This study assesses the probability that an older person in Bridgetown, Barbados receives financial, functional and/or material support from their adult children according to the proximity of their nearest child, adjusting for demographic and socio-economic factors. As in many countries of the developing world, older Barbadians receive much of their support from adult children. Population ageing, smaller family sizes and high rates of out-migration may be placing stress on systems of formal and informal support within the country. Yet, very little research has examined determinants of support within the Caribbean let alone Barbados, one of the most rapidly ageing countries in the region. Data (N = 1,248) come from the 2000 Pan American Health Organization Survey on Health, Well-being and Ageing in Latin America and the Caribbean (SABE). Multivariate logistic regression analyses highlight the overwhelming importance of co-residence in the receipt of informal support transfers. Although there is a lower probability of receiving support as distance to nearest child increases, several indicators of vulnerability, such as having a disability, increases support probabilities among those whose nearest children live outside the neighbourhood. The results have implications for current and future cohorts of older adults in the region given the combination of declining fertility, persistent migration and population ageing within a broader context of social protection systems across the region.

This study aims to assess racial differences in subjective wellbeing (SWB) and to examine whether the pathways of social support and social engagement to SWB vary by racial groups in the United States of America. Using a local sample (N = 1,035) and a nationally representative sample of the Health and Retirement Study (N = 7,718), we compared life satisfaction and happiness between non-Hispanic Whites and Blacks aged 55 and over. We evaluated the extent to which race, other socio-demographic characteristics, health, social engagement and social support explained the variances in SWB and examined the moderation effects of race on the relationships of SWB with age, social support and social engagement. Multiple regression analyses showed that non-Hispanic Blacks were at least as satisfied as, and even happier than White peers, after equalising social resources and health variables. Social support was significantly related to SWB, and it seemed that positive support was more important to Whites than to Blacks in predicting life satisfaction. In addition, the racial crossover effect existed, that is, the old-old (80+) Blacks were happier than their White peers. Findings indicate a national trend of the race paradox in SWB and underscore the importance of social support in promoting older adults’ wellbeing. Future research is recommended to investigate other potential mechanisms among Black older Americans to explain their relatively better SWB.

In the current ecology of care, social, rather than medical, support is critical in enabling frail older people to live at home. This paper reports findings from a qualitative study about how home care workers (HCWs) support persons with dementia living in the community. Semi-structured qualitative interviews were carried out in England with 14 family care-givers (FCGs) recruited from a single private home care provider. A thematic analysis of the data was undertaken using the constant comparative method. In every instance, it was FCGs who initiated domiciliary care for the person with dementia, highlighting ambiguity about who is the ‘client’. Rather than focusing on the HCWs’ work in undertaking practical tasks and personal care, respondents prioritised HCWs as companions, providing emotional and social support for their relatives. From an organisational perspective, respondents valued the capacity of the provider to deliver a consistent, personal, reliable and punctual service. These attributes were important in supporting their relative's agency and dignity. Respondents described HCWs engaging in skilled and sensitive communication with clients but considered ‘character’ and ‘innate’ caring abilities to be more important than those derived from training. The results highlight the need to acknowledge the family, rather than the individual client, as the functioning unit of care, and to recognise the highly skilled communicative and emotional work undertaken by HCWs.

With the predicted growth in the number of people with dementia living at home across the globe, the need for home-based care is expected to increase. As such, it will be primarily family carers who will provide this crucial support to family members. Designing appropriate support for family carers is thus essential to minimise risks to their health, to prevent premature institutionalisation or poor care for persons with dementia, as well as to sustain the effective functioning of health and social care systems. To date, the high volume of research related to care at home and acknowledged low impact of interventions suggests that a re-examination of the nature of care at home, and how we come to know about it, is necessary if we are to advance strategies that will contribute to better outcomes for families. This paper describes findings from an ethnographic study that was designed to support an analysis of the complexity and materiality of family care arrangements – that is, the significance of the actual physical, technological and institutional elements shaping care-giving situations. In this paper, we describe the arrangements made by one family to show the necessary collectivity of these arrangements, and the consequences of the formal care system's failure to respond to these.

