In 2004 in Europe, more than two-thirds of those born during 1945–54 had a parent or parent-in-law alive, and the rates of co-residence with their ascendants ranged from less than four per cent in Sweden, Denmark and The Netherlands, to between 17 and 24 per cent in Italy, Spain and Greece. The proportions that had provided practical help to their parents during the previous 12 months had a north-south gradient, from approximately one-in-three in the northern countries to 15 per cent or less in the southern countries. In contrast, the proportions of the helpers that provided regular and almost daily help had an inverse pattern, being low in Sweden and Denmark and much higher in the south. Some of these differences may be attributable to variations among the countries in the interpretation of ‘help’. Help to elderly parents tends to be most associated with the gender of givers and receivers, the living arrangements, geographical proximity and needs of the parents, and the availability of adult children who can help. There is little evidence of a specific ‘baby-boomer generation’ effect on the probability of giving help.

This paper reports a study of the associations between social relations, language and cognition among people aged 85 or more years (hereafter the ‘oldest old’). Although the links between cognition and both social relations and language ability are well-established, less is known about the relationship between social relations and language skills, especially among the oldest old. With a sample of 20 adults aged 85–93 years living independently in two retirement communities (a seniors' apartment complex and independent apartments in a continuum-of-care setting), we used the approach of the Rochester Interaction Record to assess the frequency, purpose and quality of their social interactions over one week. It was hypothesised that aspects of social relations, as well as the type of residential setting, would associate with both cognitive skills (measured using the Composite Cognistat) and language skills (measured using the Boston Naming Test). It was found that participants who had a low proportion of interactions with family members, or a high proportion with friends, as well as those with diverse relationships, performed better on the cognitive and language tasks. Furthermore, those from the setting with more programmed activities performed better on the language task. The conclusion critically examines the findings about the influence of family relationships and the importance of residential setting.

This paper presents a new scale for the assessment of the salience of age in social interaction and of levels of agreement with four age stereotypical assertions, about the characteristics of people in the ‘third age’ and the ‘fourth age’, about older people's social roles and social participation, and about the problems for society produced by population ageing. The scale was constructed by testing the agreement of a national sample of 804 German respondents aged 41–84 years with over 60 item-statements in two pilot studies. The final scale has 24 items, and was tested using a stratified sample of 1,275 subjects aged 40–75 years. Five postulated subscales were confirmed using principal components analysis: ‘age salience’ in social interaction, old age as a time of ‘developmental gains and potentials of development’, old age as a time of ‘developmental losses and risks of development’, ‘the social downgrading of older people’, and believing that ‘older people are a burden on society’. For age stereotypes and age salience, no significant sex differences were found, but those aged 58–64 years held more optimistic views about old age and population ageing than both the younger and the older age groups (with no differences between the latter). Moreover, age stereotypes and age salience varied by several social-economic variables, particularly occupational status, the rate of unemployment in the region of residence, and being resident in the eastern or western part of Germany. No significant interactions between age group and sex were found for any of the five subscales.

The epidemiological health transition in Indonesia has lead to a substantial ageing of its population and a rapid increase in the prevalence of chronic progressive illnesses in advanced age that, in most cases, require some sort of care. This shift from ‘cure’ to ‘care’ necessitates new paradigms in both health-care delivery and research on older people in less-developed countries. Care involves both attitudes and practice, and is a dynamic interaction between giver and recipient. The vulnerability of frail older people is strongly related to the resources, capability and willingness of kin and non-kin to act as care-givers for extended periods. Normative filial piety and kinship obligations are no longer undisputed. This paper reports a study of the care and support received by chronically ill older people in urban areas of North Sulawesi, Indonesia. The majority rely on close family members, most often a wife or a daughter (or both), to provide treatment, care and support. The main care activities are support with ‘activities of daily living’ and therapies for specific illnesses. Care-givers experience manifold burdens when providing care for frail older people, and tend to reduce their support as the severity and duration of their relative's illness increases. It is shown that an older person's vulnerability to inadequate care provision, or its withdrawal, is associated with marital status and gender (unmarried women and widows being most at risk), poverty, weak support networks, and having care-givers who are themselves vulnerable.

