Whatever the balance between successful and unsuccessful ageing that is achieved by a particular generation or society, each success creates in its shadow new possibilities of failure. As more people age there are more examples, of both success and failure. The presence of the unsuccessfully aged, whether framed as the ‘aged and infirm’ or as those ‘impotent through age’ sees them become the objects of what we have called society's moral imperative of care. Where once their numbers were few and their circumstances more amenable to resolution, in contemporary ageing societies their predicament has become more challenging as the later lives of successive cohorts have improved. In response, the post-war welfare state has searched for alternative ‘post-modern’ resolutions beyond the modern developments of pensions and long-stay hospital beds. Community care, deinstitutionalisation and the marketisation of services have all been adopted and all found wanting.

Even in the light of scandals, funding crises and market failures, the moral imperative of care remains unchallenged. The provision of care for aged and infirm persons, now especially including those with mental infirmity, has lost none of its ethical underpinnings. Arguably it has become more sensitive to quality of life concerns compared with the care regimes of first modernity. This is reflected in the centrality of terms such as ‘dignity’ and ‘person-centred care’ in motivating improvement in the provision of formal care. In this book we have approached the problem of ‘unsuccessful’ ageing through the rubric of the fourth age and its positioning within the moral imperative of care. In particular we have considered how the new vocabulary of ‘personhood’ and ‘person-centred’ care serves to reduce the impact of such failure.

Personhood has become a pivotal term among those concerned with improving care particularly for people with dementia. Acknowledging the importance of personhood has become one of the defining aspects of policy and practice in dementia care (NICE, 2006; Nuffield Council on Bioethics, 2009; Thomas and Milligan, 2015). A concern for person-centred care is not confined to those working in this area, and has been applied more generally to people of all ages, and with varied disabilities and impairments. What makes the articulation of these arguments within the field of dementia care so significant is the way that dementia itself has been understood.