The prevention of falls is currently high on the health policy agenda in the United Kingdom, which has led to the establishment of many falls-prevention services. If these are to be effective, however, the acceptability of services to older people needs to be considered. This paper reports a systematic review of studies of older people's perceptions of these interventions. The papers for review were identified by searching electronic databases, checking reference lists, and contacting experts. Two authors independently screened the studies and extracted data on the factors relating to participation in, or adherence to, falls-prevention strategies. Twenty-four studies were identified, of which 12 were qualitative. Only one study specifically examined interventions that promote participation in falls-prevention programmes; the others explored older people's attitudes and views. The factors that facilitated participation included social support, low intensity exercise, greater education, involvement in decision-making, and a perception of the programmes as relevant and life-enhancing. Barriers to participation included fatalism, denial and under-estimation of the risk of falling, poor self-efficacy, no previous history of exercise, fear of falling, poor health and functional ability, low health expectations and the stigma associated with programmes that targeted older people.

The aim of this study was to investigate ‘successful ageing’ among low income elderly people in the Republic of Korea (South Korea). A sample of men and women aged 65 or more years who received welfare benefits and social welfare services from senior welfare centres and who had good cognition were identified and recruited by the staff of eight such centres in Seoul, the capital city of the country. Face-to-face interviews were conducted with a structured questionnaire using measures and instruments that were selected following a literature review and previous studies of low-income older people. The survey instrument was pre-tested with seven subjects to ensure the comprehensibility of the items, and 220 main interviews were conducted in the respondents' homes and at senior welfare centres during October and November 2006. Factor analysis identified three factors in successful ageing: ‘a positive attitude towards life’, ‘success of adult children’, and ‘relationships with others’. Men reported higher scores on successful ageing than women. It was concluded that the concept of ‘successful ageing’ does apply to low-income elderly people in Korean, although its components have little to do with material or social success as conceived by previous studies of the general elderly population in either western or Asian countries.

During the later 20th century, France experienced a dramatic turn around in the quality of its housing. The current cohort of older people witnessed and lived through the transformation. Most people aged over 50 years in France are homeowners and almost one-in-four own a second home. Although the oldest age groups are much less residentially mobile than younger people, home moves are more likely around the age of retirement or widowhood. In recent years, new forms of residential mobility in later life have been emerging. These include a weakening of the commonly observed pattern of a permanent drift away from cities and towns towards areas of childhood origin or family connections. One current trend suggests a preference for preserving residential links with areas of relatively high population density and good access to amenities, coupled with being able to spend time elsewhere, whether in second homes, in children's and grandchildren's homes, or elsewhere. The arrival of the post-1945 baby-boom cohort at retirement has begun, and this may increase the current level of residential mobility and lead to more diverse types, although the change will depend on the development of the housing market as well as residential preferences in old age.

Currently there is no specific policy on dementia care in India. Rather, the responsibility for care for people with dementia is not clearly articulated and formal care services straddle mental health and aged care. The result is that much care is placed upon individual families. This paper critically reviews Indian legislative and policy documents on this field of care, namely, the Mental Health Act 1987, the National Mental Health Programme, the National Policy on Older Persons and the Senior Citizen's Act 2007. The invisibility of dementia care in public policy translates into the absence of adequate treatment facilities and mental health staff, and leaves informal care-giving unsupported. This gap is replicated in mental health and dementia-care research and literature in India, with little being known about how family carers respond to the experiences of care-giving, manage the stigma, and access support. As India, like other middle-income and low-income countries, is experiencing an increase in its older population, more research is needed to develop the epidemiological, medical and anthropological understanding of ageing, dementia and care. This knowledge is vital to understanding the cultural context of the disease and must also be incorporated into public health policy if there is to be effective management of the rising need for personal care.

Generativity refers to activities that help to establish and guide the next generation. This paper explores the nature of generative concern among older people and how it manifests itself in an era of rapid social and technological changes that have produced wide generation gaps. Eight focus groups were conducted with 51 women and 20 men who were recruited from social centres in Hong Kong on the basis of age, socio-economic status, and level of participation in the centres. The discussions were transcribed verbatim and analysed using grounded-theory principles. The elders frequently referred to the superior educational level and technological knowledge of their offspring, as well as the differences in values and lifestyles between the generations, which they thought had made their own knowledge and wisdom obsolete. They had concerns about social and technological changes, however, and they aroused a sense of urgency to protect the younger generation from contemporary evils, while many considered that passing on moral and behavioural codes nowadays was the most important generative role. Although they wanted to help, their efforts were often criticised. In order to maintain harmonious relationships and to avoid conflicts with their offspring, many participants adopted passive generative roles. Attempts to stabilise the generative self by redefining generativity were also observed. The final section of the paper discusses the implications of the findings for the maintenance of the generative self in personal situations of declining resources.

