Social gerontologists have long grappled with the meaning of ‘community’ to older people. This paper lies within this tradition and focuses on the extent to which the past emphasis upon communities of place needs to be rebalanced or rethought in the light of emerging evidence for the growing engagement of older people in communities of interest linked to friendships, enthusiasms and their increasing spending power. This theoretical paper highlights the traditional emphasis on the role of community and place in later life and explores the emergence of a debate about communities of interest linked to such factors as the ‘discovery’ of ‘the Third Age’, marketisation, consumerism, the importance of social interaction in the lives of many older people, and the impact of the internet and virtual communities. This debate is placed in an international policy context in which numerous governments are concerned about the greying of the global population and the consequent desire to promote ‘ageing well’ to offset resultant health and social care costs. The paper argues for a reconceptualisation of community through a more sophisticated view of ‘place’ and ‘interest’ that avoids false dichotomies between the two and acknowledges the impact of social, economic and cultural change upon the lives of older people.

Three hypotheses concerning negative social interaction in later life were evaluated in this study. First, it was predicted that greater personal economic difficulty is associated with more frequent negative social interaction with social network members in general. Secondly, it was proposed that more frequent negative social interaction exacerbates the undesirable effect of personal financial strain on change in self-rated health during late life. Thirdly, an effort was made to see if some types of negative social interaction, but not others, accentuate the undesirable effects of personal economic problems on self-rated health. Data from two nationwide longitudinal surveys that were conducted in the United States revealed that greater personal financial difficulty is associated with more interpersonal conflict. The findings further indicate that the undesirable effects of personal economic difficulty on change in self-rated health are more pronounced at progressively higher levels of negative social interaction. Finally, the data suggest that one form of negative social interaction (not getting help when it is expected) is more likely to intensify the unwanted effects of personal financial strain on self-rated health than other types of negative social interaction.

Routinely-collected statistics show considerable variation between local authorities in Great Britain, in the proportions of supported residents placed in nursing and residential care. This raises the question of whether this is due to variations in demand (the type of resident approaching authorities), supply (the level and type of provision available for local authorities to purchase), or policy (in terms of eligibility criteria or interpretations of need at field level). Data were used from a national longitudinal survey of individuals admitted to publicly-funded residential and nursing home care. Information was collected from 18 local authorities on a cohort of 2,544 local authority supported residents who had been admitted to residential and nursing home care. The paper examines the pattern of admissions, the characteristics of people admitted and the relationship between these characteristics and admissions to residential or nursing home care. Characteristics of the individual explained the placement of over 80 per cent of admissions. Supply factors were statistically significant but did not improve the explanatory power of the model. Survival among those admitted to a type of care that was not predicted by the model, suggested that some unmeasured aspects of prognosis may account for some of the residual variation in placements. Overall, the results indicate a reasonably high level of consistency between authorities in nursing home placement decisions. This suggests that either there is considerable variation in the types of individual approaching local authorities or, more likely, that some authorities are more successful in maintaining people for longer at home than others. In addition to maintaining people at home to a higher level of dependency, prevention of admission to residential care is likely to be associated with: interventions that address carer support, safety issues among people who are deaf, and motivation.

The services used by people with dementia and their carers were measured at three time points over 17 months. This analysis is unusual in that both informal care and formal inputs were costed. The costs estimates for informal inputs developed here may be applied to other data sets. Two hypotheses to explain the inter-relationship between informal and formal care inputs, substitution and supplementation, were compared in analysing the data. This paper explores the variations in costs according to the living arrangements of the people with dementia, by level of dependency and over time, and finds systematic differences. The costs of the inputs from co-resident carers consistently exceeded the costs of formal services, with informal care constituting up to 40 per cent of the total costs burden for dementia care. When informal inputs were included, non-domestic residential care emerged as less, not more, costly than care in the community. There was a shift in costs burden from health services to social services over time as more people moved into non-domestic settings. Multivariate analyses identified several predictors of informal and formal care costs: physical disability, level of cognitive impairment, living in non-domestic settings, and formal care provided. Non-domestic care predicted lower inputs of both formal and informal services. Dementia level was positively associated with informal inputs. Physical frailty was associated with more formal care, but less informal care. More formal service inputs predicted higher informal care inputs. There is evidence of supplementation of informal care by formal services in the early stages of care, followed by substitution as the person with dementia enters residential care.