The present study aims to determine how family size affects psycho-social, economic and health wellbeing in old age differently across two cohorts with declining fertility. The data are from the 2012 Mexican Health and Ageing Study (MHAS) including respondents aged 50+ (N = 13,102). Poisson (standard and zero-inflated) and logistic regressions are used to model determinants of wellbeing in old age: psycho-social (depressive symptoms), economic (consumer durables and insurance) and health (chronic conditions). In the younger cohort, having fewer children is associated with fewer depressive symptoms and chronic conditions, and better economic wellbeing. For the older cohort, having fewer children is associated with lower economic wellbeing and higher odds of being uninsured. Lower fertility benefited the younger cohort (born after 1937), whereas the older cohort (born in 1937 or earlier) benefited from lower fertility only in chronic conditions. Further research is needed to continue exploring the old-age effects of the fertility transition.

This study responds to a gap in the literature relating to the resilience of people living with dementia in care homes. We applied an ecopsychosocial framework of resilience, theorising that sources of resilience may be personal, social and structural. Visual arts enrichment activities were examined to see how they might provide opportunities for resilience. The data used for this study were qualitative and originated from people with dementia aged between 70 and 99 years old (N = 48) living in four care homes in North East England, United Kingdom and staff/carers/family members (N = 37). The results showed that visual arts enrichment activities supported the resilience of those with dementia through creative expression, increased communication, improved self-esteem, and influenced relationships with carers and family members. It is concluded that even those with advanced dementia are capable of demonstrating resilience which can be supported by, and explored through, visual arts enrichment activities.

New Zealand's ageing population and health inequities for Māori (Indigenous peoples) have prompted calls for innovative, culturally based approaches to improving health and wellbeing, and managing transitions in later life. This is particularly important for kaumātua (Māori elders) who, despite cultural strength and resilience, carry a significant burden in health, economic and social inequities. This paper describes the culture-centred development of a ‘tuakana‒teina’ (elder sibling‒younger sibling) peer support education programme designed to help kaumātua support other kaumātua experiencing transitions in later life. Taking a strengths-based approach that highlights ‘kaumātua mana motuhake’ (elder independence and autonomy), the study used kaupapa Māori (Māori approach, knowledge, skills, attitudes and values) and community-based participatory research methodology, to develop and pilot a culture-centred tuakana‒teina/peer education programme. Methods included establishing two advisory groups (one of kaumātua and one of sector experts); holding five focus groups with kaumātua; and running a pilot programme with 21 kaumātua. The findings demonstrate the value in a strengths-based approach that centralises Māori culture and kaumātua potential, capacity and ability, and recognises the continuing value and contribution of kaumātua to society. The study helps shift the focus from dominant stereotypes of ageing populations as a burden on society and shows the value of kaumātua supporting others during transitions in later life.

Primary and secondary care services are charged with failing to adequately detect and treat mental disorder in older adults due to the ‘understandability phenomenon’; the belief that mental disorder in old age is inevitable and therefore not worthy of intervention. Quantitative data appear to support this hypothesis but lack the explanatory power of detailed accounts. Nine general practitioners (GPs) participated in group interviews about their assessment and treatment of older patients, and their expectations and experience of referral to secondary care. Resulting transcripts were subject to Thematic Analysis. Respondents recognised the unique features of these clients, and their impact on the detailed, recursive processes of assessment, clinical decision-making and intervention. GPs described confidence in managing most cases of mental disorder, describing the role of secondary care as one of consultancy in extreme or unusual cases. GPs did view mental disorder as commonly originating in adverse circumstances, and queried the validity of pharmacological or psychological interventions in these cases. They did not, however, equate understandability with acceptability, and called for social interventions to be integrated with health-care interventions to tackle the cause of mental disorder in older adults. At a wider level, findings highlight the discrepancy between assumptions about GP attitudes and actions, and their own accounts. At a local level, findings will assist in focusing secondary care service development where need is perceived, into consultancy and training.

