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Access to social protection in old age is crucial and yet contingent upon negotiations between the social structures of the welfare states and the personal networks within which individuals are embedded. International migration, changing family dynamics, and the transformation of care and other welfare policies in the global North make it challenging for older migrants to negotiate social protection. Drawing on 45 semi-structured interviews with first-generation older Turkish migrants in London and 13 semi-structured interviews with professional service providers for the community, the paper aims to investigate the assemblages of formal and informal social protection in the lives of older migrants. Findings indicate the complexity in accessing informal social protection and the navigation of formal care support in the UK for first generation older Turkish migrants and the contingency of access to formal care services on informal support networks for participants. It has been demonstrated that built infrastructure and policies aimed at older adults have great influence on assemblages of care, highlighting the need for more age-friendly and integrated policies to facilitate access to social protection for diverse groups of older adults. [ABSTRACT FROM AUTHOR]

As people age they are at increased risk of cardiovascular disease, the leading cause of mortality and morbidity worldwide. Understanding cardiovascular ageing is essential to preserving healthy ageing and preventing serious health outcomes. This collection of papers published in Age and Ageing since 2011 cover key themes in cardiovascular ageing, with a separate collection on stroke and atrial fibrillation planned. Treating high blood pressure remains important as people age and reduces strokes and heart attacks. That said, a more personalised approach to blood pressure may be even more important as people age to lower blood pressure to tight targets where appropriate but avoid overtreatment in vulnerable groups. As people age, more people experience blood pressure drops on standing (orthostatic hypotension), particularly as they become frail. This can predispose them to falls. The papers in this collection provide an insight into blood pressure and orthostatic hypotension. They highlight areas for further research to understand blood pressure changes and management in the ageing population. Inpatient clinical care of older people with heart attacks differs from younger people in UK national audit data. People aged over 80 had improved outcomes in survival after heart attack over time, but had lower rates of specialist input from cardiology compared with younger people. This may partly reflect different clinical presentations, with heart attacks occurring in the context of other health conditions, frailty and multimorbidity. The care and outcomes of acute and chronic cardiovascular disease are impacted by the frailty and health status of an individual at baseline. The research included in this collection reinforces the wide variations in the ageing population and the necessity to focus on the individual needs and priorities, and provide a person-centred multidisciplinary approach to care. [ABSTRACT FROM AUTHOR]

Previous research has suggested that older trans and gender non-conforming (TGNC) people may face particular challenges related to stigma, social exclusion and discrimination in later life. However, direct data on social support and needs in older TGNC population both internationally and within the UK is limited due to the small, dispersed nature of this population, and the absence of specific data collection on aging TGNC populations. During the UK COVID-19 lockdown in summer 2020, older people and those with long-term health conditions were advised to adopt particular precautions. This study aimed to explore older TGNC people's social support networks, key concerns and unmet needs during the COVID-19 'lockdown'. A UK cross-sectional survey of LGBT + people aged 60+ (n = 375) was undertaken during the lockdown. This paper analyses responses from the subset (n = 38) of TGNC participants. The majority of TGNC respondents described diverse social networks, often centered around friends and non-kin social networks, although partners and adult children were also significant for some. In most cases, those with existing strong networks continued to maintain social connections during lockdown, albeit with some regrets about loss of activities and face-to-face connection. However, a minority of respondents had experienced greater challenges prior to lockdown, and may have been at increased vulnerability during the pandemic, for example indicating that they had no-one to call on for practical support in an emergency. When asked about unmet needs and challenges, social isolation was repeatedly raised as the most frequent concern. Several respondents also mentioned issues specifically affecting TGNC communities, including access to gender affirming care and a perceived rise in social intolerance. Health and social care providers should be aware of the diversity of support networks within TGNC communities. There may also be benefits in community sector interventions to help older TGNC build and maintain strong social networks. [ABSTRACT FROM AUTHOR]

Recent political processes have rendered people with dementia an increasingly surveilled population. Surveillance is a contentious issue within dementia research, spanning technological monitoring, biomarker research and epidemiological data gathering. This paper explores surveillance in the relationships of people affected by dementia, how older relatives both with and without diagnoses are surveilled in everyday interactions, and the importance of expectations in guiding surveillance. This paper presents data from 41 in-depth interviews with people affected by dementia living in the community in the United Kingdom. Agedness was a key contributor to expectations that a person may have dementia, based on previous experiences, media accounts and wider awareness. Expectations provoked surveillance in interactions, with participants looking for signs of dementia when interacting with older relatives. Older people also enacted self-surveillance, monitoring their own behaviour. Various actions could be attributed to dementia because interpretation is malleable, partly vindicating expectations while leaving some uncertainties. Expectant surveillance transformed people's experiences because they organised their own actions, and interpreted those of others, in line with pre-existing meanings. The ability to interpret behaviours to fit expectations can bring coherence to uncertainties of ageing, cognition and dementia, but risks ascribing dementia to many older people who straddle those uncertainties. [ABSTRACT FROM AUTHOR]

Despite the identification of social inclusion as a key objective of age-friendly policies and programs, there is limited research evidence as to either the extent to which this has been achieved or how it might be realized. Gaps remain in our understanding of how age-friendly programs might involve different groups of older people and the possible barriers that might be encountered. This paper seeks to address this gap by drawing on evidence from the Ambition for Aging program in Greater Manchester, UK, which implemented a range of projects designed to tackle social isolation in later life. The paper argues that due to its co-production approach and spatial lens, Ambition for Aging was able to involve sections of the older population that otherwise might have remained excluded. In providing further insights relevant to age-friendly programs, the paper also considers some of the barriers experienced by the Ambition for Aging program and builds a case that taking a spatial justice perspective to age-friendly work may help identify and overcome obstacles to achieving social inclusion. [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]

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]

