This article addresses the subject of the role of older women in nineteenth-century North America. Existing historical accounts of the lives and position of older women in Canada and north-eastern USA are both partial and flawed, focusing mainly upon negative images of older women in poverty or in subjugated, passive domestic roles. These images of women's roles are based upon nineteenth-century guides and manuals which tended to portray later life as bleak, unfulfilling and restricted. However, through an examination of diaries and other biographical material describing the everyday lives of middle class women, contrasting evidence emerges of active and powerful roles and positive views of later life. It is argued that the examples discussed are not exceptional cases but rather are representative of a wider nineteenth-century pattern of older women undertaking satisfying and vital social roles within their family and community networks.

Over thirty years ago geriatric nursing, as it was then called, was at the forefront of nursing research in the United Kingdom. Concurrent with the emergence of geriatric medicine as a distinct speciality, the pioneering study of Doreen Norton and colleagues (Norton et al. 1962) served to highlight both the deficits that existed in the hospital care of older people and the enormous potential of nursing to improve the situation, particularly for the ‘irremediable’ patient (Norton 1965). Caring for those who could not be cured but required on-going support was seen to constitute ‘true nursing’ and was identified as an area of practice in which nurses should excel (Norton 1965, Wells 1980). Such potential went largely unrealised, however, as nursing focused on acute, hospital-based care (Nolan 1994). As a consequence, those working in continuing care struggled to find value in their work and patients were subjected to ‘aimless residual care’ (Evers 1991), a situation exacerbated by the continued application of the biomedical model (Reed and Watson 1994). Despite claims that nurses working with older people have ‘special skills’ (Royal College of Nursing 1993), the nature of such skills has therefore never fully been explicated. Indeed, Armstrong-Esther et al. (1994) asked what nurses currently contribute to the well-being of elderly people and, following their study, suggested that nurses must take the initiative and expand their role if ‘we are going to avoid simply warehousing the elderly until they die’. The need to act is particularly pressing at present as the spectre of ‘bed-blockers’ emerges once more and there is growing professional concern that older people may soon be denied the right to receive care from a qualified nurse (Nursing Times 1996).

This paper critically assesses an increasing use of mask motifs to examine questions of identity in later life. Two approaches are subjected to detailed analysis, both of which propose distinctive answers to the challenge to identity management emerging from high or post modernity. First, consideration is given to a postmodern ‘mask of ageing’ (Featherstone and Hepworth 1989), key elements of which include consumer culture and the ageing body. Secondly, psychodynamic conceptions of masquerade and the use of personae are examined, whereby discussion centres on expanded personal potential in the second half of life and protection against a hostile social environment. A developmental model of social masking is proposed. Whilst there are superficial similarities in the use of masking, these traditions are shown to have radically different ideas concerning the core contradictions of an ageing identity. Implications for identity management and the status of body, midlifestyle and authenticity in later life, plus the need for subtlety in research methodology, are drawn out.

In response to recent community care policies in Britain, co-ordinated, needs-led models of care have been introduced into day care services for older people. Whilst their introduction has prompted detailed consideration of the changes required in the organisation and management of these services, less attention has been paid to their implications for the design of day care premises. Yet design factors impinge on all aspects of service delivery and any shortcomings in design may undermine the effective delivery of new models of care. This article uses findings from recent research to explore how design factors may facilitate or constrain service delivery, focusing on two aspects of the new models of care – that services should meet the needs of individual users and be locally-based.

Alex Marsh and Moyra Riseborough, Making Ends Meet: Older People, Housing Association Costs and the Affordability of Rented Housing, National Federation of Housing Associations, London, 1995, 93 pp., no price, ISBN 0 862 97307 4.

Anthea Tinker, Fay Wright and Hannah Zeilig, Difficult to Let Sheltered Housing, Her Majesty's Stationery Office, London, 1995, 174 pp., £17.50, ISBN 0 113 21964 4.

