About 65 million people use wheelchairs worldwide. Powered wheelchairs offer independent mobility for those who find it difficult to propel a manual wheelchair. Previous studies have described powered wheelchairs as a mixed blessing for the users in terms of usability, accessibility, safety, cost and stigma; however, few studies have explored their impact on mobility and participation over time. Therefore, as part of a larger longitudinal study, we used a combined retrospective and prospective lifecourse perspective to explore the experiences of older adult powered wheelchair users. Based on the interpretive description approach, 19 participants took part in a series of semi-structured interviews over a two-year period about their mobility, social participation and ageing process. The participants were powered wheelchair users, at least 50 years of age, recruited in Vancouver, Montreal and Quebec City (Canada). We identified three themes that highlighted how the powered wheelchair experience was integrated into the life continuum of the users. ‘It's my legs’ emphasised how powered wheelchairs are a form of mobility that not only enables users to take part in activities, but also impacts their identities, past and present. ‘Wheels of change’ explored the dynamic nature of powered wheelchair use and changes related to ageing. ‘Getting around’ illustrated how users’ mobility was affected by the interaction with their physical and social environments. Developing public policies to advance social and environmental changes could help countries to ensure equity of access and social inclusion of those ageing with disabilities.

In rapidly urbanising China, a high number of elderly people, the so-called ‘laopiao’, float to cities where their sons or daughters live to look after their children and grandchildren. Laopiao in urban China are thought to suffer poor mental health owing to their floating status. This study explores the inter-relationship among social capital, the built environment and mental health in urban China. Using a recent survey conducted in Nanjing (N = 591), structural equation modelling was performed to compare the local elderly people and the laopiao. Results showed that mental health determinants are dissimilar between the two groups of elderly people. Bonding social capital promotes mental health in both groups, while bridging and linking social capital only contributes to the mental health of the laopiao. Also, access to public transportation is positively correlated with mental health in both groups. Furthermore, lower street network density and better access to parks enhance the mental health of the local elderly people, while higher street network density and more open space within a community enhance the mental health of the laopiao. Our findings suggest that different policy measures should be implemented for different groups of elderly people in urban China to improve their mental health.

In the United Kingdom (UK), an ageing population met with the reduction of social care funding has led to reduced support for older people marked with an increased demand on family care-givers. Assistive telecare (AT) devices are viewed as an innovative and effective way to support older people. However, there is limited research which has explored adoption of AT from the perspectives of family care-givers. In-depth, semi-structured interviews were conducted with 14 family care-givers of patients who used the Assistive Telehealth and Telecare service in Cambridgeshire, UK. Family care-givers were either the spouse (N = 8) or child of the patient (N = 6). The patients' age ranged from 75 to 98, and either received a telecare standalone device or connected service. Framework analysis was used to analyse the transcripts. This study revealed that family care-givers play a crucial role in supporting the patient's decision to adopt and engage with AT devices. Knowledge and awareness, perceived responsibility, usefulness and usability, alongside functionality of the equipment, were influential factors in the decision-making process. AT devices were viewed positively, considered easy to use, useful and functional, with reassurance of the patient's safety being a core reason for adoption. Efforts to increase adoption and engagement should adapt recruitment strategies and service pathways to support both the patient and their care-giver.

This study investigated the association between environmental mastery and depression in a sample of 96 older adults (aged 64–98 years) in residential care. The participants completed a scale that assessed depression along with measures for risk factors for depression such as functional capacity, self-evaluated physical health, bereavement experiences and environmental mastery. The results showed that 49 per cent of the variance in participants' scores in depression could be attributed to their self-reported level of environmental mastery. Given the complexity of depression and the likelihood of reduced environmental mastery among older adults in residential care, the construct was further assessed as a mediating variable between the risk factors and depression. With environmental mastery taken as such, the explained variance in depression increased to 56 per cent. It was concluded that environmental mastery may be one of the more important factors affecting the mental health of older adults living in residential care and that strategies for increasing the residents' environmental mastery are important to their psychological wellbeing. The discussion notes that among the questions needing further investigation are whether older adults who experience high environmental mastery make the transition from community living to residential nursing home care more successfully than others, and whether perceived mastery diminishes over time or occurs at the point of transition from community independent living to dependent supported living.