The UK's ageing population has generated contradictory policy responses. On the one hand, facing the lack of specialist housing for the elderly, older people are incentivised to 'age in place'; on the other, to move to smaller homes to free-up family housing, reducing pressure on housing supply. This 'downsizing' discourse is presented as a 'win-win' situation which benefits older people and the rest of society. However, a survey and interviews conducted with over 55 s in England reveals more nuanced patterns of residential moves, behaviours and aspirations than suggested by 'downsizing'. Only a minority of older households choose to downsize. This paper looks into this mismatch between observed housing choices and the construction of downsizing as a policy goal. It suggests that theoretically speaking, the very notion of downsizing is problematic and difficult to define and is an over-simplistic concept which in reality applies to a heterogeneous group of people. [ABSTRACT FROM AUTHOR]

Housing options for older people in the United Kingdom (UK) have been rather limited to remaining living 'independently' in one's own home and some variant of institutionally provided, pre-established and age-exclusive housing such as retirement communities, extra-care or sheltered housing. However, interest in alternative forms of housing and living which align more closely with the expectations of those currently entering later life is steadily growing. In this paper, we present some findings from original, mixed-methods research on the UK's only established example of senior co-housing, which also happens to be women only. Through thematic analysis, we explore two key questions about this important social experiment: (a) is this a model merely for the dedicated, activist and privileged few, as is often presumed; and (b) what might it tell us about post-traditional ageing. Is it merely a retirement lifestyle choice and identity project, grounded in logics of age denial, activity, choice, individualism and risk management? Our findings cannot be conclusive at this stage, but they do suggest a new model of later-life dwelling for the UK based on more collectivist values of inter-dependence, commitment, learning and, even, love. [ABSTRACT FROM AUTHOR]

While death features widely in various humanities and some social science disciplines, to date it has not been given the attention it deserves in social policy discourse or research. This paper sets out to begin to rectify that omission. Outlining a range of policy areas affected by death, it argues that budget and outcome-driven priorities in the UK have resulted in the evolution of disconnected and inconsistent policy responses to death. The paper begins by outlining death rates and characteristics of population ageing before focussing on social divisions in death and associated policies. It considers the death and UK social policy agenda before outlining the key characteristics involved in developing a coherent policy response and policy analysis in this field. It argues for a more comprehensive, consistent and joined up policy response to death, and corresponding academic study of death, which acknowledges and supports individuals preparing to die, when they die and those left behind. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to provide qualitative evidence from the experience of Chinese service users in the UK to expand the literature on the use of intersectionality analysis in research on the mental health of ethnic minority groups.Design/methodology/approach Repeated in-depth life-history interviews were carried out with 22 participants. Interviews were analysed using the constant comparative method.Findings Four areas of life are identified for their possible negative impact on mental health for this minority group: labour market and work conditions, marriage and family, education, and ageing. The findings illustrate how these intersecting variables may shape the social conditions this ethnic minority group face. For this ethnic minority group in the UK, inequalities can intersect at national as well as transnational level.Originality/value This paper highlights how power relations and structural inequalities including class, gender, age and ethnicity could be drawn upon to understand the interplay of determinants of mental health for ethnic minority groups. As the multi-factorial social forces are closely related to the emergence of poor mental health, it is suggested that interventions to reduce mental health problems in ethnic minority communities should be multi-level and not limited to individualised service responses. [ABSTRACT FROM AUTHOR]

The use of ‘brain training’ games is often regarded as relating to wider ideals of self-improvement and youthfulness. Hence, use is intertwined with discourses of ‘active’ ageing. This paper analyzes how the use and users of brain training games were configured in the UK media, from 2005 to 2015, and examines how notions of active ageing relate to these representations. Game users were rarely constructed solely as gamers, and were more often presented as prudent individuals focused on a serious goal. This configuration related to assumed and enjoined motivations for brain training; specifically, users were commonly framed as seeking to enhance cognition and limit/delay cognitive decline. Scientific evidence about brain training was often deployed to explain how games might work; sometimes, however, it was used to undermine the utility of games and assert the significance and cognitive health-benefits of other activities. A minority of texts explicitly critiqued ideals of self-improvement, arguing that game playing was important for its own sake. Yet, even the pleasure associated with gaming was occasionally instrumentalized as a mechanism for ensuring prudent life choices. The analysis casts fresh light on how debates around health, ageing, and science correspond to configurations of technology uses and users. It presents evidence of the widespread cultural circulation of enjoiners regarding self-care and healthy ageing within British society. However, the paper also provides indications of the limits to such imperatives: discourses of pleasure co-exist with and perhaps supplant logics of prudence in (accounts of) practices ostensibly aimed at ageing ‘well’. [ABSTRACT FROM AUTHOR]