Learning to live with a diagnosis of dementia is a complex process. Being able to talk about the diagnosis to others represents a major challenge for some people with dementia. This study explores the experiences of people with dementia, and members of their families, around the task of informing others during the six months immediately following their diagnosis of dementia. Five people with dementia living in the community, and their immediate family members, were recruited into an ethnographic study. Data were collected through recorded interviews and participant observation, and were analysed through a grounded theory method within a continuing iterative process. Findings suggest that participants recognised the need to tell others about their diagnosis but these conversations were difficult to initiate and manage, and hindered the processing of emotions. Findings are discussed in relation to implications for practice.

The phase of retirement has been steadily growing since the 1950s. Rules and regulations related to retirement have been changing. Recent cohorts have reached this phase in better health than previous ones. Until recently, retirement has been rather void of societal expectations, leaving room for individual decisions regarding amount and type of activity. Thus, investigating activity patterns displayed during this life phase, their predictors and outcomes seems overdue. The study addresses three questions: (a) Which distinct clusters of productive activities among retirees can be identified in Germany? (b) Do activity patterns of clusters follow complementary or substitutive composition rules? (c) Which are the most important predictors of cluster membership? Using probability-based sample data (N = 2,141) from the survey ‘Transitions and Old Age Potential’ (TOP), this study investigated clusters of productive activities among retirees aged 60–70 years in Germany. The activities examined included paid work after retirement, formal and informal volunteering, child care and care-giving. Results showed a four-cluster structure. The clusters (Multiple Engagers, Volunteers, Family Helpers and Family Disengagers) differed with regard to the composition and the intensity of productive activities. Both complementary and substitutive relations were identified within clusters. Individual, familial and economic resources were predictors of cluster membership. Results are discussed with regard to role theory, cumulative inequality theory and the ongoing debate about old-age potential.

This article deals with the interplay of care as practical tasks and as ways of constructing and reconstructing social relations. We maintain that the division of tasks in care reflects a social organisation, and that the ‘who’ and ‘what’ in care are inseparably linked. On this basis we suggest that care be studied as care systems. This perspective is developed through case studies and other data. Theoretical and practical implications are suggested.

The average expected lifespan in Canadian long-term care (LTC) homes is now less than two years post-admission, making LTC a palliative care setting. As little is known about the readiness of LTC staff in Canada to embrace a palliative care mandate, the main objective of this study was to assess qualities relevant to palliative care, including personal emotional wellbeing, palliative care self-efficacy and person-centred practices (e.g. knowing the person, comfort care). A convenience sample of 228 professional and non-professional staff (e.g. nurses and nursing assistants) across four Canadian LTC homes participated in a survey. Burnout, secondary traumatic stress and poor job satisfaction were well below accepted thresholds, e.g. burnout: mean = 20.49 (standard deviation (SD) = 5.39) for professionals; mean = 22.09 (SD = 4.98) for non-professionals; cut score = 42. Furthermore, only 0–1 per cent of each group showed a score above cut-off for any of these variables. Reported self-efficacy was moderate, e.g. efficacy in delivery: mean = 18.63 (SD = 6.29) for professionals; mean = 15.33 (SD = 7.52) for non-professionals; maximum = 32. The same was true of self-reported person-centred care, e.g. knowing the person; mean = 22.05 (SD = 6.55) for professionals; mean = 22.91 (SD = 6.16) for non-professionals; maximum = 35. t-Tests showed that non-professional staff reported relatively higher levels of burnout, while professional staff reported greater job satisfaction and self-efficacy (p < 0.05). There was no difference in secondary traumatic stress or person-centred care (p > 0.05). Overall, these results suggest that the emotional wellbeing of the Canadian LTC workforce is unlikely to impede effective palliative care. However, palliative care self-efficacy and person-centred care can be further cultivated in this context.