Westerners increasingly retire outside their home countries, and some venture to developing nations. A growing number go to Thailand, usually after working there or after many tourist visits. The present study examined currently and formerly resident Western retirees in Thailand, with a focus on their reasons for migrating to Thailand, their wellbeing and perceived assimilation, the reasons why some leave, and their long-term welfare needs. The principal data source was an online survey of 152 current and former retirees in Thailand. The major reported motives were low living costs, a warm climate, to escape a disliked home nation, like of the Thai lifestyle and culture, and the availability of attractive sexual partners. Most survey respondents had a Thai spouse or live-in partner. The move apparently works out well for most, at least initially. They report positive wellbeing and feel assimilated, but most live with visa insecurity and their assimilation may be partly illusory, as many reported socialising mainly with other foreigners. The major long-term concerns of Western retired men in Thailand are their health-care and welfare needs, income problems, increasing negative local reactions to the influx of Westerners, and the possibility of visa cancellation that would enforce a move elsewhere.

Compared with the many studies in western countries, research on the prevalence of and risk factors for loneliness amongst older people in China is sparse. This paper reviews the current cross-national literature on loneliness and, using data from two national surveys undertaken in 1992 and 2000, assesses the prevalence of loneliness amongst older people in China and explores the factors that raise their vulnerability to the negative feeling. The reported prevalence of loneliness was 15.6 per cent in 1992 and 29.6 per cent in 2000. We suggest that part of the differential is accounted for by the differences in the methodologies of the two surveys and in the questions used to assess loneliness. The evidence from both surveys suggests that loneliness was relatively prevalent among those aged 65 or more years, females and those living in rural areas, and that these variations had greater amplitude in 2000. As in western countries, increased age, being widowed or divorced, and poor self-rated health were significantly associated with old-age loneliness in China at the two dates. Two factors positively related to loneliness were found that are specific to the Chinese context, however: living in a rural (as opposed to urban) area, and thinking that one's children are not filial. To develop our understanding of loneliness among older people in China and other non-western countries, it will be necessary to construct more rigorous and comparable measurements of loneliness and to undertake longitudinal studies of social relationships.

The substantial and increasing number of older Australian people from culturally diverse backgrounds justifies the investigation and inclusion of their experiences in ageing research. Few empirical studies have addressed culturally diverse issues in the older population, however, in part because of the particular challenges in recruiting and retaining people from different cultural backgrounds. This article reflects on a research team's experience of recruiting participants from seven cultural groups into a study that sought to explore the links between physical activity and the built environment. Three key issues for recruiting and retaining participants from culturally diverse backgrounds were identified: having access to key local informants; the central role of paid and trained bilingual interviewers; and supporting the research partners in recruitment activities. Furthermore, it appeared that a ‘one size fits all’ approach was not appropriate and that a flexible recruitment strategy may be required to ensure successful recruitment from all cultural groups. The differences observed in this study relating to recruitment and retention rates may be more dependent on the skills and characteristics of those responsible for the recruitment and interviewing, rather than the specific cultural group itself. Older people from some cultural backgrounds may be less likely to respond to traditional recruitment methods and researchers need to be more assiduous and strategic to improve participation rates in research.

Older men are becoming more visible in care-giving research but there are still few studies that focus expressly on the extent to which care-giving has made positive contributions to their life and has been rewarding. Drawing on data from in-depth personal interviews, this Portuguese study analyses the positive statements in the personal descriptions of the care-giving experience of 53 elderly men who were caring for chronically-ill wives. It also explores the differences between the positive references made by the men who were caring for a wife who had dementia and those made by men whose wives had physical impairments. Using open coding and content analysis, positive aspects were identified in 32 of the 53 care-giving situations. The most prevalent themes were ‘satisfaction’ and ‘perceived social honour’. The findings show that positive returns from the caring experience and role were strongly associated with previous good marital relationships and the husband's good self-rated health, and manifested in both specific coping strategies and global and situational meaning-making processes. The study demonstrates that much more can be learnt about the positive dimensions of care in older men's lives, and that such understanding can inform and strengthen formal and therapeutic support.

Over the past few years, the pivotal roles older women play in responding to the unprecedented HIV/AIDS epidemic in southern Africa has received increasing recognition by academics, governments, funding agencies, non-governmental organisations, and citizens around the world. Yet, discourses surrounding AIDS and ‘grandmotherhood’ are laden with a number of ungrounded assumptions that have important implications for researchers, advocates and decision-makers. Drawing on ethnographic and survey data predominantly from South Africa, this paper challenges seven such assumptions. The paper illustrates how certain prevailing ‘wisdoms’ about grandmothers and AIDS in southern Africa are not entirely accurate and may mask many women's struggles and vulnerabilities, perpetuate stereotypes and misguide well-meaning policies. It also suggests that the societal impacts of AIDS in the region are, at present, not as dramatic as often portrayed, largely because the strength and resilience of many older women have cushioned some of the negative consequences. The paper thus calls for more nuanced and forward-looking analyses and interventions – ones that recognise grandmothers as central to the society's thin safety net and that grapple with older women's complex and diverse vulnerabilities.