Objective: This paper describes the development of a novel mobile health (mHealth) educational intervention, called m2Hear, designed for first-time hearing aid users based on previously developed educational multimedia videos, or reusable learning objects (RLOs), branded C2Hear. Design: The development of m2Hear used theoretical and ecologically valid approaches. The COM-B model and associated Theoretical Domains Framework were employed to identify specific components (or "active ingredients") of the original RLOs that facilitate hearing aid use. An mHealth platform was then developed following an iterative, user-centred and participatory design approach. Study sample: Fifteen existing hearing aid users completed synchronous, real-time Think Aloud interviews. A sub-group of these participants (n = 5), along with patient and public involvement panel members (n = 4), subsequently reviewed the usability of the mHealth platform. Results: While factors associated with Capability featured strongly across all RLOs, topics relating to Opportunity and Motivation were also incorporated. The RLOs were broken-down into 42 shorter mobile-enhanced RLOs (or mRLOs). Each mRLO was labelled with a specific user-centred question generated from the Think Aloud interviews. The final mHealth platform was developed following four separate usability iterations. Conclusions: Overall, m2Hear provides greater opportunities for individualised learning and encourages greater interaction to facilitate self-management in first-time hearing aid users. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to assess frailty, geriatric conditions and multimorbidity in people experiencing homelessness (PEH) using holistic evaluations based on comprehensive geriatric assessment (CGA) and draw comparisons with general population survey data. Design/methodology/approach: Cross-sectional observational study conducted in a London-based hostel for single PEH over 30 years old in March–April 2019. The participants and key workers completed health-related questionnaires, and geriatric conditions were identified using standardised assessments. Frailty was defined according to five criteria in Fried's phenotype model and multimorbidity as the presence of two or more long-term conditions (LTCs). Comparisons with the general population were made using data from the English Longitudinal Study of Ageing and the Health Survey for England. Findings: A total of 33 people participated with a mean age of 55.7 years (range 38–74). Frailty was identified in 55% and pre-frailty in 39%. Participants met an average of 2.6/5 frailty criteria, comparable to 89-year-olds in the general population. The most common geriatric conditions were: falls (in 61%), visual impairment (61%), low grip strength (61%), mobility impairment (52%) and cognitive impairment (45%). All participants had multimorbidity. The average of 7.2 LTCs (range 2–14) per study participant far exceeds the average for even the oldest people in the general population. Originality/value: To the best of authors' knowledge, this is the first UK-based study measuring frailty and geriatric conditions in PEH and the first anywhere to do so within a CGA-type evaluation. It also demonstrates the feasibility of conducting holistic evaluations in this setting, which may be used clinically to improve the health outcomes for PEH. [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 considers the lack of choice in sheltered housing and residential/nursing care provision for older lesbian, gay and bisexual ( LGB) individuals in the UK. While there is a growing body of knowledge about their concerns about current options, the precise kinds of alternative provision which older LGB individuals would prefer are not yet well understood. This article reports on a qualitative study conducted in 2012 which aimed to explore ageing, gender and sexuality from an equalities perspective. The study deployed semi-structured interviews with 60 older LGB individuals living in the UK, and used a thematic analysis approach to the data. This paper describes one aspect of the data, relating to participants' concerns about health and social care provision. The analysis identified several key themes underpinning older LGB individuals' concerns about mainstream sheltered accommodation and residential care, namely: lack of visibility, risky visibility, unequal openness and compulsory co-occupation of care spaces. It highlights the significance of gender for housing/care preferences, with a greater proportion of older LGB women wanting gender- and/or sexuality-specific provision compared with men. The social policy, equality and human rights implications of these findings are considered. [ABSTRACT FROM AUTHOR]

Aims: This study is the first to systematically document histological features of fractures of known age in infants (≦12 months). It has been used to develop a tabulated database specifically to guide histopathologists to age fractures in children considered to have suffered accidental or non‐accidental injury (NAI). Currently in the United Kingdom there are insufficient pathologists with experience in histological ageing of fractures to meet the medicolegal need for this examination. This study provides a practical tool that will allow those skilled paediatric and forensic pathologists currently involved in assessing infants for evidence of accidental or non‐accidental injury a basis for extending their assessment into this area of unmet need. Methods and results: One hundred and sixty‐nine fractures of known age at death were obtained from 52 anonymised infants over a period of 32 years (1985–2016 inclusive). Sections stained using haematoxylin and eosin (H&E) and Martius scarlet blue (MSB) were used to identify specific histological features and to relate them to fracture age. In 1999 the data were entered into a tabulated database for fractures accumulated between from 1985 to 1998 inclusive. Thereafter cases were added, and at 2‐yearly intervals the accumulated data were audited against the previous database and adjustments made. Conclusions: This paper describes the final data set from the 2017 audit. The study was terminated at the end of 2016, as there had been no material changes in the data set for three consecutive audits. [ABSTRACT FROM AUTHOR]

Little is understood about social work students or social workers' perceptions of ageing in the UK. This paper presents a small-scale study of 20 master social work students' perceptions of ageing during the first year of their programme. A mixed method approach was employed over a two-staged research project, in both stages the social work students were asked to complete Kogan's attitudes towards older people scale (KATOPS) and draw a person aged 75. Results demonstrated that most students had neutral to positive attitudes towards older people at the beginning of the programme and these improved in stage two; all had positive attitudes. The drawings provided a visual narrative of their perceptions of older people; visual signifiers included physical signs of ageing. Fulfilment, emotion, family, individuality and appearance were emergent themes. Whilst the programme enhanced the students' perceptions more work is needed to dispel the myths and stereotypes about ageing. [ABSTRACT FROM AUTHOR]

Little is known about the perspectives of health-care workers when it comes to prolonging their working lives. This exploratory paper focuses on physiotherapists and aims to offer new insights into the underlying processes that may influence perceptions of ageing and how they impact on motivation to work longer. Data gathering took the form of focus groups with 43 National Health Service physiotherapists. A thematic analysis was used to characterise and articulate key concepts and meanings. The analysis applied interpretive techniques. The six headline themes to emerge were: worry over physical capability and ability to cope; the need to maintain a professional image; work, retirement and exit norms; beliefs about ageing; extrinsic job demands; organisational support – line management; and organisational support – career progression. The key findings suggest that the current unchanging context of high job demands is very salient, consequently resulting in negative and pessimistic feelings about capabilities when it comes to being an older worker and having an extended working life. [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]

Research on minority ethnic ageing remains a neglected area within mainstream race and ethnicity studies as well as that of social gerontology. This paper examines the background and reasons for this, arguing that a focus on minority ethnic issues provides a reminder of the complexity of the lifecourse, and of the diversity of ageing as a cultural, economic and social construction. The discussion reviews definitions of ethnicity and their relevance to work in social gerontology. The paper provides an account of early studies of minority ethnic ageing, identifying the strengths and limitations of this research. Later work is then considered, notably that focusing on issues connected with the rise of transnational communities and the changing character of neighbourhoods in urban environments. The paper argues that developing research on minority ethnic ageing has become especially important for understanding the impact of globalisation on re-defining communities, relationships and identities, within and beyond nation states. Globalisation, it is suggested, can be seen as a product of the movement of ethnic groups; equally, ethnic groups are themselves transformed by the possibilities created by global change. The paper concludes with a number of suggestions for embedding work on ethnicity within research in social gerontology. [ABSTRACT FROM PUBLISHER]