By the late 20th century, the plight of millions of older people in many developed countries was regarded as serious and was acknowledged to require concerted cross-national remedial action. Sociologists and social gerontologists only then were beginning to put together explanations rooted in the evolution of social policy and its corresponding institutions. One thesis that attracted support was that the dependency of the aged had been ‘structured’ by long-term economic and social policies. During the final decades of the 20th century, older people were perceived and treated, according to accumulating research evidence, as more dependent than they really were or needed to be. This had been fostered by the emerging institutions of retirement, income maintenance, and residential and domiciliary care. This development had been the responsibility primarily of the State, which tried to deliver welfare but also to accommodate the market. Forms of discrimination against older people had become, or continued to be, as deep as forms of discrimination against women and ethnic minorities. Such ‘institutionalised ageism’ had to be countered. Hopes were invested in anti-discriminatory policies that reflected good reciprocal relationships between the generations in many families and the rights of individuals of any age to human dignity and opportunities to practise their skills. The globalisation of the market and affiliation to neo-liberal policies, together with the simultaneous passage of various instruments of human rights, have changed the nature of the problem, and therefore the debate, during the early 21st century. This paper argues that the release and implementation during and after the Second World War of collective liberal egalitarian values, expressed in many countries in international statements on human rights, as will be shown, had a big impact on the design of public services, including those for older people. If the claims for the elderly in the welfare states of 50 years ago were exaggerated, as we can now safely conclude, the claims for older people today are even more exaggerated – at a time of heightened emphasis on individual rights and individual market powers. The various problems of ‘structured’ dependency persist, and seem set to grow in many parts of the world. Human rights offer a framework of rigorous analysis and anti-discriminatory work. Success depends on good operational measurement, and the incorporation of international and national institutions and policies that reflect those rights.

Payments for care, by which people in need of long-term care directly employ care workers, have been introduced in many European countries. In The Netherlands, care dependants are allowed to use these payments to hire relatives to perform care tasks. Care-givers who are employed by their relatives are in a hybrid position, because they are contracted as employees in the informal setting of a family home and its affective care relationships. This paper reports a qualitative study of relatives' experiences of payments for care and how these affect their care-giving. In-depth interviews were undertaken with 17 paid carers: they were asked to respond to three fictional vignettes of contrasting care trajectories. It was found that the cash nexus had mixed and partly contradictory implications for the paid care-givers. On the one hand, the care-givers were satisfied with the arrangement, as the payments recognised and raised their status as carers, and were seen as reward and reciprocation for their care work. Some carers had found that the contract helped manage strained relationships, by enabling a clearer differentiation of care tasks from affection. On the other hand, some who regarded themselves as employees and saw their role as equivalent to formal carers felt a greater obligation to provide high-quality care, and found that they were thanked less often and received fewer tokens of gratitude.

Older adults with a chronic health condition (e.g. hypertension) use various self-management methods. Healthcare technologies have the potential to support health self-management. However, it is necessary to understand the acceptance of these technologies as a precursor to older adults’ adoption and integration into their health plan. Our focus was on the factors older adults with hypertension initially consider when introduced to three new healthcare technologies that might support their health self-management. We compared their considerations for a blood pressure monitor, an electronic pillbox and a multifunction robot to simulate incrementally more complex technologies. Twenty-three participants (aged 65–84) completed four questionnaires and a semi-structured interview. The interview transcripts were analysed using a thematic analysis approach. We identified the factors that were frequently mentioned among the participants for each of the three healthcare technologies. The factors that older adults initially considered were familiarity, perceived benefits, perceived ease of use, perceived need for oneself, relative advantage, complexity and perceived need for others. Upon further reflection, participants considered advice acceptance, compatibility, convenience, facilitating conditions, perceived usefulness, privacy, subjective norm, and trust. We integrated the factors that older adults considered into the Healthcare Technology Acceptance Model (H-TAM), which elucidates the complexity of healthcare technology acceptance and provides guidance for future explorations.

