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This paper reports on a study which examined the notions of authenticity and citizenship for people living with cognitive impairment or dementia in a care home in the North-East of England. We demonstrated that both notions were present and were encouraged by engagement with an artist, where this involved audio and visual recordings and the creation of a film. The artist's interactions were observed by a non-participant observer using ethnographic techniques, including interviews with the residents, their families and the staff of the care home. The data were analysed using grounded theory and the constant comparative method of qualitative analysis. Our findings suggest that participatory art might help to maintain and encourage authenticity and citizenship in people living with dementia in a care home. Certainly, authenticity and citizenship are notions worth pursuing in the context of dementia generally, but especially in care homes. [ABSTRACT FROM AUTHOR]

Research has suggested ecopsychosocial initiatives can promote a sense of wellbeing and inclusion in people with dementia. However, few studies have elucidated the 'active mechanisms' whereby such initiatives can achieve these outcomes, so hindering their generalisability. This is particularly pertinent when seeking to support community-dwelling older men with dementia who are reluctant to engage with traditional health and social care initiatives. This paper reports on a study that drew from the principles of Participatory Action Research to explore the 'active mechanisms' of a technological initiative for older men (65+ years) with dementia in rural England. An individually tailored, male-only initiative, using off-the-shelf computer game technology (e.g. iPad, Nintendo Wii and Microsoft Kinect) was delivered over a nine-week period. Multiple qualitative methods were employed, including: focus groups, open interviews and extensive reflective field notes, to gather data from the perspective of 22 men, 15 care partners and five community volunteers. The data were analysed thematically and interpreted using a masculinity lens. Three mechanisms contributed to the initiative's success: the use of the technology, the male-only environment and the empowering approach adopted. The paper argues that initiatives aimed at community-dwelling older men with dementia would be advised to consider these gendered experiences and ensure participants can maximise their masculine capital when participating in them, by providing enabling activities, non-threatening environments and empowering approaches of delivery. [ABSTRACT FROM AUTHOR]

In the current ecology of care, social, rather than medical, support is critical in enabling frail older people to live at home. This paper reports findings from a qualitative study about how home care workers (HCWs) support persons with dementia living in the community. Semi-structured qualitative interviews were carried out in England with 14 family care-givers (FCGs) recruited from a single private home care provider. A thematic analysis of the data was undertaken using the constant comparative method. In every instance, it was FCGs who initiated domiciliary care for the person with dementia, highlighting ambiguity about who is the 'client'. Rather than focusing on the HCWs' work in undertaking practical tasks and personal care, respondents prioritised HCWs as companions, providing emotional and social support for their relatives. From an organisational perspective, respondents valued the capacity of the provider to deliver a consistent, personal, reliable and punctual service. These attributes were important in supporting their relative's agency and dignity. Respondents described HCWs engaging in skilled and sensitive communication with clients but considered 'character' and 'innate' caring abilities to be more important than those derived from training. The results highlight the need to acknowledge the family, rather than the individual client, as the functioning unit of care, and to recognise the highly skilled communicative and emotional work undertaken by HCWs. [ABSTRACT FROM AUTHOR]

There has been a renewed call for a revaluing of informal caring in order to counter the way that caring is undervalued, taken for granted and invisible. Travel is one area where a detailed critique of this issue has emerged with the concept of 'mobility of care', however, this concept has only been applied in relation to younger age groups, and our understanding of mobilities of care in later life remains underdeveloped. By 'mobilities of care' we mean journeys made for the purpose of giving and receiving informal care and support. This paper draws on the mobility narratives of 99 older people (aged 55 and above) living in three locations in the North of England who participated in a two-year qualitative longitudinal study that explored the inter-play between mobility, wellbeing and life transitions. We focused on the experience of managing life transitions rather than assume that chronology per se determines wellbeing. Narratives of ageing emphasise the importance of getting out and about, and being socially connected active citizens. Our study demonstrates that for many older people getting out and about is not for leisure or utility purposes but to give support and care. As such, these journeys have a particular significance in the lives of older people and in the construction of roles, meaning and identity in later life. [ABSTRACT FROM AUTHOR]

