This article examines three kinds of social relationship likely to be present when people with dementia are cared for at home by relatives or friends: custodial care, an intimate relationship, and home-life. Using Goffman's three defining aspects of custodial care – routinisation, surveillance and mortification of the self – the paper examines whether these characterised the care of people with dementia at home and, if so, whether they conflicted with the intimate relationship and with home-life. The study involved sustained observations and interviews with 20 people with dementia and their carers in and around London, and qualitative analysis of the data. It was found that all three aspects of custodial care were present although not fully realised, and that they led to difficulties, many of which were associated with the concurrent pursuit of an intimate relationship and home-life. In all cases, daily life was routinised partly to help accomplish care tasks but was found monotonous, while surveillance was usual but restrictive, and prevented both the carers and those with dementia from doing things that they wished to do. Those with dementia were distressed by the denial of their former identities, such as car-driver or home-maker, and by being treated like children. Both the carers and the people with dementia had various ways of balancing custodial care, their intimate relationships and home-life, such as combining routines with other activities, evading surveillance or carrying it out by indirect means, and there were many attempts to maintain some semblance of former identities.

This paper reports one component of an evaluation of the different forms, types and models of local authority social services' care-management for older people that have emerged in England since 1993. It was undertaken at a time of a growing debate about whether care-management differentiated those with simple from complex needs, and whether for the latter a multi-disciplinary approach was required. A sample representative of different approaches to care-management was selected from a national survey of local authorities to explore the associations between types of care-management and case-mix, the services received by the clients, and the use of staff time. The paper addresses the categorisation of the types of care-management and the differences associated with these. The care-management teams were distinguished by whether they used a ‘targeted approach’, had ‘specialist older people's teams’, or used other arrangements. It was found that those with a targeted approach undertook more multi-disciplinary assessments, provided more assistance to older people with mental health problems, and that their staff spent significantly less time in direct contact with users and carers. Conversely, those with specialist older people's teams had more users in receipt of occupational therapy services. Further research is required to explore the influence of these different arrangements on the wellbeing of service users and their carers.

Much of the literature on ageing and transport has been concerned with older drivers, which underlines the importance of private transport in their everyday lives, but little has been written about how a lack of transport impacts on quality of life. A survey was commissioned by the Office for Senior Citizens of the New Zealand government, and face-to-face semi-structured interviews were conducted in 2004 with 28 couples and 43 single people (14 men and 29 women). The sample was identified through Volunteer Community Co-ordinators (VCCs) and drawn from metropolitan, urban, small-town and rural areas. The average age of the men was 84.5 years and of the women 81.4 years, and all had been without private transport for at least six months. The interviews sought the experiences and opinions of older people who were ‘coping without a car’, and asked how this affected their lifestyle and quality of life, and how they met their transport needs. The findings reveal variations by gender, health status and personal outlook, including views on independence and reciprocity. While ‘serious’ transport requirements may be provided for by alternative means, the ‘discretionary’ trips that contribute significantly to the quality of life may be lost when private transport is unavailable. The findings have implications for local and national policy and planning, extend well beyond the sphere of transport, and illuminate processes of social exclusion among older people.

Several studies of frail older people have focused on the relationship between formal and informal care, while others have examined the character of inter-generational relationships. Yet knowledge of the significance of the informal-support networks of older people who receive formal care is still scarce. The aim of this paper was to explore how older Swedes who receive formal elder-care experienced their informal support networks. The findings presented emanate from a qualitative case study. The structural, interaction and functional dimensions of the support networks were the main analytical tools. In the study population, the size of the formal support network varied from one to 12 people (or categories of people), and the size of the informal support network varied from one to six people (or categories of people). The main results demonstrate the importance of informal support with reciprocal relationships, and the value of confidants and emotional support, both of which contribute to feelings of belonging, security and wellbeing. A well-functioning formal and informal support network allows individuals to maintain autonomy in old age, even when they have to depend on help from others.