This article presents an analysis of privacy, care practices and architectural space in assisted living in Sweden. The presented research is a qualitative case study. Observations and personal interviews with staff as well as residents were the major data collection methods. The analysis revealed the evasiveness of a private–public dichotomy; that is, how privacy appears in public spaces and how private spaces became public under certain conditions. During the course of a day, the residents' privacy was qualified and structured by caring activities that took place in various spaces and that associated with variable distance or closeness to the staff. The study shows that individualised care practices improved privacy for the resident, and that although architectural features constrained the staff, they used a number of spatial strategies to promote the residents' privacy, for instance, in the dining room at meal times or when residents were subject to intimate care in their private rooms. Access and control are dimensions of privacy that are relevant to assisted living. The residents had more control of access to their private rooms than control of their personal space in public areas. Individualised care strengthened the residents' agency. Staff supported the residents to lead a private life in the assisted-living facility.

In most western nations, laws discourage discrimination in paid employment on the basis of disability, but for these policies to be of benefit, individuals must define their functional limitations as disabilities. There is a strong relationship between age and disability among those of working age, yet it is unclear whether older workers attribute their limitations to disability or to ‘natural ageing’. If the latter is true, they may not believe that they need or qualify for workplace accommodations (i.e. adaptations or interventions at the workplace). Similarly, if an employer ascribes a worker's limitation to ‘natural ageing’, rather than to a disability, they may not offer compensatory accommodation. Using data from the Canadian 2001 Participation and Activity Limitation Survey, this paper asks whether workers who ascribe their functional limitation to ageing are as likely as those who do not to report a need for a workplace accommodation. It also addresses whether those who identify a need for compensatory accommodations and who ascribe their limitation to ageing have unmet workplace-accommodation needs. The findings suggest that, even when other factors are controlled, e.g. the type and severity of disability, the number of limiting conditions, gender, age, education, income and occupation, those who made the ageing attribution were less likely to recognise the need for an accommodation; and among those who acknowledged a need, those who ascribed their disability to ageing were less likely to have their needs met.

We investigated the extent to which the geographic proximity of adult children affected the relocations of older people in the Netherlands in 2008. A major contribution of this study is the examination of the differentiation between relocation to care institutions and elsewhere. Data from the Dutch population register linked to complementary datasets were analysed for nearly one million inhabitants aged 75 and above, using multinomial logistic regression models to estimate the effects of intergenerational proximity and of other factors on the propensity to relocate to an institution and elsewhere. An interaction of proximity with partnership status as an indicator of the presence of an important care provider was considered. We found that older people were less likely to move elsewhere when their children were living very close by, and were more likely to do so when their children were living farther away. Having children living close was negatively associated with the likelihood of moving to a care institution. Very close proximity had an additional negative effect on the propensity of older people with a partner to relocate elsewhere whereas the negative effect was less for older people without a partner on moving elsewhere. Our findings did, however, show that (recently) widowed people were more likely to move elsewhere when their children were living more than 40 kilometres away.

Intergenerational help and care among members of the family belong to the most important dimensions of contemporary welfare regimes. Recent research has indicated that a major part of caring responsibilities is placed on the middle-aged generation. The ‘pivot generation’ is expected to provide help to their adult children and grandchildren as well as to their ageing parents. It has been hypothesised that people helping their parents are discouraged from looking after their grandchildren because they experience lack of energy and time. Using data from the four waves of the Survey of Health, Ageing and Retirement in Europe (SHARE), this paper analyses the effect of providing help to ageing parents on the likelihood and intensity of looking after grandchildren. It takes a four-generation perspective: grandchildren, children, parents and grandparents. The results show that the support of parents is not associated with less-frequent and less-intense care of grandchildren. On the contrary, a positive association between caring responsibilities has been observed. The highest tendency to care for grandchildren has been found for people regularly helping their parents. This effect holds after controlling for grandparents’ characteristics and country effects. It is suggested that caring responsibilities tend to accumulate rather than compete with one another and therefore could represent a potential risk of overburden for those who have a general tendency to care.

