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In the context of current and expected demographic changes, the issues of which services the welfare state should offer and, ultimately, the very function of the welfare state are currently debated in Norway. The political discourse on health and care services for older adults has morphed into an accepted reality in which the system must be altered, prompting policy makers and stakeholders to find new and novel solutions to problems associated with population ageing. In this paper, we discuss one such proposed solution: the transformation of health and care services for the older adult population through the increased involvement of volunteers. We ask how volunteer efforts are articulated and delineated through official accounts and discuss the implications of such an articulation and delineation. We seek answers to these questions through a critical discourse analysis of recent governmental white papers. We investigate, in other words, volunteer efforts as a political instrument. We argue that the official representation of how efforts in health and care services should be re-aligned take the form of a distinct discourse of 'voluntarism'. Within this 'voluntarism', volunteer efforts have been altered from a third sector comprising charity and non-profit organisations that contribute within or as a supplement to the largely public-run welfare system to a limitless and extensive concept that is blurring the boundaries to informal care. [ABSTRACT FROM AUTHOR]

This review updated a previous review [Gaugler JE (2005) Family involvement in residential long-term care: a synthesis and critical review. Aging and Mental Health 9 , 105–118] and focused on dementia. Fourteen years of development in family involvement with care homes following placement of a relative was explored. The review aimed to investigate two questions: (1) What types of involvement do families have with care homes following placement of people living with dementia? (2) Which factors influence family involvement with care homes? PsycINFO, MEDLINE and CINAHL Plus were searched for publications between January 2005 and December 2018. Thirty-three papers representing 30 studies were included. Papers were appraised using a quality rating tool designed for use with mixed study designs. Studies were of a reasonable quality though some weaknesses included single-site samples, high attrition rates and poor reporting. Twenty-eight papers highlighted types of involvement including collaboration, family–staff relationship development, decision making and visiting. Twenty-five papers pertained to factors influencing involvement, which included outcome of care quality evaluation, wish for recognition and sense of integration into the care team. Type of family involvement has changed over time with increased emphasis on families' desire for partnership, to be active rather than passive advocates, and to focus on care monitoring and evaluation. Seven themes of family involvement activities are featured and a non-linear process is proposed. When compared to patient and family-centred care principles, an analysis of family involvement types found good fit overall and potential for framework improvements. Over 30 diverse factors influence inter-family variation in the level and nature of family involvement. Consideration of these factors and resolution of the gaps in evidence, including intergenerational and cultural concerns, can improve care home facilitation of family participation. This dementia-specific review is a comprehensive timely complement to Gaugler's seminal work about older adults in care. [ABSTRACT FROM AUTHOR]

Person-centred care (PCC) in residential care facilities (RCFs) is valuable but creates challenges for care professionals balancing involvement and a partnership approach for residents while considering the health and safety outcomes of all residents. This review evaluates what is known about the substance use and misuse of residents living in RCFs and what is important to study in future research to enhance PCC, especially in cases in which residents wish to choose unhealthy behaviours. A scoping review was conducted and exclusion criteria were set. The included papers were assessed on methodological quality using the Mixed Methods Appraisal Tool and the results were qualitatively analysed. The included papers consisted of studies regarding alcohol, tobacco and illicit drugs. The results showed that care professionals are involved in facilitating and regulating alcohol and tobacco. The focus of the included papers is on alcohol and tobacco. Five of the 16 papers assessed the residents' perspective. This review highlights the importance of incorporating the perspectives of residents, care professionals and the organisation to enhance PCC and enable residents to make shared and well-informed decisions in dialogue with care professionals. Future research should also assess the distinction between substance use and misuse, and how this affects implementing PCC in RCFs. [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]