The decision to start a new career might seem an unusual one to make in later life. However, England has seen a steady rise in numbers of workers undertaking an apprenticeship in their fifties and sixties, through a government-funded policy initiative opening up training to adults at all stages of the lifecourse. At the same time, in most Western contexts, the amalgamation of ‘older’ and ‘apprentice’ presents a challenge to normative understandings of the ‘right age’ to undertake vocational training. What is it like to make a new start as an older worker? This paper draws on new qualitative research conducted in England with older apprentices, exploring how they found the experience and management of training ‘out of step’. Inspired by Elizabeth Freeman's temporalities approach, our findings reveal how powerful norms of age-normativity routinely structure understandings, experiences and identities of older-age training for both organisations and apprentices. While these norms demand careful negotiation by both apprentices and trainers, if managed successfully older workers gain significant benefits from their training. These findings have resonance not only for England, but for other international contexts considering expanding vocational training into older age. The paper concludes that if adult training schemes are to succeed, some fundamental changes may need to be made to understandings of age and ageing within contemporary workplaces. [ABSTRACT FROM AUTHOR]

This paper explores the different ways in which informal carers for people with dementia negotiate their care-giving role across the changing organisational and spatial landscape of care. In-depth qualitative data are used to argue that the decisions of carers are socially situated and the result of negotiations involving individuals, families and wider cultural expectations. These decisions affect where care occurs. In addressing these issues this paper draws attention to the lack of choice some carers may have in taking on the care-giving role; how and why carers draw upon support; and the different expectations of the care-giver's capabilities across the different sites of care, specifically at home and in nursing homes. It concludes that research and policy attention should focus on how the expectations about the role and abilities of carers are affected by where, and how, care is delivered. In doing so this paper contributes to the emerging health geography literature on care-giving as well as developing the spatial perspective in the established gerontological literature. [ABSTRACT FROM PUBLISHER]

The mouth may be presented and understood in different ways, be subject to judgement by others and, as we age, may intrude on everyday life due to problems that affect oral health. However, research that considers older people's experiences concerning their mouths and teeth is limited. This paper reports on qualitative research with 43 people in England and Scotland, aged 65–91, exploring the significance of the mouth over the lifecourse. It uses the concept of 'mouth talk' to explore narratives of maintaining, losing and replacing teeth. Participants engaged in 'mouth talk' to downplay the impact of the mouth, demonstrate socially appropriate ageing, and distance themselves from 'real' old age by retaining a moral identity and sense of self. They also found means to challenge dominant discourses of ageing in how they spoke about missing teeth. Referring to Leder's notion of 'dys-appearance' and Gilleard and Higgs' work on the social imaginary of the fourth age, the study illustrates the ways in which 'mouth talk' can contribute to sustaining a sense of self in later life, presenting the ageing mouth, with and without teeth, as an absent presence. It also argues for the importance of listening to stories of the mouth in order to expand understanding of people's approaches to oral health in older age. [ABSTRACT FROM AUTHOR]

Older people living in long-term facilities (nursing and residential homes providing 24-hour care) spend the majority of their time inactive, despite the known health and wellbeing benefits of physical activity and reduced time spent sedentary. In order to successfully embed interventions that aim to increase physical activity or reduce sedentary behaviour, it is necessary to understand the features of the care environment that influence residents’ routine patterns of movement. Drawing on an organisational perspective, this paper explores the structures and mechanisms that shaped different care practices concerning residents’ movement in two contrasting care homes in the north of England. This study adopted an ethnographic approach, using a combination of qualitative observations, informal conversations and interviews. A grounded theory approach to data analysis was adopted. The findings illustrate the importance of translating espoused values of care into tangible and acceptable care practices, systems of management, staff training and development, and the use of care planning in residents’ routine patterns of movement. Understanding how organisational factors shape routine movement among care home residents will help inform the development of embedded and sustainable interventions that enhance physical activity and reduce sedentary behaviour. This study is part of a wider programme of research developing and testing a complex intervention, embedded within routine care, to reduce sedentary behaviour among care home residents. [ABSTRACT FROM AUTHOR]

