This paper discusses the mechanisms whereby the needs and interests of carers might be integrated into the service delivery system. Over the last decade, informal care has emerged as a major subject for research and discussion, and much work has been undertaken exploring the experiences, burdens and needs of carers. Carers are increasingly recognised as central to community care, but little work has so far addressed the means whereby their needs and interests might be integrated within mainstream service provision. The mechanisms for achieving this are underdeveloped. This paper puts forward six possible strategic responses, and discusses the merits and demerits of each. The responses are: taking evaluation a step further; consumerism; case management; performance or service indicators; rights; and targets. The issues raised in the discussion have relevance beyond the subject of informal care, and address questions that are central to the provision of welfare services generally.

Burden is today often applied to elderly people in two senses, for the fiscal load of income support and health and social care costs, and for notions and scales of care-giving effort and stress. It does not however convey straightforward meanings for its understanding is affected by two millenia of metaphorical and rhetorical usage. The use of burden tends to simplify relationships, whether between age-groups of a population or between a carer and an elderly person, and it communicates senses of a nuisance and an excessive charge. Portentous implications are invoked from biblical senses and derogatory overtones are strengthened by association, earlier this century, with racial stereotyping. An etymological survey reveals many sources of the word's versatility and rhetorical power. Important extensions of usage towards the two contemporary gerontological applications are then studied. A bibliometric examination of the surge in the word's social science use since the early 1980s is undertaken, and the paper concludes with a discussion of current usage as evidence of current attitudes towards, and constructions of, old age on the part of politicians and policy analysts.

The present paper describes and traces the emergence of an innovative psychoeducational model of support for family caregivers of dependent elderly persons, its associated systematic evaluation and leadership training process, provides details of a small group programme and its underlying philosophy, and reports on outcome evaluation research ascertained from both quantitative and qualitative data analyses. Details of these analyses are presented within the context provided by a three-level model of support, which recruits and trains professionals from a range of disciplines to help families in caregiving situations. The 72 treatment and 29 waiting-list control subjects were assessed at pretreatment and at posttest on measures of anxiety and psychological well-being. Statistically significant differences emerged between the treatment and waiting-list control groups on these measures. Positive changes for programme participants were further demonstrated by contextual analysis of evaluative responses. Implications for practitioners, educators, and policy specialists, as well as for research and programme development are discussed.

This paper describes where elderly people with moderate to severe (‘advanced’) cognitive impairment are living, what resources they use and the costs of these services to different funding agencies. It operationally defines dementia in terms of cognitive impairment and uses the OPCS disability surveys to estimate the prevalence of moderate to severe cognitive impairment in England. The paper goes on to describe services received by this client group on the basis of the same surveys, and costs these by supplementing the data with information from related studies by the PSSRU. Since accommodation is a major cost, the population of elderly people with cognitive impairment is classified according to their place of residence. Thus we are able to estimate the ‘baseline’ global cost of provision for this client group at current prices. We make cost projections at 1991/92 price levels to the national level, and discuss the implications in terms of burdens to different agencies.

Stability and change in self-esteem and its reported sources were investigated in a sample of older people re-interviewed 10 and 13 years after initial study. Most indicated a continuing high to medium-high level of self-esteem, and apart from an increase in mention of interest activities their pattern of illustrations also remained consistent. Variables in the initial study which predicted a maintained high level of self-esteem included number of hobbies, number of types of outings, self perceived activity level, and mention of people other than family members as sources of self-esteem. The usefulness of collecting data on expressed sources is exemplified in two case histories. Consideration is given to the implications of these findings for conceptualising identity processes in later life.

This article, the introduction to a collection of six related articles, describes the general rationale and design of the Berlin Aging Study (BASE). The distinguishing features of BASE are: (1) a special focus on the very old (70–105 years), (2) broad inter-diciplinarity (medicine, psychiatry, psychology, sociology and economics), and (3) sample heterogeneity achieved by local (West Berlin) representativeness. In addition to discipline-specific topics, four theoretical orientations guide the study: (1) differential ageing, (2) continuity versus discontinuity of ageing, (3) range and limits of plasticity and reserve capacity, and (4) ageing as an inter-disciplinary and systemic phenomenon. To provide a foundation and framework for the remaining articles, this paper outlines the protocols, designs, and measurement procedures of fourteen data collection sessions. In addition, information is given on the samples used for empirical analysis. Two samples from the first wave of the Berlin Aging Study are addressed in this collection of articles. The first (N = 360), uses data from the BASE Intake Assessment Protocol (Session 1). The second (N = 156), employs data from the entire 14-session full protocol of BASE. Selectivity analyses involving 22 comparison variables are reported in this paper and demonstrate that, with the exception of 12-month mortality, these two samples displayed the intended sample heterogeneity. Those results suggest that data from BASE hold high generalizability.