We carried out a narrative review and thematic analysis of literature on the physical health care, mental health care and social care of trans older adults to ascertain what is known about older trans adults' contacts with and use of health and social care. Thirty papers were found: a majority originated in the United States of America. Five themes were identified: experience of discrimination/prejudice and disrespect; health inequalities; socio-economic inequalities; positive practice; and staff training and education. The first three themes present challenges for providers and service users. Experiences of discrimination/prejudice and disrespect over the course of their lives powerfully influence how older trans adults engage with care services and practitioners. Health and socio-economic inequalities suggest that older trans adults are likely to have greater need of services and care. The remaining two themes offer opportunities for service improvement. We conclude that more research is needed, that there is a strong argument for taking a lifecourse perspective in a spirit of cultural humility, and that contextual societal factors influence service users and providers. We identify positive trans-inclusive practices which we commend to services. More needs to be done now to make older adult services appropriate and welcoming for trans service users. [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]

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]

Loneliness among older people is perceived as a global public health concern, although assumptions that old age is a particularly lonely time for everyone are not accurate. While there is accumulating quantitative and qualitative evidence on the experience and impact of loneliness amongst older adults, there is little exploration of methodological issues that arise in engaging with older adults particularly through research-oriented conversations. The sensitivity and stigma often attached to loneliness means that interviewing research participants presents ethical challenges for researchers navigating complex emotional responses. This paper presents reflections from three research projects that used research interviews to explore accounts of loneliness experienced by older people. The everyday methodological decisions of research teams are often hidden from view, but through a critical examination of reflexive accounts of fieldwork, this paper makes visible the internal and external negotiations of researchers responding to ethical complexity. The paper explores the key decisions that researchers make during interviews about loneliness: how to introduce the topic; how to phrase questions about loneliness; when to ask the questions; how to deal with the stigma of loneliness and respond to ageism; and how to manage the participant–researcher relationship post-interview. The paper concludes with recommendations for appropriately navigating ethical complexity in loneliness research, thus contributing to an effective qualitative methodological approach to researching loneliness in later life. [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]

In Australia, numerous reviews and inquiries have documented concerns about inadequate access to, and the quality of, aged care. Despite those concerns, research is yet to appraise fully how care needs are assessed, prioritised, and met or left unmet. This paper asks two interrelated questions: (1) How should we conceptualise and measure unmet care need and care inequalities among older people? (2) What are the policy parameters for assessing needs, prioritising access to support and monitoring quality in aged care in Australia? Key insights from academic literature are used to critically review Australian policy documents describing rights, assessments, prioritisation, quality standards and performance indicators for the aged care sector. Using the concepts of care inequalities and care poverty, the paper develops a framework for understanding and measuring needs and unmet needs in aged care, and for encompassing fundamental and valued aspects of life for older people, their carers and their care network. The paper argues that the concept of care poverty opens the space to discuss what level of unmet need and inequality in access to aged care in any society may be considered intolerable. [ABSTRACT FROM AUTHOR]

This paper develops knowledge of the logistics of moving house amongst older people living in insecure housing. These people typically do not move once and settle into a new house, but face ongoing moves driven by factors including housing affordability, tenure conditions and eviction. The paper identifies four domains of experience faced by people undergoing cumulative, involuntary residential moves: the material (process of relocating oneself and possessions), economic (costs of moving house), embodied (physical experience) and affective (how relocation is experienced and felt). The logistics of relocation are examined through the experiences of single older women living in insecure housing in the greater Sydney region of Australia. The accounts of these women foreground the costs and challenges of insecure housing that are a consequence of relocation. Conceptually this work contributes to understandings of mobility-based disadvantage in older age through drawing out the ways that the logistics of moving house – of relocating oneself and possessions – contribute in distinct ways to mobility-based disadvantage through risks to identity and senses of home. Empirically it addresses gaps in gerontological and housing scholarship through developing knowledge of the logistics and experiences of ongoing, involuntary residential moves. [ABSTRACT FROM AUTHOR]

