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This paper explores how dignity is articulated and pursued by care workers in two currently prominent policy initiatives seeking to reform Danish care services for older people. Based on ethnographic case studies of 'reablement' practices and the use of 'welfare technologies', the paper shows how these attempts to create dignified care services transform interactions between care recipients and care workers. The analysis is inspired by a socio-material perspective on dignity as 'crafted' and 'co-laboured' in daily practices, in an interplay between multiple human and non-human actors. In the cases studied, dignity is articulated as closely related to older people's increasing autonomy and independence of formal care, and is pursued through enhancing care recipients' self-care ability, and through technological automation of care tasks. However, these articulations and pursuits of dignity do not stand alone. When everyday care practices are closely examined, dignity is also pursued by care workers as increased co-operation and equality between care workers and care recipients, as de-objectification, and as promotion of enjoyment and quality of life. In these practices, care is ambivalently positioned as both a potential threat to dignity, and as a prerequisite to achieving it. The paper concludes by discussing the risks of policy agendas pursuing a narrow understanding of dignity as simply independence of care. [ABSTRACT FROM AUTHOR]

Dementia, a global health priority, poses a disproportionately high risk to lesbian, gay, bisexual and trans plus (LGBT+)/gender and sexuality diverse people. Despite this, little research has explored the lived experience of LGBT+ people with dementia or their care partners. This scoping review aims to understand what the literature reveals about their experiences, the ways in which their lives have been investigated, to inform future research, policy and practice. Using an established scoping review methodology, we identified seven papers that reported empirical research on the lived experience of LGBT+ people with dementia and their care partners. Only a single study reported on in two of the papers included people who were trans. This in itself reveals how rarely LGBT+ people are asked to speak about how dementia has shaped their lives in academic research. Our reflexive thematic analysis indicates that LGBT+ people with dementia and their care partners endure overlapping forms of disadvantage. This results in heightened experiences of fear and discrimination, lack of services and compounded social isolation. Importantly, while dementia was embodied as interference and loss by LGBT+ people, it was their gender and sexuality differences that provided solace, even in the face of disadvantage. Importantly, people's relationships with LGBT+ identities were framed as fundamental for safety, resilience and wellbeing, rather than a complicating or confounding factor in living with dementia. [ABSTRACT FROM AUTHOR]

The health and wellbeing benefits of Men's Sheds to the men who participate have had significant research attention for over a decade. However, there has been little research into the broader impacts of Men's Sheds, particularly in relation to the impacts on significant others in the lives of the men who participate. Our paper aims to redress this lack of research by focusing on the interrelated perceptions and experiences of men and those closest to them in four Men's Sheds in regional Victoria, Australia. The research shows that the partners and carers of 'shedders' reported that the men's participation not only benefited the men but also had benefits for their significant others. The study also showed that the partners of shedders in the study found that their individual and joint adjustment to retirement was in some cases assisted by the men enjoying the social and structured environment of the Men's Shed, while in other cases it was seen by partners as an over-commitment and impacting negatively on the marriage. The findings also shed some important light on some tensions experienced by the partners associated with carer burden and adjustments to retirement. [ABSTRACT FROM AUTHOR]

Little is known about the experiences of informal family care-giving for persons with ADRD in the context of Arab and Muslim communities. This paper offers fresh insight into the less-studied private sphere of the home, showing how families respond to the onset and long-term care of persons with Alzheimer's disease and related dementias (ADRD). It considers the extent to which sociocultural and religious influences are appropriated by family care-givers as coping mechanisms and motivators for care. Drawing upon interviews with 32 family care-givers for older persons living with ADRD in Qatar, findings reveal the intersectionality of the care-giving experience with various sociocultural, religious and emotional influences through seven emergent themes: (a) reasons and motivations for care-giving; (b) role of the extended family; (c) socio-demographic attributes of care-givers, their allocated responsibilities and how these intersect; (d) socio-religious attitudes towards care-giving of older persons; (e) social stigma; (f) personal knowledge of ADRD; and (g) coping mechanisms. The paper is concluded with key implications of these sociocultural insights for theory, policy and practice, which could inform Qatar's health and social care provision sector as well as other Arab and Muslim communities that share similar cultural and religious belief systems. [ABSTRACT FROM AUTHOR]

