The introduction of choice and consumer mechanisms in public services has been identified as a fundamental shift in welfare service provision internationally. Within the United Kingdom (UK), such mechanisms developed and integrated into English services have not been replicated in their entirety in Scotland and Wales. For the first time since the inception of the UK welfare state, there are now formal differences in entitlement for older people as a result of devolution. This paper uses comparative policy analysis to review a range of sources not hitherto brought together in order to explore how these concurrent developments – choice and devolution – impact on people over state retirement age. We also consider the extent to which a more consumerist approach to public services might redress or increase later-life inequalities. Drawing on theoretical research and policy evidence, we argue that for many people over state retirement age, the prospect of becoming a consumer in these varied contexts is difficult and unwelcome. We suggest that although it is too early in the devolutionary process for any significant impact of these divergent policies to materialise, continued policy divergence will lead to different experiences and outcomes for older people in Scotland, Wales and England. We conclude that these divergent social policies offer significant research opportunities, particularly concerning their impact on later-life inequalities.

In this article we shall be analysing the representations of old age and ageing made by three generations of older women with different life stories (single, married, children and childless). Our principal findings, based on a qualitative analysis of 25 in-depth interviews conducted with three generations of older women (65–74, 75–84 and 85 and older), mainly reveal their reluctance and even refusal to define themselves as ‘older or elderly women’, largely due to persistent stereotypes linking old age to dependency, social isolation and fragility. Aware of the social prejudice regarding women and old age, they reject it unanimously. Older women represent a challenge to these homogenising preconceptions of old age, which they, on the contrary, experience in a multitude of ways, often enjoyable. Their conceptions of ‘ageing well’ are diverse and do not correspond to a clinical definition of ageing. Their representations of ‘ageing well’ and of ageing express positive values of autonomy, independence, consistency and integrity, maintenance of physical and intellectual health, and being socially active so they can ‘stay in the swing of things’, in the continuum of their lives and future projects, rather breaking with contemporary life or existing on the margins of society.

Reciprocity is a powerful principle in social ties. The ethos of family reciprocity is especially strong in Asian societies. We study contemporaneous family exchanges, hypothesising that the more current help older Singaporeans receive from family, the more they give in return. Cross-sectional analyses were undertaken of data from two national Singapore surveys conducted in 1995 and 1999. The help received by older people is measured by income and cash support, payment of household expenses by others, having a companion for away-from-home activities, and having a principal carer. The help given by older people is measured by baby-sitting, doing household chores, giving financial help to children, and advising on family matters. Multivariate models are used to examine the factors that affect an older person's ability and willingness to give help. The results show that the more financial support Singapore seniors received from kin, the more baby-sitting and chores they provided. In their swiftly modernising society, Singapore seniors are maintaining family reciprocity by giving time in return for money. We discuss how during the coming decades, reciprocity in Southeast and East Asian societies may shift from instrumental to more affective behaviours.

The purpose of this study is to examine the relationship between traumatic events that arise across the lifecourse and a sense of meaning in later life. In the process, three important issues are evaluated. First, analyses are performed to see if traumatic events at six different points in the lifecourse are associated with a sense of meaning in life. Second, an effort is made to see if current emotional support helps reduce the deleterious effects of trauma on meaning, and whether current levels of negative inter-personal contacts exacerbate the effects of trauma on meaning in life. Third, the relationship between trauma and meaning is assessed in three age cohorts: the young-old, the old-old and oldest-old. Findings from a nationwide United States survey reveal that trauma arising between the ages of 18 and 30 years is associated with a diminished sense of meaning in life, and that current emotional support reduces the effects of trauma on meaning, whereas negative inter-personal contacts tend to intensify the pernicious effects of trauma on meaning in life. Further analyses suggest that the relationships among trauma, emotional support, and negative inter-personal contacts emerge primarily in the oldest-old cohort.

This paper examines differences in work restrictions of midlife family carers of older people in terms of prevalence, gender and explanatory variables, in six European countries: Germany, Greece, Italy, Poland, Sweden and the United Kingdom. A sample of 2,897 carers aged 45–64 was extracted from the EUROFAMCARE (Services for Supporting Family Carers of Older People in Europe: Characteristics, Coverage and Usage) European project database, in order to analyse four possible work restrictions experienced in connection with the activity of care-giving: the reduction of working hours; giving up working; difficulties in career developments and forced occasional work. The results show that work restrictions are experienced differently between countries especially by women: they are reported to a higher degree in the United Kingdom, Germany and Greece, less so in Italy, and seldom in Poland and Sweden. Gender differences within countries are not so marked. Country differences are explained in the light of the different welfare regimes characterising the countries under investigation, in order to elucidate how policy makers may act to improve working carers' conditions through appropriate policies.