This study investigates the variations by older people's socio-economic status (SES) (i.e. educational level and social class) in the use of informal and formal help from outside the household in Great Britain, Italy, Belgium and The Netherlands. In all these countries, it was older people in low SES groups who mostly used such help. Multinomial logistic regression analyses showed that, in each country and for both types of help, there were SES gradients in the utilisation of both formal and informal care, and that differences in age, health and marital status largely accounted for the former but not the latter. Cross-national differences in the use of both informal and formal help remained when variations in sex, age, SES, health, marital status, home ownership and the use of privately-paid help were taken into account. Significant interaction effects were found, which indicated that older people in low SES groups in Great Britain and The Netherlands had higher odds of using informal help from outside the household than their counterparts in Italy, and similarly that those in The Netherlands were more likely to use formal help than their Italian peers. The results are discussed in relation to the cultural differences and variations in the availability of formal services among the countries.

This article examines the leisure behaviour, attitudes and life satisfaction of a sample of 383 retirees aged 50 or more years in an Israeli national survey. Multivariate analyses identified four leisure-styles on the basis of the type of leisure activity engaged in, its relative sophistication, whether it was a formally-organised cultural activity, and its location (at home or outdoors). The four styles were: ‘company seekers’, ‘media consumers’, ‘culture enthusiasts’ and ‘sophisticated choosers’. The levels of participation in the four styles were associated with nine background characteristics: gender, education, income, former occupation, work status, retirement pattern, origin, residential area and health. Differences in life satisfaction were associated with leisure participation and leisure satisfaction. Two of the groups, the ‘culture enthusiasts’ and the ‘sophisticated choosers’, were relatively active, and enjoyed significantly higher levels of satisfaction in both their leisure and their lives. These findings tend to support Havighurst's ‘activity theory’. Since these two leisure-styles were followed by minorities, and most of the sample pursued the other leisure-styles, the findings imply that a large proportion of the retired population are inadequately prepared to take up ‘active leisure’. If more older people are to become engaged in active leisure, with benefits to both themselves and to society, they require more guidance and support.

Productivity among older adults manifests in engagement in paid work, voluntary work, giving support to others, home maintenance and housekeeping. This paper reports an investigation into the extent to which levels of participation in the different productive activity types in The Netherlands are associated with age, gender and the settings in which older people live. The regional and urban–rural dimensions of variation are examined. The data were derived from the European Study of Adult Well-Being survey (ESAW). The results show that the oldest women tended to restrict their productivity to the private domain of housekeeping, while the oldest men were more often productive in the community, and that regional variations were stronger for women than for men. Traditional gender roles particularly affected the way in which older women living in a peripheral region participated in productive activities. In contrast, the urban–rural dimension was more important for men than for women, partly because a group of older men in the cities were not involved in paid work. Overall, strong gender influences on the variations in productive engagement were found. Processes of age-related contraction and convergence in patterns of participation in productive activities were imputed from the cross-sectional data. A full understanding of the ageing and cohort effects underlying the reported patterns would require much more detailed information on the spatial and temporal dimensions of older people's activity patterns.

This paper explores the usefulness of the ‘asset vulnerability framework’, as devised by Moser (1998), for assessing the economic wellbeing of older people living in poor rural and urban communities in Thailand. Gaining an accurate view of older people's material situation is essential for the development of policies that target the needs of older people in contexts of resource scarcity. The paper shows the limitations and potential biases of assessments based purely on reported income levels. It then sets out the key principles of the asset vulnerability framework, which seeks to combine information about exposure to different economic risks with the relative capacity to deal with them. Drawing on survey data, the paper maps resilience to economic risk, finding that the very old and those living in rural communities are in the most precarious position, whereas gender differences are less apparent. The asset vulnerability framework is then applied to specific forms of risk: catastrophic health expenditure and the death of a child caused by HIV/AIDS. Patterns of vulnerability revealed by the framework roughly accord with those revealed by reported income, but there are important differences, such as the size of the vulnerability gap between rural and urban populations. The framework provides a much fuller picture of why some groups of older people are in a more precarious economic situation than others. The paper recommends that future surveys draw on Moser's framework, and place emphasis on identifying the risks that older people consider most important.

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.

Life expectancy has been increasing rapidly in many parts of the world, including Hong Kong. A longer life can be welcome as an opportunity to fulfil as yet unmet aspirations, or to take up new challenges and projects, but it may also be a burden, especially for individuals who are unprepared. A pressing question for longer-life societies is: how may older people live their longer lives to the full positively? This article reports a qualitative study of Hong Kong Chinese people's views about ‘positive ageing’, as expressed and discussed in 15 focus groups of middle-aged and older people. Two themes emerged: first, the participants considered that positive ageing should comprise good health, having a positive life attitude, active engagement with an activity or with society, feeling supported by their families and friends, being financially secure, and living in a place with emotional ties; and secondly, several key factors that enable positive ageing were identified, namely, adopting a healthy lifestyle, thinking positively, promoting family and inter-personal relationships, and building up financial resources. The views of the participants about ‘positive ageing’ are compared with those reported from western studies, and the policy implications are considered.

