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Aim: This descriptive paper aims to describe the design and implementation of a community engaged primary healthcare strategy in rural Australia, the Primary Healthcare Registered Nurse: Schools-Based strategy. This strategy seeks to address the health, education and social inequities confronting children and adolescents through community engaged service provision and nursing practice. Background: There have been increasing calls for primary healthcare approaches to address rural health inequities, including contextualised healthcare, enhanced healthcare access, community engagement in needs and solutions identification and local-level collaborations. However, rural healthcare can be poorly aligned to community contexts and needs and be firmly entrenched in health systems, marginalising community participation. Methods: This strategy has been designed to enhance nursing service and practice responsiveness to the rural context, primary healthcare principles, and community experiences and expectations of healthcare. The strategy is underpinned by a cross-sector collaboration between a local health district, school education and a university department of rural health. A research framework is being developed to explore strategy impacts for service recipients, cross-sector systems, and the establishment and maintenance of a primary healthcare nursing workforce. Findings: Although in the early stages of implementation, key learnings have been acquired and strategic, relationship, resource and workforce gains achieved. [ABSTRACT FROM AUTHOR]

Introduction: Developments in information and communication technologies have enabled electronic health and seen a huge expansion over the last decade. This has increased the possibility of self-management of health issues. Purpose: To assess the effectiveness of the Baby Buddy app on maternal self-efficacy and mental well-being three months post-birth in a sample of mothers recruited antenatally. In addition, to explore when, why and how mothers use the app and consider any benefits the app may offer them in relation to their parenting, health, relationships or communication with their child, friends, family members or health professionals. Methods: We will use a mixed-methods approach, a cohort study, a qualitative element and analysis of in-app data. Participants will be first-time pregnant women, aged 16 years and over, between 12 and 16 weeks of gestation and recruited from five English study sites. Evaluation plan: We will compare maternal self-efficacy and mental health at three months post-delivery in mothers who have downloaded the Baby Buddy app compared with those that have not downloaded the app, controlling for confounding factors. Women will be recruited antenatally between 12 and 16 weeks of gestation. Further follow-ups will take place at 35 weeks of gestation and three months post-birth. Data from the cohort study will be supplemented by in-app data that will include, for example, patterns of usage. Qualitative data will assess the impact of the app on the lives of pregnant women and health professionals using both focus groups and interviews. Ethics: Approval from the West Midlands-South Birmingham Research Ethics Committee (NRES) (16/WM/0029) and the University of the West of England, Bristol, Research Ethics Committee (HAS.16.08.001). Dissemination: Findings of the study will be published in peer reviewed and professional journals, presented locally, nationally and at international conferences. Participants will receive a summary of the findings and the results will be published on Best Beginnings' website. [ABSTRACT FROM AUTHOR]

Meeting individuals' social care needs is a core element of UK social policy. However, the conceptualisation and operationalisation of 'unmet need' remain a challenge. This paper advances our understanding by incorporating a temporal dimension into the conceptual framework on unmet need to investigate the dynamics of met and unmet need for social care over time. Using data from Waves 8 and 9 of the English Longitudinal Study of Ageing, this paper examines five possible trajectories among individuals with a social care need for bathing or dressing at baseline: (a) no longer having such a need; (b) having continued needs met; (c) delayed needs met; (d) newly arisen unmet needs; and (e) repeated unmet needs. The results indicate that amongst those with need at baseline, unmet need has decreased over time – indicating that some needs for social care may be fulfilled with a delay. However, a significant proportion of older people experienced repeated unmet needs, particularly those who were younger, with no spouse or civil partner, and those whose activities of daily living index scores worsened over time. Understanding the dynamics of unmet need can support policy makers in better ensuring that those facing an elevated risk of repeated unmet need over time do not fall through the social care safety net. [ABSTRACT FROM AUTHOR]

Health authorities worldwide address older adults as a risk group for more serious illness and health complications associated with COVID-19, while social gerontologists have warned that addressing older adults as a risk group of COVID-19 bears the risk of reinforcing ageism. This paper empirically explores to what extent older adults perceive themselves as part of a COVID-19 risk group and how these perceptions influence their everyday lives and experiences of age and ageing. This paper draws upon data from a mixed-methods study on older adults' risk perceptions during COVID-19 in Lower Austria, including a representative survey on 521 adults (60+ years) and data from 20 semi-structured interviews. Approximately two-thirds of the respondents consider themselves at risk of COVID-19 and name age, in addition to pre-existing illness, as a contributing factor in this risk perception. Older adults with health constraints, and especially older men, have a higher probability of perceiving risk due to COVID-19. Additionally, older adults report that they experience being 'suddenly seen as old' or 'being put into a box' during the pandemic, which influenced their experiences and images of ageing. Our study provides insights into how perceived COVID-19 risk affects the everyday lives of older adults. Age-based categorisations of risk contribute to a shift in images of age and ageing, drawing on insecurity and risk, rather than successful and active ageing, to conceptualise later life. [ABSTRACT FROM AUTHOR]

Objective:To study the clinical effect of lens cleaning paper patching on traumatic eardrum perforations.Methods:A total of 122 patients were divided into 2 groups, of which 56 patients were treated with lens cleaning paper patching and 66 acted as controls. The closure rate and healing time were compared between the two groups.Results:The healing rate of small perforations was 96.4 per cent (27 out of 28) in the patching group and 90 per cent (27 out of 30) in the control group. The difference was not statistically significant (p > 0.05). The healing rate of large perforations was 89.3 per cent (25 out of 28) and 80.6 per cent (29 out of 36) in the two groups, respectively. The difference was statistically significant (p < 0.05). The healing time of large perforations was shorter in the patching group than in the control group (p < 0.01).Conclusion:Patching with lens cleaning paper under an endoscope can accelerate the closure of large traumatic eardrum perforations. [ABSTRACT FROM AUTHOR]

Older people have increasingly been using the new information and communication technologies (ICTs), namely the internet. Seeking to contribute with substantive information on their digital inclusion, this paper focuses on the adoption and use of ICTs by older adults, highlighting their experiences and considering their plurality. Taking a qualitative approach, the core goal of the empirical research underlying this paper was to understand what mechanisms and modalities configure the relationship of older internet users with the new ICTs. With that objective in mind, interviews were conducted with 20 internet users over the age of 60. Those interviews, which included a biographical element, were subjected to multi-categorical analysis. Results suggest a typology of modes of relating to the new ICTs among older internet users that reflects different trajectories, practices, skills, significances and impacts. The analysis shows how life trajectories and differentiated uses are reflected in equally differentiated impacts for older adults, contributing to their quality of life in different ways and to different degrees. Digital skills play a fundamental role in enhancing or limiting those effects. The results of this research help break down the stereotypes associated with the older generations and may have relevant implications for the design of digital inclusion policies and initiatives. [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]