Drawing on data from a qualitative study, this paper explores the impact of ‘village services’ on the lives of people aged 70 or more years living in rural England. Throughout the paper, the phrase ‘village services’ refers to six community-based services and activities provided to help meet the needs of older rural residents, namely lunch clubs, welfare rights information and advice services, befriending schemes and community warden support, in rural areas in three regions of England. It is argued that, in various ways, village services promote social inclusion by enhancing older rural residents' access to the resources, rights, goods and services that encourage social interaction and meaningful participation in community life. It is clear, however, that the overwhelming majority of users of village services are female, that older men are often reluctant to engage with the services on offer, and that the providers of village services need to find new and innovative ways of engaging with older men in rural areas. It is concluded that restricted revenue and capital resources means that the expansion of village services so that they may better meet the requirements of older rural men is unlikely.

This study investigates trends in, and the interdependence of, the use of informal and formal home care of community-dwelling older people over the last two decades in the context of governmental reform of long-term care services and modernisation of informal relationships. Seven observations of the Longitudinal Aging Study Amsterdam covering the time span between 1992 and 2012 were analysed using multi-level logistic regression analysis. The sample entailed 9,585 observations from 3,574 respondents, aged between 65 and 85 years and living independently at each time of measurement. Measures included formal and informal care use, health, physical and cognitive limitations, socio-demographics, partner status, social network, privately paid help and sense of mastery. Results showed that between 1992 and 2012, formal home-care use increased slightly while there was a large decrease in the use of informal care. Multivariate multi-level logistic regression analyses showed a substitution effect between formal and informal care use which decreased over time. Analyses also showed improved cognitive functioning, increased partner availability and social network size, as well as increased use of privately paid care over time. Nevertheless, these positive trends did not explain the large decrease in informal care use. The results regarding informal care use suggest a societal trend of weakened informal solidarity, reflecting increased individualisation and increased availability of formal home care. The decreased substitution effect suggests that, in agreement with current reforms of long-term care, complementary or supplementary forms of care use may be more common in the near future.

This paper explores the different ways in which informal carers for people with dementia negotiate their care-giving role across the changing organisational and spatial landscape of care. In-depth qualitative data are used to argue that the decisions of carers are socially situated and the result of negotiations involving individuals, families and wider cultural expectations. These decisions affect where care occurs. In addressing these issues this paper draws attention to the lack of choice some carers may have in taking on the care-giving role; how and why carers draw upon support; and the different expectations of the care-giver's capabilities across the different sites of care, specifically at home and in nursing homes. It concludes that research and policy attention should focus on how the expectations about the role and abilities of carers are affected by where, and how, care is delivered. In doing so this paper contributes to the emerging health geography literature on care-giving as well as developing the spatial perspective in the established gerontological literature.

This paper reports on the methodological and ethical issues that were encountered when using focus groups to explore older people's knowledge, beliefs and risk perceptions about the use of innovative health technologies in end of life care. Older people drawn from community organisations in Sheffield, England, took part in discussions about the application of ‘life prolonging’ and ‘comfort care’ technologies during serious illness and impending death. The paper offers a reflective account of the management of recruitment and informed consent, and of the issues that arose when facilitating group discussions of potentially distressing material. It concludes with a brief account of the steps that were taken to enhance the ‘credibility’ of the data.

The aim of this paper is to ascertain the existence of differences in self-perceived health and depression between immigrants and native-born populations aged 50 years and older living in Western and Northern European countries. We examine the effect of country of origin, length of time in the host country and citizenship on the health of adults, using data from the Survey on Health, Ageing and Retirement in Europe (SHARE). As the logistic regressions reveal, some immigrant groups are more likely to perceive worse self-rated health and to suffer from depression than native-born groups, even when demographic and socio-economic variables are taken into account. In particular, people born in Eastern Europe living in Germany, France and Sweden have the highest odds ratio of poor health with respect to natives. Nativity status, duration and citizenship clearly contribute towards explaining health differences which are shown to vary significantly across countries. Furthermore, the perception of poor health rises as the length of stay increases, although a non-linear pattern was found. Results indicate that greater efforts by policy makers are needed in order to improve the health of specific middle-aged and older groups of immigrants in Europe.

This study explored associations between socio-economic status (SES) at different phases in the lifecourse and regular internet use among older adults. A sample (N = 11,035) from the 2010 wave of the United States Health and Retirement Study was used. Odds ratios were estimated to explore the relationship between regular internet use in older adulthood and measures of SES in childhood and in adulthood, and cumulative SES. Findings provided support for the lifecourse perspective, suggesting that variations observed among older adults are reflective of cumulative experiences. Three main themes emerged: higher SES in childhood increased the odds of being an internet user in older adulthood; SES advantages tended to accumulate, so that having at least one period of high SES in the lifecourse increased the odds of being an internet user in older adulthood; age did not appear to modify the positive relationship between cumulative SES and internet use.

