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While research on the health and wellbeing of older lesbian, gay and bisexual adults is gradually expanding, research on older trans and gender non-conforming (TGNC) adults lags behind. Current scholarship about this group raises important questions about the intersection of ageing and gender identity for enhancing care and support for older TGNC adults and the lack of preparedness of health and social professionals for meeting these needs. In this paper, we examine the accounts of 22 TGNC individuals (50–74 years) on the topic of ageing and unpack their concerns for and expectations of later life. We present qualitative findings from a study of gender identity, ageing and care, based in Wales, United Kingdom. Data were generated from two-part interviews with each participant. Four key themes are identified: (a) facilitative factors for transitioning in mid- to later life; (b) growing older as a new lease of life; (c) growing older: regrets, delays and uncertainties; and (d) ambivalent expectations of social care services. We argue that growing older as TGNC can be experienced across a multitude of standpoints, ranging from a new lease of life to a time of regret and uncertainty. We critically discuss emergent notions of trans time, precarity and uncertainty running across participants' accounts, and the implications for enhancing recognition of gender non-conformity and gender identity in social gerontology. [ABSTRACT FROM AUTHOR]

This paper examines the ways in which older people's residential and nursing homes can constitute heteronormative environments – social spaces in which the same-sex attractions and desires of residents are disregarded in the provision of everyday care. The aim of this discussion is to examine the synergies and differences between older lesbian, gay and bisexual (LGB) adults' expectations for future care home provision and the expectations of care staff and managers in providing residential services to older people with diverse sexual backgrounds. We present qualitative evidence from research into the provision of care environments in Wales. In this paper, we present findings from two cohorts: first, from five focus groups with care and nursing staff and managers; and second, from 29 semi-structured interviews with older LGB adults (50–76 years) residing in urban and rural locations across Wales. We argue that residential care environments can constitute heterosexualised spaces in which LGB identities are neglected in comparison to the needs and preferences of other residents. To this extent, we discuss how care staff and managers can be more attentive and responsive to the sexual biographies of all residents and argue against the separation of care and sexual orientation in practice. [ABSTRACT FROM PUBLISHER]

Trans people – those whose gender identity does not match that assigned to them at birth – are at considerably elevated risk of homelessness, reflecting their marginalized legal, bureaucratic and socio-economic status. Recent substantial international expansion to the medico-legal rights afforded them operates in tension with cisnormative welfare structures. Based upon a Critical Discourse Analysis of interviews with 35 trans people with experience of homeless in Wales, UK, alongside 12 workers in the system, I argue that anti-discrimination legislation is insufficient in its current form to prevent discrimination against trans people. I suggest that, without addressing deeper structural cisnormativity, service provision for trans people experiencing homelessness and other forms of social marginalisation will remain inadequate. This argument rests upon the following findings. (1) Failing to consider exclusion at a structural level leads to system-gaps and misunderstandings, producing poor service experiences. (2) The specific needs of trans applicants are under considered in system planning, reducing scope for meaningful homelessness interventions. (3) An equalities approach can produce a reductive and potentially pathologizing focus upon trans identity, diverting from specific individual needs. I conclude that provision of inclusive services necessitates consideration of the impact of deep cisnormative assumptions in service design and delivery, and their resultant exclusion of trans people. [ABSTRACT FROM AUTHOR]

As an increasing number of Government services have moved away from traditional modes of provision to online formats, there has been a corresponding need to ensure greater access to the internet. Although older people (those over 60) are least likely of all age groups to have access to the internet in their homes, the internet holds much potential as an information and advice resource for those older people who may find it difficult to access advice over the telephone or in person. Realising this potential extends beyond issues of physical access; consideration must necessarily be given to issues of internet literacy and the inclination of this cohort to utilise what may be new and unfamiliar technology. This paper examines these matters in the context of the resolution of everyday problems with a legal dimension. Looking first at the use of the internet for information and advice seeking related to such problems, we find that those aged over 60 demonstrate the least use of the internet for problems with a legal dimension. Simultaneously, those aged over 60 are also the group with the lowest level of home access – a particular issue given that for over 60-year-olds, home access is a far stronger determinant of internet use for problems than it is for other age groups. Examining use of the internet for advice seeking over the last decade, findings demonstrate the existence of a general increase in use amongst all age groups over time, albeit with a lower rate of growth amongst those currently over 60. As an indication of future growth, this will have implications for the provision of services. Whilst the ‘young old’ will utilise the internet to a greater degree and will require websites which are tailored to their needs, those individuals at the older end of the age spectrum may best be served by continued access to face-to-face or outreach advice. The implications these findings pose for policy makers in setting priorities in the remit of online service provision are discussed, with results having particular relevance in England and Wales given planned changes to civil legal aid. [ABSTRACT FROM PUBLISHER]