Previous research has found varied effects of informal care provision on the carer's health status. Few studies have, however, examined this relationship dynamically. This paper is the first to analyse trajectories of care among men and women in mid-life and their impact on health outcomes using a nationally representative prospective cohort study. Data from three waves of the United Kingdom (UK) National Child Development Study (N = 7,465), when the respondents were aged 46, 50 and 55, are used to derive care trajectories capturing the dynamics of care provision and its intensity. Logistic regression investigates the impact of caring between the ages of 46 and 55 on the carers' report of depression and poor health at age 55. At age 46, 9 per cent of men and 16 per cent of women provided some level of informal care; rising to 60 per cent for both genders at ages 50 and 55. Just 7 per cent of women and 4 per cent of men provided care at all observation points, with the most common trajectory being 'starting to care' at ages 50 or 55. New carers experienced a lower risk of depression at age 55, reflecting that they may not have experienced the caring role long enough to have an adverse impact on their wellbeing. The findings highlight that the majority of individuals with surviving parents experience caring at some point during mid-life, underlining the need for further longitudinal research to better understand the complex relationships between care-giving and health for different groups of cares. [ABSTRACT FROM AUTHOR]

This paper explores telecare manager and other 'stakeholder' perspectives on the nature, extent and impact of family and other unpaid/informal carers' involvement in the provision of telecare equipment and services for older people. Data used in the paper are derived from a larger study on telecare provision by local councils in England. The paper aims to add to the growing evidence about carers' engagement with electronic assistive technology and telecare, and considers this in the context of typologies of professionals' engagement with carers. How carers are involved in telecare provision is examined primarily from the perspectives of senior managers responsible for telecare services who responded to an online survey and/or were interviewed in 2016 as part of a wider study. The perspectives of three unpaid carers were captured in a separate strand of the main study, which comprised more detailed case study interviews within four selected councils. Thematic and comparative analysis of both qualitative and quantitative survey data revealed the varied involvements and responsibilities that carers assumed during the telecare provision process, the barriers that they needed to overcome and their integration in local council strategies. Findings are discussed in the context of Twigg and Atkin's typology of carer support. They suggest that carers are mainly perceived as 'resources' and involvement is largely taken for granted. There are instances in which carers can be seen as 'co-workers': this is mainly around responding to alerts generated by the telecare user or by monitored devices, but only in those councils that fund response services. Though some participants felt that telecare devices could replace or 'supersede' hands-on care that involved routine monitoring of health and wellbeing, it was also acknowledged that its use might also place new responsibilities on carers. Furthermore, the study found that meeting carers' own rights as 'co-clients' was little acknowledged. [ABSTRACT FROM AUTHOR]

In many sub-Saharan African communities, caring for vulnerable children in the era of HIV/AIDS appears to be creating deep financial, physical and psychological strains for care-givers, the great majority of whom are ageing women or ‘grandmothers’. Yet, limited primary research has been carried out with older women in specific communities, and therefore grandmothers' collective responses, sources of support, complex lived experiences, and diverse family situations are not well understood. This paper presents the findings of research undertaken in four communities in KwaZulu-Natal, South Africa, between 2006 and 2010. The purpose was to understand the daily stresses, collective responses and mobilisations of older women in these communities. The research involved repeated focus groups, interviews and participant observation involving approximately 100 older women. In the analysis, attention is given to the diversities among participants, the ways in which HIV/AIDS intermingles with other stresses in their lives to drive their mobilisations, and their collective responses, even amidst highly constrained conditions. Through these lenses, the paper illuminates how older women in these communities are organising in response to the combined, devastating and diverse effects of HIV/AIDS, poverty, violence and illness. It also suggests that, counter to some stereotyping of ‘African grandmothers’ as frail or passive, these women are forming associations in order to generate incomes, resist stigma, connect with broader support networks and provide care to hundreds in their communities. [ABSTRACT FROM PUBLISHER]

Across Europe a rising number of migrants are reaching higher ages. As old age is related to care dependency, care-giving within migrant families is becoming more important. To date, little research has focused on health outcomes for migrant care-givers. Theories and empirical evidence suggest differences in the relationship of care-giving and health between migrants and non-migrants due to differences in support, income, norms and values. Furthermore, across Europe the degree of formal care supply and the obligation to provide informal care vary considerably and presumably lead to different health outcomes of care-giving in different countries. Based on data from the Survey of Health, Ageing and Retirement in Europe (Waves 1, 2, 4, 5 and 6) and the English Longitudinal Study of Ageing (Waves 2–6), this paper studies the relationship between informal care-giving inside the household and health for migrant and non-migrant care-givers across Europe and analyses changes in health. In most countries migrant care-givers are in worse self-perceived and mental health compared to non-migrant care-givers. When controlling for important influences no differences in the relationship between health and care-giving for migrants and non-migrants can be found. Moreover, care-giving deteriorates mental health irrespective of origin. The country models showed that for non-migrants care-giving is most detrimental in Southern welfare states whereas for migrants care-giving is also burdening in Nordic welfare states. [ABSTRACT FROM AUTHOR]