This paper extends our understanding of employment and gendered rural ageing by examining the latent benefits of paid work for mid-life women in rural Ireland. Existing social gerontology literature deals extensively with manifest financial reasons to work, consequences of gendered pay and pension inequalities, work-related health concerns and the negative impacts to an extended working life for women. However, there is much less focus on the latent non-financial positive contributions that work provides for the older woman, especially within a rural context. Findings from this study show how mid-life women, even if in lower-paid, precarious work or in poorer health may choose to continue working into older age. Paid work provides not only financial autonomy, but also temporal structure, life purpose, personal agency, social connectivity and a self-identity that most women are reluctant to relinquish to retirement. Meaningful work plays a critical role in the ageing experience of older rural women. A qualitative study of 25 women aged 45–65 in Connemara, Ireland was undertaken from a lifecourse perspective and analysed using constructivist grounded theory to allow rich, novel narrative to emerge. Narrative from seven, who best represent all participants, are utilised in this paper. Conclusions suggest that the latent benefits of paid work are at least as, if not more important than financial gain for rural mid-life women. [ABSTRACT FROM AUTHOR]

Research on later-life generativity has promoted a new view of older persons that, far from the traditional images of disability, dependence and frailty, recognises their capacities, and potential to continue growing, while underlining their participation and contributions to families, communities and society. The goal of this study was to carry out a scoping review on later-life generativity, the first one conducted on this topic as far as we know, to show how studies in this area have evolved, which aspects of generativity in later life have been studied, and the methodological and epistemological approaches that are dominant in this area of inquiry. Our scoping review shows that research into generativity in later life has grown steadily over the past 30 years, and particularly during the last decade. However, our results also show how such growing interest has focused on certain methodological approaches, epistemological frameworks and cultural contexts. We identify four critical gaps and leading-edge research questions that should be at the forefront of future research into generativity in later life, gaps that reflect biases in the existing literature identified in the study. These are classified as methodological, developmental, contextual and 'dark-side' gaps. [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]

A large body of literature shows that the emotional health of rural elders in China is negatively affected by the migration of their adult children. However, the precise mechanism that underpins this relationship has yet to be fully uncovered. This paper introduces two new dimensions of analysis to expand the understanding of this 'left behind' phenomenon, and offers statistical insights, theoretical explanations and policy recommendations, as well as suggestions for further study. Firstly, in this paper, rural elders have been distinguished based on whether all , or any , of their adult children have migrated. This distinction leads to the finding that rural elders suffer more adverse mental health impacts when all adult children from a household move away. Secondly, the temporal dimension of migration is investigated, finding that there is a 'turning point' after which the mental health of rural elders appears to recover after the migration of their adult children. Comparison of the two groups shows that rural elders who see any of their adult children migrate recover from depression twice as quickly as those who see all of their children migrate. Receiving financial support or providing child care can only partly mediate the negative influence of migration. Also, the level of depression and wellbeing of rural elders can be significantly moderated by the emotional closeness between them and their adult children. Providing (grand)child-care assistance and receiving economic support is shown to have smaller mitigating effects. This paper concludes with a discussion of how the notion of 'filial piety' could, directly and indirectly, play a role in the emotional health of rural elders, with policy implications provided. [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]

Little is known about the experiences of informal family care-giving for persons with ADRD in the context of Arab and Muslim communities. This paper offers fresh insight into the less-studied private sphere of the home, showing how families respond to the onset and long-term care of persons with Alzheimer's disease and related dementias (ADRD). It considers the extent to which sociocultural and religious influences are appropriated by family care-givers as coping mechanisms and motivators for care. Drawing upon interviews with 32 family care-givers for older persons living with ADRD in Qatar, findings reveal the intersectionality of the care-giving experience with various sociocultural, religious and emotional influences through seven emergent themes: (a) reasons and motivations for care-giving; (b) role of the extended family; (c) socio-demographic attributes of care-givers, their allocated responsibilities and how these intersect; (d) socio-religious attitudes towards care-giving of older persons; (e) social stigma; (f) personal knowledge of ADRD; and (g) coping mechanisms. The paper is concluded with key implications of these sociocultural insights for theory, policy and practice, which could inform Qatar's health and social care provision sector as well as other Arab and Muslim communities that share similar cultural and religious belief systems. [ABSTRACT FROM AUTHOR]