The aim of this article was to ascertain nursing home residents' preconceptions about institutionalisation and analyse the causes and circumstances of and the justification for their admission. Grounded theory was used to design and analyse a qualitative study based on in-depth interviews in a theoretical sampling of 20 persons aged over 65 years with no cognitive impairment, and eight proxy informants of residents with cognitive impairment, institutionalised at a public nursing home in Spain. Our analysis revealed that preconceptions about nursing homes differ between residents and relatives, and are strongly influenced by the views held by society about such centres and by previous experiences. Regarding the causes and circumstances underlying nursing home placement, while the principal cause of institutionalisation among residents with cognitive impairment was the ineffectiveness of informal care systems, in the case of residents without cognitive impairment reasons tended to revolve around two main themes: social causes (loneliness, not be a burden to the others, household-related, comfort and absence of relatives in the vicinity), and limitations in physical functioning, with the former predominating. This study shows society's perception of such centres and the circumstances surrounding admission. These points of view are useful for analysing why informal care systems prove inadequate, and are crucial for designing programmes targeted at acceptance and successful adaptation to institutionalisation when this becomes necessary.

Chronic disease, mobility limitations and low physical functioning are determinants of an earlier age of retirement. Therefore, long-term population trends in these factors may have an impact on the proportion of individuals near traditional retirement age who continue to work. Our objective is to develop a projection model that accounts for trends in these factors in order to estimate the proportion of the population aged 55–74 with the capacity to participate in the labour force. We used logistic regression models to quantify how chronic disease, mobility and functional status predict labour force participation among individuals aged 55–59. Next, we obtained estimates of the population prevalence of each of these predictors for the years 2010–2050. We then used estimated coefficients from the logistic regression models to predict the age-specific probability of capacity for work up to the age of 74. We find that population capacity for work depends on trends in disability and on level of education. Future population capacity for work depends on trends in functional limitations primarily in the population with lower levels of education. Changes in functional limitations, changes in the environment, technology and social policy targeted towards individuals with lower levels of education could result in mitigation of future decreasing capacity for work in the population near retirement age.

As the world undergoes rapid ageing, informal support from friends and relatives is becoming especially important among older adults in middle- and low-income countries, where formalised social protections may be limited. We use new data from a cohort of adults aged 40 and older in rural South Africa to explore how receipt of emotional support differs by gender and marital status. Our findings suggest that women are more likely to get emotional support than men and have more sources of support. Moreover, women are more likely to get emotional support from relatives, whereas men are more likely to get support from friends. In regard to marital status, married people are more likely to get emotional support and have more sources of support than people who are not married. However, separated/divorced and widowed people are more likely to get emotional support from relatives and have more sources of non-spousal support than married people. These findings point towards gaps in informal systems of support, and the particular importance of considering men and unmarried (especially never-married) people when designing policies to offer social protections to older populations.

The inclusive development strategy proposed by the Chinese government embraces social inclusion for older people. In line with most developing countries, China's policy on social inclusion for older people focuses almost exclusively on material security in the form of pensions. This paper examines the impact of pensions on social inclusion for older people across four dimensions: family interaction, social support, social participation and self-assessment using data from the 2014 China Longitudinal Ageing Social Survey. The results demonstrate that pensions improve dramatically the relationships between older adults and their family members and friends, and therefore their social inclusion in the life world. The exception is social participation which seems to be immune to material income effects. However, the stratified pension system in China generates complex and hierarchical effects on social inclusion among different sub-groups. Social inclusion among older people with high exclusion risks but low pensions is very sensitive to pension levels. Conversely, most pensions are distributed to those with the lowest exclusion risks as a result of the disappearance of their impact on social inclusion. We argue that future social inclusion policies for older people in China should focus first on achieving greater equality in pensions.

