This study examines the relationship between age and the injury outcomes for belted drivers in road vehicle crashes in the United Kingdom. The sample of 1,541 drivers was divided into three age groups: 889 drivers were aged 17–39 years (young drivers); 515 were 40–64 years (middle-aged), and 137 aged 65–84 years (older drivers). Both frontal and side impact crashes in which the vehicles sustained sufficient damage to be towed away from the scene are considered. In-depth information obtained from examinations of the crashed vehicles was combined with clinical data obtained from hospitals to throw light on the mechanisms that led to the injuries. Results show that in crashes of approximately equal severity, older drivers were significantly more likely than middle-aged and young drivers to be fatally injured in both frontal (p<0.001) and side (p<0.05) impact crashes. The results also show that older drivers sustained more injuries to the chest (p<0.0001) and that this body region is particularly problematic. The main sources of the chest injuries were found to be the seat belt in frontal crashes and the door in side impact crashes. As the number of older car users will increase rapidly in most OECD countries in the coming decades, the results suggest that vehicle re-designs are required, including in-vehicle crashworthiness systems, to take into account older people's relatively low tolerance of crash impacts.

One of the key objectives of the community care reforms of 1990 in the United Kingdom was the development of a flourishing independent sector alongside good quality public services. The aims of the reforms were to increase the available range of options, widen consumer choice and promote independence. The purpose of the study reported here was to examine – from the perspective of older service users, their carers and care managers – experiences at the operational level of arranging, delivering and receiving care services. The findings are based on data gathered in seven local authorities including reviews of case files, policy documents and face-to-face, in-depth interviews with 55 users, 37 carers and 28 care managers. There is evidence of a pronounced emphasis on procedure-based systems of care management. Potentially this has two significant consequences. First, the fostering of personal relationships may be subordinated to the organisation of short-term tasks and thereby may threaten patterns of trust and accountability. Second, the associated fragmentation of the assessment and care management process which in turn can lead to discontinuities of care for users and their carers. The paper concludes that there is still some way to go before care managers as micro-commissioners have sufficient and reliable information or available service capacity to match providers' capabilities with users' and carers' needs.

Despite the growing awareness of the significance of helping a relative to relocate to a care home as a key phase in the care-giving career, relatively few British studies have explored this experience in depth. Informed by a constructivist perspective, this study sought a better understanding of nursing home placements from the viewpoint of relatives. Data were collected in 37 semi-structured interviews involving 48 people who had assisted a close relative to move into a nursing home. Analysis revealed three perceived phases to the transition: ‘making the best of it’, ‘making the move’ and ‘making it better’. The relatives' experiences through these phases had five perceived elements, all of which were continua, from absent to very strong, reflecting the extent to which they were felt. They were: operating ‘under pressure’ or not; ‘in the know’ or ‘working in the dark’; ‘working together’ or ‘working alone’; ‘in control of events’ or not, and ‘supported’ or ‘unsupported’ both practically and emotionally. This paper reports findings about the first phase of the transition, ‘making the best of it’, and documents the experiences of decision-making about nursing home placements. It is argued that health and social care practitioners have enormous potential to influence whether or not helping a relative to move into a nursing home is perceived as a positive choice.

The living arrangements of older people are changing. An analysis of official registration data (1993–1998) in Flanders, Belgium, shows that while the number of single person households has been increasing, the proportion of people aged 75 or more years living alone has been falling and the proportion living with a spouse or partner increasing. No less than one third of the older people who lived alone in 1993 sustain a one-person household into very old age. It was also found that those who are widowed at a very advanced age change house or move very quickly, women to a greater extent and at younger ages than men. The principal destinations are residential care homes and, to a lesser extent, child's households. Living alone appears to be a decreasingly acceptable option. Since very old people with a disability appear to have an increasing preference for residential care and a lessening preference for co-residence with relatives, these developments have consequences for both informal family care and public social services. Particular attention needs to be paid to men who live alone as a risk-group, and residential care provision requires expansion.

The purpose of this article is to analyse with longitudinal data from Norway the caring activities of sons and daughters who were the primary care-giver to a parent aged 80 or more years. The study sample consists of the 227 offspring care-givers in the Larvik study, which examined the illnesses and disabilities and the informal and formal care received until their deaths of all those aged 80 or more years in the town's population in 1981. Prospective and retrospective data were collected from that year about the health, functional losses and formal service utilisation of the older people. After the death of an older person in the study, the next-of-kin was interviewed about the informal care provided by relatives and friends during the same time span. The sequences and content of the care-giving activities differed little for son or daughter care-givers, except during a short escalation phase. The average duration of informal home care was shorter for sons than for daughters, primarily because a minority of the daughters had very long care-giving careers. The duration of the care recipients' stays in acute or long-term care institutions before death did not differ by the gender of the carer. Compared with many earlier studies, few gender differences in offspring care-giving activities were found. The findings suggest that the potential of sons to provide informal care to frail older parents is underestimated in modern societies.

This paper reports an analysis of the relative influence of work-related, care-related and personal factors on carer outcomes among 204 working female carers. To examine the importance of personal factors, the ‘Motivations in Elder Care Scale’ (MECS) and the ‘Relationships in Elder Care Scale’ (RECS) were developed. In a qualitative pilot study, interviews with working-age carers were drawn on to form the items for inclusion. The MECS included items for external pressures to care, e.g. guilt, the older person's expectation of care, and perceived disapproval of others, and for internal desires to adopt the caring role, e.g. carer's resistance to other forms of care, living up to one's principles and caring nature. Psychometric tests revealed that two subscales had greater reliability, the EXMECS (extrinsic motivations to care) and the INMECS (intrinsic motivations). The RECS included both positive items, e.g. respect, admiration for the older person, and lack of generational differences, and negative relationship items, e.g. struggle for power, and older person's resistance to caring efforts, and had good reliability. Measures of carer stress and carer satisfaction were included as outcome variables. Multiple regression analyses showed that the RECS and the MECS were the most significant predictors of carer outcomes. Greater extrinsic motivations to care and poorer quality of the relationship with the older person were the most significant predictors of carer stress. Better relationship quality and greater intrinsic motivations to care were the most significant predictors of carer satisfaction.

This paper reviews recent research on care-giver networks and the concepts and approach that they apply, with particular reference to the support networks of the primary care-givers of older people with Alzheimer's disease. It makes the case for an integrated approach to the explanation of the various combinations of formal and informal support that are found. It argues that more attention needs to be given to transformations in care-giver networks over time, and that this will require more development of both theoretical perspectives and analytical tools. The stages of a care-giver's commitment towards an elderly relative are examined, to understand the associations between changes in the ailing person's needs, the structure of the support network and the primary care-giver's roles. This approach makes useful contributions to the understanding of the development, maintenance and dissolution of supportive ties. Following the work of Pescosolido (1991), we propose an integrated perspective that combines the ‘care-giver career’ approach and the methods of ‘social network’ analysis.