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Background Given the globally ageing population, care homes have an important role in delivering palliative and end-of-life care. Advance care planning (ACP) is promoted to improve the quality of end-of-life care in this setting. While many professionals can be involved in ACP, little is known about what influences multi-professional involvement and how multi-professional working impacts the ACP process in the UK. This study investigated multi-professional practice in relation to ACP in nursing homes. Design and methods An ethnography was undertaken in two UK nursing homes using multiple methods of data collection: observations, interviews and document review. Participants included the following: nursing home residents (n  = 6), relatives (n  = 4), nursing home staff (n  = 19), and visiting health and social care professionals (n  = 7). Analysis integrated thematic analysis, mapping of resident ACP trajectories and documentary analysis. Findings This paper suggests that multi-professional and relatives' involvement in ACP was disjointed. Continuity and coordination were disrupted by misalignment of visiting professional and nursing home organisational structures. Findings show a 'knotworking' approach to teamwork and power imbalance between nursing home staff and visiting professionals, such as general practitioners. While residents wished their relatives to be involved in their ACP, this was not formally recognised, and limited support existed to facilitate their involvement. Conclusion The structure and organisation of multi-professional and relatives' involvement in ACP led to fragmentation of the process. This marginalised the voice of both the resident and nursing home staff, thereby limiting ACP as a tool to enhance quality of end-of-life care. [ABSTRACT FROM AUTHOR]

This paper reports on an innovative interprofessional education (IPE) initiative conducted in three care homes across Greater Manchester in the United Kingdom (UK). Students from a variety of professions including nursing, physiotherapy, social work, podiatry, counseling, and sports rehabilitation worked collaboratively in the homes to address the residents' individual goals. We found that care homes provided students with many opportunities for interprofessional working and learning. Through better understanding the dimensions of different perspectives and approaches, students improved their education and transformed their perceptions of aged care. Having a diverse range of professionals allowed staff to gain insight into the latest evidence-based practice and address the multiple needs of the residents more holistically. Residents gained an enriched sense of meaning and purpose in their daily life by engaging in fulfilling and meaningful activities. The complexities of undertaking an IPE initiative in this setting are also considered and we conclude by proposing important avenues for future research. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to report on a scoping review of the advantages and challenges of extra care housing (ECH) provision in the UK for people living with dementia. Access to suitable housing is a fundamental right for people living with dementia and can enable people to live as well as possible (Twyford and Porteus, 2021). Understanding the advantages and disadvantages of different models of housing with care has been identified as a research priority by people living with dementia (Barrett et al., 2016) but "there is no current consensus on the best model of specialist housing for people with dementia" (Twyford and Porteus, 2021, p. 29). Design/methodology/approach: This scoping review identifies the advantages and disadvantages of living in ECH for people with dementia. It is the preliminary stage of a study that seeks to develop knowledge about different models of ECH for people living with dementia (Atkinson et al., 2021). Findings: Advantages include the promotion of independence, flexible staffing, safety and security, social inclusion, physical design and integrated service provision. Disadvantages include barriers to entry, tensions between independence and support, managing advanced dementia, resourcing flexible care, managing social exclusion, loneliness and stigma and a disabling environment. Research limitations/implications: The scoping review reinforces the need for further research into different models of ECH provision in the UK for people living with dementia. The review provides insight that is of benefit to all stakeholders involved in ECH and contributes to the development of evidence-based provision called for in the recent All Party Parliamentary Group inquiry (Twyford and Porteus, 2021). Originality/value: This scoping review summarises the current position for people living with dementia in ECH. [ABSTRACT FROM AUTHOR]

Increasing longevity has led to a rising number of adult children who are at higher ages when they provide care for their parents. Drawing on the lifecourse approach and exchange theory, the paper addresses similarities and differences in parent care between late middle-aged and older adult children. The study uses the UK Household Longitudinal Study, restricting the analysis sample to individuals aged 50 and older with a living parent or parent-in-law. It presents multivariate models to examine differences between late middle-aged (aged 50–64) and older (aged 65+) children in being a parent carer, providing intensive care, the duration of parent care and providing selected types of help to parents. The involvement in parent care increases among women up to the end of their seventh decade of life and for men up to their eighth decade of life. At higher ages, the proportion of parent carers decreases more strongly for women than men. Older carers have shorter care-giving episodes than younger carers, but there is no significant difference in the type of care provided. Even past retirement age, parent care remains classed and gendered, with women from lower social classes having the highest likelihood of providing intensive parent care in old age. Having dependent children or living in a non-marital union depress the likelihood of caring for a parent even past retirement age. [ABSTRACT FROM AUTHOR]

Despite the growth of cultural gerontology this century, relatively few gerontologists have interrogated their own experiences of ageing through a critical reflexive lens. This paper seeks to address this lack of attention by discussing some findings of the Ageing of British Gerontology project: a two-year (2015–2017) Leverhulme-funded study focused on identifying key developments and changes in gerontological research, theory, policy and practice in Britain since the founding of the British Society of Social and Behavioural Gerontology (now the British Society of Gerontology) in 1971. As part of our mixed-method study, we undertook 50 in-depth biographical interviews with 'senior' or retired individuals who have played a key role in the creation and development of gerontology in Britain. As well as focusing more widely on gerontological developments, we asked participants about the relationship between their professional insights into ageing and their personal experiences of ageing – both their own and that of loved ones. In this paper, we discuss the findings in relation to five key themes: health, illness and mortality; close personal relationships; work relationships; challenging ageism; and ageing selves. We found evidence that participants often drew upon their personal experiences of ageing in a range of contexts, including teaching and research. There were also numerous examples of professional insights informing personal decision-making, especially in relation to care of loved ones, though the emotionally challenging aspects of this emphasised the limitations of professional insights. Ultimately, we argue that the distinction between the personal and the professional is something of a false dichotomy, and there is often a complex interplay between the two aspects. [ABSTRACT FROM AUTHOR]

Extra-care housing (ECH) has been hailed as a potential solution to some of the problems associated with traditional forms of social care, since it allows older people to live independently, while also having access to care and support if required. However, little longitudinal research has focused on the experiences of residents living in ECH, particularly in recent years. This paper reports on a longitudinal study of four ECH schemes in the United Kingdom. Older residents living in ECH were interviewed four times over a two-year period to examine how changes in their care needs were encountered and negotiated by care workers, managers and residents themselves. This paper focuses on how residents managed their own changing care needs within the context of ECH. Drawing upon theories of the third and fourth age, the paper makes two arguments. First, that transitions across the boundary between the third and fourth age are not always straightforward or irreversible and, moreover, can sometimes be resisted, planned-for and managed by older people. Second, that operational practices within ECH schemes can function to facilitate or impede residents' attempts to manage this boundary. [ABSTRACT FROM AUTHOR]

