In common with other developed countries at the end of the 20th century, modernising public services was a priority of the United Kingdom (UK) Labour administration after its election in 1997. The modernisation reforms in health and social care exemplified their approach to public policy. The authors were commissioned to examine the evidence base for the modernisation of social care services for older people, and for this purpose conducted a systematic review of the relevant peer-reviewed UK research literature published from 1990 to 2001. Publications that reported descriptive, analytical, evaluative, quantitative and qualitative studies were identified and critically appraised under six key themes of modernisation: integration, independence, consistency, support for carers, meeting individuals' needs, and the workforce. This paper lists the principal features of each study, provides an overview of the literature, and presents substantive findings relating to three of the modernisation themes (integration, independence and individuals' needs). The account provides a systematic portrayal both of the state of social care for older people prior to the modernisation process and of the relative strengths and weaknesses of the evidence base. It suggests that, for evidence-based practice and policy to become a reality in social care for older people, there is a general need for higher quality studies in this area.

This study analyses the development of the economic wellbeing of Swedes aged 65 years and older from 1990. This period was characterised by Sweden's deepest and most prolonged recession since the Great Depression, but was then followed by buoyant growth. In a series of interventions from 1991 through to 1998, pensions were cut and their full price indexation abandoned. In spite of these dramatic measures, this study shows that pensioners fared better than the working-age population, but also that poverty among older Swedes increased in absolute terms. During the following years of rapid economic growth, in contrast, the growth in pensioners' income fell behind that of workers and their relative poverty increased. The analysis shows that the limited resources of many older Swedes put them close to a social poverty line. The study also shows that income inequality among older Swedes has grown with the increasing importance of capital income for the better off. We conclude that the increasing gap between better-off and worse-off older people raises issues about the future provision of expenditures on public services for them. The paper concludes that, overall, poverty among older people in Sweden remains low by international standards and that the Swedish welfare state has maintained its resilience.

This study examined the associations between a large set of health indicators and wellbeing among older people (aged 66 or more years) in Sweden. The data were drawn from the Swedish Panel Survey of Ageing and the Elderly (PSAE), with variables covering information about health, daily activities, social interaction, anxieties and worries, and economic hardship. A series of confirmative factor analyses were used to reveal if and how indicators of living conditions could be subdivided into latent factors, and several socio-economic and socio-demographic variables were used as their predictors. Differences between men and women and between a number of age groups of old people were systematically scrutinised. The preferred representation of the data was a nested model that identified one global factor, which related to all manifest indicators, and three residual factors that measured the specific experiences of physical impairment, psychosocial distress and economic difficulties. The findings improve our understanding of the relationships between indicators of health and wellbeing and the various latent dimensions that simultaneously affect response patterns. More importantly, they also facilitate our understanding of older people's wellbeing and assists the interpretation of single, commonly used indicators such as subjective health.

The ‘Barriers to Access to Care for Ethnic Minority Seniors’ (BACEMS) study in Vancouver, British Columbia, found that immigrant families torn between changing values and the economic realities that accompany immigration cannot always provide optimal care for their elders. Ethnic minority seniors further identified language barriers, immigration status, and limited awareness of the roles of the health authority and of specific service providers as barriers to health care. The configuration and delivery of health services, and health-care providers' limited knowledge of the seniors' needs and confounded these problems. To explore the barriers to access, the BACEMS study relied primarily on focus group data collected from ethnic minority seniors and their families and from health and multicultural service providers. The applicability of the recently developed model of ‘candidacy’, which emphasises the dynamic, multi-dimensional and contingent character of health-care access to ethnic minority seniors, was assessed. The candidacy framework increased sensitivity to ethnic minority seniors' issues and enabled organisation of the data into manageable conceptual units, which facilitated translation into recommendations for action, and revealed gaps that pose questions for future research. It has the potential to make Canadian research on the topic more co-ordinated.

Many current discussions of welfare state reforms focus on the ‘young old’, a group now generally perceived as healthy people past retirement age without a legal responsibility for dependent persons in need of care. For the welfare state, they constitute a resource whose activities are hard to steer. This article focuses on the influence of the welfare state on the number of ‘young old’ people. It describes different ways in which the welfare state influences the number of young old persons, and investigates whether variations in the regulations for the ages of normal, early and late retirement are the prime cause. The paper also estimates the share of the young old among those aged 50–90 years in 10 European countries in 2004 using comparable survey data. These shares ranged between 36 and 49 per cent for men and between 35 and 52 per cent for women. High shares were found in continental European countries, and low shares in Scandinavian countries and the United Kingdom. The shares in southern European countries varied among the countries and by gender. To explain the variations in the share, country differences in retirement regulations proved helpful but insufficient. When the overall influence of the welfare state on the share of young old persons in the population was analysed, a country-characteristic pattern emerged.

This study analyses gender inequalities in health among elderly people in Catalonia (Spain) by adopting a conceptual framework that globally considers three dimensions of health determinants: socio-economic position, family characteristics and social support. Data came from the 2006 Catalonian Health Survey. For the purposes of this study a sub-sample of people aged 65–85 years with no paid job was selected (1,113 men and 1,484 women). The health outcomes analysed were self-perceived health status, poor mental health status and long-standing limiting illness. Multiple logistic regression models separated by sex were fitted and a hierarchical model was fitted in three steps. Health status among elderly women was poorer than among the men for the three outcomes analysed. Whereas living with disabled people was positively related to the three health outcomes and confidant social support was negatively associated with all of them in both sexes, there were gender differences in other social determinants of health. Our results emphasise the importance of using an integrated approach for the analysis of health inequalities among elderly people, simultaneously considering socio-economic position, family characteristics and social support, as well as different health indicators, in order fully to understand the social determinants of the health status of older men and women.