In many countries, population ageing is challenging the viability of the welfare state and generating higher demands for long-term care. At the same time, increasing participation in the labour force is essential to ensuring the sustainability of the welfare state. To address the latter issue, affected countries have adopted measures to increase employment; e.g. welfare recipients in Germany are required to be available for any type of legal work. However, 7 per cent of welfare benefit recipients in Germany provide long-term care for relatives or friends, and this care-giving may interfere with their job search efforts and decrease their employment opportunities. Our paper provides evidence of the relationship between the care responsibilities and employment chances of welfare recipients in Germany. Our analyses are based on survey data obtained from the panel study 'Labour Market and Social Security' and on panel regression methods. The results reveal a negative relationship between intensive care-giving (ten or more hours per week) and employment for male and female welfare recipients. However, employment prospects recover when care duties end and are subsequently no longer lower for carers than for non-carers. [ABSTRACT FROM AUTHOR]

The concurrent ageing of parental care-givers and people with intellectual disabilities is driving academic and social welfare concern for a post-parental care 'crisis'. The 'crisis' typically pertains to a transition from primary care in the family home precipitated by the death or incapacity of older parents without a pre-planned pathway to post-parental care. This crisis is amplified in rural communities given low service engagement with families and a deficit of disability-supported accommodation and services. Academics, service providers and policy makers have responded through a problematisation of post-parental care planning. This focus continues to normalise informal care, burdens families with responsibility for planning, and diverts attention from structural deficits in the socio-political carescape. This paper attends to the Australian policy landscape in which long-term care-giving for families living with intellectual disability is enmeshed. It contends that the dyadic and didactic model of informal long-term care has profound implications for social service support and post-parental care planning. Problematisation of carers' 'need' to relinquish primary care and for people with intellectual disabilities to transition to independent and supported living is necessary to unsettle the dominant policy and service discourse around the provision of services to sustain informal care-giving. Innovation is then needed to forge pathways of support for families in rural communities planning on continuing, transitioning and transforming care arrangements across the lifespan. [ABSTRACT FROM AUTHOR]

China has seen a rapid decline of the traditional multi-generational household and an increase in rural-to-urban migration, raising concerns about a possible breakdown of the informal support system. Against this background, the paper looks at family care-giving (or the absence thereof) to parents in three different living arrangements: with any child or child-in-law (co-resident); independent with at least one child living in the same community (networked); and without any children in either the household or the community (isolated). It also compares the care-giving arrangements of single elders to those living with a spouse. The sample, which is derived from the comprehensive China Health and Retirement Longitudinal Study (CHARLS), contains data on 887 functionally impaired individuals aged 60 and above. The findings suggest that married parents are mostly cared for by their spouse, even if they co-reside with adult children. Proximity to children is particularly important for single elders, who are more likely to lack a care-giver when living independently. There appears to be a hierarchy in family care responsibilities, where children step in as care-givers only when the spouse is no longer able to fulfil this role. While these findings imply a significant deviation from traditional practices and norms of ‘filial piety’, they can be interpreted as a rational adaptation to the changed economic circumstances in rural China. [ABSTRACT FROM PUBLISHER]

In this article, we use clothes as a tool for exploring the life stories and narratives of people with dementia, eliciting memories through the sensory and material dimensions of dress. The article draws on an Economic and Social Research Council-funded study, ‘Dementia and Dress’, which explored everyday experiences of clothing for carers, care workers and people with dementia, using qualitative and ethnographic methods including: ‘wardrobe interviews’, observations, and visual and sensory approaches. In our analysis, we use three dimensions of dress as a device for exploring the experiences of people with dementia: kept clothes, as a way of retaining connections to memories and identity; discarded clothes, and their implications for understanding change and loss in relation to the ‘dementia journey’; and absent clothes, invoked through the sensory imagination, recalling images of former selves, and carrying identity forward into the context of care. The article contributes to understandings of narrative, identity and dementia, drawing attention to the potential of material objects for evoking narratives, and maintaining biographical continuity for both men and women. The paper has larger implications for understandings of ageing and care practice; as well as contributing to the wider Material Turn in gerontology, showing how cultural analyses can be applied even to frail older groups who are often excluded from such approaches. [ABSTRACT FROM PUBLISHER]