Tensions between religious freedoms and lesbian, gay, bisexual, trans and queer (LGBTQ) rights have evolved from debates about sinful deviance to competing equality claims. There is a growing debate, originally in the US, but emerging in the UK, about whether religious social workers, particularly those holding fundamentalist Christian beliefs, can deliver affirmative, anti-oppressive services to LGBTQ people. This is important because over two-fifths of social workers identify as Christian and almost a quarter of UK charities, including those running community and residential care services for older people, are religious organisations. These concerns have been highlighted in a recent judicial review involving a social work student, Felix Ngole, who was expelled by the University of Sheffield for making homophobic comments on his Facebook page. The Court of Appeal ruled the University's decision was procedurally flawed and had conflated religious prejudice with discrimination. This paper considers 70 online responses to a Community Care article written by Ngole, which highlight divided opinions within the social work profession. It critically interrogates, within regulatory contexts, whether it is possible to be both deeply opposed to LGBTQ people's lives and yet work affirmatively and anti-oppressively with them. An urgent research agenda is proposed. [ABSTRACT FROM AUTHOR]

The care of older people is being radically reformulated by placing the individual at the centre of care process through the introduction of individual care plans. This marks a significant transition for the care of older people away from acute responsive clinical care towards a greater emphasis on co‐produced preventative health and social care and relations of care "with" older people. Geographies of volunteerism are yet to consider the effect of co‐production as a dominant rhetoric in UK health and social care. In this paper we show that the Health and Social Care Act (2012) and the Care Act (2014) has the potential to fundamentally alter discourses of care by introducing new spatialities to older people's care. New spatialities of care will not only rely on the reciprocity and interdependence of care between individuals and organisations but also the mobilisation of a voluntary care‐force to be attentive to individuals. Spatialising co‐production reveals the institutional and professional boundaries that prevent the type of open partnership that sits at the heart of the rhetoric. Our ethnographic and qualitative methodology was developed to understand how our case study of Living Well (Cornwall, UK), as a philosophy of care, is realised in practice and to consider the main collaborators' views of different methods of co‐production involving volunteers. We discuss two principal spaces of co‐production, highlighting the opportunities provided for, and barriers to, co‐production expressed by volunteers and other partners by attending to the relations of care that are recognised through: (1) formal meetings and coffee mornings, which provide spaces for volunteers to contribute, and (2) multi‐disciplinary team (MDT) meetings, in which volunteers are largely absent. The care of older people is being radically reformulated by placing the individual at the centre of care process through the introduction of individual care plans. In this paper we show that the Health and Social Care Act (2012) and the Care Act (2014) has the potential to fundamentally alter discourses of care by introducing new spatialities to older people's care. Our ethnographic and qualitative methodology was developed to understand how our case study of Living Well (Cornwall, UK), as a philosophy of care, is realised in practice and to consider the main collaborators' views of different methods of co‐production involving volunteers. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to present findings from face-to-face interviews with three former care staff who were proven to have abused some of the older people living in the care and nursing homes in which they had once worked. The research sought to explore the intra-personal dynamics, personal characteristics and work experiences that led these staff to perpetrate abuse. Design/methodology/approach: Semi-structured interviews were undertaken with three former care and nursing home staff who had committed abusive acts and the data secured subjected to thematic narrative analysis. Findings: None of the three people interviewed had intended to become care staff and reported that the interview and induction processes they experienced did little to establish their suitability for the work they would be undertaking or to prepare them for its demands. Participants expressed their generally negative perceptions of older people, particularly those living with dementia, and told of how they also felt that they were under pressure to conform with the often abusive care home regimes that they had entered. They also recounted some specific abusive practices developed to allow them to manage the constant tension between the time available to complete all of the tasks required when "caring" for older people, and revealed their perceptions of external scrutiny of care home conduct and the behaviours developed to deflect the effectiveness of this oversight. Two interview participants also revealed their unfavourable attitudes to some of the people they were employed to care for that were based upon perceptions of ethnic differences, and of how this had contributed to the abuse they perpetrated. Research limitations/implications: Though the research draws upon the experiences of only three former care staff, the data reveal some of the intra-personal dimensions of individual staff who have engaged in abusive acts, and illuminates how the care home environment with which they interact can engender conditions under which abuse is more likely to occur. Originality/value: Unusually, the paper explores the characteristics, perceptions and experiences of care staff who have actually committed abusive acts against those entrusted to their care. [ABSTRACT FROM AUTHOR]

Purpose In most European countries there is a range of quality control system mechanisms, however, poor quality and institutional violence can be found in the residential sector. Taking Portugal as an example of a country that uses an inspection-only approach, this paper focuses on the monitoring system for controlling the quality of care in nursing homes. The purpose of this paper is to analyse how mistreatment of older people is identified and dealt with by the national social security services. In particular it looks at what the indicators are with which to assess poor quality care and mistreatment (how it is perceived and defined), which factors affect mistreatment of older people and intervention outputs (i.e. what are the sanctions to prevent and combat this).Design/methodology/approach An exploratory approach was based on a mixed method, using a database of 3,685 complaints reported to the social security inspection services. To understand the context of the complaints and the assessment of institutional violence, focus groups were carried out with inspectors from the National Inspection Service.Findings The focus groups identified severe situations of poor care, mistreatment of older people and loss of human rights and dignity. Some indicators were found in key areas of care and the factors associated with this were based on Kamavarapu's typology (2017): physical conditions of facilities; closed organisational models; difficult working conditions; and perceived concerns of residents. Monitoring and inspection systems are still based on minimum standards focusing on structural and process quality, devoting little attention to the human rights situation of older persons and clinical issues.Research limitations/implications The number of participants in the focus groups was limited in size but the uniqueness of this exploratory method draws a dark picture of non-licensed nursing homes in Portugal.Originality/value An exploratory analysis was useful to identify institutional violence and discuss potential implications, in terms of effectiveness of quality care control, which calls for special attention by policy makers and researchers when monitoring the human rights of older persons. [ABSTRACT FROM AUTHOR]

Asset-based thinking is increasingly prevalent in health policy and is to be found also in discourses on social care. This article explores and critiques the applicability of asset-based approaches to social care for older people, using Carol Bacchi's analytical framework to consider developments in the United Kingdom especially. The problem construction, assumptions and suggested solutions underpinning an asset-based approach are considered in turn. The paper draws two major conclusions. The first is that, while it has potential application to the field, the key assumptions and objectives of the asset-based approach do not hold well for social care and therefore adopting the approach carries risks. The paper concludes, secondly, that an asset-based approach is ‘over-promised’ in the sense of being insufficiently theorised and lacking empirical evidence. A number of suggestions are made for greater critical interrogation, improved empirical evidence and closer scrutiny of the policy ‘solutions’ associated with assets-related thinking. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic and the lockdown measures imposed as a result affected the lives of people in all parts of society across the world. In 2020, during the first UK national lockdown, older adults (aged 70 years and over) were told to 'shield' within their homes, as they were regarded as being at higher risk of serious COVID-19 infection compared to other age groups. This paper explores older adults' experiences of COVID-19 lockdown measures whilst living in housing with care schemes for older people. The purpose is to examine the impact of the lockdown measures on scheme life including social connections amongst residents and their general everyday wellbeing during this time. We present qualitative findings based on interviews with 72 residents who took part in longitudinal and cross-sectional interviews across 26 housing with care schemes. Data were analysed using a thematic framework approach to examine specifically their experiences of living in housing with care schemes during the 2020 UK lockdown. The paper highlights that COVID-19 restrictions had a detrimental impact on the social connections and interactions of older residents living in housing with care schemes, as well as on their feelings of autonomy and independence. Despite this, residents adapted and coped with self-isolation restrictions and sought out positive ways to maintain social contact with others inside and outside to the scheme. We further highlight the tensions that providers of housing for older adults faced in promoting residents' autonomy and connectedness whilst also trying to provide a safe living environment and protect residents from risk of COVID-19 infection. Our findings apply not only to a pandemic situation but to the broader understanding of how housing with care for older adults must navigate between autonomy and support. • COVID-19 lockdowns challenged the independence and autonomy of older residents of housing with care in the UK. • Older adults in housing with care exercised autonomy through employing practices to maintain social connections. • Housing staff bolstered residents' autonomy, facilitated social interactions, and supported residents' wellbeing. • Housing staff faced challenges in maintaining the independent ethos of housing schemes whilst also protecting residents. [ABSTRACT FROM AUTHOR]