Paperwork has always been a central part of bureaucratic work. Over the last few years, bureaucratic procedures have become increasingly standardised and digitalised. Based on interviews and ethnographic fieldwork within welfare offices in Switzerland and Belgium, we reflect on the way evidence is constructed within social policy and cases built for or against noncitizen welfare recipients in order to show how paper truths are established and challenged. The focus on digital practices within public policy implementation highlights how it contributes to enhanced control mechanisms on the implementation level and how migration law continues to guide welfare governance for noncitizens. This allows targeting of the most marginalised groups, whose rights to access state support are institutionally impeded. Through database information flows, official forms, paper reports and face-to-face meetings, we further show how a hybrid form of bureaucratic work emerges, where direct contact with the client is still key, yet highly influenced by standardisation processes. [ABSTRACT FROM AUTHOR]

Involvement in sports is considered a powerful way to generate social capital. However, the role of sport engagement in the development of social relationships of older adults has not received much attention. Remarkably, there is a lack of empirical evidence on the quality and diversity of social relations built through active sport participation and spectatorship. This paper attempts to assess the relationship between sport engagement and various measures of network social capital, including the extension and quality of social networks and the heterogeneity of personal relationships. Also, it proposes new and more informative measurements of an individual's quantity and quality of social ties. By analysing data from a survey in Spain (N = 600) and applying logistic regressions, the results show that sport participation and attendance at sporting events are closely related to different dimensions of network social capital. Concerning people who are not actively engaged in sports, more extensive social networks characterise those who frequently attend sporting events. In contrast, active sport participation is associated with the extensity and quality measures of social connectedness, the level of satisfaction with friends and the opportunity to enjoy close relationships. Therefore, this paper provides new evidence on how sport engagement may result in tighter and extensive networks for older adults and serve as support for emphasising sports, physical activity and leisure as strategies for maintaining and boosting older people's social and psychological health. [ABSTRACT FROM AUTHOR]

Whilst ageing in place is integral to international policy, there is less understanding of how individuals utilise formal services and informal supports in diverse rural environments to maintain their wellness and independence. Consequently, how older people negotiate their care within rural communities is subject to misconceptions. This paper draws on the convoy of care model to explore how older rural Australians negotiate their preferences and needs in the context of informal networks, availability of community resources, and the health and aged care system. The analysis draws on 60 in-depth interviews in six diverse rural communities across two Australian states. Three distinct care convoys are identified and demonstrate the interaction of multiple factors including individual preferences and needs, availability of family and community supports, and accessibility of local health and aged care services in the context of resource allocation. The findings highlight how families and communities compensate for a lack of accessible formal services. For older people without family and strong social networks, formal services are relied upon despite their inadequacy in some locales. This research has provided evidence that some Australian rural locales have limited resources resulting in challenges for older people to access home care and support. This results in many older people facing challenges to age in place. With aged care and health policy commonly designed for an urban context, our findings illustrate the importance of tailoring policy to respect the strengths and challenges existing in rural communities. [ABSTRACT FROM AUTHOR]

Decision-making deficits, assessed cognitively, are often associated with mental health symptoms, however, this relationship is not fully understood. This paper explores the relationship between mental health disorders and decision-making, using the Cambridge Gambling Task (CGT). Our study investigated how decision-making varied across 20 different mental health conditions compared to controls in a sample of 572 young adults from the Minneapolis and Chicago metropolitan areas, using a computerized laboratory-based task. Almost all mental health conditions were associated with at least mild (i.e. at least small effect size) impairment in all three studied parameters of the CGT (risk adjustment, quality of decision-making and overall proportion of bet). Notably, binge eating disorder had the largest cognitive impairment and gambling disorder had moderate impairment. Post-traumatic stress disorder (PTSD) was associated with impaired decision-making while obsessive–compulsive disorder (OCD) and depression showed moderate impairment. Additionally, half of the disorders assessed had moderate to large impairment in risk adjustment.These findings suggest that mental health conditions may have a more complex cognitive profile than previously thought, and a better understanding of these impairments may aid in risk assessment and targeted clinical interventions. This study underscores the need for further research to determine the causal pathways between mental health conditions and cognition, as well as to better understand the day-to-day impact of such deficits. [ABSTRACT FROM AUTHOR]

Within growing marketisation of publicly funded services, the internet has provided new opportunities for marketing, delivery, and coordination of those services. Using web scraping and hyperlink network analysis techniques, this paper examines the ways in which organisations operating in Australia's evolving National Disability Insurance Scheme (NDIS) system inter-connect online. Social media plays the most important role in the online network. Government agencies also play a central role, with many disability service organisations linking their web users to them. Government agency websites do not hyperlink to disability service providers, suggesting that governments do not see their role as assisting access to such services. Advocacy and peak disability organisations are important in online connections between the websites of government and service organisations. Innovative uses of the internet for online brokerage of disability services are evident. The implications of these findings for service delivery are discussed. [ABSTRACT FROM AUTHOR]

The discourse of deservingness has been mobilised against certain groups in the UK society navigating UK labour markets, among them refugees and asylum seekers. These discourses, leading to the stigmatisation of the unemployed are coupled with an emphasis on the importance of individuals taking responsibility to develop their 'employability'. Little attention has been paid to scrutinise the contrast between the deservingness rhetoric and policy making with the actual conditions newcomers, and in particular refugees and asylum seekers, are confronted with when seeking employment. Our paper fills such a gap by indicating key contradictions at the heart of labour market integration in the UK. On the one hand, the emphasis on deservingness is coupled with policy discourses that construct an environment shaped by welfare and labour market chauvinism. On the other hand, the policy architecture is fundamentally flawed in a number of ways in terms of the support mechanisms necessary to ensure that newcomers can successfully integrate into the labour market. [ABSTRACT FROM AUTHOR]

Background: We compared dissociative seizure specific cognitive behavior therapy (DS-CBT) plus standardized medical care (SMC) to SMC alone in a randomized controlled trial. DS-CBT resulted in better outcomes on several secondary trial outcome measures at the 12-month follow-up point. The purpose of this paper is to evaluate putative treatment mechanisms. Methods: We carried out a secondary mediation analysis of the CODES trial. 368 participants were recruited from the National Health Service in secondary / tertiary care in England, Scotland, and Wales. Sixteen mediation hypotheses corresponding to combinations of important trial outcomes and putative mediators were assessed. Twelve-month trial outcomes considered were final-month seizure frequency, Work and Social Adjustment Scale (WSAS), and the SF-12v2, a quality-of-life measure providing physical (PCS) and mental component summary (MCS) scores. Mediators chosen for analysis at six months (broadly corresponding to completion of DS-CBT) included: (a) beliefs about emotions, (b) a measure of avoidance behavior, (c) anxiety and (d) depression. Results: All putative mediator variables except beliefs about emotions were found to be improved by DS-CBT. We found evidence for DS-CBT effect mediation for the outcome variables dissociative seizures (DS), WSAS and SF-12v2 MCS scores by improvements in target variables avoidance behavior, anxiety, and depression. The only variable to mediate the DS-CBT effect on the SF-12v2 PCS score was avoidance behavior. Conclusions: Our findings largely confirmed the logic model underlying the development of CBT for patients with DS. Interventions could be additionally developed to specifically address beliefs about emotions to assess whether it improves outcomes. [ABSTRACT FROM AUTHOR]

