Understanding vulnerability matters because being vulnerable represents a profoundly undesirable state. People who experience vulnerability in old age are of obvious humanitarian concern, as their insecurity and heightened exposure to certain threats is likely to be compounded by reduced capacities for coping independently. Comprehension of the causes and consequences of vulnerability is important for the development of social policies as it indicates ways of avoiding and alleviating bad outcomes. Policies which have the concept of vulnerability at their heart encourage the development of preventive and targeted measures, which is crucial in conditions of financial constraints and competing demands. By studying vulnerability we investigate processes of relative disadvantage or exclusion and, for purposes of comparison, absolute differences in socio-economic or policy context can be set aside. This makes the study of vulnerability particularly germane to cross-cultural and cross-national research on old-age and elderly support.

Identifying vulnerable older people and understanding the causes and consequences of their vulnerability is of human concern and an essential task of social policy. To date, vulnerability in old age has mainly been approached by identifying high risk groups, like the poor, childless, frail or isolated. Yet vulnerability is the outcome of complex interactions of discrete risks, namely of being exposed to a threat, of a threat materialising, and of lacking the defences or resources to deal with a threat. In this article, we review approaches to vulnerability in various disciplines in order to develop a systematic framework for approaching vulnerability. This framework distinguishes and examines the interactions among the domains of exposure, threats, coping capacities and outcomes. Drawing on European and Asian gerontological literature, we discuss what might be meant by these domains and their place in the understanding of vulnerability in old age. Two case studies are presented – one on homelessness in Britain, the other on familial care provision in Indonesia – to illustrate the ways in which specific vulnerabilities are created and distributed over the lifecourse.

Contemporary trends in population ageing and urbanisation in the developing world imply that the extensive out-migration of young people from rural areas coincides with, and is likely to exacerbate, a rise in the older share of the rural population. This paper examines the impact of migration on vulnerability at older ages by drawing on the results of anthropological and demographic field studies in three Indonesian communities. The methodology for identifying vulnerable older people has a progressively sharper focus, beginning first with important differences between the communities, then examining variations by socio-economic strata, and finally the variability of older people's family networks. Comparative analysis indicates considerable heterogeneity in past and present migration patterns, both within and between villages. The migrants' contributions are a normal and important component of older people's support, often in combination with those of local family members. Higher status families are commonly able to reinforce their position by making better use of migration opportunities than the less advantaged. Although family networks in the poorer strata may effect some redistribution of the children's incomes, their social networks are smaller and insufficient to overcome their marked disadvantages. Vulnerability thus arises where several factors, including migration histories, result in unusually small networks, and when the migrations are within rural areas.

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 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.

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.