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

Old-age care has frequently been conceptualised as being either family-based or publicly-provided. This article analyses the overlap in provision from the two sources and their relationship in the Swedish welfare state. Many older people and their carers rely on both sources of help rather than on just one, and prefer to do so. The empirical evidence on patterns of care in Sweden supports a joint family-state conceptualisation of care. Its realisation may depend on general coverage rates of public services and the efficient targeting of frail elderly people who live alone. Most older people in need of care rely on help only from their family, but many are helped by both the family and the state, particularly those with the greatest needs. Dynamic concepts like ‘substitution’ and ‘complementarity’ are hard to apply in cross-sectional studies: there may be complementarity in individual cases but long-term substitution or its reversal in successive cohorts. Yet again, both sources of care may increase simultaneously in individual cases. The need for care varies considerably among Swedish municipalities, with implications for the levels of both public services and family support. High coverage rates of the public services may facilitate and support family care.

Drawing upon interviews with 22 young athletes aged on average 20 years, this article examines the ways in which they used observations of the ageing and old age of their family members to shape the ways in which they anticipated the ageing of their own bodies. The representations of the bodies, roles and lifestyles of their parents and grandparents provided ‘narrative maps’ that held pre-presentations of the young athletes' possible futures. They included both preferred and feared scenarios about middle age and old age, particularly the opportunities they would have for maintaining physical activity and the appearance of their bodies. The young men's and the young women's narrative maps differed: the women's accounts of old age gave more prominence to the loss of appearance, while the men's focused more on the loss of control and independence. The informants were highly sensitised to the biological dimensions of ageing which, for them, meant the inevitable decline of the material body, especially in performance terms, and both genders recognised social dimensions, particularly that responsibilities to jobs and family would constrain the time available for exercise. To understand more fully young athletes' experiences of self-ageing, and the family as a key arena for the embodied projection and inscription of ageing narratives, further research is required.

The Senior Help Line in Ireland provides a confidential telephone listening service for socially-excluded older people and is operated by older volunteers. The service has grown rapidly in recent years and is highly regarded as an important service for older people in the country. This paper provides a systematic examination and assessment of the service, from the perspectives of costs, outcomes and best practice. The study uses personal interviews, focus groups and postal questionnaires to elicit information about the service and its impact on volunteers and callers. The Senior Help Line has made a significant contribution to the health and wellbeing of older people in Ireland at relatively low cost. The service demonstrates the positive effects of volunteering for older people, and the value and effectiveness of peer-to-peer communication for vulnerable callers. The help-line is a model project in terms of accountability and best practice, but requires additional resources, particularly for publicity and training. It needs to become a branded national service for vulnerable older people to meet the level of need for a service of this kind. The help-line also needs to be linked more formally to existing health and social care provision for older people, to become part of a holistic model of healthy ageing for older people. For the service to reach its manifest potential, the efforts of the volunteers need to be supported by higher and sustained levels of public spending, through more widespread and substantial public-voluntary partnership arrangements.

Ever since Erving Goffman (1962) discovered unexpected social bonding and elaborate social networks among the ‘inmates’ of total institutions, researchers and policy makers have used ‘community’ to refer to those very persons (nursing-home residents, in-patients in psychiatric hospitals, and others incarcerated for diverse disabilities) believed to be ‘its principal victims’ (Hazan 1995: 211). The concept ‘community’ was built upon Tönnies's (1955/1887) concept of Gemeinschaft, which depicted homogeneous groups integrated through multiple social linkages and face-to-face relations. By the 1970s, scholars of community studies called into question the conceptual underpinnings and potentially negative implications of the concept. They reframed ‘community’ as a concept that addressed more refined questions concerning locality, and reserved the term for the social networks that reflected group interests and provided symbolic evidence of identity formation or belonging (Davies 2003). Nonetheless, the term retains prominence for the institutions that provide residential care for people with various disabilities.