Improving responsiveness to the needs of older people from minority ethnic communities has been emphasised as a goal in England since the publication of the National Service Framework for Older People in 2001. Despite this, people from minority ethnic groups consistently give poorer ratings of their health services than ‘majority’ populations, both in England and across many other health-care systems. Language barriers have been shown to play a particularly important role, and appear to be a stronger predictor of perceived quality of care than ethnic origin per se. This paper reports findings from a larger study exploring older people's experiences of care transitions, focusing on the findings from one case study area which explored the hospital and discharge experiences of older people from minority ethnic communities. A participatory approach was adopted, with older people from the local area collaborating in the design, delivery and analysis of the research as ‘co-researchers’. Twenty-four in-depth narrative interviews were carried out with people who had experienced a recent hospital stay as a patient or a family member providing care and support. Our findings show that many aspects of the hospital experience, including the desire for personalised and humanistic approaches to care, are important to older people irrespective of ethnic background. However, older people from minority ethnic communities can also face language and cultural barriers which negatively affect the quality and experience of care. People who had limited English proficiency struggled to understand, communicate and participate in their care. Where professional services were not available or requested, interpreting was provided informally by other patients, family members, hospital staff in clinical and domestic roles, or not at all. We conclude that targeted strategies are required to ensure appropriate and effective hospital services for a multicultural population. [ABSTRACT FROM PUBLISHER]

This article is based upon qualitative research carried out with members of the Sikh community caring for a person with dementia. Previous research with South Asian carers of people with dementia has reported problems with both access to, and use of, health and social care services namely due to cultural and language barriers within existing services. The research reported in this article sought for an in-depth understanding of the experiences of Sikhs caring for their family member with dementia. The aim of the research was to explore how migration experiences and life histories impact on perceptions and experiences of caring for a family member with dementia for Sikhs living in Wolverhampton in the West Midlands, United Kingdom. The research, undertaken by the author, applied a biographical approach using narrative interviews. Twelve Sikh carers of a family member with dementia were interviewed. Findings highlighted that migration experiences and migration identities are important for understanding participants’ experiences of services and experiences of caring for a family member with dementia. Person-centred dementia care as a model for practice highlights the importance of understanding life histories to support people to live well with dementia, including their family carers. This paper reinforces this message, demonstrating the impact of specific migration experiences on the experiences of caring for a family member with dementia. [ABSTRACT FROM PUBLISHER]

Older people are increasingly being cared for in the community across Europe. Dependent care in Spain largely remains a private issue involving family carers and migrant women from developing countries. Qualitative research on respite care has contributed to our understanding of respite as a subjective experience. Nonetheless, how care-givers relieve the burden of care is still not fully understood. Migrant care-givers are present in family life but their need for rest remains unseen. The aim of the study presented in this paper was to contrast family care-givers and migrant care-givers' strategies for relief from their caring role. Care-givers rest by thinking, doing and being but in a different manner from that of care-giving, that is: when they are a different person. To leave the life of care-giving is the general strategy that family care-givers use to rest from their care-giving selves while turning to one's own world describes the way migrant care-givers seek to relieve the burden of care. The comparative analysis shows that both strategies have in common the necessity to disconnect from the care-giving identity and that both migrant and family care-givers employ strategies that are false exits to a care-giving identity: they apparently relieve the burden of care. Respite goes beyond places, times and activities; as family care itself, it requires identity. [ABSTRACT FROM PUBLISHER]

Although older migrants in Southern Europe are increasing in number, relatively little attention has been paid to their care needs and resources. The availability of informal care is an important determinant of wellbeing in later life and norms regulating filial obligations have an important role in affecting the quality and quantity of support received. Using data from a qualitative survey conducted in Italy, this article sheds light on the social norms regulating filial obligations towards older parents among natives and three groups of immigrants: Maghrebis, Chinese and Filipinos. The results indicate a number of commonalities between the four different groups considered, such as: the principle of delayed reciprocity at the basis of filial support obligations; a gender bias in attributing the most psychologically, physically and time-demanding caring obligations to adult daughters and daughters-in-law; and a preference for intergenerational residential autonomy shared by Italian, Filipinos and, to a lesser extent, Maghrebi respondents. At the same time, numerous differences emerge between natives and immigrants, and between immigrant groups. The most significant differences are observed regarding: the possibility of resorting to a paid care-giver, which is more common among Italians and, to a lesser extent, Filipino respondents; and a stronger gender bias among the Chinese and Maghrebi groups, i.e. they attribute the majority of personal care responsibilities to daughters and daughters-in-law. [ABSTRACT FROM AUTHOR]