Reciprocity is a powerful principle in social ties. The ethos of family reciprocity is especially strong in Asian societies. We study contemporaneous family exchanges, hypothesising that the more current help older Singaporeans receive from family, the more they give in return. Cross-sectional analyses were undertaken of data from two national Singapore surveys conducted in 1995 and 1999. The help received by older people is measured by income and cash support, payment of household expenses by others, having a companion for away-from-home activities, and having a principal carer. The help given by older people is measured by baby-sitting, doing household chores, giving financial help to children, and advising on family matters. Multivariate models are used to examine the factors that affect an older person's ability and willingness to give help. The results show that the more financial support Singapore seniors received from kin, the more baby-sitting and chores they provided. In their swiftly modernising society, Singapore seniors are maintaining family reciprocity by giving time in return for money. We discuss how during the coming decades, reciprocity in Southeast and East Asian societies may shift from instrumental to more affective behaviours.

Many have presumed that in developing countries contact with children is beneficial to older people's wellbeing, and particularly that women receive more support from children than men because of their lifelong commitment to family responsibilities. This study questions these stylised notions through an analysis of 22 life histories of older women and men living in a district with high rates of social exclusion in Buenos Aires, Argentina. It focuses on the subjective accounts of relationships with children and grandchildren and their influence on current wellbeing. The life histories reveal complex lived experiences and the significance of key events. The informants speak of the anxiety and harm caused by struggling children, about problems of remote relations with successful children, and of the insecurity of the neighbourhood. The analysis contrasts a materialistic interpretation of the influence of children on older people's wellbeing with the informants' more holistic evaluation of family relationships. By applying a lifecourse framework, we demonstrate among other things that children may be a key source of vulnerability for older people, that the gendering of parent-child relations and later-life wellbeing is nuanced, and that both local and national conditions influence relationships with specific children, with implications for the intergenerational transmission of wellbeing.

There has long been an interest in the United Kingdom about whether and how changes in family life affect support for older people, but nevertheless the consequences of partnership dissolution for late-life support have been little researched. Using data from the British Household Panel Study (1991–2003), this study investigated the longitudinal association between partnership dissolution and two types of support for 1,966 people aged 70 or more years: (i) informal support from children in the form of contacts and help (e.g. household assistance including care), and (ii) formal support from community care services (i.e. health visitor or district nurse, home-help and meals-on-wheels). The paper also examines the level of reported support among: (i) all parents aged 70 or more years and (ii) 1,453 unpartnered parents in the same age group (i.e. those lacking the most important source of support in later life: a spouse). We found diversity in the experience of partnership dissolution in the past lives of people aged 70 or more years. Patterns of support varied by the respondent's age, whether partnered, the timing and type of partnership dissolution, and by gender, having a daughter and health status. Overall, however, partnership dissolution did not show the expected detrimental relationship with later-life support. Health needs and increasing age were strongly associated with increases in contact and informal and formal help, regardless of family history.

This article reports findings from a three-year project on ‘Communication patterns and their consequences for effective care’ that explored communication in dementia-care settings. As the proportion of people with dementia living in British care-homes continues to grow, there is a need to understand better their care. Using a range of qualitative methods, the project set out to identify the constituent elements of dementia-care practice and the patterns that characterise day-to-day relations in care homes. The tightly prescribed and standardised nature of the interactions between staff and residents is described: it raises questions about the capacity for dementia care to be truly person-centred. The project found that people with dementia are both capable of communication, and invest much effort in seeking to engage those around them, but are excluded from the monitoring, planning and provision of care in ways that we argue are discriminatory. The case is made for promoting and supporting communication as key skills and competencies for care workers. The value of measuring the level and quality of communication as a means to evaluate care is demonstrated. The authors question the priorities that currently guide care practice and argue that we need to listen to people with dementia and rethink what lies at the heart of dementia care.