In 2002, the World Health Organization emphasised the concept of active ageing to manage and increase the last third of life. Although many efforts have been made to optimise treatment management, less attention has been paid to health promotion initiatives. To date, few shared guidelines exist that promote an active life in healthy older targets. To fill this gap, we conducted a systematic review to map health promotion interventions that targeted an active and healthy ageing among older citizens. Articles containing the key term active ageing and seven synonyms were searched for in the electronic databases. Because we were interested in actions aimed to promote healthier lifestyles, we connected the string with the term health. A total of 3,918 titles were retrieved and 20 articles were extracted. Twelve of the 20 studies used group interventions, five interventions targeted the individual level and three interventions targeted the community level. Interventions differed for the health focus of the programmes, which ranged from physical activity interventions to social participation or cognitive functioning. Most of the studies aimed to act on psychological components. The review suggests that different interventions promoted for active ageing are effective in improving specific healthy and active lifestyles; however, no studies were concerned directly with a holistic process of citizen health engagement to improve long-term outcomes.

Migrants make up a significant and growing proportion of the aged-care workforce in Australia. Using data from the 2016 National Aged Care Workforce Census and Survey, we investigate employment conditions for Australian-born and overseas-born frontline workers working in residential and home-based aged care, focusing on two key poor job quality indicators. We find that migrant home care workers from non-English-speaking background (NESB) countries are the most likely to be employed on a casual basis and to report hours-related underemployment. Migrant residential care workers from English-speaking background (ESB) countries are more likely to be casual while NESB migrants are more likely to be underemployed. Controlling for a range of employment and socio-demographic characteristics, we find that being an NESB migrant is significantly associated with both casual status and underemployment. Generally, while this association lessens with years spent in Australia, exposure to casual employment is amplified over time for NESB migrants in the residential sector. Holding a temporary visa increased the likelihood of casual employment for residential care workers and underemployment for home care workers. Working for a for-profit employer was also associated with poorer job quality. Further policy shifts in Australia towards temporary migration and increased marketisation of aged care may impact on the working conditions of migrant aged-care workers.

The purpose of this exploratory study was to examine the contextual experiencing of humour by community-dwelling older adults. Data for this study consisted of audio-recorded, transcribed interviews with 20 older adults who had participated in a larger study of a number of dimensions associated with the process of ageing. Qualitative coding of the interview content was used to extract salient themes that identified types of humour experienced in different life contexts. The analysis of older adults' narratives about their day-to-day lives yielded four types of experienced humour: affiliative, self-enhancing, self-defeating, and authentic. Within an inter-personal context, expressing and appreciating humour contributed to sustaining positive social connections. The use of authentic humour and being able to laugh at one's self and life's uncontrollable circumstances appeared to support a positive sense of self and was adaptive for coping with the inevitable losses that accompany the ageing process, such as declining health status. The results of this study suggest that humour expression and appreciation may play an important role in managing the ageing process in ways that are adaptive especially in inter-personal contexts. Possibly health-care providers in both community and institutional settings need to be made aware of the benefits for older adults of experiencing humour in different life contexts.

There is a growing interest among several disciplines in the phenomenon of the abuse of elderly people (elder abuse). This article examines how elder abuse is being constructed as a social problem and the particular conceptual difficulties which sets elder abuse apart from other forms of family violence. American elder abuse research findings are discussed focusing upon the difficulties of developing indicators of ‘abuse’ and the consequent problems of comparing findings. A lack of British research on elder abuse is noted and this deficit is examined with reference to the methodological and ethical issues of researching a sensitive topic. The way in which the research process interacts with and influences our understanding of elder abuse is examined in the light of these considerations. The article concludes with a call for greater awareness of these issues in future research on elder abuse.