This paper assesses provision for older people affected by homelessness in England, giving regard to research findings, such as those developed through a pathways model, which show that the experiences of this group are qualitatively distinct when compared to younger households. Current conceptualisations of older age held by Local Authority Housing Option Service professionals are considered, alongside factors relating to government policy and resource issues. It was found that some practitioners adopted an age-blind approach when assessing older groups, despite this being contrary to policy guidance on assessing vulnerability in England. Further, services and housing options aimed at older groups were viewed as inadequate due to a mixture of lack of awareness, targeting and resources. It is concluded that assessment of vulnerability based on older age is complex, as whilst gerontological discourse may discourage viewing age as a number, homelessness scholars stress that rooflessness causes poor health conditions consistent with premature ageing. It is therefore asserted that policy makers must focus greater attention to developing suitable provision for older service users and look to incorporate a richer conceptualisation of how older age may impact upon the homelessness experience. [ABSTRACT FROM PUBLISHER]

With demographic changes and the growing numbers of older people living alone, concerns have been raised about the care of the ageing population. Increasingly, developments in technology are being seen as the solution to these concerns. For those who do not see themselves as old or frail enough to require personal care provision, and who prefer to maintain their identity as autonomous and independent individuals, the development of assistive technologies such as ambient home monitoring systems is one answer. However, this involves careful negotiations with older people's understandings of safety and privacy, and their experiences and relationships with technology, their carers and relevant service-providers. In two trials of a home monitoring system funded by the United Kingdom Technology Strategy Board, older people were interviewed pre-trial and post-trial about their perspectives on these issues. This paper presents a conceptual analysis of the qualitative data using a sociological framework of trust that considers habitual action, and relationships with kin and with wider institutions. The research found that older people's habits and norms do not need to be disrupted by the ambient system. What was of more importance was relationships between the older person and her or his ‘monitor’ based on trust, as well as institutional providers who need to instil or earn trust. [ABSTRACT FROM PUBLISHER]

This paper adds to the growing number of studies about mobility and wellbeing in later life. It proposes a broader understanding of mobility than movement through physical space. Drawing on the ‘mobility turn’ in the social sciences, we conceptualise mobility as the overcoming of any type of distance between a here and a there, which can be situated in physical, electronic, social, psychological or other kinds of space. Using qualitative data from 128 older people in County Durham, England, we suggest that mobility and wellbeing influence each other in many different ways. Our analysis extends previous research in various ways. First, it shows that mobility of the self – a mental disposition of openness and willingness to connect with the world – is a crucial driver of the relation between mobility and wellbeing. Second, while loss of mobility as physical movement can and often does affect older people's sense of wellbeing adversely, this is not necessarily so; other mobilities can at least to some extent compensate for the loss of mobility in physical space. Finally, wellbeing is also enhanced through mobility as movement in physical space because the latter enables independence or subjectively experienced autonomy, as well as inter-dependence in the sense of relatively equal and reciprocal social relations with other people. [ABSTRACT FROM PUBLISHER]

Across literature on loneliness and ageing, little attention is given to the intersection of ageing, sexuality and masculinities, and how this shapes the social connections of older men. We report findings from a qualitative study of older men's experiences of loneliness and social participation, focusing on perspectives from two groups who are single and/or living alone: men identifying as (a) heterosexual and (b) gay (not bisexual). We present findings generated from semi-structured interviews with 72 men residing in England (65–95 years). We discuss three prominent themes: (a) loneliness, loss and social dislocation; (b) diverging life-events that trigger loneliness; and (c) variations in visibility and exclusion across social settings. Embedded within men's descriptions of loneliness is a running theme of social dislocation that speaks to a wider sense of social separation and estrangement. Unique to gay men's accounts are the ways in which experiences of loneliness and social isolation are compounded by living in heteronormative social environments and their encounters with ageism in gay social settings. Older men's accounts convey anxieties about visibility and anticipated exclusion across social settings shared with other men that vary according to sexual identity and context. We discuss how sexuality and being single and/or living alone impact on older men's social participation as we seek to move beyond a heterocentric understanding of loneliness. [ABSTRACT FROM AUTHOR]