The literature on older migrants often focuses on identifying the characteristics of ethnic groups that constitute 'barriers' for members of these populations to access care. This paper offers an alternative conceptualisation of access to care, by combining relational approaches to place and the notion of super-diversity. From this perspective, 'access to care' is perceived as an outcome of an individual's embeddedness in relationships of care in urban places. The objective of the study is to identify relationships of care that facilitate access to aged care for older first-generation migrants. Thirty-two semi-structured interviews were conducted with older migrants who were residents of Nijmegen or The Hague, The Netherlands. All interviewees had accessed home care, home aid and/or day care. Both relationships with minority-specific services and informal relationships of care, particularly those within local minority communities, were found to facilitate access to aged care. Past experiences with health and social care were also found to influence current relationships with formal care providers. This study, therefore, suggests that policy makers and care organisations should build long-term positive relationships with new and incoming migrant groups. In addition, it argues that policy makers and care providers should identify locally relevant shared migration-related (rather than ethnic) identities around which communities can be mobilised and targeted with appropriate services. [ABSTRACT FROM AUTHOR]

The health and wellbeing benefits of Men's Sheds to the men who participate have had significant research attention for over a decade. However, there has been little research into the broader impacts of Men's Sheds, particularly in relation to the impacts on significant others in the lives of the men who participate. Our paper aims to redress this lack of research by focusing on the interrelated perceptions and experiences of men and those closest to them in four Men's Sheds in regional Victoria, Australia. The research shows that the partners and carers of 'shedders' reported that the men's participation not only benefited the men but also had benefits for their significant others. The study also showed that the partners of shedders in the study found that their individual and joint adjustment to retirement was in some cases assisted by the men enjoying the social and structured environment of the Men's Shed, while in other cases it was seen by partners as an over-commitment and impacting negatively on the marriage. The findings also shed some important light on some tensions experienced by the partners associated with carer burden and adjustments to retirement. [ABSTRACT FROM AUTHOR]

The active ageing approach supports a set of roles or activities that are supposed to be beneficial for older adults. This paper reassesses the benefits of activities for the quality of life by (a) analysing many activities at the same time to control each other, (b) using panel data to detect the effects of activities over time, and (c) performing separate analyses for four European regions to test the context-specificity of the effects. The effects of roles in later life are tested on panel data from three waves of the Survey of Health, Ageing and Retirement in Europe (SHARE) project. The results of fixed-effects regression show that only some activities – volunteering, participating in a club and physical activity – increase the quality of life, and that care-giving within the household has the opposite effect. Moreover, the beneficial effects are much weaker and less stable than the other types of regression suggest; they are beneficial only in some regions, and their effect is much weaker than the effects of age, health and economic situation. Therefore, the active ageing approach and activity theory should reflect the diverse conditions and needs of older adults to formulate more-context-sensitive and less-normative policy recommendations. [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]

Research to-date has examined the impact of intergenerational support in terms of isolated types of support, or at one point in time, failing to provide strong evidence of the complex effect of support on older persons' wellbeing. Using the Harmonised China Health and Retirement Longitudinal Study (2011, 2013 and 2015), this paper investigates the impact of older people's living arrangements and intergenerational support provision/receipt on their physical and psychological wellbeing, focusing on rural–urban differences. The results show that receiving economic support from one's adult children was a stronger predictor for higher life satisfaction among rural residents compared to urban residents, while grandchild care provision was an important determinant for poor life satisfaction only for urban residents. Having weekly in-person and distant contact with one's adult children reduced the risk of depression in both rural and urban residents. Older women were more likely than men to receive support and to have contact with adult children, but also to report poor functional status and depression. The paper shows that it is important to improve the level of public economic transfers and public social care towards vulnerable older people in rural areas, and more emphasis should be placed on improving the psychological wellbeing of urban older residents, such as with the early diagnosis of depression. [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]

Interest in co-research with older adults has grown in the past 20 years, yet few published studies have addressed why and how older people have been involved as partners in research. This article presents a systematic review of the literature, examining the aims and challenges of co-research and the ways in which older adults can be involved in research. Systematic searches covering several databases were conducted, yielding a total of 3,293 articles, with 27 papers reviewed which involved older people as co-researchers across more than one stage of the research cycle. We find that co-research with older people offers improved understandings of the issues facing older people; more inclusive and responsive policy, practice and service design; and opportunities for co-researchers to develop new skills whilst giving voice to marginalised groups of older people. The analysis highlights the different ways in which older adults can be involved across phases of research, and identifies ethical, methodological and practical challenges encountered in the process. Involving older adults as co-researchers, while labour intensive and practically challenging, holds promise as an underdeveloped resource for social gerontology, as well as older people themselves. The paper identifies four pathways for improving and extending co-research: developing diversified structures of involvement, supporting co-researchers, embedding research rigour and ensuring co-ownership of change. [ABSTRACT FROM AUTHOR]

