The global population is ageing and the likelihood of living alone increases with age. Services are necessary to help older people living alone to optimise health and wellbeing. This systematic review aimed to summarise the effectiveness and accessibility of interventions to improve the health and wellbeing of older people living alone. Relevant electronic databases (CINAHL, MEDLINE, PsycINFO and Scopus) were searched for all years up to August 2018. Studies were included if they involved older people (aged ⩾55 years) living alone, and an intervention with measured health and wellbeing outcomes. All study types were included. The Theory of Access was used to assess interventions across dimensions of accessibility, availability, acceptability, affordability, adequacy and awareness. Twenty-eight studies met the eligibility criteria; 17 studies focused on ageing safely in place and 11 on psychological and social wellbeing. Studies comprised quantitative (N = 19), qualitative (N = 4) and mixed-methods (N = 5) approaches. Dimensions from the Theory of Access were poorly addressed in the studies, particularly those of higher-quality methodology. Studies were heterogeneous, preliminary in scope and lacked consistent study design, methodology or measurement. Services that do not address user accessibility in design or evaluation may be limited in their uptake and impact. It is recommended that dimensions of access and co-creation principles be integrated into service design processes and be evaluated alongside clinical effectiveness.

Community health-care services for older, home-dwelling persons with dementia tend to be underutilised. Family care-givers provide substantial care, and they often arrange for and co-ordinate health-care services on behalf of persons with dementia. The aim of this study was to examine family care-givers’ knowledge of unused services and their self-reported reasons for non-use of such services. We gathered cross-sectional survey data from 430 family care-givers of older persons with dementia in Northern Norway. Multinomial logistic regression analysis was used to identify predictors of family care-givers’ knowledge of unused services. An open-ended question regarding reasons for non-use of services was analysed by thematic text analysis. Characteristics of family care-givers (e.g. education level) and factors related to the care-giving circumstances (e.g. negative impact of care-giving) predicted family care-givers’ knowledge of unused services. Reasons for non-use of services were multifaceted and complex, and were related to attributes of the person with dementia and/or the family care-giver (e.g. reluctance to use services) and/or the health-care services (e.g. low quality). Although services were unused, several family care-givers indicated substantial needs for the services. Strategies aimed at addressing the non-use of services should emphasise individuals’ and families’ needs and the adaptation of information about available services and their benefits for both care recipients and family care-givers. A relationship-centred care approach is thus recommended in dementia care.

The health and social benefits of volunteering behaviours by older adults are well acknowledged. However, few review articles have been concerned with the correlates/dimensions of older adults’ volunteerism. Some focused only on the North American context or reviewed studies only up to 2008. This study reviewed the recent global literature in the past decade about the correlates of older adults’ volunteerism. We carried out a literature search in PsycINFO, Social Services Abstracts, Sociological Abstracts and Google Scholar to identify empirical journal publications about the correlates of older adults’ (age 60+) volunteerism from 2008 to 2019. Among 112 initially eligible papers, 41 were selected. Findings were synthesised using the framework of the Socioecological Model. Existing studies mainly have used quantitative methodologies and were conducted within the context of a single Western country. Motivations included higher education, morale and mentality, previous experiences, social network, community cohesion and organisational management. Major barriers were health and financial constraints. Few studies focused on macro-level correlates. Irrelevant and confounding correlates were also discussed. We suggest practitioners recruit and retain older volunteers by identifying their needs and optimising management within the organisation. Policy makers should create a supportive environment and increase resource accessibility. Future research could conduct cross-cultural comparisons, use diverse methodologies and embrace more correlates, especially at the macro-level.

Many persons with dementia live at home and are cared for by their relatives. If the relatives are still employed, this can lead to higher burden and losses in their work-life. The interplay between informal care-giving and working is complex. Different studies have explored this issue, but the results have not been yet synthesised. In this mixed-studies review, we elucidate the underlying complexity. Our objective is to identify the factors related to care-giving that influence employment, and to describe their impact on dementia care-givers’ employment. We performed a literature search of primary studies using four databases and one meta-database, and retrieved English- and German-language articles. We used the Mixed Methods Appraisal Tool to assess their methodological quality. Evidence identified was synthesised by a parallel-results convergent synthesis design. We included 55 qualitative, quantitative and mixed-method studies published up to January 2018. The emerging model identified factors linked to the care recipient with dementia, the informal care-giver and the care-giving context. The impacts of these factors on care-givers’ employment are mostly negative (e.g. stopped/reduced work, decreased job performance). Nevertheless, the results provide encouraging insights as working can counterbalance care-giving strain, and managing both roles can enhance care-givers’ wellbeing. Practical efforts should focus on enabling informal care-givers to better manage the balance between care-giving and work responsibilities.