In recent years, there has been an increasing interest in researching ageing ethnic minority populations in the West. However, older people from such minority communities have received comparatively little attention in wide-ranging discussions on appropriate research methodologies. By a process of critically reflecting on our experiences of undertaking fieldwork for our Economic and Social Research Council New Dynamics of Ageing study of ‘Families and Caring in South Asian Communities', this paper maps out the key methodological and ethical challenges we faced and, in the process, highlights the importance of developing socially appropriate research methodologies and ethical frameworks for research with such populations. With a reflexive approach, we specifically explore the significance of gender, age, time and space to the fieldwork processes and the ‘field’ relationships formed at various stages of the research process. In particular, we explore three key emergent issues which conflicted with our formal research protocols and presented particular challenges for us and our older Pakistani Muslim participants: (a) structuring of time in daily life; (b) gendered use of public and private spaces; and (c) orality of informal social contexts and relationships. Using illustrations from our fieldwork which reveal the particular significance of these issues to our fieldwork experiences and performativities of public/private identities, we highlight important tensions between formalised ethical and methodological dimensions of conducting funded research and the realities of being in ‘the field’. We conclude the paper by emphasising the need to explore further not only the ways in which researchers can adopt more socially and culturally sensitive data collection processes and methodologies at the micro level of their interactions with research participants, but also contextualising the particular challenges experienced by researchers and their participants in terms of the wider research frameworks and agendas as well as the broader social contexts within which they live and work. [ABSTRACT FROM PUBLISHER]

Population ageing is a key challenge confronting European policy makers. Ageing is a complex issue, requiring a value-driven approach to law and policy. However, there has been limited consideration of what values are driving ageing law and policy in the European Union, or if these values are appropriate. Drawing on an empirical study of United Kingdom (UK) legal policy documents, this paper identifies and critiques the primary values and objectives driving ageing law and policy in the field of employment. It is argued that the values driving UK law and policy are often contested, contradictory and under-defined, and there has been limited thought given to how they should be prioritised in the event they conflict. Thus, there is a serious need to reconsider the approach to age and employment taken by policy makers, and to clarify better the key values on which law and policy rest. [ABSTRACT FROM AUTHOR]

Purpose -- Appropriate housing for the growing population of older adults is becoming an international concern. The purpose of this paper is to report on a review of UK and international literature carried out as part of a project exploring the commissioning and delivery of social care in housing with care settings. The paper also considers housing with care in the context of UK policy and practice. Design/methodology/approach -- The peer literature review process used a range of academic databases as well as government and third sector web sites, drawing on relevant material in English published from 1990 to 2012. Findings -- Findings are presented within three main themes: how care and support is provided; the role of the built environment; and the benefits for resident well-being. The review found a paucity of literature focusing specifically on care and support in housing with care settings, particularly in terms of how social care is delivered, but the evidence base suggests that housing with care is in a strong position to deliver on most if not all UK government aspirations. Practical implications -- Despite a growing literature both in the UK and internationally exploring the characteristics and benefits of housing with care for older people, substantial gaps remain in the research evidence. Originality/value -- This paper presents an up to date review of the housing with care literature in the context of current UK policy. [ABSTRACT FROM AUTHOR]

The concept of social capital is widely used in the social sciences and has, to an extent, been applied to the lives and social networks of older lesbian, gay and bisexual (hereafter LGB) adults. Developing existing research, this paper argues that while not without its problems, the concept of social capital enriches our understanding of these networks, whilst simultaneously deconstructing the negative stereotypes surrounding homosexuality in later life. However, little attention has been paid to the social factors that mediate access and participation in lesbian and gay communities and the implications of this on the quality and experience of later life. Drawing on qualitative research conducted in the United Kingdom, this paper illustrates how biography, gender and socio-economic status are significant mediators in the development and maintenance of social capital by older LGB adults. It concludes with a set of recommendations aimed at improving the social capital of older LGB adults, together with the importance of ‘queering’ the concept itself. [ABSTRACT FROM PUBLISHER]