Long-term care (LTC) planning is important in helping the older people tackle their future needs better. The needs for LTC services represent generational characteristics as they may be different between the current and upcoming cohorts of older adults. However, very few studies have examined the cohort differences in terms of their expected utilisation of LTC services, while understanding the patterns is crucial in helping policy makers prepare for the development of LTC services. This study fills the research gap by examining the plans and expectations for LTC services of 1,613 middle-aged and older persons in Hong Kong with data collected from a telephone survey. By applying the Andersen Model to examine LTC expectations, this study analyses the LTC needs and plans of the middle-aged and older cohorts of Hong Kong adults, as well as their associated factors, with a multiple logistic regression method. Both gender and birth cohort were examined individually and in combination. Birth cohort and gender have been found to exert an impact on all aspects of LTC needs and planning to varying degrees. The findings are interpreted and contrasted with those of a key study based in the West, with reference to the contextual characteristics of Hong Kong. This study furthers the scholarly understanding on LTC needs and planning and their cohort effect, and draws evidence-based recommendations for LTC development in Hong Kong, a rapidly ageing East Asian society.

In this comparative study focusing on the population aged 50 and over in three European countries, we investigate the association between household debt and depressive symptoms, and possible country differences in this association, using data from Waves 1, 2, 4, 5 and 6 of the Surveys of Health, Ageing and Retirement in Europe (SHARE) for Belgium, France and Germany. Multi-level regression models with random intercepts for individuals were used to analyse the association between household debt status and number of depressive symptoms (EURO-D score). Country differences in the household debt–depression nexus were tested using country interaction models. After controlling for other measures of socio-economic position and physical health, low or substantial financial debt was associated with a higher number of depressive symptoms in all countries. Housing debt was strongly linked to depressive symptoms for women while the association was weaker for men. The only country difference was that for both sexes substantial financial debt (more than €5,000) was strongly associated with depressive symptoms in Belgium and Germany, but the association was weak or non-significant in France. Associations between financial debt and depression were also evident in analyses of within-individual changes in depressive symptoms for a longitudinal sub-group, and in analyses using a dichotomised, rather than a continuous, measure of depression. The findings indicate that measures of household indebtedness should be taken into consideration in investigations of social inequalities in depression and suggest a need for mental health services targeted at indebted older people.

This study investigated the perceived value of informal and formal supports for older adults with multi-morbidity from the perspectives of patients, care-givers and family physicians. Semi-structured interviews were conducted with 27 patients, their informal care-givers and their family physicians in an urban academic family health team in Ontario. Analysis was conducted using a General Inductive Approach to facilitate identification of main themes and build a framework of perceived value of supports. Participant views converged on supports that facilitate patient independence and ease care-giver burden. However, important differences in participant perceptions arose regarding these priorities. Physicians and care-givers valued supports that facilitate health and safety while patients prioritised supports that enable self-efficacy and independence. While formal supports which eased care-giver burden were viewed positively by all members of the triad, many patients also rejected formal supports, citing that informal support from their care-giver was available. Such conflicts between patient, care-giver and physician-perceived value of supports may have important implications for consumer and care-giver willingness to accept formal supports when supports are available. These findings contribute to the broader literature on community-based care by incorporating the perspectives of patients, informal care-givers and family physicians to understand better the barriers and facilitators of uptake of supportive services that contribute to successful ageing at home.

In health and chronic illness, satisfying marriages promote wellbeing and life satisfaction, yet stroke research has focused on either the stroke survivor as the patient or the spouse as a care-giver. Using Pope, Mays and Popay's framework for synthesising qualitative and quantitative methods, we conducted a systematic review and synthesis of 39 peer-reviewed studies to determine what happens to marital relationships after one partner has suffered a stroke. All the articles examined the impact of stroke. Three overarching themes characterise the evolution of marriage after stroke: chaos in the marriage, work to re-establish the marriage and evolution of the marriages. While both the stroke condition itself and the survivors’ need for care undermined the emotional qualities of the relationship for some couples, about two-thirds were able to retain or regain the relationship closeness. As in other chronic illnesses, the relationship closeness and a couple's ability to collaborate contributed to the survivor's recovery and to the satisfaction with life of the stroke survivor and the spouse. Our results underscore the need to consider the quality of, and the qualities of, the relationship between stroke survivors and their spouses. Future research could include a greater focus on qualitative or mixed-methods approaches to explore the interactions between stroke survivors and spouses that impact the wellbeing of both partners.