Social media facilitates the sharing of ideas, thoughts and information about older people and later life through online networks and communities in contemporary society. Social media content about older people has become important for understanding media representations of older people, but it has not been sufficiently studied. Recent studies suggest that older people are predominantly represented as a disempowered, vulnerable and homogeneous group on social media sites, such as Facebook and Twitter. Because local authorities in many countries have begun using Facebook to reach out to and interact with citizens, they are seen as a significant producer of media content about older people and later life. The purpose of this study is to examine the ways in which Swedish local authorities have visually portrayed older people in their use of Facebook compared with other age groups. This research performed a visual content analysis of 1,000 Facebook posts posted by 33 Swedish local authorities, employing ten analytical aspects to describe and interpret the signs, activities and contexts associated with older people and other age groups (infants, children, adolescents and adults). The study found that the representations of older people on the Facebook pages of local authorities appeared to be not very diverse; specifically, older people (including those in residential care homes) were mainly portrayed as remaining socially engaged and moderately physically capable. This media representation destabilised the prevalent negative stereotypes of older people as being out of touch and dependent; however, it collided with the reality of older individuals with care needs. Additionally, this study argues that older people are represented as inferior to the young in terms of physical and technological competence, based on the connotations of the signs. Given that local authorities have progressively incorporated social media into their daily work, it is expected that this study will contribute to a greater understanding of the ways in which local authorities produce (non-)stereotypical representations of older people on social media.

In Western welfare states, notions of age-friendly communities and ageing-in-place are increasingly important in new health policies. In the Netherlands, care reforms are modifying the former welfare state to be more participatory; local governments are seeking collaborative solutions. Municipalities and housing, care and welfare organisations in the southern part of the country developed the concept of ‘lifecycle robust neighbourhoods’, envisioned as places where older people can age-in-place. Although many scholars have used the concept ageing-in-place in their studies of neighbourhoods, we aim to unravel this concept further by exploring how this particular ageing policy plays out in practice. This paper explores what the development of ‘lifecycle robust neighbourhoods’ means in relation to notions of ageing-in-place and age-friendly communities. We used ethnography (interviews, observations and focus groups) to reveal how, on the one hand, the policy makers, housing, care and welfare directors and representatives of older people, as developers of ‘lifecycle robust neighbourhoods’ and, on the other hand, older people, give meaning to places to age-in-place. It becomes clear that ageing-in-place has a different meaning in policy discourses than in practice. While developers mainly considered place as something construable, older people emotionally attached to place through lived experiences.

Population ageing in China calls for evidence-based solutions, especially in terms of fulfilling long-term care needs among frail older adults. Respite services are identified as effective resources for alleviating care-giver burden and promoting the wellbeing of both older adults and their family care-givers. However, respite care is often under-used in China. This research aimed to examine factors associated with intention to use respite services among informal care-givers in Shanghai, mainland China. This study was part of the Longitudinal Study on Family Caregivers for Frail Older Adults in Shanghai. Pairs of older adults and their care-givers (N = 583) who successfully completed the 2013 and 2016 waves were included in the data analysis. Two logistic regression models were conducted, one with time-invariant and one with time-variant factors. The model with time-variant factors had greater explanatory power than the original Andersen model with time-invariant factors influencing intention to use respite services among care-givers. Care-givers had higher odds of intending to use respite services if they had higher care-giving burden, were caring elderly people who experienced care-giver transitions, or were caring for elderly people with increased function of ambulation or decreased function of feeding. The findings imply that change in functional health was a significant determinant of intention to use respite care. Relevant policy and service implications will be discussed.

This paper reports a study of the religious, spiritual and philosophical responses to spouse bereavement. Twenty-five bereaved spouses aged 60 or more years living in the south of England and from Christian backgrounds were followed from the first to the second anniversary of the loss. The participants expressed a range of attitudes, from devout religious belief to well-articulated secular conceptions of the meaning of life, but the largest group had moderate spiritual beliefs that were characterised by doubts as much as hopes. Uncertain faith was more often associated with depressive symptoms and low levels of experienced meaning. Nine case studies are presented that illustrate different levels of adjustment to bereavement and both changing and stable expressions of faith across the one year of observation. Attention is drawn to the importance of both secular agencies and religious organisations developing a better understanding of older people's spiritual responses to loss. Although to many British older people, practise of the Christian faith may be less evident now than in their childhood, quality of life assessment should not ignore sources of spiritual satisfaction and dissatisfaction. Moreover, previous and especially early-life religious experiences provide useful points of reference for understanding present religious and spiritual attitudes. The study suggests that there may be a substantial need for pastoral counselling among today's older people, especially those of uncertain or conflicted belief.