Fundamental shifts in state intervention in recent years have resulted in steady curtailment in public provision of community and social care. A longitudinal study of elderly women receiving home care in Ontario explored the reverberations of these shifts in the texture of frail elderly people's lives. Three distinct accounts of negotiating unstable and rationed home care were discernible. Taking charge was an active account of women successfully impressing their particular needs and identities on home care provision. Pushed over the edge was a vulnerable account of insufficient and depersonalised care in which participants felt themselves practically and emotionally out of control. In Restraining expectations, women adjusted silently to the shortcomings of home care, stoically making themselves smaller as they found their previous orbits and identities unsupported. Home care's front line emerged as a complex site of struggle for identity and agency – a struggle in which elderly people engage with inventiveness and determination but also with dwindling support, few witnesses and in mounting isolation.

Care management has become a key component in the development of community-based care in many countries, and this paper examines the different care management arrangements for older people's services that are now emerging. It has been United Kingdom government policy since 1989 that the providers of social services develop care management systems, as confirmed in the White Paper, Modernising Social Services. The paper opens with the background to the policy changes and a discussion of the role of care management in the British social care system. Secondly, evidence from the early phases of care management development is examined; and thirdly, the evidence from a major national study of care management arrangements for older people on the patterns of variation on key dimensions is considered.

Transfers of assistance from older to younger family members are an important, though often ignored, component of intergenerational exchanges. The ability to help younger family members, either financially or practically, may be influenced by the health and socio-economic status of older parents, but very little is known about these patterns. This article examines the effects of socio-economic and health status on the help that late mid-life parents in Britain and the United States give their children with money, domestic tasks, and grandchild care. Results for the different types of family support yield three main findings. First, there are relatively few differences between Britain and the USA in the factors affecting the provision of support. Secondly, socio-economic factors appear to be more important among married respondents while health is more important among the unmarried. Thirdly, children's co-residence has greater effects on the provision of domestic task help in Britain than in the United States.

The study examines the relationship between husband-wife equality in late adulthood and two dimensions of marital quality: burn-out, and satisfaction with marriage. Husband-wife equality has been examined on the basis of marital power relations and the division of roles in three areas: in-home tasks, financial management, and social life. Equity theory provided the conceptual framework for the hypothesis that equality in various aspects of marriage enhances marital quality. The research sample consisted of 116 retired Israeli couples. Negative correlations were found between equality in family roles and burn-out among both husbands and wives. Surprisingly, equality in the performance of in-home roles correlated positively with burn-out among husbands. Moreover, equality in power relations correlated positively with marital satisfaction among wives. In addition, an interaction was found for wives' perceptions of equality in power relations and their husbands' level of burn-out. State of health correlated negatively with burn-out for both partners. Furthermore, husbands' religiosity explained a substantial percentage of the variance in their level of burn-out and marital satisfaction. On the whole, wives reported a higher level of burn-out and a lower level of marital satisfaction than did their husbands.

Dementia care is in transition, and the potential exists for a radical reform of the provision of services to people with dementia. Recent developments in Scotland based on the report of the Royal Commission on Long Term Care, With Respect to Old Age, provide an example of the possibilities and opportunities available to governments for creating services based on principles of equity and justice. It is timely therefore to consider the implications of recent government reports for the development of dementia care provision. This paper explores the social and political context of formal dementia care provision and considers the implications of recent government reports for the future. The historical discourses surrounding the term ‘dementia’, and where and who cares for people with dementia, provide insights into the options available to policy makers. A brief exploration of the economic context of dementia care provision, and of the historically low level of political interest in dementia care, provides a backdrop to recent political initiatives that seek to redress this omission.

Access to health care should be determined by clinical need and not by age. Older people form an increasing proportion of the general population and of those with coronary heart disease, but compared with younger people they are less likely to be invited for cardiac rehabilitation programmes and more likely not to complete them. This study examined the factors that contribute to these trends in Scotland. A national survey of rehabilitation centres (n = 30) found that the majority of their programme co-ordinators believe that age does influence access to rehabilitation. While only one programme used an overt age criterion, age was widely perceived to influence access, both during initial assessment and in assessments for exercise components; and while the respondents acknowledged that other criteria influenced selection, the factors cited most often were all more common during old age, e.g. the presence of other medical ailments, lower initial exercise tolerance, and poor access to private or public transport. Focus groups undertaken with a sub-sample of the co-ordinators revealed that staff appeared to have knowledge of the benefits of cardiac rehabilitation for older people, but that the scarcity of resources prevented them from offering more accessible and appropriate services.

This paper reports on the methodological and ethical issues that were encountered when using focus groups to explore older people's knowledge, beliefs and risk perceptions about the use of innovative health technologies in end of life care. Older people drawn from community organisations in Sheffield, England, took part in discussions about the application of ‘life prolonging’ and ‘comfort care’ technologies during serious illness and impending death. The paper offers a reflective account of the management of recruitment and informed consent, and of the issues that arose when facilitating group discussions of potentially distressing material. It concludes with a brief account of the steps that were taken to enhance the ‘credibility’ of the data.