Frailty has recently emerged as a dominant concept against a backdrop of media and governmental narratives that frame the growing ageing population as an economic threat to the current configuration of health care in the United Kingdom (UK). Despite frailty's popularity amongst geriatricians and policy makers, the concept faces resistance from other health-care professionals and older people themselves. This paper draws on the Foucauldian idea of biopower; by suggesting that the contemporary emergence and utilisation of frailty represents a biopolitical practice a number or critical observations are made. First, despite biomedical experts acknowledging ambiguities in the definition of frailty, the concept is presented as a truth discourse. This is driven by the ability of frailty measurements to predict risk of costly adverse outcomes; the capability of frailty scores to enumerate complex needs; and the scientific legitimacy frailty affords to geriatric medicine. Consequently, frailty has become pervasive, knowable and measurable. Second, the routine delineation between frail and robust objectifies older people, and can be said to benefit those making the diagnosis over those being labelled frail, with the latter becoming disempowered. Last, studies show that frailty is associated with increasing wealth inequalities in the UK; however, experts' suggested management of frailty shifts the focus of responsibility away from ideologically driven structural inequalities towards the frail older person, attempting to encourage individuals to modify lifestyle choices. This neglects the association between lifestyle opportunities and socio-economic deprivation, and the impact of long-term poverty on health. These observations, set against the contemporary political climate of economic austerity, cuts to public services and rationalisation of health resources, bring the urgency of a critical consideration of frailty to the fore. [ABSTRACT FROM AUTHOR]

This paper explores the challenges that female elder carers in the United Kingdom face in combining paid work with elder care, and the implications of this care for their current and future working lives. In-depth interviews with 11 working women from a large organisation were conducted, and five of the women were re-interviewed after a period of one year to examine any changes in their situation. The interviews revealed the precarious nature of their daily schedules, which required constant effort to maintain, the intrusion of elder care into their working lives, and the impact it had upon their career development and future aspirations. The findings provide insight into the reasons why carers, especially women, are more likely to reduce their working hours, do not take advantage of training opportunities and retire early. The findings are discussed in relation to the expectation of an extended working age and gender equality. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to examine and explicate the concept of poor care by exploring what it is and what contributes to its occurrence in practice with a particular focus on the care of older people.Design/methodology/approach The results of systematically searched published literature were analysed using an inductive, descriptive, thematic approach as part of Rodgers' evolutionary concept analysis method.Findings The concept of poor care is understood in the context of the antecedents of vulnerability, use of healthcare services and interaction with healthcare personnel. Its defining characteristics involve individual's personal traits, interpersonal dynamics, an endangered self, misconceptions or organisational constraints.Research limitations/implications Further research is needed to explore the recognition of poor care and reporting thresholds. In addition, the role of the "zone of tolerance" of expectations in the delivery and receipt of interpersonal care and attention for older people needs to be better understood.Originality/value Understanding the continuum and mapping the structures of poor care in contemporary UK healthcare practice can help sensitise practitioners to the widespread range and potential for instances of poor care. This concept analysis uniquely demonstrates consequences not only for the patient but also for healthcare staff and other individuals. [ABSTRACT FROM AUTHOR]

Recent years have seen a growth in research on retirement/lifestyle migration to Spain, however this has tended to focus on the reasons for moving, as well as the lifestyles adopted as part of a healthy and active retirement. However, ageing in Spain can bring challenges as a person's resources for independent living diminish. This paper draws on narrative interviews with vulnerable older British people in Spain, focusing on those who have encountered a severe decline in health, are frail and in need of care. It looks at the formal and informal networks and agencies that support these individuals, in particular the resources and strategies they employ to access care. Drawing on a framework of care provision developed by Glucksmann and Lyons, four broad modes of provision for old age care used by older British people in Spain are identified: state/public, family/community, voluntary/not-for-profit and market/for-profit. The paper argues that there are language, cultural, spatial and financial barriers when accessing care in Spain as an older British citizen. It is concluded that there are some frail, vulnerable people that may fall through a support gap, whereby they are no longer the responsibility of UK welfare services, yet not fully recognised in their new country of residence, and asks if more should be done to support this population. [ABSTRACT FROM PUBLISHER]

Understanding patterns of intergenerational support is critical within the context of demographic change, such as changing family structures and population ageing. Existing research has focused on intergenerational support at a given time in the individuals' lifecourse, e.g. from adult children towards older parents and vice versa; however, few studies have focused on the dynamic nature of such support. Analysing data from the 1958 National Child Development Study, this paper investigates the extent to which the receipt of parental help earlier in the lifecourse affects the chances of adult children reciprocating with support towards their parents later in life. The findings show that three-quarters of mid-life adults had received some support from their parents earlier in life, and at age 50 more than half were providing care to their parents. Patterns of support received and provided across the lifecourse differ markedly by gender, with sons being more likely to have received help with finances earlier in the lifecourse, and daughters with child care. The results highlight that care provision towards parents was associated with support receipt earlier in life. However, the degree of reciprocity varies according to the type of care provided by children. Such findings have implications for informal care provision by adult children towards future cohorts of older people, and by extension, the organisation of social care. [ABSTRACT FROM AUTHOR]

Purpose -- With population projections indicating that the number of older adults in the UK (those aged 65 years and over) will increase from 9. 6 million in 2005 to 12. 7 million in 2021, the numbers of those growing older with a serious mental illness (SMI) is likely to rise. Currently there is a lacuna of both policy and quality research evidence on how to meet the needs of this vulnerable group of citizens. The purpose of this paper is to add to the emerging debate and discourse around current policy and practice in this field. Design/methodology/approach -- The authors have undertaken a general review of both the literature and current UK policy guidance to determine the current state of provision for people with a SMI. Findings -- Much of the relevant literature the authors identified originates from the USA, with older adults with SMI perceived as an under-served population in need of urgent attention. Additionally, UK policy provision is patchy with very limited pockets of good practice currently available to guide clinicians and inform service users. Research limitations/implications -- Clinicians, researchers and other stakeholders must engage with service users, their family and/or friends to produce quality and meaningful research to improve outcomes for this vulnerable group of citizens. Finally, the policy, practice and service user communities need to collaborate in a spirit of "boundary spanning" working across disciplines to generate practical policies which can be operationalised by organisations and individuals. Originality/value -- This paper highlights the distinct lack of literature, evidence and policy which currently exists in the UK addressing the needs of older adults with a serious mental illness. [ABSTRACT FROM AUTHOR]