This paper presents a model for studying ageing and technology. It investigates the theoretical gains that can be made by combining insights from Age Studies and Science and Technology Studies (STS). Although technology has become a much more salient part in the everyday lives of older people and investments are high in technologies to deal with the alleged challenges of demographic change, theory development about ageing–technology relations has not kept up with these trends. Partly this is due to the poor connection between the social scientific understanding of ageing and the technically focused discipline of gerontechnology. This has led to an interventionist logic that underlies much of the current and implicit theorising about ageing and technology. We briefly analyse the problems of the interventionist logic and then present a model that conceptualises ageing and technology as co-constituted. We propose this model – which we call the CAT-model – to highlight a number of fundamental ideas about ageing–technology relations. At the centre are four different arenas (life-worlds of older people, design worlds, technological artefacts and images of ageing) in and across which these relations can and should be studied. To develop the model, we build on our own theoretical and empirical work over the last decade, and on examples from recent scholarship that straddle the disciplinary boundaries between STS and Age Studies.

Mass media research on the portrayal of older people has primarily focused on television series and advertisements. News programmes on television have received little attention. We argue that viewers perceive characters on the news as more direct and more accurate representations of social reality than fictional characters, and therefore portrayals on the news are more likely to be integrated in viewers’ stereotypes about elderly people or used as standards of comparison. In order to explore potential differences in the representation of senior men and women, we conducted a quantitative content analysis on a sample of 754 elderly people who appeared on the evening news programmes of four major Hungarian television channels with high viewership. Each character was coded in terms of 115 qualitative variables. Our results indicate that older men are portrayed significantly more often than women as affluent, elegant, knowledgeable, powerful and actively working. By contrast, women are more commonly shown as kind, family-oriented, in ordinary roles (e.g. as the ‘woman in the street’) and engaged in less-productive activities such as shopping. Based on previous research on the role of mass media in the socialisation process as well as social comparison theory, we discuss how these imbalances in the representation of older men and women may affect viewers of different age groups, genders and social status.

The aims of the present study are twofold: first, to examine the importance of socio-economic disadvantage, adverse experiences and poor health in childhood on later-life depression by sex and, second, to discern the direct and indirect effects of childhood circumstances using a decomposition technique. Data are derived from Waves 2 and 3 of the Survey of Health, Ageing and Retirement in Europe (SHARE). The methods involve use of logistic regression models and a decomposition approach. The findings indicate that childhood socio-economic status (SES) for both genders and cognitive function for men have only a significant direct effect, consistent with the critical period model. Childhood health for men and poor parental mental health for women are nearly fully mediated by adulthood and later-life circumstances, a fact in line with the pathway model. Poor childhood health, parental excessive alcohol consumption and cognitive function for women and adverse experiences for men have both significant direct and indirect effects, consistent with both models. Mediating factors include poor adulthood and later-life health, socio-economic adversity and stress; adulthood and later-life SES mediate early life health and adverse experiences more strongly for men, whereas stress seems to mediate early life adverse experiences to a greater extent among women. Intervening policies should address childhood adversity while considering the differential vulnerability of men and women.

Transition to a care home often follows a hospital admission and can be distressing. Care home settings play an important role in the care of many people at the end of life. This longitudinal study employed a narrative approach, aiming to explore the perspectives of older care home residents on transitions to, and life and death within, care homes. Five participants, aged 85 years and over, were recruited from two privately owned care homes in the South-West of England. All participants had a diagnosis of an advanced progressive condition (excluding advanced dementia), or were thought to be frail. Longitudinal interviews (19 in total) were conducted over a ten-month period. A structural narrative analysis was performed and participants’ narratives are presented under three headings, with one participant's story chosen to illustrate each narrative type: ‘becoming a care home resident’, ‘living in a care home’ and ‘death and dying’. Findings revealed that care home residents experience a loss of autonomy and a lack of agency; they are often excluded from decision-making. Older care home residents have few choices with regard to care at the end of life. Further work is required to improve transition into care homes, including support and advocacy during decision-making, which often takes place in hospitals at a time of crisis.