The number of older self-funders in England is growing in the context of tight eligibility criteria and fixed financial thresholds to access statutory adult social care. Older people who self-fund their social care fall largely under the radar of statutory services and of research. Our study aimed to listen closely to the stories that older people tell about finding, managing and paying for their care. We interviewed 65 older people living in the community who were funding all or some of their social care. This paper focuses on narrative analysis of selected transcripts from these interviews. It sheds light on how older people represent their experiences of self-funding and what underpins these constructions. A key finding is that the disjunctions within older people's accounts between the care they want and the care they receive reflect wider political and structural tensions in the funding and delivery of care. Older self-funders temper their expectations in light of their experience of shortfalls in the system. This enables them to adjust to the deficiencies but obscures and perpetuates poor care. The discussion considers the findings in relation to: the fundamental incompatability of body labour and commodified care; the shared precarity of older people and care workers; and the individualisation of risks that makes older people and their carers responsible for making a failing care system 'work'. Our analysis adds to the case for major reform of adult social care, including a revaluing of the status and employment conditions of front-line care workers. [ABSTRACT FROM AUTHOR]

Independent mobility is an important component of healthy ageing. Public transit may be an affordable way to achieve independent mobility, and yet little is known about older adults' transition to public transit. This paper addresses this research gap by providing an exploration of older adults' experiences transitioning to public transit use, and by comparing these experiences to those of older people who have always travelled using transit. Twenty-four older adults (65+) living in Hamilton, Canada, who use public transit completed semi-structured interviews during which they discussed their experiences when they first began to use transit. These experiences are framed herein with the concept self-efficacy, i.e. how one's belief in their ability to complete a task shapes their ability to complete said task. Results indicate that most older adults acquire skills to transition to public transit, such as trip planning, boarding, knowing where to sit and exiting the bus. These skills are developed through practice. As one gains experience, one becomes more confident in their ability to meet their daily travel needs using transit. Therefore, the transition to public transit as an older adult can be more challenging for those with little experience using public transit. This paper highlights the danger of assuming all older adults will effortlessly take up transit and stresses the importance of older adults gaining experience using public transit. [ABSTRACT FROM AUTHOR]

Existing policy research has not comprehensively examined the processes by which young people experience social exclusion: that is, the relationships among different risk factors for exclusion, their actual experiences of exclusion, and outcomes that matter for their life chances. Drawing on data from a survey of Australian 13-14 year olds (N=3,535), this paper adapts the Bristol Social Exclusion Matrix to examine pathways from young people's personal and family resources, their experience of participation (school engagement; bullying victimization; teacher support), and their life satisfaction – a predictive indicator of wellbeing and mental health in adulthood. The effects of other characteristics or risk factors for young people's social exclusion (living with disability, being a young carer, identifying as Indigenous, and speaking a language other than English at home), are also examined. This paper shows that experience of exclusion mediates the relationship between young people's personal and family resources and life satisfaction. Controlling for characteristics or risk factors does not change this relationship, suggesting that processes of social exclusion, enacted in interpersonal encounters, are driven by overarching structural factors. These findings are relevant for policy in Australia, and in other countries with similar policy regimes. [ABSTRACT FROM AUTHOR]

Northern European international retirement migrants are often viewed as affluent and use migration as a route to a better quality of life. However, as these migrants transition into the 'fourth age', the onset of age-related illnesses, frailty and care needs can lead to increased levels of risk and insecurity. Through 34 qualitative interviews with older British migrants in Spain, the paper explores how these migrants access and experience care as they age. It draws on a lens of precarity that allows an understanding not only of individual care needs, but of the political, economic and social context in which they are situated, including social protections and public safety nets. The findings suggest that distant family relationships and limited access to formal social protection can both create and exacerbate precarity. These older migrants therefore develop different strategies to access care that include drawing on informal relationships and voluntary organisations within the British community in Spain. The paper contributes to understanding how international retirement migrants manage their care needs, and theoretically extends our understanding of how the intersection of old age, migration and care can create new forms of precarity. [ABSTRACT FROM AUTHOR]

Decision-making capacity (DMC) among psychiatric inpatients is a pivotal clinical concern. A review by Okai et al. (2007) suggested that most psychiatric inpatients have DMC for treatment, and its assessment is reliable. Nevertheless, the high heterogeneity and mixed results from other studies mean there is considerable uncertainty around this topic. This study aimed to update Okai's research by conducting a systematic review with meta-analysis to address heterogeneity. We performed a systematic search across four databases, yielding 5351 results. We extracted data from 20 eligible studies on adult psychiatric inpatients, covering DMC assessments from 2006 to May 2022. A meta-analysis was conducted on 11 papers, and a quality assessment was performed. The study protocol was registered on PROSPERO (ID: CRD42022330074). The proportion of patients with DMC for treatment varied widely based on treatment setting, the specific decision and assessment methods. Reliable capacity assessment was feasible. The Mini-Mental State Examination (MMSE), Global Assessment of Function (GAF), and Brief Psychiatric Rating Scale (BPRS) predicted clinical judgments of capacity. Schizophrenia and bipolar mania were linked to the highest incapacity rates, while depression and anxiety symptoms were associated with better capacity and insight. Unemployment was the only sociodemographic factor correlated with incapacity. Assessing mental capacity is replicable, with most psychiatric inpatients able to make treatment decisions. However, this capacity varies with admission stage, formal status (involuntary or voluntary), and information provided. The severity of psychopathology is linked to mental capacity, though detailed psychopathological data are limited. [ABSTRACT FROM AUTHOR]

More people are working into older age, raising questions about how many hours they can work before their health becomes compromised. This paper models work-hour tipping points for mental health and vitality among older Australian workers aged 50–70 years. We use longitudinal data from the Household, Income and Labour Dynamics in Australia (HILDA) survey, 2005–2016 (about 44,900 observations), and bootstrapping Three Stage Least Squares (3SLS) estimation techniques to adjust for reverse and reciprocal relationships between wages, work hours and health. Our approach corrects for heteroscedasticity in the system equation error terms, and we estimate models on the relatively healthy older adults who have remained employed into older age. Among these older workers we observe weekly thresholds of 39–40 hours beyond which mental health and vitality decline. This average, however, hides variability in work-hour limits linked to overall health and occupation. Thus, weekly tipping points for blue- and pink-collar jobs are 7–9 hours lower compared to white-collar jobs, and even wider gaps (11 hours) are apparent for workers with poorer physical functioning, which becomes common as people age. Our modelling reveals that age is not the biggest limiting factor for how many hours older adults can work, rather their health and the types of jobs are critical, and likely widen the gap in who ages successfully or not. [ABSTRACT FROM AUTHOR]