This paper considers the processes and circumstances that create vulnerability among older people, specifically to a very poor quality of life or an untimely or degrading death. Models of ageing processes are used to define vulnerable older people as those whose reserve capacity falls below the threshold needed to cope successfully with the challenges they face. Compensatory supports may intervene to mitigate the effects of challenges and to rebuild reserve. The dimensions of reserve, challenges and compensation are discussed, with emphasis on demographic and other influences on the availability of family and social support. Policy initiatives to reduce vulnerability can focus on each part of the dynamic process that creates vulnerability, namely, ensuring that people reach later life with ‘reserve’, reducing the challenges they face in later life, and providing adequate compensatory supports. The promotion through the lifecourse of healthy lifestyles and the acquisition of coping skills, strong family and social ties, active interests, and savings and assets, will develop reserves and ensure that they are strong in later life. Some of the physical and psychological challenges that people may face as they age cannot be modified, but others can. Interventions to develop compensatory supports include access to good acute care and rehabilitation when needed, substitute professional social and psychological help in times of crisis, long-term help and income support. Our knowledge of which interventions are most effective is however limited by the paucity of rigorous evaluation studies.

This study contributes to our understanding of the ageing process by investigating whether particular psychological dispositions among older people are associated with healthy ageing. The study's objective is to further our knowledge about what constitutes ‘health’ for the ‘oldest-old’ (people aged 80 or more years) in China. It is recognised that apart from the absence of disease, good health is a subjective experience, and it is posited that self-reported health is associated with psychological disposition, or in other words, that an individual's personal attitudes, motivations, and beliefs condition their perception of health and illness. Using data from China's Longitudinal Healthy Longevity Survey (1998 and 2000 waves), we examine whether psychological disposition in 1998 had an independent effect on self-reported health in 2000. The study is based on a stratified random sample of 4,366 people aged 80 or more years. After introducing controls for health status and socio-demographic variables, the multivariate, longitudinal results demonstrate that a robust psychological disposition was indeed associated with good short-term, self-reported health. The findings also illustrate that the effect differed by age, for the relationship was significant for octogenarians and nonagenarians but insignificant for centenarians. Data limitations prevented an empirical investigation of the processes that underlie the relationship between psychological disposition and self-reported health.

This paper reports findings from a European Commission funded study of future long-term care expenditure in Germany, Italy, Spain and the United Kingdom, and presents projections of future long-term care expenditure in the four countries under a number of assumptions about the future. Macro-simulation (or cell-based) models were used to make comparable projections based on a set of common assumptions. A central base-case served as a point of comparison by which to explore the sensitivity of the models to alternative scenarios for the key determinants. The sensitivity of the models to variant assumptions about the future numbers of older people, the prevalence of functional dependency and informal care, patterns of long-term provision, and macroeconomic conditions are examined. It was found that, under the base-case, the proportion of gross domestic product spent on long-term care is projected to more than double between 2000 and 2050 in each country. The projected future demand for long-term care services for older people is sensitive to assumptions about the future number of older people, the prevalence of dependency and the availability of informal care, and projected expenditure is sensitive to assumptions about rises in the real unit-costs of services and the structure of the models. It is important, for planning purposes, to recognise the considerable uncertainty about future levels of long-term care expenditure.

This article describes and evaluates cash-for-care programmes for older people in four European countries, namely Home-Care Grants in Ireland, Direct Payments in the United Kingdom (England), Service Vouchers in Finland and Personal Budgets in The Netherlands. The purpose is to raise understanding of the background and reasons for the introduction of cash-for-care programmes and their impact on the countries' care regimes. It is argued that while the motives for introducing cash-for-care programmes in the four countries are similar, namely to promote choice and autonomy, to plug gaps in existing provision, to create jobs, and to promote efficiency, cost savings and domiciliary care, the relative importance of these goals varies. Current cash-for-care programmes have comparatively modest coverage as compared with direct service provision and provide no more than an optional, supplementary source of care in three of the studied countries. Cash-for-care schemes have not radically transformed the care regimes in Finland, The Netherlands or the United Kingdom. In Ireland, however, the restricted availability of alternative forms of formal service provision means that the expansion of cash-for-care might shift care provision significantly towards private provision and financing.

There has been debate for some years as to whether the best model of care for people with dementia emphasises specialist facilities or integrated service provision. Although the United Kingdom National Service Framework for Older People recommended that local authority social services departments encourage the development of specialist residential care for people with dementia, uncertainty continues as to the benefits of particular care regimes, partly because research evidence is limited. This paper examines a large number of ‘performance measures’ from long-term care facilities in North West England that have residents with dementia. Of the 287 in the survey, 56 per cent described themselves as specialist services for elderly people with mental ill-health problems (known familiarly as ‘EMI homes’). It was envisaged that EMI homes would score higher than non-EMI homes on several measures of service quality for people with dementia that were developed from research evidence and policy documents. The analysis, however, found that EMI homes performed better than non-EMI homes on only a few measures. While both home types achieved good results on some standards, on others both performed poorly. Overall, EMI and non-EMI homes offered a similar service.