This study employs path analysis to examine the relationship between clergy age and certain quantitative indices of church life in two samples: a sample of 1,553 villages and rural communities, ranging in size from 251 to 1,250 inhabitants and a sample of 584 suburban parishes. The data indicate that clergy aged sixty or over working in rural parishes tend to have contact with a smaller number of active church members, as indicated by attendance on a normal Sunday, than younger clergy working within comparable rural parishes, although they maintain contact with the same number of nominal church members, as indicated by the electoral roll and festival communicants. Clergy aged sixty years or over working in suburban parishes, on the other hand, have contact with the same number of active church members as younger clergy working within comparable suburban parishes. These findings are discussed in the light of a growing body of research which suggests that changing patterns of rural ministry may be generating difficulties and stresses for clergy approaching the age of retirement.

A description of the microstructure of interpersonal processes is developed, based on the analysis of interaction as a succession of reflexive triadic units. This account can be modified in some aspects so as to provide a detailed theory of the process of dementia care. The theory is particularly relevant to moderate and severe dementia, and to formal care settings. A key concept is that of facilitation. The idea of a ‘culture of dementia’ is explored. Cautiously optimistic conclusions are reached about the possibilities for enabling dementia sufferers to remain in a state of relative well-being.

Data on a nationally representative sample of ever-married white American women born in 1900–1910 show living arrangements to be closely associated with the quality of the ageing experience (with, that is, whether these women were ageing ‘successfully’). The proportions ageing ‘successfully’ were highest among those living only with their husbands, and lowest among those living with kin other than their husbands. In between, but much closer in position to the women living only with their husbands, were those who were living alone. The paper looks at explanations accounting for these differences and considers some of the policy implications of these findings.

The Sociology and Social Policy Research Unit of the Berlin Aging Study focuses on four substantive areas: (1) life course antecedents and generational experiences, (2) later phases of the family life course, (3) action resources and social participation, and (4) economic situations and the provision of care. This paper reports results on the relationship between social and economic inequality and differential ageing, using the BASE multidisciplinary Intake Assessment (N = 360). The socio-economic position of older people is measured along three dimensions: economic resources, social status and prestige, and cultural status. Several ageing outcomes are considered, including functional physical health, cognitive functioning and mental health, overall subjective well-being, social autonomy and dependency. First, we show that old people as a group are neither socially nor economically homogeneous: very old women possess unusually low economic resources; and cohort differences in educational attainment are carried into old age. Second, cognitive functioning and mental health are positively correlated with socio-economic resources, while functional physical health is not. For women, socio-economic resources slightly affect overall subjective well-being, and are linked to the likelihood of living in a nursing home. We speculate that the wide availability of compulsory health insurance reduces social differentials in physical health and that these inequalities may determine who survives into old age.

Staying Put projects provide practical help to older home owners with the repair and improvement of their homes. A number of studies have examined the immediate impact of this help on the housing conditions experienced by older people and on their ability to remain living independently in the community, but the extent to which these benefits could last for a long period of time was not known. This paper describes the findings of a study which attempted to examine the longer-term impact of the Staying Put service. A sample of clients helped by Staying Put in the early 1980s were traced and interviewed in order to assess the impact of the assistance received and to examine their current and future housing and care needs. Although the study could not conclusively disentangle the impact of the Staying Put service from other factors influencing the ability of clients to live independently, it concluded that the help received was significant in improving housing conditions over a long period. The study made recommendations which aim to increase the effectiveness of Staying Put projects in the future, including the establishment of a target standard for the housing conditions of clients, the development of mechanisms for continuing contact with clients, and the provision of advice on moving on options where appropriate. More generally, however, the study concluded that more resources to fund services like Staying Put were required from government and from local and health authorities if they were to be more effective in helping clients to live independently.

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.