Although there has been significant research on the relationship between alcohol consumption and demographic and psychological influences, this does not consider the effect of social influence among older drinkers and if these effects differ between men and women. One aspect of social influence is social capital. The aim of this paper is to examine whether relational and cognitive social capital are associated with higher or lower risk of alcohol use among adults aged 50 years or older and to assess the extent to which this relationship differs between men and women. To investigate this, data were collected from a cross-sectional questionnaire survey of adults over the age of 50 in the United Kingdom who were recruited from general practitioners. The sample consisted of 9,984 individuals whose mean age was 63.87 years. From these data, we developed proxy measures of social capital and associate these with the respondent's level of alcohol consumption as measured on the Alcohol Use Disorders Identification Test (AUDIT-10) scale. In the sample, just over 20 per cent reported an increasing risk or dependency on alcohol. Using two expressions of social capital – relational (social relationships) and cognitive (knowledge acquisition and understanding) – we found that greater levels of both are associated with a reduced risk of higher drinking risk. Being female had no significant effect when combined with relational capital but did have a significant effect when combined with cognitive capital. It is argued that interventions to enhance social relations among older people and education to help understand alcohol risks would be helpful to protect older people from the damaging effects of excessive alcohol consumption. [ABSTRACT FROM AUTHOR]

Little is known about the effects of informal care-giving on employees' absenteeism due to illness. This paper therefore provides a longitudinal analysis of the consequences of taking on informal care-giving for men's and women's working hours and workplace absenteeism due to illness. Data were taken from the Dutch Labour Supply Panel (waves 2004–2018); 495 of the 6,452 male observations in this panel and 696 of the 5,961 female observations had taken on informal care-giving. It was tested whether respondents who became (intensive) informal carers were more likely than respondents who remained non-care-givers to reduce their work hours or stop working between waves t and t1, or to be absent from work due to illness in wave t1. (Multinomial) logistic regression analyses showed that taking on informal care reduced women's working hours when the care they provided was intensive, but not men's. The predicted probability of women reducing their work hours was 12 per cent if they had remained non-care-givers between waves t and t1, 15 per cent if they had started giving non-intensive care and 19 per cent if they had begun providing intensive help. In addition, starting to provide (non-intensive) informal care increased the risk of workplace absenteeism among both women and men. The study highlights the need for workplace policies that prevent female carers from reducing their work hours, and enable male and female carers to continue working in a healthy way. [ABSTRACT FROM AUTHOR]

Inter- and intragenerational relationships are known to be important in maintaining the wellbeing of older people. A key aspect of these relationships is the exchange of both emotional and instrumental social support. However, relatively little is known about how this exchange of support changes in the context of widespread disruption. The COVID-19 pandemic provides an opportunity to examine how older people's family relationships are impacted by such social change. The present qualitative study explores how older people in the United Kingdom experienced changes in inter- and intragenerational support during the COVID-19 pandemic. Participants (N = 33) were recruited through a large-scale nationally representative survey (https://www.sheffield.ac.uk/psychology-consortium-covid19). We asked how life had been pre-pandemic, how they experienced the first national lockdown and what the future might hold in store. The data were analysed using constructivist grounded theory. This paper focuses on the importance of family relationships and how they changed as a consequence of the pandemic. We found that the family support system had been interrupted, that there were changes in the methods of support and that feelings of belonging were challenged. We argue that families were brought into disequilibrium through changes in the exchange of inter- and intragenerational support. The important role of grandchildren for older adults was striking and challenged by the pandemic. The significance of social connectedness and support within the family had not changed during the pandemic, but it could no longer be lived in the same way. The desire to be close to family members and to support them conflicted with the risk of pandemic infection. Our study found support for the COVID-19 Social Connectivity Paradox: the need for social connectedness whilst maintaining social distance. This challenged family equilibrium, wellbeing and quality of life in older people. [ABSTRACT FROM AUTHOR]

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]

Adult children with siblings can share caring for older parents but adult only children face this responsibility alone. Given increased longevity and reliance on informal care-giving, as well as an increase in one-child families, there is a need to investigate only children's care-giving further. Using data from three large-scale British birth cohorts, this paper investigates patterns of parent-care, care intensity and wellbeing at ages 38 and 42 (N = 17,255, N = 16,703; born 1970), 50 and 55 (N = 12,775, N = 11,339; born 1958) and 63 (N = 2,364; born 1946), how sibling composition intersects with gender in relation to care-giving and whether different care-giving patterns are associated with wellbeing. Only children are more likely to provide parent-care and the pattern is consistent with an interpretation that differences by sibling status might increase with age. Provision is gendered, and the sibling group composition matters for involvement. Although care-giving is related to wellbeing, we found no evidence that this differs between only children and those with siblings. The literature on only children has hitherto focused largely on childhood, suggesting that on some outcomes they benefit from a concentration of parental resources. Our results suggest that in middle adulthood parental care needs may instead be concentrated for the only child without the 'resource' of siblings. This indicates a need to develop further our understanding of this growing demographic subgroup. [ABSTRACT FROM AUTHOR]

Many countries have implemented policies to extend working lives in response to population ageing, yet there remains little understanding of what drives paid work in later life, nor how this is changing over time. This paper utilises the 1988/89 Survey of Retirement and Retirement Plans, the 1999 British Household Panel Survey and the 2008 English Longitudinal Study of Ageing, to investigate drivers of paid work in the ten years surrounding state pension age (SPA) for women and men in, comparing cohorts born in the 1920s, 1930s and 1940s. Using optimal matching analysis with logistic and multinomial regression models, the study assesses the relative importance of lifecourse histories, socio-economic circumstances and contemporaneous factors, in determining paid work in mid- and later life. Participation in paid work in the five years preceding and beyond SPA increased markedly for men and women across cohorts, with women's lifecourses and engagement with paid work changing considerably in these periods. However, for women, a lifetime history of paid work remained a crucially important predictor of paid work in later life, and this relationship has strengthened over time. Experiencing divorce has also become an important driver of paid work around SPA for the youngest cohort. Having children later, and still having a mortgage, also independently predict labour force participation for women and men. Across all cohorts and for women and men, working at these older ages was a function of higher income and better health. These findings suggest that policies which enable people to maintain ties to paid work across the lifecourse may be more effective at encouraging later-life employment than those concerned only with postponing the retirement transition. [ABSTRACT FROM AUTHOR]

