The post-war period has witnessed considerable change in England affecting family structures and social relationships both within, and between, the generations. In this paper, we report on research which has examined the impact of these changes on the lives of older people. Three urban areas: Bethnal Green and Woodford in London, and Wolverhampton in the West Midlands, are the locations for this project. All three were the subject of classic community studies in the 1940s and 1950s, providing rich material about the family and community life of older people. Using these as a baseline, we have examined changes to the social and family networks of older people over the intervening years. Our research comprised a questionnaire-based survey of 627 older people, followed-up one year later by a series of in-depth interviews with 62 people over the age of 75 (and 19 second generation members in their networks). We also undertook 35 interviews with Indian and Bangladeshi elders in Wolverhampton and Bethnal Green. Findings reported concern the living arrangements of older people and their relationships with network members. In particular, we note the marked trend towards solo living or living in married pairs amongst the white population, and the importance of multi-generation households amongst the two minority ethnic groups. Together with the enduring importance of family and the significance of friends, there are also crucial differences, notably in the ways people maintain contact with members of their networks.

The preservation of self-identity in dementia is dependent upon internal (cognitive) and external (social) conditions. This study investigates the integrity of self (internal) and personae (external) in dementia as indexed by the verbal and nonverbal behaviours of dementia residents and their caregivers in a special care unit. Videotaped observations of spontaneous nursing staff-resident interactions were collected over a three-day period. The recordings were transcribed and subjected to detailed discourse analysis. Our analyses focused on several indexicals of self and personae including personal pronouns, proper nouns, interpersonal conflicts, and discursive positioning. The findings revealed that both self and personae are susceptible to decline in dementia. However, the results also provide evidence that even in severe dementia self and personae can be indexed in a variety of ways. We discuss the important role that caregivers can have in reinforcing self and personae in dementia.

The financial, opportunity and social costs and benefits of providing informal support to frail older people are described within an economic framework. Mentally and/or physically frail older people were identified through screening interviews with random community samples of people aged 65 and over in four UK areas: 884 frail older people living in private households nominated key informal supporters and 650 of these supporters were interviewed. Around half the supporters reported financial costs (43 per cent) or lost social opportunities (45 per cent). A minority of supporters had reduced their working hours or withdrawn from employment because of caregiving. Nearly all supporters reported at least one social cost (92 per cent) and identified at least one positive aspect of caregiving (95 per cent). Co-resident supporters were more likely to report opportunity costs and loss of health and well-being. Daughters supporting a frail parent were generally most likely, and friends or neighbours least likely, to report each type of cost. Supporters of older people who were both mentally and physically frail reported significantly greater opportunity and social costs. The benefits of caregiving were not consistently related to co-residency, relationship of supporter or frailty type. Possible strategies for decreasing the costs and increasing the benefits of caregiving are discussed.

While studies investigating factors associated with carer burden suggest that intellectual impairment and behavioural disturbance in the care recipient are more demanding for the carer than physical impairment, comparative research findings are equivocal. Family carers of people with a long-term illness or disability were identified through a survey of 26,000 households in Victoria, Australia. Focusing on carers of those aged over 50 years, three subsamples were selected: 186 carers of relatives with physical impairment only, 182 carers of those with diagnosed memory loss and 117 carers of those with intellectual impairment diagnosed as dementia. Carers of physically impaired relatives reported better health, greater life satisfaction, and less overload, negative affect, family conflict, anger and resentment than carers of those with intellectual impairment, whether labelled as dementia or not. Despite lower impairment levels in the care recipient, carers of those with undiagnosed memory loss reported more resentment about their caring role than carers of those with a diagnosed dementia. The effects on the carer of significantly greater impairment in the dementia care recipient group may be ameliorated by having a diagnosis, bringing with it the potential for increased understanding and tolerance. Fortunately, negative feelings predictive of a sense of burden are subject to a range of interventions: providing information to promote understanding; counselling to tackle negative feelings and family conflict; guidelines to deal with behaviour problems and physical aspects of caring; and community services to reduce overload.