Purpose – The purpose of this paper is to explore whether handyperson services are able to meet the needs of diverse groups of older people, specifically in the UK policy context, to meet the requirements of the Equality Act (2010). Design/methodology/approach – The scoping review of the literature was conducted in 2012 using a wide range of literature from the UK. Findings – In an under-researched field it is difficult for policy makers to determine whether handyperson schemes and their associated services are accessible to and being used by all sections of the older population. Schemes do not generally collect and report data about their users. Research limitations/implications – The scoping review concentrates on UK literature. There are a variety of handyperson schemes and they operate in different ways with different criteria and priorities. Some of the accounts of handyperson schemes provide little data about user characteristics. Practical implications – The paper suggests how handyperson schemes may be able to meet the requirements of the Equality Act (2010) by outlining what data are needed and approaches to gathering it sensitively and proportionally. Originality/value – The paper is the first to consider the implications of the Equality Act for handyperson schemes, which may be relevant to other housing and care services. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to review the management of the (accessible) social housing stock as a means to achieve a cost effective solution to meeting the needs of an ageing population. The paper examines the costs and effectiveness of an accessible housing register (AHR) as the primary means social landlords have to utilise accessible housing stock efficiently. Design/methodology/approach – The paper examines the cost effectiveness of the most advanced AHR in the UK. The data for the study was collected in 2009 (costs/expenditure quoted relate to that year) and is derived from a combination of interrogating computerised allocation records and the collection of information on costs through interviews with local authority staff. Findings – The concept of an AHR can involve substantial set up costs. The financial analysis to assess their cost effectiveness proves complex but suggests that an efficient full register could be more than justified in these terms if it led to a reduction in costs, through the removal of the need for a relatively small number of adaptations in the first years of a tenancy. Originality/value – This is the first study that assesses the financial case for AHRs. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to learn lessons from North America on housing an ageing population, both in terms of supporting people to "age in place", and available options for those who need/wish to move. The project, funded by the Winston Churchill Memorial Trust, comprised a six-week travel fellowship to USA and Canada to meet with housing professionals from the public and private sectors and find out about best practice initiatives and efficient models for housing older people.Design/methodology/approach – The paper is in two parts, of which this is the second. Part 2 focuses on the links between housing and health and, recognising significant differences between the countries, draws out lessons which may be applied as similar challenges of austerity, an ageing population and the increasing interest in personal budgets are faced.Findings – There is no one size fits all approach to addressing the housing needs of the older population; a continuum of options across tenures is required. There are opportunities for growth in the private and non-profit sectors in terms of the provision of services for the ageing population. Large scale social change comes from better cross-departmental coordination and cannot be achieved by the isolated intervention of a single organisation. Originality/value – This was a unique opportunity to learn lessons from North America on how to effectively meet the needs of the older population, now and in the future. The findings are based on the personal observations and conclusions of a housing practitioner. [ABSTRACT FROM AUTHOR]

The current generation of older people who are approaching or recently experiencing retirement form part of a unique generational habitus who have experienced a cultural shift into consumerism. These baby boomers are often portrayed as engaging in excessive levels of consumption which are counter to notions of sustainable living and to intergenerational harmony. This paper focuses on an exploration of the mechanisms underpinning the consumption patterns of baby boomers as they retire. We achieve this through an understanding of the everyday practices of grocery shopping which have the potential to give greater clarity to patterns of consumption than the more unusual or ‘extraordinary’ forms of consumption such as global travel. In-depth interviews with 40 older men and women in four locations across England and Scotland were conducted at three points in time across the period of retirement. We suggest that the grocery shopping practices of these older men and women were influenced by two factors: (a) parental values and upbringing leading to the reification of thrift and frugality as virtues, alongside aspirations for self-actualisation such as undertaking global travel, and (b) the influence of household context, and caring roles, on consumption choices. We conclude with some tentative observations concerning the implications of the ways baby boomers consume in terms of increasing calls for people to live in more sustainable ways. [ABSTRACT FROM AUTHOR]

Medical innovations have created a future of survivorship for many groups of people with a variety of conditions that were previously untreatable or untreated. This has led not only to an expansion of medical activity in a whole variety of new areas but also to the emergence of new groups of individuals defined or defining themselves through their experiences, diagnosis and treatment. Through analysis of in-depth interviews with 27 of the now-adult survivors of the pioneer cohort of children receiving liver transplants in Britain in the early 1980s and 1990s, this paper presents how this group not only illustrate the capacities of modern medicine and healthcare to transform the survival prospects of a more diversified population, but also create new narratives of embodied identity. Specifically, we examine how childhood identities were shaped in three settings; home, hospital and school. At home, parents appeared to shape their child's identity through controlling tightly a daily medical regime focused on the concept of ‘body as machine’, celebrating their survival as a transplant recipient, yet at the same time socialising their child as a ‘normal’ child, albeit one who had a serious illness. The hospital appeared instrumental in shaping parents' focus on their child's body, and offered a way, through other patients with liver disease, for children to feel ‘normal’ in their difference. It was in school, through interaction with ‘healthy’ children and teachers, that corporeality and embodiment appeared most salient, and where social identity was negotiated and more often held in contention. Adult survivors of childhood liver transplant straddle the different discourses of normality and difference as their embodied experiences shape their narratives of identity and shed light on an underexplored aspect of the relationship between medicine and society. [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]

Older people who live alone face particular challenges if they are to age and die well in the place and manner of their choosing. This discussion paper examines the experiences and needs of older people living alone towards the end of life. The paper focuses on the UK, given recent policy and service development initiatives there which emphasize home as a place of support and care; the promotion of independence; ensuring choice and decision making; and equity. These initiatives do not acknowledge diversity in the older population and make little provision to meet the specific needs that older people living alone may have as they approach the end of life. We identify three broader social factors that influence whether older people who live alone can remain at home until the end of their lives. The first factor is the physical environment; the second concerns their material environment; and the third relates to their social environment and their access to informal and formal care services. In future, palliative care research of relevance to older people should consider living arrangements as an important variable and be cognisant of the way in which wider social issues constrain the quality of end-of-life care that those living alone in older age receive. [ABSTRACT FROM AUTHOR]

Abstract: Improvements in health and longevity in countries such as the UK and USA have radically destabilised notions of ageing and old age. From the 19th century onwards the idea of a natural lifecourse following normatively understood stages ending in infirmity and death has been challenged by social and bio-medical developments. Breakthroughs in bio-gerontology and in bio-medicine have created the possibility of an increasingly differentiated idea of normal ageing. The potential to overcome or significantly reduce the age-associated effects of bodies growing older has led many social gerontologists to argue for a return to a more ‘normatively’ based conception of ageing and old age. This paper examines and outlines the tensions between these different discourses and points out that our understanding of the norm is also fast changing as it intersects with the somatic diversity inherent in contemporary consumer society. Drawing on the theoretical work of Ulrich Beck and Zygmunt Bauman, this paper argues that the normalization of diversity leads to a reworking of the idea of normativity which in turn is reflected in profound transformations at the level of institutional arrangements and legal systems. Such changes not only lead to more discussion of what is legally and socially acceptable but also potentially lead to greater calls for regulation concerning outcomes. In this paper we argue that we need to distinguish between the newly reconfigured domains of the natural, the normal and the normative now being utilised in the understanding of ageing if we are to understand this important field of health. [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]