The number of dependent older people in England, as elsewhere, is projected to rise substantially, while the number of unpaid carers is not projected to rise by an equivalent amount. Barriers to people caring for older relatives have been theorised, however, there is a lack of understanding of attitudes to providing care in the future among people who are not currently carers. This paper presents qualitative analysis of interviews with 20 people in middle age about their willingness to care for older relatives in the future. Interviewees were asked their general views about who should provide care, then to consider future scenarios in which a close relative developed care needs. Willingness to care was influenced by beliefs about reciprocity, love and identity, beliefs about who was likely to provide the best quality and most appropriate care, and beliefs about how difficult caring would be. Older relatives' care preferences were a key consideration. While some interviewees felt the best care would always be provided by family, others considered that professional skills were needed. Interviewees saw important roles for easily accessible information and advice, sharing care, including respite care, and financial support, in making it easier to provide care. The COVID-19 pandemic and lockdown had highlighted relevant issues for interviewees, which are discussed. [ABSTRACT FROM AUTHOR]

This paper investigates the comprehension of long and short passives in 15 Mandarin preschool children with Developmental Language Disorder (DLD) (aged 4;2–5;11 years), 15 Typically Developing Age-matched (TDA) (aged 4;3–5;8 years) children, and 15 Typically Developing Younger (TDY) (aged 3;2–4;3 years) children by using the picture-sentence matching task. The results reveal that children with DLD encounter more difficulty comprehending long passives compared with short passive, that they perform worse on the comprehension task than TDA children and TDY children, and that this population is more likely to commit thematic role reversal errors and point to pictures with the incorrect agent (patient) than typically developing children. Given that Mandarin passives are Topic Structures, we maintain that children with DLD are insensitive to the edge feature of the moved element in long passives, leading to Relativized Minimality effect and causing the asymmetry between the comprehension of long and short passives. These results align well with the Edge Feature Underspecification Hypothesis. Errors found in the children with DLD in the comprehension task point toward impaired syntactic knowledge and the lexical semantic deficit. [ABSTRACT FROM AUTHOR]

This article investigates the impact of NPM reforms on two prominent welfare state professions; medical doctors and teachers. The case study context is Sweden, where the impact of NPM led to a series of reforms in health care and education after 1990. The focus in the paper is on professional autonomy, which can be seen as a core trait in professional work. The findings in the article point to both medical doctors and teachers having lost professional autonomy as a result of NPM-reforms, particularly with regards to the dimensions of work organization and evaluation. Autonomy in individual decision-making seems to have been least affected, even if there are indications of this being infringed upon as well. Despite these broad similarities, the loss of autonomy is found to be more pronounced in the case of teachers. One reason behind this difference, which manifests itself in teachers having become subject to higher level of direct administrative control by school managers while at the same time experiencing a more distinct loss of autonomy to evaluate their work, appears to be that medical doctors have been more successful in establishing themselves as experts in relation to new public audit agencies. [ABSTRACT FROM AUTHOR]

Background: There is growing evidence to support the use of the psychedelic drug psilocybin for difficult-to-treat depression. This paper compares the cost-effectiveness of psilocybin-assisted psychotherapy (PAP) with conventional medication, cognitive behavioural therapy (CBT), and the combination of conventional medication and CBT. Methods: A decision model simulated patient events (response, remission, and relapse) following treatment. Data on probabilities, costs and quality-adjusted life years (QALYs) were derived from previous studies or from best estimates. Expected healthcare and societal costs and QALYs over a 6-month time period were calculated. Sensitivity analyses were used to address uncertainty in parameter estimates. Results: The expected healthcare cost of PAP varied from £6132 to £7652 depending on the price of psilocybin. This compares to £3528 for conventional medication alone, £4250 for CBT alone, and £4197 for their combination. QALYs were highest for psilocybin (0.310), followed by CBT alone (0.283), conventional medication alone (0.278), and their combination (0.287). Psilocybin was shown to be cost-effective compared to the other therapies when the cost of therapist support was reduced by 50% and the psilocybin price was reduced from its initial value to £400 to £800 per person. From a societal perspective, psilocybin had improved cost-effectiveness compared to a healthcare perspective. Conclusions: Psilocybin has the potential to be a cost-effective therapy for severe depression. This depends on the level of psychological support that is given to patients receiving psilocybin and the price of the drug itself. Further data on long-term outcomes are required to improve the evidence base. [ABSTRACT FROM AUTHOR]

Research shows that older people tend to not only be underrepresented on television (TV), but also to be represented within a number of fixed types. These correspond to cultural myths about ageing, which emphasise vulnerability and decline but also increasingly stress the individual's responsibility for successful ageing. This paper analyses the representation of older people on Flemish public TV, using qualitative content analysis to identify patterns of representation in a sample of 44 programmes broadcast in 2019 and 2020, including the first months of the COVID-19 pandemic. To complement our own analysis, we also interviewed eight experts on ageing. Our research shows that representations of older people on Flemish public TV tend to gravitate towards two types related to different age groups: vulnerable and passive old-old people (over 80 years old), particularly those in nursing homes who feature prominently in reporting on the COVID-19 pandemic; and dynamic and active young-old people (65–80 years old), connected to the ideals of successful ageing. The two predominant types correspond to cultural myths about ageing and are also connected to recurrent themes: sexual intimacy, loneliness and death. Our research highlights the need for a more diverse representation, reflecting the variety of individual life conditions and the functional age of older people. [ABSTRACT FROM AUTHOR]

This paper adds to the literature by identifying the effect of home ownership on rural-to-urban older migrants' labour market participation in China. Using the 2016 wave of the China Migrants Dynamic Survey, we find that older migrants who do not own houses are more likely to participate in the labour market than home owners. To alleviate endogeneity caused by the potential sample selection problem, the propensity score matching method is employed. Our results imply that home ownership can be used as a type of precautionary/retirement savings for older migrants, especially for the ones lacking in financial security. We also show that older migrants owning houses with a higher level of liquidity are less likely to participate in the labour market. It indicates that liquidity may significantly affect the effectiveness for older migrants to use home ownership as precautionary/retirement savings. [ABSTRACT FROM AUTHOR]

Although the active ageing concept generally has positive connotations, with expected benefits at the micro, meso and macro levels, the application of this concept in terms of policy making presents challenges and risks to be avoided (for instance, a predominantly productivist interpretation and a top-down imposition with limited possibilities for bottom-up exchanges; or a disregard for the risk of excluding older people with more disadvantaged backgrounds). Two crucial strategies to minimise risks are the implementation of policies by considering and respecting territorial diversity, and the involvement of all the relevant stakeholders in a participatory consultative and co-decisional approach. This paper entwines both strategies together by focusing on Italian in-country differences in terms of active ageing, and employing the Active Ageing Index for policy-making purposes. This activity is part of a governmental national pilot project aimed at promoting multilevel co-managed co-ordination of active ageing policies across Italy. The analysis identified five groups of regions that differ from the classical, geographic and socio-economic division between the North, Centre and South. Additional in-group analyses were conducted to investigate within-cluster differences. This study will inform a large multilevel stakeholder network for evidence-based policies and their monitoring at both the national and regional levels, in line with the perspective of mainstreaming ageing. [ABSTRACT FROM AUTHOR]