Loneliness has become an issue of significant academic, public and policy focus. There has been much research on experiences of loneliness in later life and many accompanying interventions targeting lonely older people. However, there has been a dearth of research on the impact that loneliness can have on older men and the resulting implications for policy and practice. This paper aims to redress this by developing a theoretical framework to improve understanding of older men's constructions and experiences of loneliness. It draws on two qualitative empirical studies: the first explores older men's perceptions of masculinity and loneliness; and the second looks at the effectiveness of a service for older men which was designed to alleviate loneliness among older people more generally. The paper outlines the way in which older men often construct masculinity as an oppressive (hegemonic) requirement, but which can be reformed into ‘positive’ traits of ‘strength of mind’, ‘responsibility’, ‘caring’, ‘helping out’, ‘doing a favour’ and ‘giving something back’, with a consistent yet implicit assumption that enactment of these denotes a ‘proud’ masculine identity. Loneliness, on the other hand, is represented as a subordinate social role, both non-masculine and related to marginalising stereotypes of age. This results in the identification of two important implications for the way in which services can assist in the alleviation of loneliness in older men: that men are more likely to engage with a service that can facilitate the construction of a ‘proud’ masculine identity; and that services which deconstruct hegemonic masculinities, particularly by providing a space where men feel comfortable being emotionally tactile, are likely to be most effective at both alleviating loneliness and promoting overall wellbeing.

This study analyses gender inequalities in health among elderly people in Catalonia (Spain) by adopting a conceptual framework that globally considers three dimensions of health determinants: socio-economic position, family characteristics and social support. Data came from the 2006 Catalonian Health Survey. For the purposes of this study a sub-sample of people aged 65–85 years with no paid job was selected (1,113 men and 1,484 women). The health outcomes analysed were self-perceived health status, poor mental health status and long-standing limiting illness. Multiple logistic regression models separated by sex were fitted and a hierarchical model was fitted in three steps. Health status among elderly women was poorer than among the men for the three outcomes analysed. Whereas living with disabled people was positively related to the three health outcomes and confidant social support was negatively associated with all of them in both sexes, there were gender differences in other social determinants of health. Our results emphasise the importance of using an integrated approach for the analysis of health inequalities among elderly people, simultaneously considering socio-economic position, family characteristics and social support, as well as different health indicators, in order fully to understand the social determinants of the health status of older men and women.

Following West and Zimmerman's (1987) theoretical understanding of how gender identities are created and maintained, this paper examines the ways in which older women learned from their mothers how ‘to do gender’ through their bodies and specifically their physical appearances. Extracts from semi-structured interviews with 44 women aged 50 to 70 years have been drawn upon to identify and discuss the ways in which women perceive, manage and present their bodies using socially-constructed ideals of beauty and femininity. More specifically, three ways that women learned ‘to do gender’ are examined: from their mothers' criticisms and compliments about their appearance at different stages of the lifecourse; from their mothers' attitudes towards their own bodies when young and in late adulthood; and from the interviewees' own later-life experiences and choices about ‘beauty work’. Interpretative feminism is employed to analyse how the women exercised agency while constructing body-image meanings in a social context that judges women on their ability to achieve and maintain the prevailing ideal of female beauty. The study extends previous research into the influence of the mother-daughter relationship on young women's body image. The findings suggest that mothers are important influences on their daughters' socialisation into body-image and beauty work, and exert, or are perceived to exert, accountability across the life-course.

Dementia care is in transition, and the potential exists for a radical reform of the provision of services to people with dementia. Recent developments in Scotland based on the report of the Royal Commission on Long Term Care, With Respect to Old Age, provide an example of the possibilities and opportunities available to governments for creating services based on principles of equity and justice. It is timely therefore to consider the implications of recent government reports for the development of dementia care provision. This paper explores the social and political context of formal dementia care provision and considers the implications of recent government reports for the future. The historical discourses surrounding the term ‘dementia’, and where and who cares for people with dementia, provide insights into the options available to policy makers. A brief exploration of the economic context of dementia care provision, and of the historically low level of political interest in dementia care, provides a backdrop to recent political initiatives that seek to redress this omission.

This paper examines the amount of time that care-home residents spend in bed at night, focusing on how residents' bedtimes and getting-up times are managed. Using a mixed-methods approach, diary data were collected over 14 days from 125 residents in ten care homes in South East England. The findings indicate that residents spent, on average, nearly 11 hours in bed at night, significantly more time than was spent sleeping. There was greater variance in the amount of time residents who needed assistance spent in bed than there was for independent residents. Detailed investigation of six care homes, each with 8 pm to 8 am night shifts, showed that bedtimes and getting-up times for dependent residents were influenced by the staff's shift patterns. Analysis of qualitative interviews with 38 residents highlighted a lack of resident choice about bedtimes and many compromises by the residents to fit in with the care-home shift and staffing patterns. The social norm of early bedtimes in care homes also influenced the independent residents. It is argued that the current system in care homes of approximately 12-hour night shifts, during which staff ratios are far lower than in the daytime, promotes an overly long ‘night-time’ and curbs residents' choices about the times at which they go to bed and get up, particularly for the most dependent residents.