With a growing number of people reaching older age, the need for care provided in long-term care institutions is increasing. Although the goal is to deliver person-centred care that includes choice and flexibility opportunities, pre-scheduled mealtimes and set menus are still used. The aim was to explore how food choice and flexibility practices were perceived and performed by residents and staff at three care homes in Denmark. Three food journey interviews with eight residents (aged 83–96) and three focus groups with 12 people from the care and kitchen staff were conducted. Food choice and flexibility practices were mainly performed informally and selectively by the staff, and through personal practices by the residents, implying that many residents were excluded from food choice and flexibility opportunities. However, food choice and flexibility practices were also inhibited by the staff's time pressure and unfamiliarity with choice possibilities, and by the politeness of the residents. Our findings suggest that food choice and flexibility practices must be understood and performed broadly, and include various ways of listening and responding to the residents’ needs and preferences. The study highlighted the importance of incorporating the essential embodied knowledge and emotional know-how, inherent in food choice and flexibility practices, into formal and inclusive strategies concerning how to think and act in relation to the food and meal situation.

The purpose of the study is to explore feelings of loneliness among residents in assisted living facilities in terms of how loneliness is experienced and articulated, and what specific factors are related to the experiences. The study used a mixed-method approach. We individually interviewed 13 residents twice over six months. We conducted two focus group interviews and noted our observations each time we met the respondents. Data analysis leaned on abductive reasoning. The respondents described loneliness in versatile, rich ways. It proved to be time and place dependent. It was dependent on the time of day, days of the week and seasons. Lonely time was meaningless and filled with a feeling of waiting. Loneliness was also intertwined with place. None of the respondents called their apartment home; instead they called it a hospital, even a prison. They had to spend long periods of time in their apartments against their will, and their desire to interact with other residents was not met. The respondents felt invisible. Residents’ experiences of loneliness in assisted living facilities are unique and distinctive. Time- and place-dependent experiences of loneliness act as important signals for reflection on how care practices in these facilities could be more satisfying. Loneliness should therefore be a key topic and the target of prevention and interventions.

This article calls for a sociological understanding of the importance of trust to aged care. It connects existing theories of trust to empirical evidence from gerontology and nursing research. Trust is defined as a response to and management of social vulnerability. It is argued this makes trust a fundamental concept for understanding human service and social care institutions, including aged care. In light of Australia's Royal Commission into Aged Care Quality and Safety, as well as generational shifts in consumer expectations and care ethics, the article highlights four distinct yet interrelated forms of trust: interpersonal, institutional, organisational and public trust. All of these forms are shown to be critical in conceptualising and evaluating the perceived trust deficit facing contemporary aged-care systems, and existing evidence shows how these forms of trust can reinforce, conflict and misalign with each other. Efforts to rebuild trust in aged care at an organisational and institutional level should ensure mechanisms facilitate rather than hinder the formation of interpersonal trust relations between individual service users, their families and aged care staff. Broader social policy reforms must also consider and address the way cultural understandings of ageing, and media representations of aged care, have diminished the public's trust in the sector, and how the cycle of scandals, reviews and piecemeal reforms contributes to this.

While social connectedness is heralded as a key enabler of positive health and social outcomes for older people, rarely have they themselves had the opportunity to express their views about the concept. Working with a diverse group of Pacific, Māori, Asian and New Zealand European older adults, this paper explores what matters to older people when discussing social connectedness? We draw from individual, in-depth interviews with 44 older adults, and three group interviews comprising 32 older adults. Data were analysed using thematic and narrative analyses. The three themes identified were: getting out of the house, ability to connect and feelings of burden. Fundamental to social connectedness was participants’ desire to be recognised as resourceful agents able to foster relationships on the basis of mutual respect. Social connectedness was conceptualised as multi-levelled: relating to interpersonal relationships as much as neighbourhoods and wider society. Alongside these similarities we also discuss important differences. Participants preferred to socialise with people from similar cultural backgrounds where they shared taken-for-granted social customs and knowledges. This is in the context where racism, poverty and inequalities clearly impeded already minoritised participants’ sense of social connection. Key structural ways to improve social connectedness should focus on factors that enable cohesion between levels of connection, including stable neighbourhoods serviced with accessible public transport, liveable pensions and inclusivity of cultural diversity.