Theoretical positions which argue for age-related and individual variation in profiles of psychological functioning and patterns of predictive relationships are reviewed in the context of the three domains investigated by the Psychology Unit of the Berlin Aging Study (BASE): intelligence and cognition, self and personality, and social relationships. To illustrate the potential of BASE, we report initial data for a small set of variables from these three psychological domains for the first wave of study participants (N = 360, age range 70 to 103 years). Our analyses of these data were targeted toward three key questions about differential psychological ageing: namely, the extent of age/cohort-related differences and individual variation within each domain, possible age differences in the structural relationships between the three domains, and subgroup variations in cross-domain profiles of functioning. Within domains, individual differences in general were very large. Chronological age accounted for a sizeable proportion of the variance only in the domain of cognitive performance. The structural relationships between the domains of psychological functioning were similar for the old and very old age groups and reflected much domain independence. Examination of subgroup variations in cross-domain profiles of functioning revealed ten subgroups. All subgroups showed an uneven, that is, age-selective group membership: five subgroups included more of the very old, two more of the old, and three were age-specific. Preliminary explorations of these subgroups suggested substantial links to selected health-related variables, supporting proposals for multi-disciplinary research into differential ageing.

After noting the centrality of local authority homes for older people in British research on institutionalisation, influential research undertaken in this setting during the 19803 is reviewed. Three problems are identified in this current of research. Firstly, the assumption that there is a uniform process of institutionalisation is questioned. Secondly, the lack of comparative studies is highlighted. Thirdly, the absence of the structured dependency thesis is regarded as indicative of the lack of attention paid to social divisions. In conclusion, it is suggested that the concept of institutionalisation may have outlived its usefulness and that an alternative approach needs to be developed which is capable of focusing on the degree of dependency, independence and interdependence existing in a range of care settings.

Relatively little is known about what has been termed cultural gerontology, or the experience of ageing among members of particular ethnic minority groups. One of the greatest gaps in current knowledge relates to the subjective health status and use of health services among elderly people in ethnic minorities, particularly those who are Jewish. The research results reported here are from a survey of elderly people in City and Hackney, London, of whom 16% were Jewish. They show that Jewish respondents were more likely than other elderly people to report problems with emotional well-being, with mental and physical health and with functional ability (tasks of daily living). Jewish respondents were also more likely to use services, particularly health services, than other respondents. The associations with service use generally remained after health status had been controlled for.

Key questions in the psychiatric understanding of elderly people are the development of psychiatric morbidity, its phenomenology in old age, the differentiation between ‘normal’ and ‘pathological’ ageing, the interrelatedness of different types of mental disorders, their relation to somatic morbidity, and their consequences in daily life. Under the hypothesis of the de-differentiation of psychopathological features in old age, the relation between depression and dementia is studied. Contrary to most gerontopsychiatric research, the Berlin Aging Study (BASE) permits an analysis of these questions in a heterogeneous and primarily non-clinical community population. Initial data from the first 360 intake assessments and the first 156 intensively studied participants of BASE are presented. Results show that, even in very old individuals, depression and dementia still exhibit clearly distinctive psychopathological features. Prevalence rates in consecutive age groups show an age-related increase for dementia but not for depression. Nevertheless dementia and depression do not seem to be fully independent, because our data indicate a masking or extinction of depressive symptoms by dementia. Finally, both disorders have a similarly significant negative impact on independence, comparable to that of somatic morbidity.

The article reports on a study which explored the relationship female undergraduates and student nurses experienced with their maternal and paternal grandmothers. In addition, the article identifies some of the factors closely associated with the relationship, considers the role played by grandmothers with regard to their granddaughters and examines differences in granddaughters' perceptions of maternal and paternal grandmothers. The results highlight the intimate relationship between granddaughter and grandmother. When compared to paternal grandmothers, maternal grandmothers were perceived by granddaughters to be emotionally closer, provide a greater sense of security, be more influential in shaping their beliefs and were more likely to be preferred. They were also found to play a more active role in granddaughters' lives.

Many people deny the existence and importance of sexuality among the elderly members of our population. In a time when people are increasingly tolerant of sexual self-determination for virtually every segment of our population, why do we cling to puritanical moralities and outdated ideas in our approach toward sex in ageing men and women? Reasons range from psychological conflicts to social taboos; some stem from the selfish concerns of the young, and others are rooted in the cultural stereotypes and ignorance about the sexual behaviour of elderly people. It is not easy to find research on ageing and sexuality that does not suffer from extreme sample bias or the difficulty in getting older people to speak candidly about their sexuality. This paper explores some of the issues relating to sexuality in the later years.

Education may have an important role to play in helping to enhance older people's quality of life. The University of the Third Age (U3A) has operated successfully in many countries for nearly two decades, yet few studies have described the characteristics of those who are attracted to the movement, or the benefits to the individual and, possibly, to wider society of the U3A approach to education. This study discusses major findings from 770 responses to a postal survey involving members from twelve independent U3A campuses in three Australian States, and compares these findings with data reported for older learners in other countries. Some implications for Australian U3As undertaking research activities which have the potential to benefit the wider ageing community are raised.