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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]

As populations age, increased focus is given to the importance of enabling older people to age in place. The study reported in this paper explored the extent to which older people considered their homes and neighbourhoods to be ‘supportive’, and sought to increase understanding of the needs and experiences of older people and their expectations of future housing needs. This paper reports qualitative data from the Housing and Independent Living (HAIL) study carried out in Australia. Semi-structured interviews were conducted with 202 community-dwelling people aged 75–79 years. Interviews were transcribed, coded and analysed using computer-assisted qualitative analysis and a narrative approach to identify broad themes. Thematic analysis was used to examine and understand how occupants subjectively viewed their homes, and how they planned to adapt/modify either their activities or homes to accommodate changing needs. Six key themes emerged, namely housing choice, attachment to place, financial issues, changes to the home over time, transport, and anticipating the future. In this study, people who most strongly identified with and felt connected to their neighbours/communities had more positive perceptions of their homes and communities, and may be better able to remain in their home despite increasing disability or frailty. Housing policies and home and urban design should ensure home and neighbourhood environments are safe, accessible, promote positive associations, and are adaptable to facilitate independence and accommodate change as people age. [ABSTRACT FROM PUBLISHER]

This paper engages with a cultural politics of ‘older’. At the centre of this politics are essentialist discourses of corporeal ‘ageing’ that limit and stigmatise the subjective experience of ‘older’. Drawing together theoretical insights from Foucault's work on care of the self with data from in-depth interviews with ‘older’ people who have undergone cosmetic surgery and cosmetic surgery practitioners, this paper advances the proposition that cosmetic surgery can be re-imagined as an ethical practice of self-care. To critique the limitations imposed by ‘natural ageing’ through an ethic of ‘ageing gracefully’, the paper explores how older people who have undergone cosmetic surgery stylise the ethical experience of ‘older’ through active resistance of an ‘elderly’ identity. It argues that the practice of cosmetic surgery by ‘older’ people constitutes a cutting critique of the limits of ‘older’ and an experiment with the possibility of exceeding and ultimately transforming those limits. [ABSTRACT FROM PUBLISHER]

There is a long tradition in the assessment of UK social policy of examining benefit entitlement and access, yet little attention has been paid towards benefits associated with bereavement and, in particular, what happens for those people who cannot afford a funeral and require state assistance. This is despite the fact that every year approximately one in ten deaths in the UK results in a claim to the Department for Work and Pensions’ Funeral Payment for a contribution towards funeral costs. Beyond a paper in this journal over ten years ago, no research has been conducted into how the scheme is administered and what happens to those people who claim. Drawing on a study with both successful and unsuccessful Funeral Payment claimants, funeral directors and key stakeholders, this paper evaluates the Funeral Payment in terms of eligibility and entitlement, and timing and cost. It argues that closer attention needs to be paid to the issue of financial support for funerals to avoid the evolution of an unwieldy system at a time when the UK death rate is predicted to rise owing to the ageing of the population. [ABSTRACT FROM PUBLISHER]

The impact of disparities in socio-economic status on the health of older people is an important issue for policy makers in the context of population ageing. As older people live in different types of economic circumstances and because, as people age, their desires and needs are different to those of younger generations, measures of living standards need to be appropriate for older people. This paper reports on the validation of a measure of living standards for older people based on Sen's Capability Approach. Using this approach, living standards are conceptualised as varying from constraint to freedom rather than from hardship to comfort. Using the New Zealand Longitudinal Study of Ageing omnibus survey of 3,923 adults aged 50–87 years, the validity of the measure was assessed. The results indicate that this measure assesses what older people are able to achieve. In addition, this measure discriminates better at the higher end of the living standards spectrum than an existing measure that assesses living standards from hardship to comfort in terms of what people possess. From this, a short form of the measure has been developed which offers a conceptually based and valid measure useful for survey research with older people. This measure of living standards provides future avenues for improved understandings of socio-economic position in later life. [ABSTRACT FROM PUBLISHER]

As interest in comparative effectiveness research grows, questions have emerged regarding whether it is ever acceptable to alter informed consent requirements for research when patients are randomly assigned to widely-used therapies. This paper reports on interviews with Institutional Review Board members and researchers and on focus groups with patients from Geisinger and Johns Hopkins health systems. The objective was to elicit participants' views of the acceptability of four different disclosure and authorization models for low-risk pragmatic comparative effectiveness trials of widely-used therapies. Results suggest that although participants valued autonomous choice, many also believed that it was acceptable to streamline information disclosure and to use an opt-out process for eligible individuals who would prefer not to participate. This provides some preliminary evidence that relevant stakeholders find alternatives to traditional informed consent acceptable for low-risk pragmatic comparative effectiveness trials of widely-used therapies as long as a sufficient amount of choice is preserved. [ABSTRACT FROM AUTHOR]

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]

The elderly population in Sri Lanka is growing rapidly. Elders are traditionally cared for in the homes of their adult children, but the shifting socio-economic environment in Sri Lanka challenges this arrangement. This paper describes the dynamics of elder–care-giver relationships in Southern Sri Lanka. Data included four focus group discussions and five in-depth interviews with elderly, and ten in-depth interviews with adult children of the elderly. Discussion guide topics included care-giving arrangements, and roles/responsibilities of elders and care-givers. Using a grounded theory approach, a comprehensive analytic memo was developed and discussed to explore emerging themes on the care-giver dynamic. Both elders and care-givers felt that elders should be taken care of in the home by their children. They pointed to a sense of duty and role modelling of parental care-giving that is passed down through generations. Even as elders desired support from their children, they feared losing their independence, and saw financial autonomy as important for maintaining relationship balance. Care-giving challenges included: households where both the adult child and his/her spouse worked outside the home; households where elders had a disproportionate amount of household work; economically stressed households; and lack of direct communication between elders and care-givers regarding conflicts. Results point to strong values around caring for elderly in the home, but identify challenges to this arrangement in the future. [ABSTRACT FROM PUBLISHER]