Home care for older people in England is commissioned through local authorities working predominantly with independent providers of care. Commissioners operate in a market model, planning and procuring home care services for local populations. Their role involves 'managing' and 'shaping' the market to ensure an adequate supply of care providers. Another imperative, emerging from the principles of personalisation, is the drive to achieve user outcomes rather than 'time and task' objectives. Little formal research has investigated the way commissioners reconcile these different requirements and organise commissioning. This study investigated commissioning approaches using qualitative telephone interviews with ten commissioners from different local authorities in England. The characteristics of commissioning were analysed thematically. Findings indicated (a) commissioning involved complex systems and processes, uniquely shaped for the local context, but frequently changed, suggesting a constant need for reframing commissioning arrangements; (b) partnerships with providers were mainly transactional, with occasional examples of collaborative models, that were considered to facilitate flexible services more appropriate for commissioning for personalised outcomes; and (c) only a small number of commissioners had attempted to reconcile the competing and incompatible goals of tightly prescribed contracting and working collaboratively with providers. A better understanding of flexible contracting arrangements and the hallmarks of a trusting collaboration is required to move beyond the procedural elements of contracting and commissioning. [ABSTRACT FROM AUTHOR]

This study responds to a gap in the literature relating to the resilience of people living with dementia in care homes. We applied an ecopsychosocial framework of resilience, theorising that sources of resilience may be personal, social and structural. Visual arts enrichment activities were examined to see how they might provide opportunities for resilience. The data used for this study were qualitative and originated from people with dementia aged between 70 and 99 years old (N = 48) living in four care homes in North East England, United Kingdom and staff/carers/family members (N = 37). The results showed that visual arts enrichment activities supported the resilience of those with dementia through creative expression, increased communication, improved self-esteem, and influenced relationships with carers and family members. It is concluded that even those with advanced dementia are capable of demonstrating resilience which can be supported by, and explored through, visual arts enrichment activities. [ABSTRACT FROM AUTHOR]

Professional boundaries may help care staff to clarify their role, manage risk and safeguard vulnerable clients. Yet there is a scarcity of evidence on how professional boundaries are negotiated in a non-clinical environment (e.g. the home) by the home-care workforce in the context of complex care needs (e.g. dementia, end-of-life care). Through analysis of semi-structured interviews, we investigated the experiences of home-care workers (N = 30) and their managers (N = 13) working for a range of home-care services in the South-East and London regions of England in 2016–17. Findings from this study indicate that home-care workers and their managers have clear perceptions of job role boundaries, yet these are modified in dementia care, particularly at end of life which routinely requires adaptability and flexibility. As a lone worker in a client's home, there may be challenges relating to safeguarding and risk to both clients and workers. The working environment exacerbates this, particularly during end-of-life care where emotional attachments to both clients and their family may affect the maintenance of professional boundaries. There is a need to adopt context-specific, flexible and inclusive attitudes to professional boundaries, which reconceptualise these to include relational care and atypical workplace conventions. Pre-set boundaries which safeguard clients and workers through psychological contracts may help to alleviate to some extent the pressure of the emotional labour undertaken by home-care workers. [ABSTRACT FROM AUTHOR]