In the United Kingdom (UK) and elsewhere, little is known about problematic drug use among older people (defined here as aged 50–74 years), either because few older drug users exist or because they represent a ‘hidden’ population. In this paper, we show that the average age of drug users in contact with treatment services and agency-based syringe exchange programmes (SEPs) in the counties of Cheshire and Merseyside in northwest England is rising. Between 1998 and 2004–05, the number of older male drug users in treatment increased from 80 to 310, and the number of older females rose from 46 to 117. Consequently, the median age rose from 30.8 years in 1998 to 34.9 years in 2004–05. Similarly, between 1992 and 2004, the number of older injectors accessing SEPs increased from three to 65 men and from one to nine women. The median age of SEP attenders was 27.0 years in 1992 and 34.9 years in 2004. Drug use amongst older people is associated with poor physical and psychological health and longer hospital stays. The future cost of the ageing of drug users may be considerable. Detailed research is needed to identify the characteristics and health needs of this vulnerable population.

It is known that, in general, people of pensionable age have gained in income compared to other age groups in the British population over the last two decades, but that a substantial minority still experience relative poverty. This paper reports a small qualitative study into the effectiveness of a welfare-rights advice and acquisition service for men and women aged 60 or more years that was provided through a local primary health-care service. Additional financial and non-financial resources were obtained by accessing previously unclaimed state-welfare benefits. It was found that these significantly improved the participants' quality of life. Fourteen of the 25 participants received some type of financial award as a result of the service offered, with the median income gain being £57 (€84 or US $101) per week. The impact of additional resources was considerable and included: increased affordability of necessities and occasional expenses; increased capacity to cope with emergencies; and reduced stress related to financial worries. Knowledge of and access to welfare-rights services also appeared to have a positive effect. It is argued that a level of material resources above a basic level is necessary for social relations and for accessing services and civic activities, and can reduce social exclusion among older people.

Japan presents a unique social laboratory in which to examine how family support impacts on older adults’ psychological wellbeing. This is because of its cultural climate where distinctively different expectations of old-age independence and the traditional norm of filial piety coexist. This study investigated how structural and functional dimensions of the family support of older Japanese parents influence their psychological morale, and whether the impacts of family support on parents’ morale vary depending on the parents’ belief in the traditional cultural norm of filial piety. Four waves of data from the Nihon University Japanese Longitudinal Study of Aging (NUJLSOA) collected in 1999, 2001, 2003 and 2006 were analysed. Combining the two- or three-year span of longitudinal data between each wave (N=3,882), an ordered logistic regression analysis was undertaken. The results reveal that although parents who were widowed or received emotional support from a child tended to report a lower level of morale, the negative influences of such support tended to be mitigated if the parent agreed with the traditional cultural norm of filial responsibilities. These results imply that the meaning and benefit of family support may differ depending on the degree to which Japanese older parents support the traditional norm of filial responsibilities.

This article draws upon six social research studies completed by members of the Dementia and Ageing Research Team at The University of Manchester and their associated networks over an eight-year period (2011–2019) with the aim of constructing a definition of ‘being in the moment’ and situating it within a continuum of moments that could be used to contextualise and frame the lived experience of dementia. Using the approach formulated by Pound et al. (2005) in synthesising qualitative studies, we identified this continuum of moments as comprising four sequential and interlinked steps: (a) ‘creating the moment’, defined as the processes and procedures necessary to enable being in the moment to take place – the time necessary for this to occur can range from fleeting to prolonged; (b) ‘being in the moment’, which refers to the multi-sensory processes involved in a personal or relational interaction and embodied engagement – being in the moment can be sustained through creativity and flow; (c) ‘ending the moment’, defined as when a specific moment is disengaged – this can be triggered by the person(s) involved consciously or subconsciously, or caused by a distraction in the environment or suchlike; and (d) ‘reliving the moment’, which refers to the opportunity for the experience(s) involved in ‘being in the moment’ to be later remembered and shared, however fragmentary, supported or full the recall.

Direct payments – cash for people eligible for adult social care and spent by them on care and support – are claimed to enable care to better reflect user preferences and goals which improve outcomes. This paper compares outcomes of older direct payment users and those receiving care via a managed personal budget (where the budget is spent on the recipients behalf by a third party). The study adopted a retrospective, comparative design using a postal questionnaire in three English councils with adult social care responsibilities in 2012–13. Included in the study were 1,341 budget users aged 75+, living in ordinary community settings. The overall response rate was 27.1 per cent (339 respondents). Three validated scales measured outcomes: EQ-5D-3L (health status), the Sheldon–Cohen Perceived Stress Scale and the Adult Social Care Outcomes Toolkit (social care-related quality of life). The study found that direct payment users appreciated the control conferred by budget ownership, but in practice, for many it did not ‘translate’ into improved living arrangements. It also found no statistically significant difference in outcomes between direct payment and managed personal budget users. The paper argues that despite policy and other guidance and research evidence about effective implementation of direct payments for older people, the absence of evidence for better outcomes may at least in part be attributable to values underpinning policies relating to personalisation and personal budgets.