SUMMARY: When a patient in an in-patient psychiatric setting allegedly commits a crime, psychiatrists are sometimes asked to assess their fitness to be interviewed by the police. This article describes how to conduct this assessment, outlines the criminal justice process leading to police interviews (with particular reference to the legal system in England and Wales) and highlights practical issues to consider when assessing fitness to be interviewed in this context. [ABSTRACT FROM AUTHOR]

At the nexus of the social and penal policy fields, problem-solving justice promises to punish offenders while working to address the complex issues that drive their law-breaking behaviour. Appealing to the left and right due to its dual focus on pragmatism and welfarism, the concept has floated in and out of political fashion for the past two decades. Recent years have heralded a renewed political interest in the approach, closely aligned to the Conservative government's commitment to 'transforming justice'. With a focus on empowerment and collaboration, the problem-solving model has much to offer women offenders in particular. Drawing on data from a large-scale study into the sentencing and punishment of women under the new probation arrangements, this article reveals a divergence of views on gender-specific courts among sentencers, probation officers and third sector workers. Moral concerns about up-tariffing sit alongside the practical barriers of government bureaucracy and hindering legislation. With data pertaining to effectiveness (rather than potential) still required, this article argues that specialist problem-solving courts for women present a risky strategy, however seductive their promise. [ABSTRACT FROM AUTHOR]

This article aims to encourage critical reflection about the limitations of the rational choice approach as an explanatory insight to understanding older people's choice-making about their health or social care requirements. It develops an interpretive framework examining how older people engage in the process of choice-making when selecting a care option. Choice-making is conceptualised as a temporal, processual phenomenon, influenced by others, and characterised by an individual's behavioural responses to changing circumstance and lifecourse events. Data are from qualitative interviews with 29 older adults whose choice of care option involved moving to an extra-care setting in Wales (United Kingdom). Transcripts were coded using in-case and constant-comparison approaches, and analysis was undertaken using concepts of engagement and temporality as elements of the choice-making process. Using an inductive approach, a typology of six different 'pathways to choice' of care setting was identified; these findings suggest that choosing a care option in later life is a diverse, interactive and time-bound social phenomenon, inadequately captured by the rational choice approach where it is understood more as an individualised, linear and logical process. Recognising that choice-making evolves through time as part of a process shaped by others means service providers will be better positioned to offer opportunities for more preventative-focused interventions which empower older consumers to make planned and informed choices about care options. [ABSTRACT FROM AUTHOR]

BackgroundAn unhealthy body mass index (BMI) has been associated with depression but the direction of association is uncertain. Our aim was to estimate the co-morbidity and direction of association between BMI and depressive symptoms at several ages, from childhood to mid-adulthood.MethodThe data were from 18 558 individuals born in 1 week in March 1958, in England, Scotland and Wales, with follow-up at ages 7, 11, 16, 23, 33, 42, 45 and 50 years. Depression (scores ⩾90th percentile) was identified from child/adolescent (teacher questionnaires) and adult (self-complete questionnaires and clinical interview) measures. BMI (kg/m2) measured in child/adolescence and adulthood was classified as underweight, normal, overweight or obese.ResultsIn cross-sectional analyses, obesity and underweight (not overweight) from 11 to 45 years were associated respectively with 1.3–2.1 and 1.5–2.3 times the risk of depression compared with normal weight. Using the time-lagged generalized estimating equation (GEE) approach, we tested (a) whether underweight or obesity at prior ages (7 to 45 years) predicted subsequent risk of depression (11 to 50 years), adjusting for baseline depression; and (b) whether depression at prior ages (7 to 42 years) predicted subsequent risk of underweight or obesity (11 to 45 years), adjusting for baseline BMI. In longitudinal analyses, underweight predicted subsequent depression in both sexes [odds ratio (OR) 1.25, 95% confidence interval (CI) 1.11–1.40] and depression predicted subsequent underweight in males only (OR 1.84, 95% CI 1.52–2.23). Obesity predicted subsequent depressive symptoms in females only (OR 1.34, 95% CI 1.14–1.56), but depression did not predict obesity.ConclusionsClinicians should consider screening routinely for depression patients with unhealthy BMI, namely underweight and obesity, and vice versa. [ABSTRACT FROM AUTHOR]