Retirement is a major life transition which is associated in public discourses with reduced economic productivity and a raft of personal vulnerabilities. Consequently, governmental, health and employment sectors have promoted 'active' planning of affordable and 'healthy' retirements. This study presents a qualitative exploration of retirement transition and preparation experiences among 52 men and women from rural and urban areas of North East England, United Kingdom. The sample was diverse in terms of social class, income level, health status and type of work exit. Health, finance, social relationships and third-age opportunities were required resources for a good transition into retirement, and a degree of planning was required to mobilise these resources. However, the degree of choice and control around the transition to retirement was highly variable and socially structured. The notion of planning was embedded as a normative practice, particularly in relation to finances, but the practice of planning was highly contingent primarily due to personal circumstances (ill-health, bereavement, relationships) and work exit (redundancy, work stress, changes to shift patterns or hours). The findings offer insights into the reasons why many people do not plan and indicate that many of the assumptions associated with retirement planning warrant further consideration both theoretically and practically. [ABSTRACT FROM AUTHOR]

Many older adults experience what is clinically recognised as frailty but little is known about the perceptions of, and attitudes regarding, being frail. This qualitative study explored adults' perceptions of frailty and their beliefs concerning its progression and consequences. Twenty-nine participants aged 66–98 with varying degrees of frailty, residing either in their homes or institutional settings, participated in semi-structured interviews. Verbatim transcripts were analysed using a Grounded Theory approach. Self-identifying as ‘frail’ was perceived by participants to be strongly related to their own levels of health and engagement in social and physical activity. Being labelled by others as ‘old and frail’ contributed to the development of a frailty identity by encouraging attitudinal and behavioural confirmation of it, including a loss of interest in participating in social and physical activities, poor physical health and increased stigmatisation. Using both individual and social context, different strategies were used to resist self-identification. The study provides insights into older adults' perceptions and attitudes regarding frailty, including the development of a frailty identity and its relationship with activity levels and health. The implications of these findings for future research and practice are discussed. [ABSTRACT FROM PUBLISHER]

National surveys show that people from minority ethnic groups tend to be less satisfied with social care services compared with the white population, but do not show why. Research indicates that barriers to accessing services include lack of information, perceptions of cultural inappropriateness and normative expectations of care. Less research has examined the experience of minority ethnic service users after they access services. This study conducted in-depth interviews with 82 South Asian and White British service users and family carers, the majority of whom were older people. Thematic analysis was used. The key theme was understanding the social care system. Participants with a good understanding of the system were more able to adapt and achieve control over their care. Participants with a poor understanding were uncertain about how to access further care, or why a service had been refused. More White British than South Asian participants had a good understanding of the system. There was more in common between the South Asian and White British participants' experiences than might have been expected. Language was an important facilitator of care for South Asian participants, but ethnic matching with staff was less important. Recommendations include better communication throughout the care process to ensure service users and carers have a clear understanding of social care services and hence a better experience. [ABSTRACT FROM PUBLISHER]

There has been an increasing emphasis on choice for older people in long-term care in both England and Japan. However, despite the emphasis on the importance of choice, the perspectives of older people have been given little attention. Considering national and local policies in Bristol, England and Kyoto, Japan, the article explores how older people are exercising (and not exercising) choice in care practice through examining the perspectives of the older people themselves, as well as key informants in the field. Empirical data were collected from interviews with older people and key informants in the two countries, and were analysed using qualitative and comparative approaches. Choice in policy is regarded as a mechanism of the market with an assumption of the independent autonomous individual who can exercise ‘rational choice’. However, the findings have reflected older people's relational decision-making, which does not conform to the rational model of decision-making, and illustrates the value of ‘interdependence’. The findings from care practice have shown that choice was considered an important value in involving older people's views and ensuring their needs are met sensitively and respectfully. The findings also suggested that consideration of the psychological aspects of choice is an important aspect of ‘care’, facilitating the inclusion of older people's views in the process of making judgements, in order to meet their needs. [ABSTRACT FROM PUBLISHER]