Research concerning the effects of migrants on elder care in affluent receiving countries has been substantial, but we know little about the effects of migrant care on elder care in sending countries. There also is limited research on elder care in the context of the return migration of migrant care workers. This theoretical article explores the potential relevance of a social network perspective, which views individuals and countries as being interconnected even when they are miles apart. A multi-level framework that considers macro-, meso- and micro-level perspectives is introduced to better account for current migrant care arrangements. The macro-level perspective takes into account country-level characteristics including policies, geography and cultural preferences; the meso-level perspective takes into account the characteristics of the entire network, which may spread over different countries; and the micro-level perspective concerns the unique characteristics of the individuals who make up the network. This approach proposes that the effects of migrant home care go way beyond the care recipient–care-giver dyads or triads to incorporate many individuals and countries that are transnationally interconnected via the work of care. This article also aims to increase public and scientific awareness to the potential impact of migrant care and return migration on elder care in the sending countries by stressing a transnational social network perspective. [ABSTRACT FROM AUTHOR]

Rapid demographic shifts and socio-economic changes are fuelling concerns over the inadequate supply of informal care – the most common source of care-giving for older people in China. Unmet long-term care needs, which are believed to cause numerous adverse effects on health, continue to increase. Drawing data from the 2015 wave of the China Health and Retirement Longitudinal Survey, this study explores the relationship between informal care provision and unmet long-term care needs among older people in China. We first examine the availability of informal care among older people with disabilities. We then analyse whether a higher intensity of informal care leads to lower unmet needs. Our findings suggest that the majority of older people with disabilities receive a low intensity of care, i.e. less than 80 hours per month. Besides, a higher intensity of informal care received could significantly lower the probabilities of unmet needs for the disabled older adults who have mainly instrumental activities of daily living limitations. Our study points out that informal care cannot address the needs of those who are struggling with multi-dimensional difficulties in their daily living. Our findings highlight a pressing need for the government to buttress the formal care provision and delivery systems to support both informal care-givers and disabled older people in China. [ABSTRACT FROM AUTHOR]

To support people with dementia to live at home, a key national and international policy driver is to create dementia-friendly communities which draws attention to the importance of a local neighbourhood and living well with dementia. However, there is a lack of evidence about how people with dementia define and interact with their neighbourhood. This longitudinal narrative research aimed to uncover the meaning, construction and place of neighbourhood in the lives of people with dementia and their care partners through a participatory approach. Five couples, where one partner had an early diagnosis of dementia and capacity to consent, participated in the (up to) one-year mixed qualitative method study. During this time-frame, 65 home visits were conducted, resulting in over 57 hours of interview data alongside the development of other artefacts, such as neighbourhood maps, photographs, diaries and field notes. Narrative analysis was applied within and across the data-sets. This led to the emergence of three themes to describe a connected neighbourhood. First, 'connecting to people' is about the couples' connections with family members, friends and neighbours through a sense of belonging, group identification and responsibilities. Second, 'connecting to places' shares the couples' emotional and biographical attachment to places. Third, 'connecting to resources' refers to the couples actively seeking support to live independently and to retain neighbourhood connections. [ABSTRACT FROM AUTHOR]

The extent to which, and the reasons why, children help to care for their parents are examined in an extensive range of literature. Although care for parents essentially takes place in parent–child dyads, many of these studies acknowledge that the amount of care a child gives is generally the outcome of collective decisions in multiple-child families. However, to our knowledge, no research in Europe enhances our understanding of how sibling characteristics influence an individual child's care-giving. Using data for 14 European countries from the Survey of Health, Ageing and Retirement in Europe, the present study relates pre-care-giving sibling characteristics to children's subsequent start of giving care. This longitudinal approach allows correction for the endogenous nature of time-changing predictors. The analysis demonstrates that daughters start to care more often when they have brothers instead of sisters. This pattern of gendered intergenerational care particularly applies to southern European countries. We also observe that both pre-care-giving parent–sibling frequency of contact and geographic distances predict children's care-giving transition strongly. Children who are closer to their parents than siblings in terms of contact and proximity have higher odds of care-taking. Finally, being the only child without a job enhances the start of care-giving as well. The results suggest that sibling characteristics are an important factor in explaining intergenerational care differences between children in Europe. [ABSTRACT FROM AUTHOR]

Art programmes have been shown to contribute to the quality of life of people with dementia. To understand how people with dementia benefit from art programmes it is important to evaluate them. 'Unforgettable' is an interactive museum programme for people with dementia and their care-givers in the Netherlands. This study examined how it is experienced and appreciated by its users. It also investigated whether the user experience and appreciation are linked to their specific background characteristics. In a single-group design, we used a 'take-home' survey to collect the participants' background characteristics and their experience and appreciation of the programme. A before and after intervention measurement took place, using a smiley face scale, to measure the change in mood of participants. Participants evaluated the programme very positively. Social interaction proved a key factor in their appreciation. The mood of the persons with dementia (N = 95) and care-givers (N = 104) improved after participation in the 'Unforgettable' programme. The results of this evaluation may contribute to the quality of art programmes in museums. [ABSTRACT FROM AUTHOR]