Staying socially engaged is known to improve health and longevity in older people. As the population ages, maintaining levels of social engagement among older people becomes increasingly important. Nevertheless, advancing age brings with it many challenges to social engagement, especially in rural areas. A three-year Australian Research Council Linkage Project sought to improve understandings of age-related triggers to social disengagement in six Tasmanian communities that are representative of rural Australian experience, and thus of wider salience. A collaboration between academics and health and social professionals, the project investigated design solutions for service frameworks that may be useful before ageing individuals become isolated and dependent, and that may support those individuals to actively contribute to and benefit from social life. The purpose of this paper is to report on perspectives about diminishing levels of social engagement held by older rural participants and service providers, and to advance a number of key insights on ways in which to nurture social engagement and improve the experience of ageing. [ABSTRACT FROM PUBLISHER]

Cash-for-care schemes offering cash payments in place of conventional social services are becoming commonplace in developed welfare states; however, there is little evidence about the impact of such schemes on older people. This paper reports on the impact and outcomes for older people of the recent English Individual Budget (IB) pilot projects (2005–07). It presents quantitative data on outcome measures from structured interviews with 263 older people who took part in a randomised controlled trial and findings from semi-structured interviews with 40 older people in receipt of IBs and with IB project leads in each of the 13 pilot sites. Older people spent their IBs predominantly on personal care, with little resources left for social or leisure activities; and had higher levels of psychological ill-health, lower levels of wellbeing, and worse self-perceived health than older people in receipt of conventional services. The qualitative interviews provide insights into these results. Potential advantages of IBs included increased choice and control, continuity of care worker, and the ability to reward some family carers. However, older people reported anxieties about the responsibility of organising their own support and managing their budget. For older people to benefit fully from cash-for-care schemes they need sufficient resources to purchase more than basic personal care; and access to help and advice in planning and managing their budget. [ABSTRACT FROM PUBLISHER]

Migrant care workers make a substantial contribution to older adult care in Ireland and the United Kingdom (UK). However, little is known about the relational aspects of care involving migrant care workers and older people. Given that the care relationship is closely linked to quality of care, and that the Irish and UK sectors are increasingly restricted by economic austerity measures, this lack of information is a concern for care practice and policy. Our paper explores the relationship between migrant care workers and older people in Ireland and the UK and draws on data collected in both countries, including focus groups with older people (N = 41), interviews with migrant care workers (N = 90) and data from a survey of and interviews with employers. The findings illustrate the complexity of the migrant care worker–older person relationship; the prevalence of need orientated, friendship and familial-like, reciprocal, and discriminatory interlinking themes; and the role of individual, structural and temporal factors in shaping these relationships. [ABSTRACT FROM PUBLISHER]

Effective use of public health law can be a powerful tool to advance the mission of public health departments to protect and promote the health of the population. However, there is little known about the way that public health officials think about law, use law, and/or interact with their legal counsel. The purpose of this paper is to examine some of the beliefs and barriers facing public health officials and legal counsel in their efforts to collaborate and to describe specific opportunities to better facilitate the use of law and collaboration, particularly in the area of training and education. Our findings are based on two studies: (1) a mixed methods study of state and local public health officials and their legal counsel, including surveys and qualitative interviews; and (2) a survey-based needs assessment of training for public health law. While state health officials and legal counsel view the role of public health law in similar ways, variation exists in organization, interactions and perceptions of collaboration on issues of public health law. Tremendous opportunity exists for improving collaboration between legal counsel and public health agencies through additional education and training opportunities. Improving the use of law in public health is possible - if practitioners and legal educators work together to fulfill its promise. [ABSTRACT FROM AUTHOR]

BackgroundEvidence for an effect of work stressors on common mental disorders (CMD) has increased over the past decade. However, studies have not considered whether the effects of work stressors on CMD remain after taking co-occurring non-work stressors into account.MethodData were from the 2007 Adult Psychiatric Morbidity Survey, a national population survey of participants ⩾16 years living in private households in England. This paper analyses data from employed working age participants (N=3383: 1804 males; 1579 females). ICD-10 diagnoses for depressive episode, generalized anxiety disorder, obsessive compulsive disorder, agoraphobia, social phobia, panic or mixed anxiety and depression in the past week were derived using a structured diagnostic interview. Questionnaires assessed self-reported work stressors and non-work stressors.ResultsThe effects of work stressors on CMD were not explained by co-existing non-work stressors. We found independent effects of work and non-work stressors on CMD. Job stress, whether conceptualized as job strain or effort–reward imbalance, together with lower levels of social support at work, recent stressful life events, domestic violence, caring responsibilities, lower levels of non-work social support, debt and poor housing quality were all independently associated with CMD. Social support at home and debt did not influence the effect of work stressors on CMD.ConclusionsNon-work stressors do not appear to make people more susceptible to work stressors; both contribute to CMD. Tackling workplace stress is likely to benefit employee psychological health even if the employee's home life is stressful but interventions incorporating non-work stressors may also be effective. [ABSTRACT FROM PUBLISHER]