While research on men's mental health is increasing, it has not typically focused on the intersections between ageing, masculinity and mental health in a rural context. Given the significant increase not only in our global ageing population, but also our growing awareness of mental health problems in the general population, understanding men as they grow older in relation to mental health is a notable gap in research. In this paper, the authors explore the ageing experiences of male participants over 50 with self-identified mental health problems in rural Manitoba. We draw on semi-structured qualitative interviews from a larger project which focused on the diversity of rural men's perceptions, experiences and expressions of mental health and wellness. Specifically, we explore how these men reflect on their mental health and wellness. Participants in the study described their experiences as a cumulative process of making meaning, developing strategies, resources and a more positive sense of self – but sometimes also simply for survival. Men's sense of time over time – looking back and reflecting on the present and the future – appears to be a critical resource and a positive coping strategy for these men associated with ageing. The main themes include sustaining relationships; work, retirement and volunteering; and reflections on physical and emotional health. Our paper concludes with a discussion of the implications for new research on ageing men's mental health in a rural context. [ABSTRACT FROM AUTHOR]

'Dementia-friendly communities' herald a shift toward the neighbourhood as a locus for the care and support of people with dementia, sparking growing interest in the geographies of dementia care and raising questions over the shifting spatial and social experience of the condition. Existing research claims that many people with dementia experience a 'shrinking world' whereby the boundaries to their social and physical worlds gradually constrict over time, leading to a loss of control and independence. This paper reports a five-year, international study that investigated the neighbourhood experience of people with dementia and those who care for and support them. We interrogate the notion of a shrinking world and in so doing highlight an absence of attention paid to the agency and actions of people with dementia themselves. The paper draws together a socio-relational and embodied-material approach to question the adequacy of the shrinking world concept as an explanatory framework and to challenge reliance within policy and practice upon notions of place as fixed or stable. We argue instead for the importance of foregrounding 'lived place' and attending to social practices and the networks in which such practices evolve. Our findings have implications for policy and practice, emphasising the need to bolster the agency of people living with dementia as a route to fostering accessible and inclusive neighbourhoods. [ABSTRACT FROM AUTHOR]

This article revisits a paper and from an autoethnographic/critical reflective biographical approach re-examines seven cultural notions or myths, which may encourage ageism. It is framed within my experiential knowledge of caring for my ageing parents, with the tensions and challenges around problematising the value of expertise based on experience, communication, grief, and autonomy and freedom versus safety. The commentary emphasises that by analysing the impact of our personal life experiences, we can start to understand both the intended and unintended consequences of policy and practice affecting those in the fourth age. As a social work educator, I wanted to reflect upon how my tacit experiential knowledge, if made explicit, could impact upon my own and others' learning. The recent death of my father has allowed for a period of reflection on my own caring and indeed my professional social work experience, knowledge, skills and practice. It is argued that the ageing process is unequal as class and socio-economic factors, i.e. geography, age, gender, religion and ethnicity, all play parts in determining how someone ages, and indeed upon the care an individual older person receives. A fuller understanding of negotiating the role of one stakeholder, that of a family carer in the ageing process, is elicited in this paper. [ABSTRACT FROM AUTHOR]