Purpose – This paper presents an overview of research and practice literature on the use of Mediation (M) and Family Group Conferences (FGC) in the context of adult safeguarding in the UK. Design/methodology/approach – This paper describes the main features of M and FGC and explores how such "family led" approaches to adult safeguarding fit within the wider agenda of personalisation and empowerment, including the Mental Capacity Act 2005 and its associated Code of Practice. It also considers the main implications for best practice and future research and service priorities. Findings – M and FGC in an adult context are inclusive processes that enable people to explore choices and options in a supportive environment, assuring maximum possible independence and autonomous control over basic life decisions, while still addressing the person's need for assistance. When used appropriately, both approaches can be a valuable response to safeguarding concerns, promoting choice and control at the same time as protecting people from risk of abuse and harm. However, there are few robust evaluation studies currently available and no systematic research studies were found on cost-effectiveness. Originality/value – The paper shows that there is a clear need for further pilots of M and FGC in adult safeguarding. If such research and pilot evaluations find M and/or FGC to be effective, then more consideration will need to be given as to how to integrate such approaches into mainstream social work practice. There is also currently wide variation in the training and experience of mediators and FGC co-ordinators, and further work is required to ensure that there are appropriate training and accreditation models in the UK for mediators and FGC co-ordinators working with at-risk adults. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to set out and discuss findings from a developmental study, commissioned by the English Department of Health and the charity, Comic Relief, which was commissioned to clarify definitional issues and recommend ways of operationalising key concepts for a prospective survey of abuse, neglect and loss of dignity in the care of older people in residential care in the United Kingdom (UK). Design/methodology/approach – As well as drawing upon their experience and expertise, the authors conducted a review of the literature, held consultation events with a range of stakeholders and undertook in-depth interviews with international academics and care home residents. Findings – Existing definitions and descriptions vary widely in form and content, are commonly subjective and imprecise and frequently make reference to abstract concepts which themselves need defining. Many of the concepts are also inherently evaluative, unspecific and open to interpretation. The study considered how, in this context, practical research definitions that are clear, unambiguous and widely acceptable to a range of stakeholders could be developed. Research limitations/implications – The study took a UK focus and the review of literature was confined to the English language. Further research might usefully extend discussion about definitions cross-culturally. The interview samples were small and should not be considered to be representative. Originality/value – The paper identifies key issues in defining the perpetrator. It focuses on the concepts of trust and intentionality, the responsibilities of the care home and multiple perpetrators and makes practical proposals for operationalising the "perpetrator" in research. Recommendations from the study were positively received and have directly informed the Government-funded research programme in England. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to develop understanding of the context in which the abuse and maltreatment of older people might proliferate within the health and social care system in the United Kingdom. Drawing on the notion of "social defences" this paper seeks to explore the dual role of consumerism and social defences in facilitating poor practice. Design/methodology/approach – Research and inquiry findings are used to establish the inter-relationship between social defences, consumerism and poor organisational structures to create a culture in which the abuse and maltreatment of older people might flourish. Findings – The paper suggests the expansion of a consumerist approach to care, along with social defences and organisational structures, reinforces an attitude of indifference to older people across society, and provides the conditions in which the maltreatment of older people by professional carers can go unchallenged. Research limitations/implications – This is a conceptual paper from which future research could develop to understand, from a societal perspective, the relationship between societal attitudes and responses to older people, their maltreatment and care provision in the UK. Practical implications – Reform is required at a structural and individual level founded on the conceptual nets of equality and human rights. A consumerist approach alone, for those most vulnerable, may increase their risk of harm. Social implications – If safeguarding older people is "everyone's" business, wider society will need to transform an attitude of indifference toward older people into one of dignity and respect. Originality/value – The current system of health and social care provision leaves many older people maltreated and without support. Whilst much research rightly focuses on practical matters this paper seeks to relocate the debate in a much wider frame of reference to try and establish the philosophical, ethical and moral framework's required to transform societal indifference toward older people to respect. [ABSTRACT FROM AUTHOR]

mcinnes e., seers k. & tutton l. (2011) Older people's views in relation to risk of falling and need for intervention: a meta-ethnography. Journal of Advanced Nursing 67(12), 2525-2536. Abstract Aim. This paper is a report of a meta-ethnography of qualitative studies of older peoples' views on risk of falling and need for intervention. Background. Falls and falls-related injuries in older people are worldwide problems. A conceptual understanding of older people's views about falls risk and need for intervention is useful for understanding factors likely to impact on acceptance of risk and recommended interventions. Data Sources. Seven electronic databases were searched 1999-2009. Reference lists of included articles were screened for eligible papers. Review Methods. Assessment of quality was carried out. Themes and concepts were extracted using a meta-ethnographic approach to compare similarities and differences across the retrieved studies. A line of argument was developed to produce an explanatory framework of the extracted themes and concepts. Results. Eleven relevant qualitative research articles of reasonable quality were identified. Six key concepts were identified: beyond personal control; rationalizing; salience; life-change and identity; taking control and self-management. A line of argument synthesis describes how older people approach self-appraisal of falls risk and intervention need, and how they cope and adapt to falls risk and intervention need. Conclusion. In response to having an elevated risk status and perceived associations with frailty and impact on an independent life-style, some prefer to adapt to this reality by taking control and implementing self-management strategies. Healthcare professionals should take into account beliefs about risk and negotiate choices for intervention, recognizing that some individuals prefer to drive the decision-making process to preserve identity as a competent and independent person. [ABSTRACT FROM AUTHOR]

Purpose - This paper aims to outline the development of a new approach, using environmental design and non-drug-based interventions to support individuals with dementia to live independently and safely in their own homes. Although in its infancy, this approach is beginning to show how it can help to improve the mood, socialisation, and short-term memory of people with dementia and reduce the need for residential care or hospital admission.Design/methodology/approach - As a case study, this paper is based upon the development teams' observations, complemented by those of other key stakeholders. It first reviews the policy context and evidence for the scale of the problem and some psychological approaches such as reminiscence work, which can alleviate the symptoms. It then outlines the potential in home improvement work in "dementia-proofing" and "retro-fitting", to enhance reminiscence-based "life experience" work. Finally, the approach is illustrated via an individual example.Findings - The results so far - though not formally evaluated - suggest that design-based approaches may add significantly to the effectiveness of psychological management of dementia via reminiscence work; early results suggest a reduction in the "chemical cosh" of medication.Practical implications - This paper describes early developments in a new approach with great potential. In the long-term, it is hoped that this dementia care model can be rolled out for replication in any home improvement agency or social care setting.Originality/value - The impact of dementia is of increasing concern both for individuals and for public budgets. The potential in dementia-friendly environmental design to complement other psychological approaches is an example of the search for more holistic approaches that respect and work with the strengths of the individual, in contrast to purely medical approaches relying on medication and/or institutional care. [ABSTRACT FROM AUTHOR]