Few studies have explored the combination of individual and contextual conditions that influence psychological health among older people. This study aimed to analyse the sense of coherence (SOC) in a sample of Italian senior citizens in relation to gender, educational level, living arrangements and former employment, when controlling for age. The short version of the SOC scale (Antonovsky 1987), which has items for the ‘comprehensibility’, ‘manageability’ and ‘meaningfulness’ components, was administered to a sample of 198 senior citizens of both genders and with an average age of 68.5 years. The findings showed that: (a) senior citizens with a higher level of education and who had retired from jobs with a high level of responsibility perceived reality as more controllable, manageable and meaningful; (b) with greater age, the perception that life's challenges are worth facing decreased; and (c) there was an interaction between living arrangements and education level, viz. those with higher education, and those with lower education living with a spouse or partner, perceived reality as more meaningful and their life challenges as worth facing. It is important to investigate further the activities that help maintain a high sense of coherence throughout the life span, and to design social policies that support senior citizens who live alone, because they appear psychologically weaker than others.

The social division of welfare literature emphasises the extent to which occupational-pension provision is distributed on the basis of class and gender. As most previous commentators have at least implicitly recognised, however, a significant proportion of less advantaged people are covered. This paper argues that the patterns of access and their distributional consequences must be considered more systematically, and that in this context, the diversity of employers' pension schemes are investigated. When this is done, it emerges that in the United Kingdom, the spread of occupational provision beyond the most privileged workers means that some vulnerable individuals avoid poverty in retirement. At the same time, however, the main determinant of which less advantaged people are covered and which not is chance. While class and gender are important predictors of who receives occupational pensions, access for the disadvantaged arises mainly as an accident of an employment decision made for reasons unrelated to savings or pensions criteria. This paper argues that the implication is that unsustainable justice-based arguments are currently used by policy makers to sanction the current distribution of UK pension incomes. The paper concludes by discussing the implications of the findings for the appropriateness of recent UK policy proposals and for international debates about pension reform.

As people grow older in late life, their need for help with the activities of daily living increases. In Spain, those who need such help constitute about 20 per cent of the population aged 65 or more years. Support may be from formal care, informal care or both, and the type has different consequences for care receivers and their social networks. The aim of this paper is to examine the relationship between informal and formal care and the use of health services among older people in Spain. Using a sample of 1,148 respondents aged 65 or more years from the Spanish National Health Survey of 2003, we analysed the association between the sources of care (formal, informal, both, or no care) and the frequency of three types of health-care utilisation: hospitalisation, emergency services and medical consultations. After controlling for sex, age, level of difficulty in the activities of daily living, self-perceived health status, and social class, it was found that older people with disabilities who received neither informal nor formal care were more likely to consult physicians than those who received informal care, but that there were no significant relationships between the type of care and health-services utilisation. The findings provide new information about the consequences of the different types of care of older people with disabilities, and suggest specifically that informal care substitutes for some tasks usually done by health professionals.

Whether life is spent in good health or disability has a critical influence on the use of health-care services. It is also known that average healthy life expectancy differs by sex. This paper reports estimations of healthy and unhealthy life expectancy in old age using self-reported health assessments for the City of São Paulo, Brazil in 2000–01. The data derived from the Health, Well-being and Aging in Latin America and the Caribbean Project (SABE), and from population censuses and mortality statistics. Sullivan's estimation method was used. It combines the age-specific schedule of the current probabilities of death with the prevalence of self-perceived ‘poor’ and ‘good’ health. The paper also reports multivariate analyses of the factors associated with variations by age group and sex in self-perceived health. The findings revealed that, at all ages, women live longer than men and for more years in a healthy state. Among men, those aged 60, 65 and 70 years were expected to live a higher percentage of their remaining life than women in a healthy state, but among those aged 75, 80 and 85 years, the opposite held. Among women, the percentage of remaining years that were unhealthy did not increase as age increased, which differs from previous findings. The multivariate analyses showed that with increasing age, for women the number of chronic diseases decreased but dependency increased, and for men the opposite held. This finding indicated that the percentage of life spent in poor self-perceived health more accurately predicts mortality in men than women.

This article reports an analysis of European Community Household Panel (ECHP) data to test the hypothesis suggested by Kemeny (1981) and Castles (1998) of a trade-off between the extent of home-ownership and the generosity of old-age pensions. To this end, we evaluate the impact of a range of both pensions arrangements and housing policies on the risk of poverty in old age. The most important analytical innovation is the inclusion of social housing provision as an important policy alternative to the encouragement of home-ownership. Although we found substantial empirical support for the trade-off hypothesis, the findings raise several issues for discussion and further research. Firstly, we found that neither generous pensions nor high ownership rates had the strongest poverty-reducing potential, for this was most strongly associated with the provision of social housing for older people. Furthermore, the analysis identified a group of older people who are faced with a double disadvantage, in the sense that in high home-ownership countries, those who did not possess their own homes also tended to receive low pension benefits. Although this effect arises at least partly as a result of selection – the larger the ownership sector, the more selective the group of people who do not own their homes – the high poverty risk among ‘non-owners’ was apparently not countered by the pension system.