In addition to the issues explored in Chapter 4 there are a number of risks and inequalities that affect the mental health and well-being of particular groups of older people. The nature and impact of three prominent issues are explored in Chapters 5 to 7: socio-economic disadvantage and poverty; abuse and mistreatment; and the fourth age, frailty and transitions. While not experienced by all, or even the majority of older people, these are risks that have powerful implications for mental health and, as such, warrant specific exploration.

It is important to note that the three sets of risks are conceptually distinctive. Socio-economic disadvantage affects a particular subpopulation of older people (usually) across the whole trajectory of their later lives; abuse and mistreatment affects a number of particular groups of older people in both service settings and the community; and issues arising from the fourth age and transitions affect all of those older people who achieve very late life. In each chapter I offer a summary of the key issues before focusing on evidence about how they impact on older people's mental health and well-being; policy issues are also discussed. At the end of Chapter 7 I offer a conclusion drawing together the key threads of all three chapters.

Age-related socio-economic inequalities

Despite growing interest in the intersection of life course inequalities with late life mental health outcomes, surprisingly little work has been done on exploring the role played by socio-economic inequalities in late life itself. While most late life inequalities have roots earlier in life, the difference is that once a person reaches later life s/he has limited (or no) opportunity to significantly alter their socio-economic status (SES). If you are poor at 65 years old you are very likely to be poor until you die. This could be a period of 40 years. There is of course huge diversity between groups, cohorts and social categories and a great variety of individual experience but key stratifications appear to be, at least partially, fixed; late life tends to amplify what is already present.

While there can be little doubt that socio-economic inequalities affect well-being, distilling connections is complex.