Spouses (and partners) are the most important source of care in old age. Informal care for frail spouses is provided by both sexes and across all socio-economic backgrounds and welfare policy contexts. There are, however, interesting differences as to whether spouses care alone, receive informal support from other family members or formal support from professional helpers, or outsource the care of their spouse completely. The present article contributes to the literature by differentiating between solo spousal care-giving and shared or outsourced care-giving arrangements, as well as between formal and informal care support. Moreover, we show how care-giving arrangements vary with gender, socio-economic status and welfare policy. Adding to previous research, we compare 17 countries and their expenditures on two elder-care schemes: Cash-for-Care and Care-in-Kind. The empirical analyses draw on the most recent wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) data from 2015. Our results show that men have a higher propensity to share care-giving than women, albeit only with informal supporters. As expected, welfare policy plays a role insofar as higher expenditure on Cash-for-Care schemes encourage informally outsourced care-giving arrangements, whereas Care-in-Kind reduce the likelihood for informally shared or outsourced care-giving arrangements. Moreover, the influence of these welfare policy measures differs between individuals of different socio-economic status but not between men and women. [ABSTRACT FROM AUTHOR]

While considerable scholarly attention has been given to factors influencing productive activity, less is known about how multiple forms of resources predict the maintenance or initiation of such activity over time. Using two-wave panel data of older adults from the National Social Life, Health, and Aging Project (NSHAP), the study investigated the relationship between measures of capital and changes in multiple types of productive activity. Findings showed that all three types of capital were associated with volunteering in cross-sectional analyses, but only education, neighbourhood socialisation and religious service attendance remain significant predictors of continued volunteerism. Human capital strongly influenced employment both cross-sectionally and over time. Aspects of social capital – marital status and network size – were linked to participation and initiation of care-giving activities. The findings demonstrate that different patterns emerge in cross-sectional and two-wave panel data of multiple productive activities, adjusting for baseline activity level and selective attrition. The project also suggests factors that promote or hinder continued engagement in productive activity. [ABSTRACT FROM AUTHOR]

Observation of long-term trends within countries is needed to increase insight into how policy initiatives are reflected in the use of care over time in addition to individual determinants of care use. In the past decades, Dutch care policies have favoured homecare and reduced the availability of institutional care which extended the care responsibilities of formal and informal care-givers at home. This study investigates the changes in the use of informal and formal homecare, community services and residential care among cognitively impaired older adults over time in the Netherlands. In addition, of special interest here are the associations of the presence of a spouse, other family members or social network with care use, and the interdependency between the use of different types of care. The study employs the Longitudinal Aging Study Amsterdam (LASA) covering the years 1992–2012, analysed with generalised estimating equations. The data consisted of 1,022 observations gathered from 813 respondents aged 65–85. The respondents were cognitively impaired according to the age- and education-standardised Mini-Mental State Examination score. The analyses took into account several individual determinants of care use. The use of informal care and residential care decreased while the use of formal homecare and community services remained the same. Simultaneously, the proportion of those who did not use the studied care types increased. The contribution of partners in informal care decreased. Informal care and formal homecare use increasingly became complementary services. The findings suggest that the decreases in informal care and residential care have not been replaced by other types of care, as reflected in the increased number of persons receiving no care. Care policies should not rely excessively on the availability of informal help and should guarantee adequate formal help, especially for those in high need. [ABSTRACT FROM AUTHOR]

Frail older people worldwide are increasingly being cared for in their own homes by migrant live-in care workers; however, extant literature on care relationships in this care context is sparse. The purpose of this mixed-methods study was to explore the quality and the nature of care relationships between full-time, live-in migrant care workers and older people in Israel. Quantitative and qualitative data were drawn from a 2014 survey of 116 migrant care workers and 73 older care recipients. Mean scores for four quantitative items relating to care relationships were examined and independent samples t -tests and Pearson correlations were performed, whereas qualitative data were examined using thematic analysis. Credibility of qualitative findings was checked by peer review. Most older people and migrant care workers gave high ratings to the four items. Significant correlations between the two groups were found for their responses on all four relationship items assessed, with only one item ('get along well') producing significant t -test differences. Qualitative data provided a deeper understanding of the quantitative ratings of care relationships. Four major qualitative themes emerged as inextricably tied with both groups' perceptions of positive care relationships. These were: an emotional connection; reciprocity; effective communication; and meeting the older person's care needs. Study findings were interpreted through the theoretical lens of relationship-centred care. Implications of the findings for theory, practice and further research are discussed. [ABSTRACT FROM AUTHOR]