As the ageing population in China continues to grow, more people will be living with long-term health conditions and require support from family care-givers. This scoping review therefore aims to explore sources of stress and coping mechanisms adopted by care-givers of older relatives living with long-term conditions in mainland China. Literature searches were conducted in English (CINAHL, EMBASE, MEDLINE, PsycINFO and SCOPUS) and Chinese (CNKI, WANFANG DATA, CQVIP and CBM) databases between October and November 2019. The searches focused on the stressors and coping mechanisms utilised by family care-givers residing in the community. Narrative synthesis was used to identify themes within the data. Forty-six papers were included: 20 papers from English and 26 from Chinese databases. Six themes captured stressors: care-giving time (N = 22), financial resources (N = 17), role and personal strains (N = 42), preparedness (N = 4), social roles (N = 10) and lack of adequate formal support (N = 22); and one theme captured coping (N = 14). Unmet needs of care-givers of older relatives in mainland China were found to be extensive. Only a few studies had attempted to explore the causal link between stressors, coping and the influence of culture. Findings underscore the significance of adequately capturing intricacies around care-givers' unmet needs, rather than generalising on the basis of culture. Qualitative studies are critical to providing a better understanding of the relationship between stressors, coping and resources afforded to care-givers by their cultural environment. Having such understanding is crucial to inform the development of competent care, which promotes self-efficacy and self-actualisation in care-givers in mainland China. [ABSTRACT FROM AUTHOR]

Background: This paper examined whether distinct life-course trajectories of psychological distress from adolescence to midlife were associated with poorer mental health outcomes during the pandemic. Methods: We present a secondary analysis of two nationally representative British birth cohorts, the 1958 National Child Development Study (NCDS) and 1970 British Cohort Study (BCS70). We used latent variable mixture models to identify pre-pandemic longitudinal trajectories of psychological distress and a modified Poisson model with robust standard errors to estimate associations with psychological distress, life satisfaction and loneliness at different points during the pandemic. Results: Our analysis identified five distinct pre-pandemic trajectories of psychological distress in both cohorts. All trajectories with prior symptoms of psychological distress irrespective of age of onset, severity and chronicity were associated with a greater relative risk of poorer mental health outcomes during the pandemic and the probability of poorer mental health associated with psychological distress trajectories remained fairly constant. The relationship was not fully attenuated when most recent pre-pandemic psychological distress and other midlife factors were controlled for. Conclusions: Whilst life-course trajectories with any prior symptoms of psychological distress put individuals at greater risk of poor mental health outcomes during the pandemic, those with chronic and more recent occurrences were at highest risk. In addition, prior poor mental health during the adult life-course may mean individuals are less resilient to shocks, such as pandemics. Our findings show the importance of considering heterogeneous mental health trajectories across the life-course in the general population in addition to population average trends. [ABSTRACT FROM AUTHOR]

It is estimated that a third of people in the United Kingdom with signs of dementia are living without a formal diagnosis. In Wales, the proportion is nearly half. Some explanations for the gap between prevalence of dementia and number of diagnoses include living with a long-term partner/spouse and systemic barriers to diagnosis. This study recruited participants from the Cognitive Function and Ageing Studies-Wales (CFAS-Wales) cohort, randomly selected from people aged over 65 living in two areas of Wales, who met study criteria for a diagnosis of dementia and did not have a record of a formal diagnosis in general practice records. We aimed to understand more about the contexts and circumstances of people who live with and cope with cognitive difficulties without having a formal diagnosis of dementia. We conducted qualitative interviews with six participants and their spouses, and additionally with four family members of three invited people who were unable to take part. Themes were generated using thematic analysis. We present the argument that there is an adaptive response to low service levels and a complex interaction between the expectations of levels of service, perceptions of the legitimacy of cognitive problems and the right to make demands on services. This paper concludes that more could be done to address barriers to diagnosis and treatment services for those living with symptoms of dementia, but that the value placed on diagnosis by some individuals might be lower than anticipated by government policy. [ABSTRACT FROM AUTHOR]

Policy responses to population ageing have focused on lengthening working lives, overlooking inequalities in older adults' participation in unpaid activities. This paper examines participation in paid and unpaid activities between the ages of 55 and 70 to answer two questions: how do people navigate pathways of paid work, informal care, volunteering, civic participation and housework in mid to later life?; and how do these pathways relate to gender, socio-economic and health inequalities? Two-staged latent class analysis was used to identify activity pathways using data from the British Household Panel Survey (1996–2008). Multinomial logistic models assessed associations between latent pathways and socio-demographic and health characteristics. Three pathways were observed: full-time work to low activity (49%), part-time and in-home work (34%) and multiple activities (16%). Aside from retirement from full-time work, the pathways of participation in paid and unpaid activities were characterised by continuity; substitution between different forms of paid and unpaid work was not observed. Participation in multiple paid and unpaid activities was more common for respondents in better health and of higher socio-economic status. Since the promotion of paid work and volunteering in later life may mainly benefit individuals in advantaged circumstances, policies should avoid taking a blanket approach to encouraging participation in multiple activities, a key component of active ageing. [ABSTRACT FROM AUTHOR]

The primary aim of this scoping review was to explore the contribution of housing adaptations to supporting everyday life for people with dementia living at home in the community. The study adopted a scoping review methodology which was guided by the Joanna Briggs Institute Reviewers Manual. Four review questions were developed which subsequently informed the inclusion criteria and search terms. Eight databases were searched resulting in 2,339 records, with 13 papers being included in the review. Evidence from the review found that the most common adaptations were recommended and/or implemented to compensate for a person's physical limitations and for safety reasons, rather than adaptations to support activities of daily living for a person with dementia. Support to implement adaptations was provided by a range of professionals coupled with 'trial and error' approaches adopted by the person themselves, and these were seen as key enablers. Barriers to implementing and using adaptations were fourfold: (a) access to information, (b) knowing when to make changes, (c) carer resistance, and (d) the unsuitability of the home. It would appear that housing adaptations have a positive impact on both the person with dementia and the carer (where one is present), with some adaptations having a relatively sustained impact and being particularly effective if implemented early in the lived trajectory of dementia. [ABSTRACT FROM AUTHOR]