Home care for older people in England is commissioned through local authorities working predominantly with independent providers of care. Commissioners operate in a market model, planning and procuring home care services for local populations. Their role involves ‘managing’ and ‘shaping’ the market to ensure an adequate supply of care providers. Another imperative, emerging from the principles of personalisation, is the drive to achieve user outcomes rather than ‘time and task’ objectives. Little formal research has investigated the way commissioners reconcile these different requirements and organise commissioning. This study investigated commissioning approaches using qualitative telephone interviews with ten commissioners from different local authorities in England. The characteristics of commissioning were analysed thematically. Findings indicated (a) commissioning involved complex systems and processes, uniquely shaped for the local context, but frequently changed, suggesting a constant need for reframing commissioning arrangements; (b) partnerships with providers were mainly transactional, with occasional examples of collaborative models, that were considered to facilitate flexible services more appropriate for commissioning for personalised outcomes; and (c) only a small number of commissioners had attempted to reconcile the competing and incompatible goals of tightly prescribed contracting and working collaboratively with providers. A better understanding of flexible contracting arrangements and the hallmarks of a trusting collaboration is required to move beyond the procedural elements of contracting and commissioning.

Social wellbeing is important to health, but maintaining social relations often becomes difficult in later life due to retirement, chronic disease, and the death of spouses and friends. Social media platforms, such as Facebook and Twitter, present accessible and low-cost communication technologies that have been demonstrated to enhance feelings of social connection and reduce loneliness in younger age groups. This exploratory study uses a four-week social media training workshop as an intervention in a randomised controlled study to examine whether similar social benefits might be realised for those at older ages, aged 65+ years. Social wellbeing measures of social capital, loneliness, social connectedness and social provisions were examined, revealing only small differences in social integration. As these findings seemingly contradict studies conducted with younger persons, the contexts of social media use in older adulthood are discussed, along with proposals for future research directions.

Falls often have severe financial and environmental consequences, not only for those who fall, but also for their families and society at large. Identifying fall risk in older adults can be of great use in preventing or reducing falls and fall risk, and preventative measures that are then introduced can help reduce the incidence and severity of falls in older adults. The overall aim of our systematic review was to provide an analysis of existing mechanisms and measures for evaluating fall risk in older adults. The 43 included FRATs produced a total of 493 FRAT items which, when linked to the ICF, resulted in a total of 952 ICF codes. The ICF domain with the most used codes was body function, with 381 of the 952 codes used (40%), followed by activities and participation with 273 codes (28%), body structure with 238 codes (25%) and, lastly, environmental and personal factors with only 60 codes (7%). This review highlights the fact that current FRATs focus on the body, neglecting environmental and personal factors and, to a lesser extent, activities and participation. This over-reliance on the body as the point of failure in fall risk assessment clearly highlights the need for gathering qualitative data, such as from focus group discussions with older adults, to capture the perspectives and views of the older adults themselves about the factors that increase their risk of falling and comparing these perspectives to the data gathered from published FRATs as described in this review.

This study aimed to systematically review the use of social networking sites (SNSs) from an older adult perspective (all papers had an average sample age of 65+ and samples ranged in age from 50 to 98). Characteristics of older adult SNS users, incentives and disincentives for use, and the relationship between SNS use, wellbeing and cognitive function were explored. From a systematic search, 21 papers met inclusion criteria and were subjected to a quality review. Paper quality was often low or medium, as rated by a standard quality assessment framework. Results indicated that older adult SNS users were more likely to have particular characteristics, including being female and younger. The main incentive for use was to maintain contact with family and friends. Disincentives included privacy concerns and lack of perceived usefulness. The relationship between SNS use, wellbeing and cognitive function was inconclusive. SNS use is a multi-dimensional phenomenon that needs to be understood in the context of broader communication practices, individuals’ social relationships, and individual preferences and characteristics.