The Consumer Choice Index – Six Dimension (CCI-6D) is a new instrument designed specifically to evaluate the quality of care received in long-term care from a consumer perspective. This study aims to demonstrate the construct validity of the CCI-6D. Older residents living in long-term care facilities and proxy family carers (where severely impaired cognition precluded resident consent) participated as consumers of long-term care. Data collected included the CCI-6D instrument, quality of life, physical function and characteristics of the care facility. Relationships between these variables and the CCI-6D dimensions were assessed and analysed through chi-squared and Kruskal–Wallis tests to assess the construct validity of each dimension. Of 430 eligible consumers, a total of 253 completed the questionnaire, of whom 68 (27%) were residents and 185 (73%) were informal carer proxy participants. There was strong evidence of construct validity of the dimensions relating to adequacy of individual care time, access to outside and gardens, access to meaningful activities and flexibility of care. There was more moderate evidence of validity of the home-like own room and shared spaces items, which may be in part due to difficulty in identifying strong discriminatory variables for comparison with these items. The results also indicate a strong association between 'processes' of care delivery (as measured by the CCI-6D) and quality of life of care recipients. [ABSTRACT FROM AUTHOR]

In the United Kingdom (UK), an ageing population met with the reduction of social care funding has led to reduced support for older people marked with an increased demand on family care-givers. Assistive telecare (AT) devices are viewed as an innovative and effective way to support older people. However, there is limited research which has explored adoption of AT from the perspectives of family care-givers. In-depth, semi-structured interviews were conducted with 14 family care-givers of patients who used the Assistive Telehealth and Telecare service in Cambridgeshire, UK. Family care-givers were either the spouse (N = 8) or child of the patient (N = 6). The patients' age ranged from 75 to 98, and either received a telecare standalone device or connected service. Framework analysis was used to analyse the transcripts. This study revealed that family care-givers play a crucial role in supporting the patient's decision to adopt and engage with AT devices. Knowledge and awareness, perceived responsibility, usefulness and usability, alongside functionality of the equipment, were influential factors in the decision-making process. AT devices were viewed positively, considered easy to use, useful and functional, with reassurance of the patient's safety being a core reason for adoption. Efforts to increase adoption and engagement should adapt recruitment strategies and service pathways to support both the patient and their care-giver. [ABSTRACT FROM AUTHOR]

Innovative methods to manage frailty are critical to managing the needs of an ageing population. Evidence suggests there are opportunities to reverse or prevent frailty through early intervention. However, little is known about older adults’, families’ and practitioners’ beliefs about the malleability of frailty. This study examined European stakeholders’ accounts of the acceptability and feasibility of frailty screening and prevention to inform future intervention development. Semi-structured focus groups and individual interviews were conducted in three European Union countries (Italy, Poland and the United Kingdom) with key stakeholders – frail and non-frail older adults, family care-givers, and health and social care professionals. Thematic analysis identified four themes: synchronicity between the physical and the psychological in frailty, living with frailty in the social world, the need for a new kind of care, and screening for and preventing frailty. Findings emphasised the need for a holistic approach to frailty care and early intervention. Integrated care services and advocacy were important in the organisation of care. Central to all stakeholders was the significance of the psychological and social alongside the physical elements of frailty and frailty prevention. Support and care for older adults and their family care-givers needs to be accessible and co-ordinated. Interventions to prevent frailty must encompass a social dimension to help older adults maintain a sense of self while building physical and psychological resilience. [ABSTRACT FROM AUTHOR]

This study explored aged care support workers' perceptions of how their health was influenced by their job, highlighting similarities and differences of those working in community-based and institution-based care. Support workers working in two institution-based and three community-based aged care organisations were invited to participate. Semi-structured interviews were undertaken with ten participants. Open-ended questions probed participants' perceptions of their health as it related to their work. Data were analysed with the General Inductive Approach. Four central themes were identified, many of which related to mental, as opposed to physical health. 'Love of the job' described various sources of satisfaction for participants. These factors commonly overrode the negative aspects. 'Stress' encompassed the negative influences on all aspects of health. 'Support' described the positive influences on health, which supported participants in their job. 'Physicality' described the physical nature of the job and the positive and negative impact this had on participants' health. Support workers perform numerous tasks, which often impact upon their health. Aspects of the job that may impact the health of the worker are improved communication and support from management, as well as recognition for support workers' contribution to society. These could be targeted to enhance support worker health. Additional training and reduced time pressure may also represent aspects for improvement, to optimise support workers' physical health. [ABSTRACT FROM AUTHOR]