This study examined the associations between a large set of health indicators and wellbeing among older people (aged 66 or more years) in Sweden. The data were drawn from the Swedish Panel Survey of Ageing and the Elderly (PSAE), with variables covering information about health, daily activities, social interaction, anxieties and worries, and economic hardship. A series of confirmative factor analyses were used to reveal if and how indicators of living conditions could be subdivided into latent factors, and several socio-economic and socio-demographic variables were used as their predictors. Differences between men and women and between a number of age groups of old people were systematically scrutinised. The preferred representation of the data was a nested model that identified one global factor, which related to all manifest indicators, and three residual factors that measured the specific experiences of physical impairment, psychosocial distress and economic difficulties. The findings improve our understanding of the relationships between indicators of health and wellbeing and the various latent dimensions that simultaneously affect response patterns. More importantly, they also facilitate our understanding of older people's wellbeing and assists the interpretation of single, commonly used indicators such as subjective health.

In western countries, large residential complexes comprising retirement villages and care facilities have become synonymous with specialised housing for older people, but gerontology has tended to view retirement villages and care facilities as separate and different spaces. By researching these spaces separately, gerontology's examination of the development of residential complexes and older people's housing has been hindered. This paper explores the geographies of residential complexes in south-east Queensland, Australia, by employing data from a larger study that utilised Lefebvre's spatial framework, social space. Its specific focus is Lefebvre's concept of representations of space, part of the triad of social space. The paper outlines how the professional knowledge of designers, planners and policy makers shape and frame the place of older people in contemporary society. The findings indicate that professional knowledge is characterised by contradictions, and that business interests sustain stereotypes of older people as either ageless or dependent. Furthermore, spaces designed for older people reinforce historical legacies of separation from the community. This form of built environment can thus be seen as both a cause and effect of ageism. Generally, the lack of attention by gerontology to these spaces has hampered discussion of alternatives for older people's housing in Australia and, importantly, the development of responsive urban and social planning.

Dementia is one of the greatest contemporary health and social care challenges, and novel approaches to the care of its sufferers are needed. New information and communication technologies (ICT) have the potential to assist those caring for people with dementia, through access to networked information and support, tracking and surveillance. This article reports the views about such new technologies of 34 carers of people with dementia. We also held a group discussion with nine carers for respondent validation. The carers' actual use of new ICT was limited, although they thought a gradual increase in the use of networked technology in dementia care was inevitable but would bypass some carers who saw themselves as too old. Carers expressed a general enthusiasm for the benefits of ICT, but usually not for themselves, and they identified several key challenges including: establishing an appropriate balance between, on the one hand, privacy and autonomy and, on the other: maximising safety; establishing responsibility for and ownership of the equipment and who bears the costs; the possibility that technological help would mean a loss of valued personal contact; and the possibility that technology would substitute for existing services rather than be complementary. For carers and dementia sufferers to be supported, the expanding use of these technologies should be accompanied by intensive debate of the associated issues.

Over the last few decades in Sweden, the proportion of older people living in the community who receive public home-help services has decreased, even amongst the oldest old. At the same time, the abilities of older people in the activities of daily living have on average improved. This paper reports a study of the changes between 1988/89 and 2002/03 in the allocation and utilisation of public home-help services and in the support and care needs of older people (aged 65 or more years). The aims were to analyse whether the reduction in the percentage of home-help recipients could be explained by a reduction in needs among the older population, whether public home-help services had been targeted at people with greater needs, and whether informal care had increased. It was confirmed that over the 15 years, even after taking needs factors into account, the likelihood of an older person being a recipient of public home care had declined. Home help had clearly been targeted at more needy individuals. Among older women (aged 80+ years) with limitations in the activities of daily living and who lived alone, the proportion that received home help declined and the proportion that received informal care increased, which suggests that informal care had substituted for formal care. The findings indicate that the Swedish welfare system had reduced its commitment to the support of older people who require less intensive care and that, in effect, the concept of need for public social care support had been redefined.