Previous research finds that members of the working class have a higher risk of early retirement compared to professionals because they are pushed into early retirement. This indicates that not all workers can respond to incentives to extend their working life. Yet, little previous work has been conducted to quantify systematically the extent to which push factors explain why members of the working class have a higher risk of early retirement compared to professionals. Using longitudinal data on Danish workers, the results suggest that members of the working class have an increased risk of early retirement compared to professionals, but poor health, previous spells of unemployment and low job quality mediate a large part of this effect. Among men, the push factors mediate 57 and 86 per cent of the effect of social class on early retirement for skilled manual and unskilled manual workers, respectively. Among women, the push factors mediate 43 and 55 per cent of the effect of social class on early retirement for skilled manual and unskilled manual workers, respectively. Overly physical work demands is the most important mediator, which explains between 23 and 31 per cent of the total effect of belonging to the working class on early retirement. Moreover, the magnitudes of the indirect effects of the push factors depend on the particular pathway into retirement.

With the increase in personal mobility and improvements in living standards, seasonal mobility for health reasons is a well-observed phenomenon among retired people worldwide. Existing studies have shown that there are relationships between seasonal retirement mobility and wellbeing, and this study attempts to explore the effects of gender on these relationships. The framework of therapeutic mobility, which includes daily activities, sociality and context, was used to analyse this relationship. Qualitative methods including semi-structured interviews, non-participatory observation and mobile ethnography were used to collect data. This study finds that female seasonal senior migrants in Sanya have more abundant and meaningful daily activities and receive more emotional supports, and as a result, gain more benefits than males, and that these differences are related to their gender roles. Furthermore, while gender itself cannot explain all the differences, it works within the intersection of economic condition, age and family support. This study has enriched the literature on therapeutic mobility and has practical implications.

This article examines the narratives of 24 knowledge workers aged 48–58 as they anticipate their future employment and employability. The term knowledge worker is used to indicate occupational roles such as software engineer, academic, architect, manager and lawyer, where work involves non-routine problem-solving using ‘intellectual assets’. Four narrative patterns about future employment are presented: winding down, reorienting ‘self’ away from work, seeking progression and renewal. These patterns reveal contrasting self-evaluations of employability and potential. We argue that employability is not a straightforward function of human capital, which usually refers to experience, knowledge and qualifications. We show through our data how judgements about a person's employability – both self-evaluations as well as evaluations by others – are complicated by social norms and cultural understandings of ‘potential’. Strategies to signal one's potential become more complex and sometimes less effective for older knowledge workers. We contend that a person's age influences others’ evaluations of their employment potential, such that the relationship between attributed merit (based largely on past experience) and attributed potential (based on assumptions about a person's future) is inverted as workers become older. The findings have implications for public policies such as ‘Extending Working Lives’. Policies that remove legal and institutional barriers to extended working lives may be only partially successful without changes to cultural attitudes about older workers’ employment potential.

Timely access to care services is crucial to support people with dementia and their family carers to live well. Carers of people with dementia (N = 390), recruited from eight countries, completed semi-structured interviews about their experiences of either accessing or not using formal care services over a 12-month period in the Access to Timely Formal Care (Actifcare) study. Participant responses were summarised using content analysis, categorised into clusters and frequencies were calculated. Less than half of the participants (42.3%) reported service use. Of those using services, 72.8 per cent reported timely access and of those not using services 67.2 per cent were satisfied with this situation. However, substantial minorities either reported access at the wrong time (27.2%), or feeling dissatisfied or mixed feelings about not accessing services (32.8%). Reasons for not using services included use not necessary yet, the carer provided support or refusal. Reasons given for using services included changes in the condition of the person with dementia, the service's ability to meet individual needs, not coping or the opportunity to access services arose. Facilitators and barriers to service use included whether participants experienced supportive professionals, the speed of the process, whether the general practitioner was helpful, participant's own proactive attitude and the quality of information received. To achieve timely support, simplified pathways to use of formal care services are needed.