Home-care re-ablement or 'restorative' services are a cornerstone of preventive service initiatives in many countries. Many English local authorities are transforming their former in-house home-care services to provide intensive, short-term re-ablement instead. The focus of this paper is on the organisation and content of re-ablement services and the features of their organisation and delivery that have the potential to enhance or detract from their effectiveness. Qualitative data were collected from five sites with well-established re-ablement services. Data included semi-structured interviews with senior service managers in each site; observation of 26 re-ablement visits to service users across the five sites (four to six in each site) and a focus group discussion with front-line staff in each site (in total involving 37 front-line staff). The data generated from all three sources were analysed using the framework approach. All five services had developed from selective pilot projects to inclusive 'intake' service, accepting almost all referrals for home-care services. A number of features were identified as contributing to the effectiveness of re-ablement services. These included: service user characteristics and expectations; staff commitment, attitudes and skills; flexibility and prompt intervention; thorough and consistent recording systems; and rapid access to equipment and specialist skills in the team. Factors external to the re-ablement services themselves also had implications for their effectiveness; these included: a clear, widely understood vision of the service; access to a wide range of specialist skills; and capacity within long-term home-care services. The paper argues that re-ablement can be empowering for all service users in terms of raising their confidence. However, the move to a more inclusive 'intake' service suggests that outcomes are likely to be considerably lower for service users who have more limited potential to be independent. The paper discusses the implications for practice. [ABSTRACT FROM AUTHOR]

Purpose - This paper seeks to describe the experiences of people visiting elderly relatives in hospital, detailing the lack of care and negligent attitudes of nursing staff with regards to providing appropriate food and drink to the elderly patients.Design/methodology/approach - This paper analyses responses from 94 concerned readers, who empathised with an article published in the Daily Mail detailing negligent, unprofessional and uncaring practice in an elderly relative's hospital care. They each wrote to A Dignified Revolution (ADR) and provided their own examples of either being a patient in hospital or witnessing their loved one's distress. This paper addresses one of the most common areas of concern: the management of hydration and nutrition.Findings - The vast majority of the criticisms in the e-mail correspondence that was received by ADR was directed towards severe deficits in nursing practice. The experiences that were shared demonstrated not only a contravention of the nurse's code of practice (Nursing and Midwifery Council), but also an abuse of older people's human rights. They also demonstrated not only the severe harm that could be caused to vulnerable older people and the trauma caused to relatives but also carers. Many respondents were dismayed at the complete lack of nursing assessments and the inconsistencies in the documentation about their relatives' care, including food and fluid charts, which was so fundamental to their care needs.Originality/value - Older vulnerable people in National Health Service (NHS) hospitals are being deprived of the fundamental right to eat and drink, a right whereby the lack of nutrition and hydration causes not only untold suffering, but can cause death. To deprive a person of food and fluid is tantamount to abuse, and to be able to eat and drink is a basic human right. However, perhaps the challenge is greater than this with regard to older people. Perhaps, a significant cultural change in attitudes and behaviour towards older people by the NHS, if not the wider society, is required in the first instance. [ABSTRACT FROM AUTHOR]

This paper critically examines new policies currently being implemented in England aimed at increasing the choice and control that disabled and older people can exercise over the social care support and services they receive. The development of these policies, and their elaboration in three policy documents published during 2005, are summarized. The paper then discusses two issues underpinning these proposals: the role of quasi-markets within publicly funded social care services; and the political and policy discourses of consumerism and choice within the welfare state. Despite powerful critiques of welfare consumerism, the paper argues that there are nevertheless very important reasons for taking choice seriously when considering how best to organize and deliver support and other services for disabled and older people. A policy discourse on consumerism, however, combined with the use of market mechanisms for implementing this, may be highly problematic as the means of creating opportunities for increased choice and, on its own, risks introducing new forms of disadvantage and social exclusion. [ABSTRACT FROM AUTHOR]

Ageing in Place is a key component of UK policy on older people and housing. Helping older people to ‘age in place’ at home is seen to benefit the quality of life and also provide a cost-effective solution to the problems of an expanding population of very old people. However, the reality is not straightforward and in this paper, some results of qualitative research are presented to illustrate the benefits, problems and challenges that exist in relation to Ageing in Place in the United Kingdom. The research is based on qualitative data collected from 40 people age 80–89 in the north-west of England as part of the ENABLE-AGE Project 2002 to 2004. The research suggests that while Ageing in Place may bring social and psychological benefits, there can also be a significant downside on an everyday level. Home in old age can be a place of negative experiences, such as isolation and loneliness and there are often significant weaknesses in terms of informal support, physical environment of the home and neighbourhood and social network, which undermine the person’s ability to live independently. The paper reviews recent UK initiatives to use “telecare” to address some of these issues. [ABSTRACT FROM AUTHOR]

Aim In the past few years, there has been an increased emphasis both on the care for older people and the management of long-term conditions within the United Kingdom. Currently, the Department of Health and the Scottish Executive identify and manage these two areas as separate entities. The aim of this article is to examine the current approaches to both of these areas of care and identify commonalities and articulate differences. Background The population across the world and particularly within the United Kingdom is ageing at an unprecedented rate. The numbers suffering long-term illness conditions has also risen sharply in recent years. As such, nurses need to be engaged at a strategic level in the design of robust and appropriate services for this increasing population group. Evaluation A comprehensive literature review on long-term conditions and the care of older people was undertaken in an attempt to identify commonalities and differences in strategic and organizational approaches. A policy analysis was conducted to support the paper and establish links that may inform local service development. Key issues Proposing service development based on identified needs rather than organizational boundaries after the establishment of clear links between health and social care for those with long-term conditions and the ageing population. Implications for nursing management Nurse Managers need to be aware of the similarities and differences in political and theoretical approaches to the care for older people and the management of long-term conditions. By adopting this view, creativity in the service redesign and service provision can be fostered and nurtured as well as achieving a renewed focus on partnership working across organizational boundaries. Conclusions With the current renewed political focus on health and social care, there is an opportunity in the UK to redefine the structure of care. This paper proposes similarities between caring for older people and for those with long-term conditions, and it is proposed these encapsulate the wider issues that need to be debated to achieve a truly joint approach to care. [ABSTRACT FROM AUTHOR]