The aim is to analyse political participation among senior citizens in the West-Finnish region Österbotten/Pohjanmaa by using data from the 2005 GERDA (gerontological regional database) survey. The first research question related to patterns of political participation and the extent to which older people in this region engage in voting and non-institutionalised forms of participation. Secondly, the driving forces behind different dimensions of participation were assessed on an individual level by using a modified variant of the civic voluntarism model as suggested by Verba and colleagues. The results show a high propensity to vote among elders in this region, but they also suggest that so-called non-institutionalised participation is likely to become more common in the future. Moreover, even though the results support the so-called resource theory of political participation, the fit of the multivariate models were modest, which necessitates further research in order to understand fully the driving forces behind political participation of older people in this specific region.

Although moving from institutional to home-like long-term care (LTC) settings can promote and sustain the health and wellbeing of older adults, there has been little research examining how home is perceived by older adults when moving between care settings. A qualitative study was conducted over a two-year period during the relocation of residents and staff from an institutional LTC home to a purpose-built LTC home in Western Canada. The study explored perceptions of home amongst residents, family members and staff. Accordingly, 210 semi-structured interviews were conducted at five time-points with 35 residents, 23 family members and 81 staff. Thematic analyses generated four superordinate themes that are suggestive of how to create and enhance a sense of home in LTC settings: (a) physical environment features; (b) privacy and personalisation; (c) autonomy, choice and flexibility; and (d) connectedness and togetherness. The findings reveal that the physical environment features are foundational for the emergence of social and personal meanings associated with a sense of home, and highlight the impact of care practices on the sense of home when the workplace becomes a home. In addition, tension that arises between providing care and creating a home-like environment in LTC settings is discussed.

The recent debate in the United States' gerontological literature on ‘anti-ageing medicine’ has profound significance for the discipline of gerontology. This review article discusses three major contributions to the debate and assesses the meaning of the wider debate for gerontology. A paper by Olshansky, Hayflick and Carnes, published in the Scientific American in May 2002, aimed at a popular science readership rather than gerontologists and had an overtly campaigning purpose. Among the many responses to the paper, that by Robert H. Binstock in The Gerontologist in February 2003 places the concerns expressed by Olshansky et al. in an historical context, and draws out its significance for gerontology as a discipline. Binstock believes that the central issue is legitimacy. What characteristics distinguish scientific endeavour that seeks an understanding of the fundamental biology of human ageing from quackery and pseudo-science? Does the ‘anti-ageing movement’ have a place in legitimate science? Also reviewed is a special issue of Generations, the journal of the American Society on Aging, on ‘Anti-Aging: Are You For It Or Against It?’. Amongst other distinguished contributions, the leading moral philosopher of old age, Harry Moody, explores key issues in ‘Who's afraid of life extension?’ The debate represented by these papers is significant not only for bio-medical but also social gerontology and for our understanding of the cultural position of old age in modern society.

This article examines whether the different welfare states of the European Union member states engender different policy preferences and attitudes among the population. More specifically, it investigates variations in attitudes towards population ageing and pension reforms, and variations in people's retirement age preferences and expectations. It is shown that despite the different cultures and welfare traditions in the old and new member states, there are commonalities in people's value orientations and views about population ageing, not least that the vast majority are pessimistic about the consequences. In both Eastern and Western Europe, the most popular options for pensions reform are to raise taxes and to extend working life, and few favour reducing pension benefits. Despite these similarities, there are also marked attitudinal differences. Eastern Europeans rely more on their children for old-age care and are much more in favour of a pension structure in which benefits depend on the number of children. On personal expectations and preferences for retirement, it is shown that both Eastern and Western Europeans expect to retire from the labour market at an older age than the current actual retirement age.