The availability of informal care will remain a key factor influencing future demand for formal services and the analysis cannot be dissociated from formal care. Based on the 'unpaid care work–paid work–paid care work circle', proposed by the International Labour Office, this paper focuses on the individual, interpersonal and organisational determinants that most influence quality care. This paper is based on 40 semi-structured interviews with care workers, in 16 Portuguese care homes, in one council in the metropolitan area of Lisbon. In spite of social change processes in the care worker profession in Portuguese nursing homes, in the last decade, in terms of numbers, age and education, the interviews allowed me to unveil qualitatively what the numbers hid: precarious working conditions, insufficient staffing, excessive workloads and long working hours, high rotation and insufficient skills. All these determinants have consequences not only on the quality of the care that these care workers can offer, but also on their physical and mental health, job satisfaction and work environment. The high demand of care needs due to the ageing of the population, calls for continued efforts in improving working conditions, and a national strategy to promote recruitment of a diverse, younger and more-qualified workforce. The professionalisation of care work must be integrated with migration and employment policies (improvement of job quality and working conditions). [ABSTRACT FROM AUTHOR]

Increased physical activity is widely promoted as beneficial for older people, but previous research indicates this may be difficult to implement in care homes, especially for people with dementia who form an increasing proportion of residents. Care home cultures can mitigate against physical activity for residents, but there is also scope for them to embed personalised physical activity. They are under-researched, but significant in terms of outcomes and quality of life for residents. This paper builds understanding of care home cultures of physical activity through qualitative, empirical research in five care homes. Key findings are that culturally framed views about physical activity, sometimes reflecting stereotypical views of dependency, can be seen in care homes. Managers, staff and residents may be invested in or resistant to physical activity and dominant managerial or societal views may be reflected or contested. The relatively closed boundaries of care homes reinforce sedentariness, and resident involvement in either chosen or enforced physical activity is varied. Interactions demonstrate potential to negotiate physical activity more or less effectively in any given care home. Rigid routines, external regulations and pressure on staffing can be negative, but management commitment has positive potential. In conclusion, the paper identifies that to increase physical activity in a sustainable manner, any intervention needs to address issues of culture change and individual needs and preferences. [ABSTRACT FROM AUTHOR]

In the development and deployment of health and ageing innovations, underlying values such as privacy or quality of life are often seen as a relatively stable starting point, if considered at all. However, values are neither stable nor singular. This paper introduces a valuation framework to explore the co-constitution of values and technological innovations. A careful and ongoing reflection on values and valuation, in particular in innovation practices targeted at older people, is crucial when aiming to increase sustainable innovations. Therefore, we include a Social Sciences and Humanities (SSH) perspective to technological development and innovation, to understand better the construction and co-constitution of ageing-in-place technologies. This framework is developed following a review of literature on values and valuation in the broad field of SSH. The proposed valuation framework consists of three core elements: (a) value multiplicity, (b) value dynamism, and (c) valuation implications. To demonstrate potential applicability of the framework, we conducted a thought experiment on values and valuation practices related to the development and potential further deployment of a COVID-19 health app in the Netherlands. This experiment pays special attention to multiple values at stake and implications for older adults who age in place. We argue this valuation framework provokes reflection on dynamic and multiple values underlying technology use and non-use, and contributes to responsible health and ageing innovations. [ABSTRACT FROM AUTHOR]

The recent Royal Commission into Aged Care Quality and Safety in Australia has documented systemic failures and shocking incidences of abuse and neglect, a not uncommon story internationally. As aged care in many countries is predominantly publicly funded, it is important to understand the general public's attitudes towards aged care quality, what aspects of care quality they think are most important and their willingness to contribute to increased funding to the sector. This paper asks specifically whether self-reported aged care literacy impacts expectations and willingness to pay. More than 10,000 members of the general population were surveyed stratified by age, gender and state. Regardless of the level of aged care literacy, there was consensus about what constitutes quality care, and care priorities for the sector. However, aged care literacy affected willingness to pay to fund a better-quality aged care system. The current crisis facing Australia's aged care system and that of many other countries internationally demonstrates the central importance of general public support to drive quality improvements, recognising that increasing public expenditure on aged care is a necessary part of the solution. This study provides important baseline data from which to commence national and international conversations to consider all options for ensuring the quality, safety and sustainability of aged care now and into the future. [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]

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]

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]