Healthy ageing concepts have been extensively studied in Western societies but few studies have explored the perceptions of older people from other cultural backgrounds. The aim of the study was to explore the conceptualisations of healthy ageing and perceived influences on ageing well amongst relatively healthy older Malays, a major ethnic group in Malaysia. Eight focus groups were conducted, with 38 participants recruited via community groups and leaders. Six themes were identified: spirituality, physical health and function, peace of mind, financial independence, family, and living environment. In this paper, we focus on the role of spirituality in healthy ageing which was a core resource in participants' lives. Participants reported that good physical health was an important resource that facilitated commitment to their spiritual activities. Furthermore, deteriorating functional ability appeared to provide an opportunity to optimise their spirituality, rather than hinder it. Participants wished for a ‘peaceful life’ and experienced this by enhancing their spirituality. Other ingredients for a peaceful life were financial independence, living in a place they love and having family members who live in harmony. In this community where religious affiliation is a tradition, spirituality can be fundamental for healthy ageing and its inclusion in aged care policy is imperative. However, further exploration on the diversity of individual expression of spirituality is important.

In our society that values men over women and youth over old age, sexism and ageism intersect to erode women's status more rapidly and severely than men's. However, limited attention is given to women's responses to their devaluation, particularly collective efforts to either resist or accommodate dominant beliefs about ageing women. We examine membership in the Red Hat Society, an international organisation for middle-aged and older women, as a response to gendered ageism. Drawing on data from semi-structured interviews with members (N = 52), our analysis focuses on the group's ‘performance of girlhood’, which involves adopting children's social roles, dressing up and playing. We examine its resonance with a dominant cultural metaphor for old age as ‘second childhood’, illustrating how it not only provides opportunities for resistance to gendered ageism but also contributes to its entrenchment. The behaviours constitute a performative act that resists gendered ageism by increasing ageing women's visibility and asserting their right to leisure. However, its accommodative features reproduce inequality by valuing youth over old age and depicting older women as girls engaging in frivolous activities, which can be seen as obstructing social change.

In the context of emerging challenges and opportunities associated with population ageing, the study of inequality in active-ageing outcomes is critical to the design of appropriate and effective social policies. While there is much discussion about active ageing at the aggregate country level, little is known about inequality in active-ageing experiences within countries. Based on the existing literature on active ageing, this paper proposes an individual-level composite active ageing index based on Survey of Health, Ageing and Retirement in Europe (SHARE) data. The individual-level nature of the index allows us to analyse inequality in experiences of active ageing within selected European countries. One important motivation behind measuring active ageing at the individual level is that it allows for a better understanding of unequal experiences of ageing, which may otherwise be masked in aggregate-level measures of active ageing. Results show large differences in the distribution of individual-level active ageing across the 13 European countries covered and across age groups. Furthermore, there is a positive association between the country-level active ageing index and the equality of its distribution within a country. Hence, countries with the lowest average active ageing index tend to have the most unequal distribution in active-ageing experiences. For nine European countries, where temporal data are also available, we find that inequality in active-ageing outcomes decreased in the period 2004 to 2013.

This paper summarises current research on the mental health status of older African-Americans with a specific focus on late-life depression, one of the most common forms of mental disorder among older persons. Social gerontologists have brought to the forefront the need to consider the impact of historical eras, cohort location, and lifecourse development when studying various dimensions of the ageing process. Unfortunately, this type of theorising is still in its infancy, and has not been widely applied to the general population and all dimensions of health, let alone investigations into the mental health status of older African-Americans. Virtually none of the empirical studies we reviewed adequately address the historical, biographical, or structural factors related to the mental health status of older African-Americans. We suggest that to understand contemporary manifestations of racial presumptions, there must be an appreciation of the historical antecedents. African-Americans live with the corrosive effects of a legacy of slavery that presumed black inferiority. The identification of salient factors of risk and resilience among this population is critical to developing effective intervention and mental health maintenance programmes. By emphasising the socio-historical influences on the mental health of older African-Americans, we can develop a greater understanding of this population's mental health needs; thus paving the way for improved mental health services and a reduction in mental health disparities.