Ethnic inequalities in health and wellbeing across the early and mid-lifecourse have been well-documented in the United Kingdom. What is less known is the prevalence and persistence of ethnic inequalities in health in later life. There is a large empirical gap focusing on older ethnic minority people in ethnicity and ageing research. In this paper, we take a novel approach to address data limitations by harmonising six nationally representative social survey datasets that span more than two decades. We investigate ethnic inequalities in health in later life, and we examine the effects of socio-economic position and racial discrimination in explaining health inequalities. The central finding is the persistence of stark and significant ethnic inequalities in limiting long-term illness and self-rated health between 1993 and 2017. These inequalities tend to be greater in older ages, and are partially explained by contemporaneous measures of socio-economic position, racism, and discrimination. Future data collection endeavours must better represent older ethnic minority populations and enable more detailed analyses of the accumulation of socio-economic disadvantage and exposure to racism over the lifecourse, and its effects on poorer health outcomes in later life. [ABSTRACT FROM AUTHOR]

Background: The purpose of this paper is to identify the trajectory of conduct and emotional problems for young people within the general population at four time points (between 9 years 7 months and 16 years 6 months), investigate their relationship with hyperactive/inattentive traits and explore the moderating effect of autistic social traits (ASTs). Methods: Data from 9305 individuals involved in The Avon Longitudinal Study of Parents and Children (ALSPAC) study were included. Conduct and emotional problems and hyperactive/inattentive traits were measured by the Strengths and Difficulties Questionnaire. ASTs were assessed using the Social Communication Disorder Checklist. Individual trajectories for conduct and emotional problems were identified via growth curve modelling. Hyperactive/inattentive traits were included within the growth curve model as a time-varying covariate to determine their effect on these outcomes. Finally, participants were split into two groups (below and above clinical threshold ASTs Groups) and multi-group invariance testing was conducted on the data to identify the moderating effect of ASTs on the relationship between hyperactive/inattentive traits and outcomes (i.e. conduct and emotional problems). Results: Hyperactive/inattentive traits were associated with higher rates of conduct and emotional problems for both boys and girls. The presence of ASTs moderated these relationships for boys, but not for girls, by increasing the risk of boys with hyperactive/inattentive traits developing greater conduct and emotional problems. Conclusions: These findings underscore the importance of identifying hyperactive/inattentive traits and ASTs in young people and addressing the increased risk of conduct and emotional problems. Research and clinical implications are explored. [ABSTRACT FROM AUTHOR]

Across the world acute hospitals are under unprecedented pressures due to shrinking budgets and increasing demand, against this backdrop they are also experiencing record levels of activity in Accident & Emergency and delayed transfers of care. Reducing pressure on hospitals by avoiding unnecessary admissions and delayed discharges has risen up the global policy agenda. However, reviews of strategies and policies have rarely involved discussions about the role that hospital social workers play in achieving timely hospital discharge. Yet discharge planning has become a, if not the, central function of these professionals. This paper presents the results of a small-scale exploratory study of hospital social work in an acute hospital in Northern Ireland. The findings reveal that the work of hospital social workers is characterised by increased bureaucracy, an emphasis on targets and a decrease in the time afforded to forming relationships with older people. Hospital social workers highlight concerns that the emphasis on discharge planning and pressures associated with the austerity agenda limits their capacity to provide other more traditional roles such as advocacy and counselling. It is argued that hospital social work should not be narrowly defined as 'simply' co-ordinating discharge plans. The tension that arises between expediting hospital discharge and advocating for older people and their families is also discussed. [ABSTRACT FROM AUTHOR]

This paper examines the associations between social participation and individual life satisfaction among older adults. It specifically considers the diversity of the practices and social inequalities among this population. For analyses, we used a large survey of individuals of 65 years and older conducted in 2011 in Switzerland (N = 2,727). The first set of linear regression analyses examines Diener's Satisfaction with Life Scale and its association with various indicators of social participation. While the second set of logistic regression addresses the issue of social inequalities by evaluating the impacts of gender, age group, region and education on social participation indicators that are significantly associated with the satisfaction with life score. Our results stressed the importance of combining multiple forms of participation for life satisfaction and shows that some forms are particularly meaningful: in particular, the involvement in associations, visitation of family or visitation of friends/acquaintances and church attendance. When inequalities among older adults are considered, having rich and varied social participation, being involved in associations and maintaining private sociability with non-kin appear more elitist. While institutionalised and/or private sociability types of participation appear particularly significant for older adults' life satisfaction, the most traditional integration forms – i.e. family and religions – are crucial for the more vulnerable. Implications for active ageing was equally discussed as well. [ABSTRACT FROM AUTHOR]

Background: In 1942, Shaw and McKay reported that disadvantaged neighborhoods predict youth psychopathology (Shaw & McKay, 1942). In the decades since, dozens of papers have confirmed and extended these early results, convincingly demonstrating that disadvantaged neighborhood contexts predict elevated rates of both internalizing and externalizing disorders across childhood and adolescence. It is unclear, however, how neighborhood disadvantage increases psychopathology. Methods: Our study sought to fill this gap in the literature by examining the Area Deprivation Index (ADI), a composite measure of Census tract disadvantage, as an etiologic moderator of several common forms of psychopathology in two samples of school-aged twins from the Michigan State University Twin Registry (N = 4815 and 1030 twin pairs, respectively), the latter of which was enriched for neighborhood disadvantage. Results: Across both samples, genetic influences on attention-deficit hyperactivity problems were accentuated in the presence of marked disadvantage, while nonshared environmental contributions to callous-unemotional traits increased with increasing disadvantage. However, neighborhood disadvantage had little moderating effect on the etiology of depression, anxiety, or somatic symptoms. Conclusions: Such findings suggest that, although neighborhood disadvantage does appear to serve as a general etiologic moderator of many (but not all) forms of psychopathology, this etiologic moderation is phenotype-specific. [ABSTRACT FROM AUTHOR]

Home equity represents a substantial share of retirement wealth for many older persons, particularly in Asia where national housing policies have encouraged home-ownership. This paper explored the potential for reverse mortgages to help 'asset-rich and cash-poor' older Singaporeans unlock their home equity while ageing in place. The empirical analysis was based on a nationally representative survey of home-owners age 50+ in the 2018 Singapore Life Panel (N = 6,258). Our analyses showed that the average older home-owner holds some 60 per cent of total net wealth in housing equity, suggestive of high demand potential for reverse mortgage products. Nevertheless, actual interest in such products was much below potential demand. Only one in four older home-owners indicated interest in commercial reverse mortgages if these were to become available; a larger majority had never heard of the financial product. Interest in reverse mortgages was positively associated with product awareness and self-rated product understanding. This implies that a critical step towards building consumer interest would be to enhance awareness of such products and simplify related contract terms. Having a mortgage, fewer children, financial literacy and preparedness for retirement were also positively associated with interest level. These results have implications for targeted interventions to enhance consumer awareness and spur interest in reverse mortgages, especially in ageing societies where older people have built up substantial equity through the housing market over time. [ABSTRACT FROM AUTHOR]