Background: Dignity has become a central concern in UK health policy in relation to older and vulnerable people. The empirical and theoretical literature relating to dignity is extensive and as likely to confound and confuse as to clarify the meaning of dignity for nurses in practice. The aim of this paper is critically to examine the literature and to address the following questions: What does dignity mean? What promotes and diminishes dignity? And how might dignity be operationalised in the care of older people? This paper critically reviews the theoretical and empirical literature relating to dignity and clarifies the meaning and implications of dignity in relation to the care of older people. If nurses are to provide dignified care clarification is an essential first step. Methods: This is a review article, critically examining papers reporting theoretical perspectives and empirical studies relating to dignity. The following databases were searched: Assia, BHI, CINAHL, Social Services Abstracts, IBSS, Web of Knowledge Social Sciences Citation Index and Arts & Humanities Citation Index and location of books a chapters in philosophy literature. An analytical approach was adopted to the publications reviewed, focusing on the objectives of the review. Results and discussion: We review a range of theoretical and empirical accounts of dignity and identify key dignity promoting factors evident in the literature, including staff attitudes and behaviour; environment; culture of care; and the performance of specific care activities. Although there is scope to learn more about cultural aspects of dignity we know a good deal about dignity in care in general terms. Conclusion: We argue that what is required is to provide sufficient support and education to help nurses understand dignity and adequate resources to operationalise dignity in their everyday practice. Using the themes identified from our review we offer proposals for the direction of future research. [ABSTRACT FROM AUTHOR]

This paper presents a research team's experience using a virtual steering group to manage a research project. The main research project was concerned with the evaluation and development of interprofessional working among health and social care staff across primary and secondary care in the United Kingdom, with a focus on older people receiving intermediate care. Intermediate care is a service aimed at preventing unnecessary hospital admission; supporting early discharge from hospital; and reducing or delaying the need for residential care in the community. Intermediate care covers multi-agency and interprofessional working across the continuum of care. We examine one aspect—the use of a virtual steering group, which is an innovative approach aimed at facilitating user and carer participation in the research in a supportive and less intimidating way. The research team includes academics, practitioners, older people and carers, and representatives from the voluntary sector—all are equal members. The team believes it is important to actively involve clients and their carers in the development and direction of research because they can provide a unique perspective ensuring that the research addresses issues of importance to them as service users. We examine and discuss the importance of preparation, support, and training to meaningfully engage in the virtual steering group and the direction of this research. The paper concludes by making recommendations about this model of involving service users in research. [ABSTRACT FROM AUTHOR]

This article deals with continuity and change in immigrant families, focusing on the caring practices of the adult children of Italian migrants in the UK. Looking at motherhood, care for the elderly and the management of kin relations at a distance, the paper explores how values and norms get transmitted and transformed across the generations. The article shows both continuity and change in norms and values about care, and argues that change occurring in immigrant families is not necessarily a move from 'tradition' to 'modernity' or from 'ethnic' to 'mainstream'. Motherhood is changing and acquiring a renewed value for second-generation women who are now putting it before paid work, contrary to first-generation women who tended to combine it with full-time work. In terms of intergenerational relations, the analysis shows that, despite the tensions sometimes occurring between parents and children, reciprocal bonds across the generations remain very strong, with children providing care for their ageing parents while at the same time receiving various forms of support from them. Finally, the paper shows how, as a result of their upbringing and their personal choices, second-generation women continue to be involved, as were their parents, in having to manage kin relationships at a distance. [ABSTRACT FROM AUTHOR]

This paper identifies variations in the age and gender characteristics of informal carers in the UK. The paper is based on the Individual Sample of Anonymous Records, a 3% random sample of the 2001 UK Census. The sample size was 1 825 595. Of this sample, 10% were reported to be carers. The analysis shows that informal caregiving is systematically linked with both age and gender. Caregiving increased with age until reaching a peak in the 45–59 age group, in which almost 20% were carers. Similarly, the amount of time spent caregiving increased with age, with the highest levels of caregiving commitment in people aged 80–89 years. Regarding gender, 11.3% of women were carers compared to 8.6% of men and overall women committed more time to caregiving than men. However, this pattern was reversed in later life (70+), where there was a higher proportion of carers and greater time commitment to caregiving amongst men. While the predominance of women as informal carers has been well reported, the importance of men as informal carers in old age is much less commented upon. This study thus suggests that informal caregiving is most prevalent in groups of the population that, according to previous research, may experience most strain from doing so: elderly people who may be frail and often are in a spousal relationship with the care-recipient, and middle-aged women with multiple roles. Therefore, it is of great importance that their particular needs and circumstances are fully taken into account both in the development of formal support and when information about available support is targeted. [ABSTRACT FROM AUTHOR]

Retirement communities are a relatively new long-term accommodation and care option in the United Kingdom. Policy makers and providers endorse the proposition that they are suited for the accommodation of both 'fit' and 'frail' older people, although comparatively little is known about what it is actually like to live in such communities, about whether they eater adequately for older people with a wide spectrum of needs and abilities, or if they provide acceptable solutions to older people's housing or care needs. This paper addresses these questions by reporting the findings of an independently funded three-year study of a new retirement village, Berryhill, in the north Midlands of England. The paper examines the background to this and similar developments, details how the study was carried out, and then examines what it was like to live at Berryhill. It focuses on the housing and care aspects, and explores the residents' motivations for moving to the village ; their views about the accommodation ; and their use of and satisfaction with the social and leisure amenities. The health and care needs of residents and the formal and informal supports are also featured. The conclusion discusses whether the village can truly be a 'home for life' in the face of increasing frailty, and whether or not these new models of accommodation and care can indeed cater for both 'fit' and 'frail' older people. [ABSTRACT FROM AUTHOR]

Currently, deregulation of social welfare provision is underway throughout Western Europe. The major tendency is for disorganisation, together with the emergence of welfare markets. This is also changing the way elderly people are provided with personal and socio-medical services. Focusing on domiciliary eldercare, the paper explores if this is accompanied by a change in what Kohli has termed the moral economy of old age welfare. Departing from a general reflection on the organisation of social services in modern welfare capitalism the paper sketches evolutions in the eldercare system of three major European countries, with a special focus on the role of civic rationales and professional norms in the organisational field under consideration. It is argued that the moral economy of eldercare has become fluid, thus implying a broader transformation in the societal treatment of old age. [ABSTRACT FROM AUTHOR]

Over the last two decades we have seen an increased interest in informal care within both political and academic communities in the UK. This has stemmed in large part from an increased emphasis on the home-space as the preferred site of care provision and a resultant increase in the complexity of the care-giving relationship. The explicitly spatial dimensions of this caring relationship, however, are vastly under-researched. This paper represents one attempt to redress the gap by examining the importance of place, and its conceptualization, in the care of frail older people. In doing so, the paper focuses, firstly, on the spatial manifestation of care at various scales, identifying some of the processes behind variations in the care-giving experience and, secondly, using the example of dementia care, it considers how Augé's concepts of anthropological place and non-space, when applied to domestic and institutional care settings, can facilitate a more nuanced understanding of the importance of people and place in the construction and delivery of care to frail older people. [ABSTRACT FROM AUTHOR]