In this paper data from a nationally representative British longitudinal study are used to analyse exchanges of support between Third Age parents (aged 55–75) and their adult children. Results show that between two thirds and three quarters of parents in this age group were involved in some sort of exchange relationship with at least one of their children. Generally, more Third Age parents were providers than recipients of help, but there was a strong reciprocal element to intergenerational exchange with, for example, married parents who provided support to at least one child being twice as likely as those who did not to receive support from a child, after allowance for a range of relevant parental and child characteristics. Parental characteristics associated with higher probability of providing help included higher income, home ownership and being married or widowed rather than divorced. Higher income and home ownership were, however, negatively associated with odds of receiving help from a child, again after adjustment for other co-variates, suggesting socio-economic differences in the balance of support exchanges. Children seem responsive to parental needs in that receipt of help from a child was positively associated with older parental age and with parental disability. The paper shows that in Britain, as in the USA, the balance of intergenerational exchanges involving Third Age adults is downward rather than upward, in contravention of depictions of older adults as‘burdens’ on younger generations. Current demographic and social changes are, it is argued, likely to increase support demands from adult children to Third Age parents in coming decades. [ABSTRACT FROM AUTHOR]

Little is currently known about the aging and later life experiences of older gay men in Britain. This paper seeks to broaden the gerontological understanding of aging for this hitherto invisible group. Using data generated from interviews with 15 homosexual men aged 57-84, the paper argues that traditionally recognized perceptions of aging and transitions from middle to old age are not necessarily reliable indicators of gay men's experiences. The signposts to aging discussed so far do not account for varied personal characteristics and backgrounds. The framework of aging reminders developed by Karp (2000) 1 is shown to be relevant to the perceptions of aging included in the data. However it is argued that these reminders are not necessarily evident just to people in their fifties, and that they may also be experienced in different ways. The paper develops Karp's model, deconstructing the reminders he introduced to show the variety of ages at which they become evident, the heteronormativity of the existing framework and how this can be reduced, the way reminders inter-connect, and how those relating to the body can usefully be subdivided to elucidate the number of different ways the body can be experienced, highlighting the transition to later life. [ABSTRACT FROM AUTHOR]

This is the second in an occasional series of paired commentaries in Age and Ageing, the Journal of the British Geriatrics Society and the Journal of the American Geriatrics Society (JAGS). The aim is to address issues of current significance and to foster dialogue and increased understanding between academics and clinicians working in comparative international settings. Both commentaries address the urgent need to improve palliative care for older people, with a critique of some stereotypes surrounding palliative care and the 'good death'. The companion commentary, published in JAGS, was written by Alexander Smith and Vyjeyanthi Periyakoil, and is grounded in their experience as academic clinicians (Smith AK, Periyakoil V. Should we bury 'The Good Death'? Journal of the American Geriatrics Society 2018; in press). In the present paper, we offer a perspective on the outcome and wider consequences of misalignment between current UK policy and aspirations for end of life care in relation to epidemiological trends and patient experience of death and dying. [ABSTRACT FROM AUTHOR]

The ‘greying’ of the United Kingdom nursing workforce: implications for employment policy and practice One in five nurses on the United Kingdom (UK) professional register is aged 50 years or older. Over the next few years, the profession will lose, through retirement, many of its most experienced practitioners. The significance for policy makers and for employers of this age-shift is two-fold. Firstly it is clear that greater numbers of nurses and midwives are reaching, or soon will reach, potential retirement age. Secondly many more nurses are now reaching their middle years and they are likely to have different requirements and attitudes to nursing work. This paper examines the employment policy and practice of the ageing of the UK nursing population. The paper examines data from official sources, and information from attitudinal surveys and case studies with employing organizations to assess the major effects of the ageing of the nursing workforce. Key findings are that the age profile of those nurses working in the National Health Service appears to be ‘younger’ than that of the total population, with the age profile of nurses working in nursing homes and as practice nurses being older than that of the NHS nursing workforce. However, the overall age profile of NHS nurses masks considerable variation between specialties and trusts, and the ‘pool’ of potential nurse returners from which the NHS and other employers attempts to recruit, is declining in numbers, as it too ages. Other major issues requiring policy attention are the provision of appropriate flexible hours to older nurses who have caring responsibilities, improving access to continuing professional development, and reducing pension provision inflexibility. [ABSTRACT FROM AUTHOR]

This paper discusses George Henry Lewes's study of living matter in The Physiology of Common Life (1859-60). Despite the physiological materiality of its subject, Lewes's text often discusses states of life that defy clear-cut classification. The process of human aging is a particularly confounding example of life and death's indeterminacy because, as Lewes describes, older age invokes both the physiological and aesthetic intermingling of animal life with stone, petrifaction, and minerality. I argue that Lewes's discussion of aging in Chapter XIII draws directly from the earlier geological research of Charles Lyell and, with brief reference to illustrative examples elsewhere in Victorian writing, I show the ways in which the Lewesian understanding of aging as a state of suspension between animality and minerality is reliant upon and a spur for the nineteenth-century literary imagination. [ABSTRACT FROM AUTHOR]

Ageing in place has been promoted by policy makers as the optimal residential solution for later life, premised on older people's reluctance to contemplate relocation, their declining residential mobility and high levels of residential satisfaction. This paper takes a critical perspective to the notion of ageing in place by examining older people's dislikes about, rather than levels of satisfaction with their home and neighbourhood environments, and establishing whether such dislikes influence a desire to move. Analysis of the 2004 Living in Wales Survey shows that despite high levels of residential satisfaction, a significant proportion of older people do wish to move. Logistic regression results indicate this desire is strongly associated with dislikes about their immediate home environment, more than neighbourhood factors. Contemplating a move in later life may be shaped more by a desire to ‘attach’ to people, than to remain in situ to preserve an attachment to place. [ABSTRACT FROM PUBLISHER]