Moyra Riseborough (ed.), Opening-up the Resources of Sheltered Housing to the Wider Community, Anchor Studies 3, Anchor Housing Association, Oxford, 1995, 32 pp., £7.50, ISBN 0 906 17827 4.

Bill Randall, Staying Put: The Best Move I'll Never Make, Anchor Housing Association, Oxford, 1995, unpaginated, £5.99, ISBN 0 906 17829 0.

For the last twenty years sheltered housing has dominated debates about housing and old age in Britain. There have recently been signs that its pre-eminent position may be threatened by the wider agenda stimulated by the community care reforms. But just when we thought the whole debate had run out of steam, back comes sheltered housing to dominate the policy debate and to re-capture the attention of housing officers. The nature of the debate now differs: gone are the heated discussions over whether sheltered housing is the answer to all our problems; rather, the key question is what to do with the increasing number of ‘difficult-to-let’ sheltered housing flats. Does this mean that the sceptics (including myself) were right all along and that sheltered housing really was ill-thought out and over-provided? After all, the main defence against these charges was that it was popular. Have older people turned against it too?

In Africa, AIDS is called the grandmothers' disease because the burden of caring for the sick and the survivors falls on older women. The two abstracts which follow report an overview of research on the social and economic effects of the HIV/AIDS epidemic in Southern Africa and a case study of an intervention among older women in a Botswanan village.

The objective of the study was to discover what fairly independent residents living in long-term residential care think about home care as an alternative. A stratified systematic sample was drawn from a one-day census of patients in all residential homes in Finland on 2 December, 1991. A postal survey was used for data collection in December, 1992. Respondents who preferred home care were compared with respondents preferring residential care according to length of stay, health, functional ability and health-related quality of life. Most respondents preferred institutional care. Preference for home care was explained most strongly by emotional factors, unwillingness for residential care at admission, and still having a home to return to. Shorter length of stay also predicted preference for home care. Those who preferred home care admitted they would need much formal care after discharge. People living in residential homes are rarely ready for discharge home, because of limitations in their physical ability or of their unwillingness to change their site of care.

Taking a life-cycle approach to marital power relations, the paper compares the attitudes of married men close to retirement with those who are retired. An integrative model based on Resource Theory was designed to analyse the effect of several variables on the husband's perceptions of power relations: perceived resources, attitudes toward gender roles, emotional commitment to his wife and anticipated dependence on her. The model was tested on a sample of 348 Israeli men – 137 pre-retired and 211 retirees. Contrary to expectations of a decline in the retired husband's perceived power, no differences were found between the two groups except for a reported increase in social power among the older group. Major differences were found, however, regarding the overall impact of variables: perceived economic resources had the strongest explanatory power for pre-retired respondents, whereas it was psycho-social factors (anticipated dependence on the wife for satisfaction of emotional needs, psychological resources, and emotional commitment to the wife) that best explained variance among retirees. The increased dependence of retired husbands on their wives' expressive resources seems to contradict their reports of greater social power, suggesting that their perceptions of marital power relations may be coloured by feelings of status anxiety.

The biology of ageing is finally becoming tractable science. After millennia of dead-ends and extravagant promises, we can now see our way to understanding the mechanisms of ageing. And there is now the genuine prospect of substantially intervening in the process so as to postpone it. These developments have taken place quite rapidly over the last twenty years, and may not be widely known. Here we introduce some of the basic features of this intellectual revolution, along with its more portentous implications for the human predicament. At the centre of this reformation has been evolutionary genetics. Mathematical research has revealed the evolutionary necessity of ageing in most organisms. Experimental research has shown that evolutionary forces readily alter patterns of ageing. The evolutionary research has been allied with genetic and molecular investigations as well, allowing a broad-based attack on the diverse problems of ageing. This attack has now penetrated far enough that the postponement of ageing has become a problem limited by ‘technological’ restraints rather than shortcomings in our general understanding of the process.