Personalisation of social care for adults is a key policy objective in the United Kingdom (UK), as in many other welfare states, having gained wide acceptance as essential for the empowerment of service users and as a means of managing increasing population demand. The system of personal budgets being established in the UK pursues twin objectives: aiming to ‘empower’ individuals to achieve ‘more for less’. However, there is mixed evidence that either objective is being achieved in practice. This is especially so in respect of older people who are less likely to accept a personal budget and more likely to be dissatisfied with their experience of using one. A qualitative study of eight cases in two local authority areas in England explored older people's experience of using a personal budget taken in the form of a direct payment. Data were elicited through a series of three in-depth interviews with each participant. The study was concerned with understanding the relationship between participants' experience of ‘Self’ and personalised services. Participants experienced personalisation when paid carers perceived and accommodated their ‘special requirements of Self’. In most cases this was achieved despite the consumerist aspects of personalisation rather than because of them, and often gave rise to risk and dilemma. The findings emphasise the importance of holistic assessment, and commissioning for quality over maximising choice. [ABSTRACT FROM PUBLISHER]

Reducing risk of a cardiovascular event involves adopting healthier lifestyles. Community-based active lifestyle schemes offer support, but problems with uptake, completion and evaluation are common. We report the engagement and experiences of older adults referred to a scheme in England. Data transcribed froma focus group or individual interviews were analysed using thematic framework analysis. Participants reported an increased awareness of health difficulties with age, and described attendance-related psychological benefits, including an increased sense of responsibility for change and having had negative beliefs about age, health and change challenged. Some physical benefits (including reduced weight and blood pressure) were also reported. Those who attended most consistently were more likely to report caring responsibilities and describe positive social and relational outcomes, but were not more likely to report marked physical benefits. We recommend several changes to ensure that schemes meet their objectives and the needs of those referred. Age-related, health and lifestyle beliefs do not prohibit change but influence attendance and so should be addressed. Outcomes should be publicised, and structured, fixed-term programmes, incorporating relapse-prevention strategies, should be delivered to a closed group at flexible times. Active follow-up of non-attenders and improved data collection are also recommended. These should reduce the risk of schemes providing social support at the expense of intended health benefits. [ABSTRACT FROM AUTHOR]

Older prisoners are the fastest growing incarcerated sub-group. They have more complex health and social care needs than both younger prisoners and their age-matched peers living in the community. Prisoners who have been recently released are at enhanced risk in terms of their physical and mental health. Consequently, there is a need for timely, multi-disciplinary release planning. The aim of this study was to explore the health and social care needs of older male adults discharged from prison into the community. Qualitative interviews were carried out with prisoners with four weeks left to serve (N=62), with follow-up interviews conducted four weeks after release (N=45). Participants were selected from nine prisons in the North of England. The constant comparison method was used to analyse the data. Older prisoners perceived release planning to be non-existent. There was a reported lack of formal communication and continuity of care, causing high levels of anxiety. Older prisoners experienced high levels of anxiety about the prospect of living in probation-approved premises; however, those who did go on to live in probation-approved premises had their immediate health and social care needs better met than those who did not move into such accommodation. Release planning for older prisoners is generally inadequate and there is currently a missed opportunity to address the needs of this vulnerable group. [ABSTRACT FROM PUBLISHER]

Community physical activity (PA) groups have come in to being worldwide to inspire older adults to engage in PA. However, there is limited evidence that older adults adhere to these groups, particularly those of a lower socio-economic status, with health conditions, from black and minority ethnic (BME) groups and men. This study aimed to explore experiences of attending PA groups from the viewpoint of community-living older adults, including those sub-groups of the population highlighted above. The purpose was to gain an understanding of what would influence long-term adherence to community PA groups. Eighteen participants aged 65 and above took part in three focus groups carried out in North West England. Thematic network analysis was used for theme generation and interpretation. Low-cost, universal locations are essential to enable older adults to engage regularly in PA, however, it is the social space that is created within these physical settings that is most influential in fostering their long-term adherence. Facilitating cross-cultural relationships and supporting older adults to have more control in shaping the PA environment will ensure that these settings are more conducive to the long-term adherence of diverse groups of older adults. [ABSTRACT FROM PUBLISHER]