Background The Whitehall II (WHII) study of British civil servants provides a unique source of longitudinal data to investigate key factors hypothesized to affect brain health and cognitive ageing. This paper introduces the multi-modal magnetic resonance imaging (MRI) protocol and cognitive assessment designed to investigate brain health in a random sample of 800 members of the WHII study. Methods/design A total of 6035 civil servants participated in the WHII Phase 11 clinical examination in 2012-2013. A random sample of these participants was included in a sub-study comprising an MRI brain scan, a detailed clinical and cognitive assessment, and collection of blood and buccal mucosal samples for the characterisation of immune function and associated measures. Data collection for this sub-study started in 2012 and will be completed by 2016. The participants, for whom social and health records have been collected since 1985, were between 60-85 years of age at the time the MRI study started. Here, we describe the pre- specified clinical and cognitive assessment protocols, the state-of-the-art MRI sequences and latest pipelines for analyses of this sub-study. Discussion The integration of cutting-edge MRI techniques, clinical and cognitive tests in combination with retrospective data on social, behavioural and biological variables during the preceding 25 years from a well-established longitudinal epidemiological study (WHII cohort) will provide a unique opportunity to examine brain structure and function in relation to age- related diseases and the modifiable and non-modifiable factors affecting resilience against and vulnerability to adverse brain changes. [ABSTRACT FROM AUTHOR]

Many older women reduce the amount of cooking and food preparation they do in later life. While cooking may be seen as traditionally associated with women's family roles, little is known about the impact of such reduced engagement with food on their lives. This paper presents the findings from a one-year qualitative study (Changes Around Food Experience, CAFE) of the impact of reduced contact with preparing and cooking meals from scratch for 40 women, aged 65–95 years, living in Norfolk, United Kingdom. Data were collected through semi-structured interviews, focus groups and observations. Women's reasons for reducing food-related activities included changes in health, loss of a partner or a caring role, and new patterns of socialising. Disengagement from cooking and shopping was not found to entail predominantly negative feelings, passive acceptance or searching for forms of support to re-enable more cooking from scratch. Accounts evidenced the dynamic adaptability of older women in actively managing changed relationships with food. In exploring new meal options, older women were not simply disengaging from their environments. CAFE findings linked women's engagement with their environments to how they were using formal services and, even more, to the value they placed on social engagement and being out and about. Through the connections they fostered with friends, family and community, older women actively enabled their continued involvement in their social, public and family spheres. Reduced contact with preparing and cooking meals from scratch, therefore, did not induce or imply passivity or debility in the CAFE cohort. By contrast, it involved their exploring new means of retaining what was important to them about food in the context of their lived situation and social connections with friends, family, the community and public spheres. [ABSTRACT FROM PUBLISHER]

During the early 1960s, Norbert Elias led a research project on the adjustment of young workers to work situations and adult roles. The data from this project, which consisted of 851 interviews with young people, were recently rediscovered and the participants, now approaching retirement, were re-interviewed as part of a restudy. In this paper we argue, that, in the context of the dramatic changes to the transition to retirement that have taken place in the United Kingdom, it is possible to use Elias's unpublished work on the transition to work as a theoretical framework for understanding of the transition from work and to retirement. In particular, we focus on the themes of fantasy and reality in the perception of retirement; changing interdependencies in the transition to retirement and the extent and impact of retirement preparation on the perception of the change in status from full-time worker to retiree. We conclude by suggesting that the implied advantages of being the ‘baby-boomer’ generation are far from the reality, with the experiences of this group being similar to those who have gone before and face an adjustment to retirement marked by uncertainty and anxiety. [ABSTRACT FROM PUBLISHER]

Previous literature confirms that older black minority ethnic populations are less likely than white populations to contact dementia services in the UK. However, it is unknown whether this is due to a higher or lower prevalence of dementia or due to different needs or coping strategies within these communities. The aim of this study was to explore the understanding and perceptions of dementia amongst Sikhs living in the UK. Six focus groups were involved with 28 Sikh participants who were recruited from Gurdware (Sikh places of worship). Data were analysed using constant comparative methodology. The themes reported in this paper include “awareness and interpretation of the characteristics of dementia”, “multiple perspectives of the same symptoms” and “causes of dementia”. The findings have been discussed in the context of existing research and provide an introductory insight into informing culturally appropriate interventions. [ABSTRACT FROM AUTHOR]

In an increasingly ageing society, its older members are receiving considerable political and policy attention. However, much remains to be learnt about public perceptions of older age, particularly the views and experiences of older individuals themselves. Drawing on qualitative interviews carried out with members of two British cohorts (N = 60) who have reached the ‘third age’, this paper discusses perceptions of age, focusing particularly on how perceived advantages and disadvantages differ by respondents' self-reported physical capability. The interviews were carried out in 2010 as part of the HALCyon (Healthy Ageing across the Life Course) collaborative research programme. Findings suggest there is some difference in the way older people view aspects of ageing by capability and that although advantages are widely perceived, physical decline and associated health concerns were the overwhelming theme across the conversations. The article concludes by making tentative suggestions to inform the positive ageing agenda and its related policies. [ABSTRACT FROM PUBLISHER]

