increased incapacity, frailty and cognitive decline in combination with a lack of social and economic resources. Evidence suggests that it is in contact with health and welfare services where dignity is most threatened. This study explored the experiences of older people in acute National Health Service (NHS) Trusts in relation to dignified care and the organisational, occupational and cultural factors that affect it. These objectives were examined through an ethnography of four acute hospital Trusts in England and Wales, which involved interviews with older people (65+) recently discharged from hospital, their relatives/carers, and Trust managers, practitioners and other staff, complemented by evidence from non-participant observation. The picture which emerged was of a lack of consistency in the provision of dignified care which appears to be explained by the dominance of priorities of the system and organisation tied together with the interests of ward staff and clinicians. The emphasis on clinical specialism meant that staff often lacked the knowledge and skills to care for older patients whose acute illness is often compounded by physical and mental co-morbidities. The physical environment of acute wards was often poorly designed, confusing and inaccessible, and might be seen as ‘not fit for purpose’ to treat their main users, those over 65 years, with dignity. Informants generally recognised this but concluded that it was the older person who was in the ‘wrong place’, and assumed that there must be a better place for ‘them’. Thus, the present system in acute hospitals points to an inbuilt discrimination against the provision of high-quality care for older people. There needs to be a change in the culture of acute medicine so that it is inclusive of older people who have chronic co-morbidities and confusion as well as acute clinical needs.

A critique of the study of ageing by sociologists and historians is provided in this paper, on the basis of the comparative neglect of life history studies across the whole lifespan. It points to the skewed nature of studies reported in the literature. As a corrective, results from a UK life history based study are presented. It focuses on leisure, grand- parenting and intimate relationships between adults, leading to conclusions about the relationship between class factors in the determination of late life experiences and self perceptions of the meaning of old age.

This inquiry examined whether social networks are associated with wellbeing among older-old people in the same way that they are among younger-old persons. The study focused on family respondents, aged 60 and older, from the second wave of the Survey of Health, Ageing and Retirement in Europe (N=14,728). The statistical analysis regressed two wellbeing measures (the CASP quality of life scale and life satisfaction) on a range of social network variables from three domains: family structure and interaction, social exchange and social engagement. In addition, the inquiry viewed these associations through the lens of age-based interaction terms, controlling for background characteristics, health status and region. The analysis revealed that the associations between subjective wellbeing and social network vary according to age. Among younger-old respondents, aged 60–79, more significant associations were found between social network variables and wellbeing outcomes in comparison to older-old respondents, aged 80 or older. Differences between age groups also emerged with the direction of the associations between social network variables and subjective wellbeing. The study results reveal that social networks do matter in very old age, but not in the same way as among younger-old persons. This finding is one indication of the differences that may emerge between third-age adults and those approaching the fourth age.

Whilst representations of old age and older people in traditional media have been well documented, examinations of such representations within social media discourse are still scarce. This is an unfortunate omission because of the importance of social media for communication in contemporary society. In this study, we combine content analysis and discourse analysis to explore patterns of representation on Twitter around the terms ageing, old age, older people and elderly with a sample of 1,200 tweets. Our analysis shows that ‘personal concerns/views’ and ‘health and social care’ are the predominant overall topics, although some topics are clearly linked with specific keywords. The language often used in the tweets seems to reinforce negative discourses of age and ageing that locate older adults as a disempowered, vulnerable and homogeneous group; old age is deemed a problem and ageing is considered something that needs to be resisted, slowed or disguised. These topics and discursive patterns are indeed similar to those found in empirical studies of social perceptions and traditional media portrayal of old age, which indicates that social media and Twitter in particular appears to serve as an online platform that reproduces and reinforces existing ageist discourses in traditional media that feed into social perceptions of ageing and older people.