The goal of this study was to explore the concepts of successful ageing held by elderly people in Taiwan. Data were obtained from the Successful Ageing of the Elderly in Taiwan survey of 2004. The sample was drawn from the population aged 65 or more years in one county in Taiwan by probability proportional-to-size sampling. The participants were asked: ‘What do you think are the essential components of an ideal and satisfactory life in old age?’ They were also asked to score the relative importance of 23 ‘successful ageing’ concepts. The replies to the initial open-ended question were grouped in six categories: physical health and independence, economic security, family and social support, engagement with life, spiritual well-being, and environment and social welfare policy. The most highly rated ‘successful ageing’ concepts were physical health, independence, living without chronic disease, living with family, and receiving emotional care. All the responses were subjected to a factor analysis, and five factors accounted for 58.7 per cent of the variance: family and social support, mastery over life, health, enjoyment of life, and autonomy. It is concluded that elderly people in Taiwan most value health and independence, and also place considerable importance on economic security and family support, which they see as inter-related. Many are also concerned about the social environment and social policy, indicating that their awareness of and participation in socio-political debates affects their quality of life.

The financial and social climate in which the residential-care sector operates in the United Kingdom has changed substantially over recent years. This paper examines the underlying motivations for providing residential-care services for older people. We focus on the motivations of a sample of managers and owners of care homes drawn from eight English local authorities, and explore the intrinsic aspects of their motivations, particularly professional achievement, recognition and job satisfaction. The majority of the respondents' primary motivations were to meet the needs of older people and to accomplish professional achievements. Their caring motivations had four principal components, which were labelled professional, financial, client-specific and client-generic, and as for their professional motivations, the interviewees reported high levels of job satisfaction. The respondents were satisfied with their career choice and felt that, through their work, they were contributing to society. The study identified several personal and external factors that influenced the providers' intrinsic motivations and professional aspirations. The presented evidence suggests that if future policies are to improve the quality of care-home services, it is essential that they also incorporate the professional needs of care-home providers.

While therapeutic interventions involving music have been shown to have benefits for people with dementia, little research has examined the role of music and music-related activities in their everyday lives. This paper presents the results of qualitative research that explored this role in terms of: the meaning and importance of music in everyday life; the benefits derived from participation in music-related activities; and the problems of engaging with music. Data were collected during in-depth interviews with 26 people with dementia and their carers, who lived either in their own homes or in residential care in different parts of England. The paper illustrates the many different ways in which people with dementia experience music. As well as being enjoyed in its own right, music can enable people to participate in activities that are enjoyable and personally meaningful. It is an important source of social cohesion and social contact, supports participation in various activities within and outside the household, and provides a degree of empowerment and control over their everyday situations. The practical implications for the provision of care and support for people with dementia are discussed. The scope and implications for technological development to promote access to music are also discussed.

Promoting older people's ability to manage at home is important both for themselves and for society, but few studies have explored whether geriatric rehabilitation actually meets the needs of this heterogeneous group. The purpose of this study was to investigate the meanings that older adults attribute to their geriatric rehabilitation experiences. A group of 27 older adults in inpatient rehabilitation were interviewed during the programme and after returning home. Semi-structured interviews were analysed using a qualitative method, which identified three categories of meaning. In the category ‘sense of confidence with everyday life’, rehabilitation was perceived as facilitating everyday living at home; in the category ‘sense of vacation’, rehabilitation was seen as a means of getting away from normal life and enjoying oneself; and in the category ‘sense of disappointment in the rehabilitation programme’, the participants expressed frustration with the limited opportunities to participate in the planning of their rehabilitation, and with the mismatch between the offered programme and what was needed. To promote older people's autonomy and to enhance their ability to live at home, professionals must involve their clients to a greater extent in the planning of the rehabilitation than is currently the case, and also individualise the rehabilitation regimen.