Volunteering is a ubiquitous and distinct feature of the British retired community in Spain, and for many older migrants volunteering constitutes a significant part of their post-retirement life abroad. Especially in the management and organisation of health and age-related problems voluntary organisations have come to play a crucial role not only for the British community but also for the Spanish host society and public health-care system. Furthermore, volunteering represents a valuable sphere of activity offering personal benefits for those who are actively engaged. Based on ethnographic fieldwork conducted in a charity organisation in the province of Alicante on the northern Costa Blanca, this paper examines the extensive functions that volunteering and charitable activities can offer British older migrants. The implementation of voluntary work within the specific context of retirement migration is identified as a multi-functional individual and societal resource. Volunteering for the retirees is described as a true means of adaptation to a new life context, and as a highly reflexive strategy of risk minimisation and self-realisation. This implies individual benefits and opens up possibilities of active ageing. Finally, volunteering will be analysed as a performative expression of transmigrants' cultural bifocality, reflecting both a high level of commitment to Spain as well as a specific feature of British community spirit and traditionalism. [ABSTRACT FROM PUBLISHER]

Purpose – It is widely acknowledged that people with intellectual disabilities are highly likely to experience mental health problems, but that support workers' knowledge and skill in this area is sometimes lacking. There is little research explicitly exploring knowledge about the mental health of older people with intellectual disabilities and the purpose of this paper is to attempt to fill this gap. Design/methodology/approach – In total, 14 support workers completed a questionnaire in which three vignettes presented progressively worsening indicators of dementia in an older person with intellectual disabilities. Participants explained what they thought was happening and what action they would take. Data were analysed using Braun and Clarke's framework. Findings – Few participants had undertaken any mental health training, and only one in relation to older people. They were generally poor at judging early and intermediate indicators of dementia, but were able to identify more overt later signs. However, they believed these advanced indicators to be the onset of dementia. Nonetheless, they would generally take appropriate action, such as observation and referral. Abuse was often considered as a causal factor. Practical implications – The most significant implication is the need for training in the mental health needs of older people and in particular, the general and specific indicators and expected trajectory of dementia in this population. Originality/value – The study adds to the limited research on staff knowledge about older people with intellectual disabilities and dementia, using a novel methodology. [ABSTRACT FROM AUTHOR]

Purpose – This paper seeks to present findings from a review of hospital policies and practices in one NHS Trust in England. Design/methodology/approach – The focus of the review was hospital staff policy and practice in safeguarding the rights of vulnerable patients. A sample of staff was surveyed to investigate their knowledge of the Mental Capacity Act 2005 in 2010. Interviews, incorporating discussion of a vignette, were undertaken with a range of staff and findings were analysed thematically. These findings are contextualised by an analysis of Trust policies and the wider literature. The findings of this case study are used to develop recommendations for the hospital and healthcare sectors. Findings – Analysis of survey data and interviews revealed limited confidence and knowledge about the Mental Capacity Act 2005 and uncertainties about its relevance to clinical practice. In relation to safeguarding, there was limited realisation of the potential of the Act to uphold the rights of patients lacking capacity and staff responsibilities. MCA training had not made a great impression; hospital policies were inconsistent and lacked coherence. Research limitations/implications – This case study was conducted in one Trust and may not be generalisable. Other hospitals may have different training, policy and procedure systems. Practical implications – The findings of this case study may be applicable to other hospitals and to other providers of health and social care services. The relevance of the MCA could be highlighted and used on several induction and training programmes. The study identifies features of policy and practice that could be investigated in other organisations. Originality/value – Few studies have investigated the operationalisation of the MCA in hospital settings. This study reveals that there are opportunities to refresh MCA and safeguarding training strategies for hospital staff but these should be accompanied by changes to culture and attention to the coherence of different procedures. Audits of MCA and safeguarding compliance can be undertaken within hospitals and a systems approach could be adopted to address any issues identified and to sustain good practice. [ABSTRACT FROM AUTHOR]

The importance of economic well-being is recognised in the recent UK Government policy. Older people may be particularly vulnerable to economic fluctuations as they are reliant on fixed incomes and assets, which are reducing in value. Within the literature, little is understood about the impact of the current economic downturn on people's general quality of life and well-being and, in particular, there is little research on the financial experiences and capability of the older age group, a concern in light of the ageing UK population. This article reports a qualitative research study into the nature of older peoples' vulnerability by exploring their perceptions of the impact of the economic recession on their well-being and quality of life. It explores specifically a group of older people who are not the poorest within the ageing population, but who may be described as the 'asset rich-income poor' group. Key themes relate to the impact of the recession on the costs of essential and non-essential items and dimensions of mental, physical and social well-being. Implications for health and social care practice in meeting the needs of older people during times of economic recession are then explored. The paper adds to the debate by demonstrating that the recession is having adverse consequences for older people's quality of life in terms of economic, mental and social well-being, although there is also evidence that some of them are equipped with certain resilience factors due to their money management and budgeting skills. [ABSTRACT FROM AUTHOR]

Abstract: Within policy and practice there is an increasing interest in the care of frail elders. However understanding of the experience and challenges of living and dying with frailty in older age is currently undeveloped. Frailty is often used as a synonym for the increasing infirmities that accompany ageing and the slow dwindling dying trajectory of many elders. However, there is little empirical work on the experience of being frail to inform social gerontological perspectives and welfare provision. Through analysis of repeated in-depth interviews over 17 months (2006–2008) with 17 frail elders living at home in the U.K., key factors that shape elders’ experience of being frail emerged. The study argues that the visible markers of functional limitations and the increasing social losses of old age bring finitude to the fore. To retain anchorage in this state of imbalance, frail elders work actively to develop and sustain connections to their physical environment, routines and social networks. This experience can be conceptualised as persistent liminality; a state of imbalance “betwixt and between” active living and clinically recognised dying. This paper highlights the precarious and often protracted dying trajectory of frail older people. Whilst it could be argued that developing into death in older age is part of a normal and successful course after a life long-lived, recognition of and support for older people deemed frail is lacking. Frail elders find themselves living in the margin between the Third and Fourth Age with little recognition of or support for the work of living and dying over time. This experience of frailty contests dominant cultural and welfare practices and policy frameworks that operate in binary modes: social or health; independent or dependent; living or dying. [Copyright &y& Elsevier]