Supported living and retirement villages are becoming a significant option for older adults with impairments, with independence concerns or for forward planning in older age, but evidence as to psychological benefits for residents is sparse. This study examined the hypothesis that the multi-component advantages of moving into a supported and physically and socially accessible ‘extra-care’ independent living environment will impact on psychological and functioning measures. Using an observational longitudinal design, 161 new residents were assessed initially and three months later, in comparison to 33 older adults staying in their original homes. Initial group differences were apparent but some reduced after three months. Residents showed improvement in depression, perceived health, aspects of cognitive function and reduced functional limitations, while controls showed increased functional limitations (worsening). Ability to recall specific autobiographical memories, known to be related to social problem solving, depression and functioning in social relationships, predicted change in communication limitations, and cognitive change predicted changes in recreational limitations. Change in anxiety and memory predicted change in depression. Findings suggest that older adults with independent living concerns who move to an independent but supported environment can show significant benefits in psychological outcomes and reduction in perceived impact of health on functional limitations in a short period. Targets for focused rehabilitation are indicated, but findings also validate development of untargeted general supportive environments.

In this introductory article for the special issue on Childlessness and Intergenerational Transfers, we first discuss the prior research literature and then overview the presented contributions. Up to now, childless older adults have been treated for the most part as both homogeneous and a problematic group. This does not do justice to the different pathways to childlessness: there are those who actively forgo having children, those who defer births so long that they involuntarily become childless, and those who are not fecund or lack a partner. It also neglects the changing social profile of the childless, e.g. the shift from less educated to more highly-educated women. Most importantly, it fails to recognise what childless older people give to others. The studies presented here aim to redress these two deficits in previous research. They examine how the consequences of childlessness are mediated by the pathways to and motivations for being childless and by factors such as gender, education and marital history, and they also examine what childless older adults provide to their families and to society at large. Such adults establish strong linkages with next-of-kin relatives, invest in non-family networks, and participate in voluntary and charitable activities, and broadly do so to a greater extent than older people with surviving children.

This article explores how far the concepts of de-familialisation/familialisation are adequate to the classification of long-term care (LTC) policies for older people. In the theoretical debate over LTC policies, de-familialising and familialising policies are often treated as opposites. We propose re-conceptualising the relation between de-familialisation and familialisation, arguing that they represent substantially different types of policy that, in theory, can vary relatively autonomously. In order to evaluate this theoretical assumption, this article investigates the relation between the generosity level of LTC policies on extra-familial care, and the generosity level of LTC policies on paid family care, introducing a new multi-dimensional approach to measuring the generosity of LTC policy for older persons. It also explores the consequences of this for gender equality. The empirical study is based on a cross-national comparison of LTC policies in five European welfare states which show significant differences in their welfare state tradition. Data used are from document analysis of care policy law, the Mutual Information System on Social Protection, the European Quality of Life Survey and the Organisation for Economic Co-operation and Development. The findings support the argument that de-familialising and familialising LTC policies can vary relatively independently of each other in theory. It turns out that we get a better understanding of the relationship between LTC policy and gender equality if we analyse the role of different combinations of extra-familial and familial LTC policies for gender equality. The paper brings new insights into the ways welfare states act in regard to their LTC policies. It helps to clarify how the concept of de-familialisation/familialisation can be understood, and what this means for the relationship between LTC policies and gender equality.

The benefits of meaningful activity in later life are well documented. Studies show that being occupied contributes to both physical and mental health as well as quality of life. Research also suggests that activity may be beneficial to people residing in care homes, including people living with dementia. This paper presents findings from a study which used the Adult Social Care Outcomes Toolkit (ASCOT) to measure quality of life in six care homes located in the south-east of England. The study found, like previous ones, that care home residents’ days were characterised by a lack of activity. Drawing on observations, interviews and focus groups with residents and staff from these homes, this paper attempts to understand why care home residents do not engage in meaningful activities. We reject the idea that these low levels of activity are a natural part of the ageing process or that they can be explained by notions of resident choice. Instead, the findings point to both insufficient funding and working practices within care homes as more substantive explanations. These explanations inform a discussion of how the low levels of engagement in meaningful activity could be addressed and residents’ quality of life improved.