The General Medical Council (GMC) provides a core curriculum for all medical degrees in the UK. However, these guidelines do not provide in-depth, specific learning outcomes for the various medical specialties. Recognising our ageing population, the British Geriatrics Society in 2013 published their own supplementary guidelines to encourage and further direct teaching on Gerontology and Geriatric Medicine in medical school curricula. Although teaching on Geriatric Medicine, a sub-discipline of Gerontology, has reassuringly increased in UK medical schools, there are convincing arguments for greater emphasis to be placed on the teaching of another sub-discipline: Social Gerontology. Considering the skills and knowledge likely to be gained from the teaching of Social Gerontology, in this paper we argue for the greater universal adoption of its teaching. This would help ensure that the doctors of tomorrow are better equipped to manage more successfully and holistically the growing cohort of older patients. [ABSTRACT FROM AUTHOR]

• This paper presents an overview of the work of the Royal College of Nursing (RCN) in developing an assessment tool to determine the need for registered nursing by older people in continuing care. • In the past, healthcare has been provided free and social care ‘means-tested’. • The erosion of the NHS’s responsibility for continuing care provision through the development of eligibility criteria has resulted in the majority of older people having their care services means-tested, including their nursing care. • The RCN has argued that older people have inter-related health and social care needs, that nursing care is an integral component of healthcare provision and that therefore older people should not have to pay for nursing care. • This paper describes the work undertaken by the RCN to develop a tool for use in assessing older people’s need for registered nursing – ‘The RCN Nursing Older People Assessment Tool’. • The underpinning theoretical framework is outlined and the process of constructing the tool is described. • In addition, the stages of assessment using the tool are outlined. • A pilot study in seven nursing homes managed by three different companies was undertaken to test the reliability and acceptability of the tool. 178 paired assessments were completed (89% of the intended sample). • The results of the pilot study demonstrated that the tool has a high degree of reliability and acceptability. • Further testing of the tool is recommended using a larger sample of nursing home residents. [ABSTRACT FROM AUTHOR]

Few interventions have directly addressed the needs of older people with arthritis. One exception is a recent initiative developed by Arthritis Care, a voluntary organisation working with and for people with arthritis in the UK. The initiative comprised two Phases. In Phase 1, older people attended a well established course designed to increase participants' sense of control over their own ability to orchestrate the management of their arthritis-related needs. The focus of this paper is on Phase 2 of the initiative, a Personal Independence Course, which introduced older people to the social model of disability and encouraged them to take an active role in the community. Although Arthritis Care have considerable experience of working within a social model framework with younger people, this paper presents the results of the first Personal Independence Course targeting older adults with arthritis. Data were collected in a series of semi-structured interviews yielding rich insight into the lives of this often neglected group of older people. [ABSTRACT FROM AUTHOR]

In the second of two articles exploring the value and application of concordance across nursing practice the discussion is aimed at clinical settings and patient groups where concordance may have been viewed as impractical. The author harnesses Cribb and Entwhistle’s broader conception of shared decision making and the notion of decision-making capacity as a continuum to argue that concordance can be pursued effectively in challenging settings such as childcare practice, mental health and the care of older people. As in the first paper (McKinnon, 2013) the discussion is not limited to medicines management but remains engaged with all aspects of nursing practice. Legal and ethical frameworks, social participation theory and research across healthcare practice are sourced to argue for concordant approaches in the care of patients who may at times have compromised decision-making capacity. Ideas of direct and indirect concordance are explored. [ABSTRACT FROM AUTHOR]

Restorative home-care services, or re-ablement home-care services as they are now known in the UK, aim to assist older individuals who are experiencing difficulties in everyday living to optimise their functioning and reduce their need for ongoing home care. Until recently, the effectiveness of restorative home-care services had only been investigated in terms of singular outcomes such as length of home-care episode, admission to hospital and quality of life. This paper reports on a more complex and perhaps more significant measure - the use and cost of the home-care and healthcare services received over the 2-year period following service commencement. Seven hundred and fifty older individuals referred for government-funded home care were randomly assigned to a restorative or standard service between June 2005 and August 2007. Health and aged care service data were sourced and linked via the Western Australian Data Linkage System. Restorative clients used fewer home-care hours (mean [ SD], 117.3 [129.4] vs. 191.2 [230.4]), had lower total home-care costs ( AU$5570 vs. AU$8541) and were less likely to be approved for a higher level of aged care ( N [%], 171 [55.2] vs. 249 [63.0]) during follow-up. They were also less likely to have presented at an emergency department ( OR = 0.69, 95% CI = 0.50-0.94) or have had an unplanned hospital admission [ OR (95% CI), 0.69 (0.50-0.95)]. Additionally, the aggregated health and home-care costs of the restorative clients were lower by a factor of 0.83 (95% CI 0.72-0.96) over the 2-year follow-up ( AU$19,090 vs. AU$23,428). These results indicate that at a time when Australia is facing the challenges of population ageing and an expected increase in demand for health and aged care services, the provision of a restorative service when an older person is referred for home care is potentially a more cost-effective option than providing conventional home care. [ABSTRACT FROM AUTHOR]

This paper examines differences in work restrictions of midlife family carers of older people in terms of prevalence, gender and explanatory variables, in six European countries: Germany, Greece, Italy, Poland, Sweden and the United Kingdom. A sample of 2,897 carers aged 45–64 was extracted from the EUROFAMCARE (Services for Supporting Family Carers of Older People in Europe: Characteristics, Coverage and Usage) European project database, in order to analyse four possible work restrictions experienced in connection with the activity of care-giving: the reduction of working hours; giving up working; difficulties in career developments and forced occasional work. The results show that work restrictions are experienced differently between countries especially by women: they are reported to a higher degree in the United Kingdom, Germany and Greece, less so in Italy, and seldom in Poland and Sweden. Gender differences within countries are not so marked. Country differences are explained in the light of the different welfare regimes characterising the countries under investigation, in order to elucidate how policy makers may act to improve working carers' conditions through appropriate policies. [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]

This article analyses and challenges the categories of dependency and independence as they feature in discourses on care for older people in two countries, Austria and the UK. Using critical discourse analysis of newspaper extracts and transcripts of focus group discussions, I demonstrate how independence and self-sufficiency are constructed as ideals for human existence. Being dependent, on the other hand, is seen as the expression of an inferior state of life. Three possible challenges to the ideal of independence in the literature on care are then discussed. The paper shows how, through their focus on empowerment, mutuality and reciprocity, they each reproduce aspects of dependency as anathema to contemporary ideas of personhood, to fall short of a fruitful critical intervention into orthodox discourses on older people and care. In contrast, this article argues for embracing a notion of dependency built upon new conceptualizations of the body, of relating and of the conditions of a good life. [ABSTRACT FROM AUTHOR]

Comparative performance evaluation has taken different forms depending upon the purposes of performance monitoring and the types of measures available. This paper investigates the different performance measurement systems in place in the social care setting, in particular for older people receiving community care services. In England, earlier systems to assist performance management within organizations have been eclipsed by national systems of regulation with top- down implementation of standards and measures. In Northern Ireland, by contrast, organizations have been compared descriptively without the use of national targets. Internationally, in Japan, organizations arranging similar services have had more local information available collected in a bottom-up fashion with greater employment of service user-level data. These differences in performance evaluation are located within an analytical framework permitting comparisons of system design and the use of measures. Conclusions are drawn concerning the breadth of evidence available for successfully monitoring service provision in this setting. [ABSTRACT FROM AUTHOR]