How does the transition to retirement affect female subjective wellbeing? The major theoretical perspectives that have been applied as frameworks to study the heterogeneous adjustment to retirement include role theory and continuity theory. They have often been integrated with a lifecourse approach, which allows us to study retirement as a transition set inside a lifelong process. In this paper, I assess how working life courses are related to changes in subjective wellbeing before and after retirement, using data from the Survey of Health, Ageing and Retirement in Europe (SHARE) and concentrating on women. Firstly, I conduct sequence analysis and cluster analysis to identify groups of typical working lifecourses from ages 20 to 50. Secondly, regression models estimate how retirement transition is associated with changes in life satisfaction, according to the different working trajectories. The results show that some of the trajectories, constituted of discontinuity or part-time periods, exhibit a continuous increase in life satisfaction, passing from employment (or unemployment) to retirement. For other trajectories, such as the full-time one, retirement seems not to have implications for subjective wellbeing. [ABSTRACT FROM AUTHOR]

Age has become an increasingly contested form of division within contemporary society, with some writers suggesting age has become 'the new class' while others point to increasing 'ageism' in society. In exploring such competing claims, this paper examines the basis for considering age as a social class, category or group. Drawing upon Bourdieu's writings on classification and the criteria for what constitutes a social class or category and the 'objective' and 'symbolic' criteria defining it, the paper argues that the material criteria for distinguishing between 'retired' and 'working-age' households have almost disappeared. At the same time, the symbolic representation of age is no longer confined to the parameters of poverty. Shorn of its objective distinction, the symbolic representation of old age seems to have bifurcated, between a generational identity where older people are represented as an advantaged group and an aged identity still essentialised as old and weak. The dissolution of an objective material basis for framing age has taken away much of the underlying basis for a coherent symbolic categorisation of age. Later life might better be seen as a contested symbolic space, framed by the dual axes of socio-historical generation and corporeal, chronological agedness. [ABSTRACT FROM AUTHOR]

The Chinese culture of filial piety has historically emphasised children's responsibility for their ageing parents. Little is understood regarding the inverse: parents' responsibility and care for their adult children. This paper uses interviews with 50 families living in rural China's Anhui Province to understand intergenerational support in rural China. Findings indicate that parents in rural China take on large financial burdens in order to sustain patrilineal traditions by providing housing and child care for their adult sons. These expectations lead some rural elders to become migrant workers in order to support their adult sons while others provide live-in grandchild-care, moving into their children's urban homes or bringing grandchildren into their own homes. As the oldest rural generations begin to require ageing care of their own, migrant children are unable to provide the sustained care and support expected within the cultural tradition of xiao. This paper adds to the small body of literature that examines the downward transfer of support from parents to their adult children in rural China. The authors argue that there is an emerging cultural rupture in the practice of filial piety – while the older generation is fulfilling their obligations of upbringing and paying for adult children's housing and child care; these adult children are not necessarily available or committed to the return of care for their ageing parents. The authors reveal cultural and structural lags that leave millions of rural ageing adults vulnerable in the process of urbanisation in rural China. [ABSTRACT FROM AUTHOR]

Despite theoretical accounts asserting the importance of children for the wellbeing of individuals as they age, research evidence suggests that children may be inconsequential when it comes to loneliness. Yet, there is reason to expect some subgroups may be more vulnerable to the impact of childlessness than others and this may also differ depending on the type of loneliness being assessed. This paper addresses the relationship between childlessness and social and emotional loneliness in middle and later life, including differential vulnerability associated with age, gender and marital/partner status. The study drew on data from three waves (2007, 2012 and 2018) of the Canadian General Social Survey for a nationally representative sample of adults aged 45 and older (N = 49,892). In general, childlessness assumed greater importance with regard to social than emotional loneliness. Women reported lower levels of social loneliness in conjunction with childlessness than men. Further, childlessness was associated with higher levels of overall and social loneliness among older than middle-aged adults. Fewer interactions were evident between marital/partner status and childlessness. Among women specifically, those who were co-habiting, separated/divorced or never married reported lower levels of social loneliness than their married counterparts. In contrast, childlessness was linked to greater emotional loneliness only among separated/divorced men and widowed women. Overall, our results suggest that having children available does matter for feelings of loneliness in middle and later life but that the relationship varies and is contingent on the social contexts (age, gender, marital/partner status) and the type of loneliness (social, emotional) involved. [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]