Emerging research has outlined the possibility for virtual reality (VR) experiences, which situate users into the perspective of someone living with dementia, to enhance dementia awareness. Currently, there is limited VR research that engages care home practitioners. It is imperative this population has high levels of dementia education given their requirements to provide care and support to residents, many of whom will be living with the condition. This paper reports on an exploratory qualitative study designed to elicit the experiences of care home practitioners who engaged with the VR application: 'A walk through dementia'. Twenty practitioners, across four care homes in the United Kingdom, watched the VR scenarios and provided their views on the experience and the potential for the VR tool to be developed into a wider training programme to support dementia awareness. Data were collected via focus group discussions. Following an inductive thematic analysis, we constructed three themes. These suggested participants perceived the VR application offered them a convincing and immersive experience that was insightful and evocative , and provided 'next-level' dementia-awareness training that enabled them to reflect on care practices. Although the findings highlight important challenges for practitioners and developers wishing to use VR within dementia care, they suggest this application may be an engaging experiential learning tool that can provide care home staff with deeper cognitive and emotional awareness of living with dementia. Further work, drawing on these preliminary insights, is required to ensure the VR tool can be incorporated into a training programme that can positively contribute to the 'dementia-friendly communities' agenda. [ABSTRACT FROM AUTHOR]

Background: Contrasting the well-described effects of early intervention (EI) services for youth-onset psychosis, the potential benefits of the intervention for adult-onset psychosis are uncertain. This paper aims to examine the effectiveness of EI on functioning and symptomatic improvement in adult-onset psychosis, and the optimal duration of the intervention. Methods: 360 psychosis patients aged 26–55 years were randomized to receive either standard care (SC, n = 120), or case management for two (2-year EI, n = 120) or 4 years (4-year EI, n = 120) in a 4-year rater-masked, parallel-group, superiority, randomized controlled trial of treatment effectiveness (Clinicaltrials.gov: NCT00919620). Primary (i.e. social and occupational functioning) and secondary outcomes (i.e. positive and negative symptoms, and quality of life) were assessed at baseline, 6-month, and yearly for 4 years. Results: Compared with SC, patients with 4-year EI had better Role Functioning Scale (RFS) immediate [interaction estimate = 0.008, 95% confidence interval (CI) = 0.001–0.014, p = 0.02] and extended social network (interaction estimate = 0.011, 95% CI = 0.004–0.018, p = 0.003) scores. Specifically, these improvements were observed in the first 2 years. Compared with the 2-year EI group, the 4-year EI group had better RFS total (p = 0.01), immediate (p = 0.01), and extended social network (p = 0.05) scores at the fourth year. Meanwhile, the 4-year (p = 0.02) and 2-year EI (p = 0.004) group had less severe symptoms than the SC group at the first year. Conclusions: Specialized EI treatment for psychosis patients aged 26–55 should be provided for at least the initial 2 years of illness. Further treatment up to 4 years confers little benefits in this age range over the course of the study. [ABSTRACT FROM AUTHOR]

The concept of dignity is core to community district nursing practice, yet it is profoundly complex with multiple meanings and interpretations. Dignity does not exist absolutely, but, rather, becomes socially (de)constructed through and within social interactions between nurses and older adult patients in relational aspects of care. It is a concept, however, which has, to date, received little attention in the context of the community nursing care of older adults. Previous research into dignity in health care has often focused on care within institutional environments, very little, however, explores the variety of ways in which dignity is operationalised in community settings where district nursing care is conducted 'behind closed doors', largely free from the external gaze. This means dignity (or the lack of it) may go unobserved in community settings. Drawing on observational and interview data, this paper highlights the significance of dignity for older adults receiving nursing care in their own homes. We will demonstrate, in particular, how dignity manifests within the relational aspects of district nursing care delivery and how tasks involving bodywork can be critical to the ways in which dignity is both promoted and undermined. We will further highlight how micro-articulations in caring relationships fundamentally shape the 'dignity encounter' through a consideration of the routine and, arguably, mundane aspects of community district nursing care in the home. [ABSTRACT FROM AUTHOR]

Many countries have taken steps to address employment insecurity by enacting employment protection legislation (EPL) for non-regular workers. Although the aggregate impacts of EPL reforms have been examined in the literature, less attention has been paid to the heterogeneous ways that different types of employers respond to these reforms. In this paper, we seek to shed additional light on the impact of non-regular workforce protections by investigating the response of establishments to legal changes in Korea in 2007. We employ a difference-in-difference framework to explore which establishment characteristics predict that employers will convert non-regular workers to regular status. Results indicate that, in the short term, the Korean labor reforms led to increased conversions of fixed-term workers to permanent status. Establishments that have shifted risk onto workers via the use of performance pay are more likely to extend permanent status to non-regular workers. However, establishments that provide favorable employment conditions were less likely to convert. Unions play a double-edged role. Unions in large establishments with a wide range of occupational categories are associated with relatively greater conversion of outsiders to regular status, while unions in smaller, more resource-constrained establishments with a narrower occupational focus are associated with more exclusionary behavior. [ABSTRACT FROM AUTHOR]

Previous studies have shown that family networks evolve over time. Nonetheless, little research has linked family expansion or shrinking to the levels of available family-based social capital in older adults' family networks. To address this research gap, this paper explores the following question: to what extent are changes in family composition and family-related life events associated with current levels of family-based social capital in later years? We use the two waves of the longitudinal CIGEV-LIVES Vivre-Leben-Vivere study, a large survey addressing the family and health conditions of older people in Switzerland. We combine data on life events occurring during old age and family configurations. We find that family networks are indeed highly dynamic, with distinct patterns of losses and gains observed among respondents. Adding and omitting significant family members has distinct significant effects on social capital, while family-related life events only have marginal effects. [ABSTRACT FROM AUTHOR]

Analysis of intergenerational contact and solidarity patterns has generally focused on the family. However, the unprecedented co-existence of a high number of different generations raises the challenge to delve into how such patterns may develop inside and outside the family. To understand better intrafamilial and extrafamilial intergenerational contact and solidarity in Spain, three national surveys were initially studied using cross-tabulation tables and measures of association. Then, factor analysis and logistic regression of most recent data focused on explanatory variables behind two dimensions of intergenerational solidarity. Regarding intergenerational co-residence, the results point to a highly relevant difference between intrafamilial and extrafamilial habits. As regards regular, but non-residential, contact between the generations, two gaps have been identified. The first gap appears between family practices and non-family practices, with a significant and progressive reduction of the latter being detected. According to the second gap, while intergenerational contact drops outside the family, levels of intragenerational contact are comparable in both settings. In this context, patterns of associational and functional intergenerational solidarity towards older relatives and non-relatives have been identified, with age, distance, civil status and especially gender being the key explanatory variables. The paper argues that there is good reason to pay combined attention to both intrafamilial and extrafamilial forms of intergenerational contact and solidarity, something that has been done very little to date. [ABSTRACT FROM AUTHOR]