There has long been an interest in the United Kingdom about whether and how changes in family life affect support for older people, but nevertheless the consequences of partnership dissolution for late-life support have been little researched. Using data from the British Household Panel Study (1991-2003), this study investigated the longitudinal association between partnership dissolution and two types of support for 1,966 people aged 70 or more years: (i) informal support from children in the form of contacts and help (e.g. household assistance including care), and (ii) formal support from community care services (i.e. health visitor or district nurse, home-help and meals-on-wheels). The paper also examines the level of reported support among: (i) all parents aged 70 or more years and (ii) 1,453 unpartnered parents in the same age group (i.e. those lacking the most important source of support in later life: a spouse). We found diversity in the experience of partnership dissolution in the past lives of people aged 70 or more years. Patterns of support varied by the respondent's age, whether partnered, the timing and type of partnership dissolution, and by gender, having a daughter and health status. Overall, however, partnership dissolution did not show the expected detrimental relationship with later-life support. Health needs and increasing age were strongly associated with increases in contact and informal and formal help, regardless of family history. [ABSTRACT FROM AUTHOR]

Aim The aim of this paper is to consider the process of ageing, the effects of ageing and research related to ageing. Background In most countries of the world, the UK being no exception, the population is ageing in terms of the absolute numbers of and relative proportion of older people. This has resulted from economic, scientific and medical progress. However, it poses challenges for health and social services. Method Selective review of the literature. Conclusion Ageing is an inevitable part of life and, while not in itself debilitating, can be accompanied by a range of debilitating physical and mental conditions which lead to frailty and dependency. There is limited evidence that the ageing process can be alleviated, as such, but there is some evidence that choices and circumstances in early life can influence the extent to which we age successfully. Implications for nursing management Nurse managers have two responsibilities with regard to age: they are increasingly engaged in organizing care for older people in acute and long-term settings and in nursing homes and the more they need to understand the process of ageing. They also have responsibilities towards their workforce and can facilitate lifestyle choices which may help their workforce to age successfully. [ABSTRACT FROM AUTHOR]

Provision of welfare benefits advice to maximise financial benefit uptake is a shared goal for social and health policy in the UK. The study was designed to explore the wider impact on elderly people provided with specialist welfare benefits advice, in terms of their health and quality of life. This paper reports on a longitudinal postal survey of community dwellers aged 60 and over referred for specialist welfare benefits advice within social services and who were followed up at 5 months (over 2003–2004). Outcome measures included the Short Form-36 (SF-36), the General Health Questionnaire-12 (GHQ-12) and the Barthel Index (postal version), along with questions relating to chronic illness. We also report on the methodological issues that arise from conducting research of this nature. Out of 233 elderly people sent questionnaires, 77 (33%) returned a completed baseline questionnaire. Of the 156 who did not return questionnaires, 35 (22%) gave reasons of being ‘too unwell’ to participate. Between baseline and follow-up, 8 (10%) of the 77 respondents died; 52 of the 69 (75%) remaining participants completed follow-up questionnaires. Although low, these response rates are comparable with other similar questionnaire surveys examining the outcome of providing benefits advice to individuals. Elderly people (mean age = 80.3, SD = 8.6 years) receiving welfare benefits advice usually reported the presence of a longstanding illness or disability, and the use of healthcare services. Baseline SF-36 scores were extremely low and remained largely unchanged at follow-up; however, there were significant improvements in GHQ-12 scores (mean difference = −1.45, 95% CI = −2.63 to −0.27, P = 0.017). Significant increases in benefit income were identified in 65% of respondents with complete financial data sets (mean increase =£14.73 per week; 95% CI = 5.27–24.18, d.f. = 39, P = 0.003). Participants were very vulnerable in their health status (compared with normative data for elderly people), and this may have contributed to the difficulty in engaging them in the research. There are methodological issues around establishing cause and effect in this type of study, which cannot be readily designed out on account of ethical issues. Extraction and analysis of financial status and benefit eligibility with a view to determining absolute changes in the material well-being of vulnerable individuals over time is a complex and challenging task. Use of suitable measures is essential. Innovative strategies are necessary to maximise survey response rates amongst the vulnerable elderly population. [ABSTRACT FROM AUTHOR]

The ‘sandwich generation’ has been conceptualised as those mid-life adults who simultaneously raise dependent children and care for frail elderly parents. Such a combination of dependants is in fact very unusual, and the more common situation is when adults in late mid-life or early old age have one or more surviving parents and adult but still partly dependent children. It can be hypothesised that for parents in this pivotal position, the demands from adult children and from elderly parents compete, with the result that those who provide help to one are less likely to provide help to the other. An alternative hypothesis, however, is that family solidarity has an important influence but is not universal, so that some pivotal-generation parents engage in intergenerational exchange in both directions, and there is a positive association between helping parents and helping children. To investigate this question, the paper presents an analysis of data from two broadly comparable national surveys, in Great Britain and the United States, on the care provided by women aged 55–69 years to their descendent and ascendent relatives. The results show that around one-third of the women reported providing help to members of both generations, and that around one-fifth provided support to neither. They broadly support the solidarity hypothesis, but provide some evidence that having three or more children is associated with a reduced likelihood of providing help to a parent. [ABSTRACT FROM AUTHOR]

This article updates a review submitted to the Department of Health (DH) in the light of the House of Commons Health Select Committee report on Elder Abuse. The review drew on recent research about elder abuse in the UK, including research published after the Select Committee's hearings, that made specific recommendations for areas of development in research and policy. The aim of this paper is to address specific questions posed by the Select Committee in light of developments up to mid 2005. [ABSTRACT FROM AUTHOR]

Opportunities for older people to take part in decision making about public policies and services are expanding in the United Kingdom and elsewhere. This paper considers the potential of older people's participation in policy processes for both transforming the policy process and for achieving socially just outcomes. It argues that the way in which such participation takes place, in particular the nature of the deliberative processes, affects both who will feel able to take part and the capacity to develop new policy discourses which can challenge official perspectives and assumptions. It draws from critical perspectives on deliberative democracy to provide a theoretical framework. This work emphasises the importance of story telling and forms of exchange designed to offer recognition to others, as well as the rational argument more usually associated with deliberation on matters of public policy. The argument is illustrated with examples of participation initiatives that have involved ‘active’ older people and those who are users of social care services. Different styles and processes of exchange are distinguished in the three case studies. In one, active facilitation enables individual stories of ageing and of service use to be woven into collective narratives that offer an alternative vision of care services. In another, a strong emphasis on ‘greeting’ enables conflicting views to be expressed without participants falling out. In the third, styles of exchange familiar in formal debate limit the development of an alternative discourse. The conclusion suggests that attention needs to be given to the process of participation as well as to outcomes. [ABSTRACT FROM AUTHOR]