The outbreak of COVID-19 has had a significant impact on societies and individual lives across the globe. In this paper, we address the impact of the pandemic and the protective measures on empirical social scientific ageing research through the lens of 'ethically important moments'. One of the most crucial measures for preventing the spread of the virus includes social distancing; therefore, empirical research methods based on person-to-person direct contact (as in interviews) and first-hand observation have been scaled back since 2020. For ageing research, the challenges are particularly pronounced due to the ongoing discussion regarding vulnerabilities associated with higher age and age-based discrimination. Hence, many researchers focusing on ageing are facing some difficult questions: How and under what conditions can we carry on with empirical research without putting our research participants and ourselves at risk? Firstly, we systematically identify the key dimensions and challenges that have shaped social scientific research during the lockdowns associated with the COVID-19 pandemic: fragmentation, fluidity, ambiguity and uncertainty. Then, using insights from two international research projects, we illustrate and critically reflect on the ethically important moments and practical dilemmas that have resulted from these pandemic challenges when researching with and about older adults. [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]

This paper aims to develop a sensory methodological framework to explore older user's landscape experience. Applying empirical experience in Australian aged-care facilities, it addresses a methodological gap in the current literature to help move beyond the current taken-for-granted approaches such as interviews, cognitive mapping, behavioural observation and visual methods. We propose a more holistic method which enables the exploration of older people's in situ environmental experience. The multisensory framework we propose here is based on the first author's doctoral fieldwork experience that took place in two aged-care facilities in Brisbane, Australia. Findings suggest this framework facilitates an understanding of users' olfactory, auditory and visual responses to the physical environment, and promotes a deeper engagement with the landscape. We argue that this is essential to promoting good landscape design which genuinely connects with older people's needs. [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]

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]

Residents of care homes across the globe are affected by the spread of SARS-CoV-2 as they have been identified as a high-risk group and because they experienced strict social isolation regulations during the first wave of the pandemic. Social isolation of older people with poor physical and mental health is strongly associated with mental health problems and decreased life expectancy. Other research has shown that older people managed to adapt to the changes brought about by the pandemic and have linked this to the concept of resilience. The aim of this research project was to investigate how this applied to residents in care home settings during the first phases of the contact ban in Germany from sociology, developmental psychology and environmental gerontology perspectives, and to gain in-depth understanding of residents' experiences. This paper draws on structured interview data collected from residents in two care homes during early June 2020 in Frankfurt am Main, Germany. The findings show that their experiences were shaped by three factors: care home settings and the approach of staff to handling the contact ban; biographical sense of resilience; and a hierarchy of life issues. The findings highlight the importance of locally specific response mechanisms in care homes, agency and belonging of residents despite health-related limitations and the importance of a critical (gendered) lens on understanding their experiences. [ABSTRACT FROM AUTHOR]

The feminisation of ageing observed across the world is a significant challenge in many societies. Women's greater longevity is associated with the increased likelihood of age-related disability and morbidity. Furthermore, gendered disadvantage and poverty can make access to health care increasingly problematic in later years. Among the Indian states, Kerala has the highest number of residents above the age of 60 and many are older widows. Given this context, this paper explores what promotes access to health care for older widows living alone in the south Indian state of Kerala. Thirty-two in-depth interviews, eight focus group discussions and eight units of participant observation were carried out among widows, health-care providers and key informants. Applying a reflexive inductive approach to our analysis, the main barriers to access that emerged were altered family structures and loneliness, whilst enablers included good social networks and access to neighbourhood clinics. Our participants' social networks were drawn from three levels: family, neighbourhood and the wider community. The ability to form a personal community from their social networks and the quality of relationships within this community strongly predicted the capacity to access health care. Efforts to improve access to health care for older widows requires a response that is rooted in the socio-cultural context of the community. Comprehensive social protection policies that promote initiatives to engender social capital among the older population, decentralised primary health-care services, and the training and sensitisation of health service staff would be key to promote equitable access for older widows. [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]