This paper provides a brief introduction to demography and population science and the newly emerged subfield of the demography of ageing. Links with gerontology are explored. Recent work on mortality at very high ages and on the black-white mortality ‘cross-over’ reported from the United States is then reviewed. These topics are important substantively and theoretically and also serve to illustrate demographic approaches to data and data analysis. Analytic approaches to the topics reviewed have had to be imaginative as there are major problems with data on very old people. Recent work indicates that the mortality of very old people, including centenarians, has fallen considerably, at least in those countries where good data exist. The mortality ‘cross-over’, however, appears to be artefactual, at least at ages under 95 years.

A revolution is occurring in information exchange among gerontologists worldwide. For research investigators the increasingly easy accessibility of public use datasets promises to facilitate both research training and useful exchange of evidence. A brief history of the development of public use datasets for research in ageing is provided, and datasets of particular interest are described. While the illustrations focus on experience in the United States the implications of these developments for training and communication among gerontologists worldwide are noted.

The purpose of this review is to identify and explore the emerging attention being paid to the individual in dementia research. Following a brief introduction, the review will examine literature which recognises three aspects of the person with dementia: the individual's sense of self; the person's rights; and the value to be gained from a concern with the perspectives of people with dementia. To date the medical model has dominated dementia research. This model tends to reduce the person with dementia to his/her neurobiology or neuropsychology (Cotrell and Schulz 1993). The experience and manifestation of dementia has been attributed solely to the disease process, with a consequent neglect of the psychosocial context surrounding the individual (Lyman 1989). Research on the psychosocial aspects of dementia has concentrated on family carers. Keady (1996) provides a useful categorisation of this research into the following topics: gender and coping style; marital relationships and the impact of dementia; access to information and services; participation in and effectiveness of support groups; adjustment and circumstances surrounding admission into care; and perception of own health needs. No literature focuses on people with dementia.

During the past year depression has remained an important theme of debate in Britain because of its continued high prevalence and association with suicide. Nonetheless patients are often inadequately assessed, the diagnosis is frequently missed, and treatment is commonly inadequate. Depression also has a complex aetiology and physical causes including several medical conditions are often causally related. The condition has a devastating effect on an individual's life and without adequate treatment can be disabling. The following papers examine some of these issues in detail.

A geriatrician's perspective

The problem and its roots

Who shall have when all will die?

RESOURCE ALLOCATION AND SOCIETAL RESPONSES TO OLD AGE

Special Issue of Ageing and Society, Volume 15 part 2, June 1995

Commentaries:

1.) And a Few Pinches of Politics and Economics

2.) The case of Alzheimer disease

3.) Professional and political influence on resource allocation for older people

Reply to Commentaries:

Facts, Values, Ideologies and Ageing

This paper, after reporting some research indicating the long-term effects of the experience of the Second World War, looks at how such a traumatic event and its sequelae should be understood in terms of the theoretical framework supporting the use of reminiscence work, most especially Erikson's life stages. Traumatic memories of the war are rarely reported in published accounts of reminiscence work. It is pointed out that this may be partly due to people with painful memories not volunteering for reminiscence groups, and that Coleman's (1986) research data would support this conclusion. Coleman's work has not been sufficiently ‘heard’ because of the much stronger framing of reminiscence as stimulation by such authors as Norris (1986). The paper looks at interpersonal difficulties of servicemen and civilians in communicating about the war; and why they might well find it easier to utilise the emotionally simpler and less unpleasant accounts offered by the media, especially film. The leaders of reminiscence groups, often having had little training, operate without awareness of such issues, and within a framework where ‘reminiscence as stimulation’ has been transmuted into the trivialising ‘reminiscence as fun’. It is suggested that mental health workers should offer regular supervision and training to reminiscence group leaders. The need for clinical awareness of the importance of the war in shaping people's lives both before and after the war is highlighted, as is the need for readily available and sympathetic psychotherapeutic services for this cohort.