As in many developed countries, foreign care-givers have made up a short-term labour force to help shoulder the responsibilities of older adult care in Taiwan since 1992. This study uses the dual labour market and the occupational segregation theoretical frameworks and a mixed-method approach to examine whether foreign care-givers are supplementary or have replaced Taiwanese care-givers in Taiwan's long-term care (LTC) industry, and to understand better the status of care workers and their influx into the secondary labour market. As of 2012, 189,373 foreign workers joined the care services, compared to 7,079 Taiwanese, indicating they are no longer supplementary. The gap between the dual care system and workforce regulation has resulted in occupation segregation, and the secondary care labour market has been divided into ‘institutional’ and ‘home’ spheres, segregating care-givers into three levels: all Taiwanese care-givers, foreign institutional care-givers, and foreign home care-givers, the latter being the cheapest, most obedient and most adaptable LTC products. This case exhibits the ‘particularistic’ associations between nationality and care-givers’ workplace, which should be abolished. Only by squarely facing the changes and impacts caused by importing workers into the secondary labour market can one propose concrete, effective LTC labour plans and retention policies. [ABSTRACT FROM PUBLISHER]

This study investigated the perceived value of informal and formal supports for older adults with multi-morbidity from the perspectives of patients, care-givers and family physicians. Semi-structured interviews were conducted with 27 patients, their informal care-givers and their family physicians in an urban academic family health team in Ontario. Analysis was conducted using a General Inductive Approach to facilitate identification of main themes and build a framework of perceived value of supports. Participant views converged on supports that facilitate patient independence and ease care-giver burden. However, important differences in participant perceptions arose regarding these priorities. Physicians and care-givers valued supports that facilitate health and safety while patients prioritised supports that enable self-efficacy and independence. While formal supports which eased care-giver burden were viewed positively by all members of the triad, many patients also rejected formal supports, citing that informal support from their care-giver was available. Such conflicts between patient, care-giver and physician-perceived value of supports may have important implications for consumer and care-giver willingness to accept formal supports when supports are available. These findings contribute to the broader literature on community-based care by incorporating the perspectives of patients, informal care-givers and family physicians to understand better the barriers and facilitators of uptake of supportive services that contribute to successful ageing at home. [ABSTRACT FROM AUTHOR]

This article is about dementia disease in the context of transnational migration. Focusing on the example of Pakistani immigrants in Norway, the article explores response processes surrounding signs and symptoms of dementia. Particular attention is lent to understanding how Norwegian-Pakistani families ‘negotiate dementia’ in the space between their own imported, culturally defined system of cure and care, and the Norwegian health-care culture, which is characterised by an inclination towards public care and biomedical intervention. Based on field observations and in-depth interviews with Norwegian-Pakistani families and hospital professionals working with dementia, we show that the centrality of the traditional family in Norwegian-Pakistanis' identity claims has significant implications for how Norwegian-Pakistanis relate to the Norwegian health-care culture, and for how signs and symptoms of cognitive decline are read and responded to in a migratory context. [ABSTRACT FROM PUBLISHER]

The gender gap in family care-giving is an established research finding: men dedicate less time to care-giving and provide specific gendered types of help. This article argues that in order to grasp men's contribution to care arrangements one should recognise the multifaceted nature of care and examine care networks beyond the 'care receiver-primary care-giver' dyad with a dynamic perspective. A qualitative analysis of the care networks of three large Dutch families with an older parent in need of care confirms the greater involvement of women in care-giving and men's tendency to provide specific types of care. However, men also contribute to the elasticity and stability of the care arrangement by filling temporary gaps and supporting the female care-givers. This article puts forward the idea that men's contribution is in turn a factor in the perpetuation of the gendered structure of care-giving. [ABSTRACT FROM AUTHOR]

A key feature of population ageing in Europe and other more economically developed countries is the projected unprecedented rise in need for long-term care in the next two decades. There is, however, considerable uncertainty over the future supply of unpaid care for older people by their adult children. The future of family care is particularly important in countries planning to reform their long-term care systems, as is the case in England. This article makes new projections of the supply of intense unpaid care for parents aged 65 and over in England to 2032, and compares these projections with existing projections of demand for unpaid care by older people with disabilities from their children. The results show that the supply of unpaid care to older people with disabilities by their adult children in England is unlikely to keep pace with demand in future. By 2032, there is projected to be a shortfall of 160,000 care-givers in England. Demand for unpaid care will begin to exceed supply by 2017 and the unpaid ‘care gap’ will grow rapidly from then onwards. The article concludes by examining how far this unpaid ‘care gap’ is likely to be met by other sources of unpaid care or by developments in new technology and examines the implications of the findings for long-term care policy. [ABSTRACT FROM PUBLISHER]