The introduction of cash-for-care schemes such as individual or personal budgets in England has been seen as central to the personalisation agenda for reforming the delivery of adult social care. However, despite there being 5.2 million carers in England and Wales, the initiative concentrates predominantly on the needs of the service user. The implementation of individual budgets (IBs) was piloted within 13 local authorities during 2005–2007 and the Department of Health commissioned an independent evaluation of this pilot (IBSEN). The focus was only on the service user in the evaluation and therefore a separate but linked study was set up to evaluate the impact and outcomes of IBs on carers. Carers of service users who had consented to take part in the main IBSEN study were identified and invited to participate in a follow-up study aimed at exploring how IBs impacted on carers and the caring role. The study found that the receipt of the budget was significantly associated with positive impacts on carers' reported quality of life and, when other factors were taken into account, with social care outcomes. These outcome gains were achieved despite no higher costs being incurred to the public purse, thus suggesting that IBs for service users are cost-effective for carers. [ABSTRACT FROM PUBLISHER]

Older age is one stage of the lifecourse where dignity maybe threatened due to the vulnerability created by increased incapacity, frailty and cognitive decline in combination with a lack of social and economic resources. Evidence suggests that it is in contact with health and welfare services where dignity is most threatened. This study explored the experiences of older people in acute National Health Service (NHS) Trusts in relation to dignified care and the organisational, occupational and cultural factors that affect it. These objectives were examined through an ethnography of four acute hospital Trusts in England and Wales, which involved interviews with older people (65+) recently discharged from hospital, their relatives/carers, and Trust managers, practitioners and other staff, complemented by evidence from non-participant observation. The picture which emerged was of a lack of consistency in the provision of dignified care which appears to be explained by the dominance of priorities of the system and organisation tied together with the interests of ward staff and clinicians. The emphasis on clinical specialism meant that staff often lacked the knowledge and skills to care for older patients whose acute illness is often compounded by physical and mental co-morbidities. The physical environment of acute wards was often poorly designed, confusing and inaccessible, and might be seen as ‘not fit for purpose’ to treat their main users, those over 65 years, with dignity. Informants generally recognised this but concluded that it was the older person who was in the ‘wrong place’, and assumed that there must be a better place for ‘them’. Thus, the present system in acute hospitals points to an inbuilt discrimination against the provision of high-quality care for older people. There needs to be a change in the culture of acute medicine so that it is inclusive of older people who have chronic co-morbidities and confusion as well as acute clinical needs. [ABSTRACT FROM PUBLISHER]

BackgroundThe hormone ‘cortisol’ has been associated with cognitive deficits in older ages, and also with childhood cognition. The extent to which the associations of cortisol with cognitive deficits in later life reflect associations with childhood cognition ability is unclear. This study aimed to assess associations between adult cortisol levels and subsequent cognitive functions, while considering childhood cognition and other lifetime covariates.MethodData are from the 1958 British Birth Cohort. Two morning salivary cortisol samples were obtained at 45 years: 45 min after waking (t1) and 3 h later (t2). Standardized tests assessing immediate and delayed verbal memory, verbal fluency and speed of processing were administered at 50 years. Information on cortisol, cognitive outcomes and covariates [e.g. birthweight, lifetime socio-economic position (SEP), education, smoking and drinking habits, body mass index (BMI), menopausal status, and depression/anxiety] was obtained for 4655 participants.ResultsWorse immediate and delayed verbal memory and verbal fluency at 50 years were predicted by elevated t2 cortisol at 45 years. For instance, for 1 standard deviation (s.d.) increase in t2 cortisol, individuals scored −0.05 s.d. lower on verbal memory and fluency tests. Childhood cognition explained about 30% of these associations, but associations with adult cognition remained.ConclusionsThis study suggests that higher cortisol levels in late morning at 45 years are associated with poorer verbal memory and fluency at 50 years, with a contribution from childhood cognition to these associations. [ABSTRACT FROM PUBLISHER]

Objective:A previous study examined the ‘patient journey’ of adults with gradual-onset acquired hearing impairment. This study examined the same for adults with sudden-onset acquired hearing impairment, and assessed differences.Study design:Data were collected from 16 audiologists, using the Ida Institute template, and from four adults with sudden-onset acquired hearing impairment, through semi-structured interviews. Data were analysed using thematic analysis and presented using a process mapping model.Results:A patient journey template for sudden-onset acquired hearing impairment was developed based on the professionals' and patients' perspectives. The main difference between these two groups' perspectives was seen in the self-evaluation phase: some stages within this phase were recognised by the patients but not by the professionals. The main difference between the current and the previous study was the absence of a pre-awareness phase in the journey described by patients with sudden-onset acquired hearing impairment, compared with that described by patients with gradual-onset acquired hearing impairment.Conclusion:Patient journey templates could be useful counselling tools for ear and hearing healthcare specialists. However, such templates should be used only as a baseline; it is important to take a detailed case history to understand each patient's unique experience, including the psychosocial impact of hearing impairment. [ABSTRACT FROM PUBLISHER]