The aim of the present research was to evaluate the effectiveness of a care-giver training programme that trains professional care-givers in cognitive stimulation strategies for functional maintenance in care-dependent older adults. The sample contained 69 older adults (37 in the treatment group, 32 control group) assessed with the Barthel Index, the Mini-Mental State Examination and the Clifton Assessment Procedure for the Elderly (Cognitive Scale). Participants in the treatment group were treated by professional care-givers who were trained with the programme CUIDA-2 in communication and cognitive stimulation strategies. The results from the Barthel Index showed significant differences in the post-intervention assessment and in the follow-up assessment, where the treatment group obtained higher scores, and there were significant differences within the treatment group between the initial assessment and the post-treatment assessment, as well as between the initial assessment and the follow-up. The data obtained reflect that a training programme to train professional care-givers produced functional benefits in the older adults, and these improvements persisted over time. Moreover, the care-givers saw themselves as more competent and more satisfied with their work.

It is estimated that a third of people in the United Kingdom with signs of dementia are living without a formal diagnosis. In Wales, the proportion is nearly half. Some explanations for the gap between prevalence of dementia and number of diagnoses include living with a long-term partner/spouse and systemic barriers to diagnosis. This study recruited participants from the Cognitive Function and Ageing Studies-Wales (CFAS-Wales) cohort, randomly selected from people aged over 65 living in two areas of Wales, who met study criteria for a diagnosis of dementia and did not have a record of a formal diagnosis in general practice records. We aimed to understand more about the contexts and circumstances of people who live with and cope with cognitive difficulties without having a formal diagnosis of dementia. We conducted qualitative interviews with six participants and their spouses, and additionally with four family members of three invited people who were unable to take part. Themes were generated using thematic analysis. We present the argument that there is an adaptive response to low service levels and a complex interaction between the expectations of levels of service, perceptions of the legitimacy of cognitive problems and the right to make demands on services. This paper concludes that more could be done to address barriers to diagnosis and treatment services for those living with symptoms of dementia, but that the value placed on diagnosis by some individuals might be lower than anticipated by government policy.

Despite older people's increasing use of social media (SM), there is relatively little research investigating the impact of SM use on wellbeing in the ageing population. This study investigates the relationship between SM use and life satisfaction, a key dimension of wellbeing, in three age groups. We focus on the Italian case, which is particularly relevant because Italy is one of the countries both with the highest incidence of older people and the lowest uptake of SM in Europe. Applying linear regression modelling techniques, we analyse data from the 2018 Multipurpose Survey – Aspects of Everyday Living, a large probability-based household survey. For two age groups, we find a positive relationship between SM use and life satisfaction which weakens after controlling for older people's demographic and socio-economic characteristics, health conditions and social network characteristics. Given the grey digital divide that still exists in some European countries, we conclude with a call for urgent interventions to remove the hurdles that prevent frail older people from enjoying the benefits of an active ageing, fully exploiting the potential of SM use.

Ever more people are in paid work following the age of state pension availability, and yet the experience of working in this phase of the late career has been little studied. We interviewed a purposive sample of 25 Swedish people in their mid- to late sixties and early seventies, many of whom were or had recently been working while claiming an old-age pension. The data were analysed with constant comparative analysis in which we described and refined categories through the writing of analytic memos and diagramming. We observed that paid work took place within a particular material, normative and emotional landscape: a stable and secure pension income decommodifying these workers from the labour market, a social norm of a retired lifestyle and a looming sense of contraction of the future. This landscape made paid work in these years distinctive: characterised by immediate intrinsic rewards and processes of containing and reaffirming commitments to jobs. The oldest workers were able to craft assertively the temporal flexibility of their jobs in order to protect the autonomy and freedom that retirement represented and retain favoured job characteristics. Employed on short-term (hourly) contracts or self-employed, participants continually reassessed their decision to work. Participation in paid work in the retirement years is a distinctive second stage in the late career which blends the second and third ages.

Although the active ageing concept generally has positive connotations, with expected benefits at the micro, meso and macro levels, the application of this concept in terms of policy making presents challenges and risks to be avoided (for instance, a predominantly productivist interpretation and a top-down imposition with limited possibilities for bottom-up exchanges; or a disregard for the risk of excluding older people with more disadvantaged backgrounds). Two crucial strategies to minimise risks are the implementation of policies by considering and respecting territorial diversity, and the involvement of all the relevant stakeholders in a participatory consultative and co-decisional approach. This paper entwines both strategies together by focusing on Italian in-country differences in terms of active ageing, and employing the Active Ageing Index for policy-making purposes. This activity is part of a governmental national pilot project aimed at promoting multilevel co-managed co-ordination of active ageing policies across Italy. The analysis identified five groups of regions that differ from the classical, geographic and socio-economic division between the North, Centre and South. Additional in-group analyses were conducted to investigate within-cluster differences. This study will inform a large multilevel stakeholder network for evidence-based policies and their monitoring at both the national and regional levels, in line with the perspective of mainstreaming ageing.

Research shows that older people tend to not only be underrepresented on television (TV), but also to be represented within a number of fixed types. These correspond to cultural myths about ageing, which emphasise vulnerability and decline but also increasingly stress the individual's responsibility for successful ageing. This paper analyses the representation of older people on Flemish public TV, using qualitative content analysis to identify patterns of representation in a sample of 44 programmes broadcast in 2019 and 2020, including the first months of the COVID-19 pandemic. To complement our own analysis, we also interviewed eight experts on ageing. Our research shows that representations of older people on Flemish public TV tend to gravitate towards two types related to different age groups: vulnerable and passive old-old people (over 80 years old), particularly those in nursing homes who feature prominently in reporting on the COVID-19 pandemic; and dynamic and active young-old people (65–80 years old), connected to the ideals of successful ageing. The two predominant types correspond to cultural myths about ageing and are also connected to recurrent themes: sexual intimacy, loneliness and death. Our research highlights the need for a more diverse representation, reflecting the variety of individual life conditions and the functional age of older people.

This paper extends our understanding of employment and gendered rural ageing by examining the latent benefits of paid work for mid-life women in rural Ireland. Existing social gerontology literature deals extensively with manifest financial reasons to work, consequences of gendered pay and pension inequalities, work-related health concerns and the negative impacts to an extended working life for women. However, there is much less focus on the latent non-financial positive contributions that work provides for the older woman, especially within a rural context. Findings from this study show how mid-life women, even if in lower-paid, precarious work or in poorer health may choose to continue working into older age. Paid work provides not only financial autonomy, but also temporal structure, life purpose, personal agency, social connectivity and a self-identity that most women are reluctant to relinquish to retirement. Meaningful work plays a critical role in the ageing experience of older rural women. A qualitative study of 25 women aged 45–65 in Connemara, Ireland was undertaken from a lifecourse perspective and analysed using constructivist grounded theory to allow rich, novel narrative to emerge. Narrative from seven, who best represent all participants, are utilised in this paper. Conclusions suggest that the latent benefits of paid work are at least as, if not more important than financial gain for rural mid-life women.

Older adults with a chronic health condition (e.g. hypertension) use various self-management methods. Healthcare technologies have the potential to support health self-management. However, it is necessary to understand the acceptance of these technologies as a precursor to older adults’ adoption and integration into their health plan. Our focus was on the factors older adults with hypertension initially consider when introduced to three new healthcare technologies that might support their health self-management. We compared their considerations for a blood pressure monitor, an electronic pillbox and a multifunction robot to simulate incrementally more complex technologies. Twenty-three participants (aged 65–84) completed four questionnaires and a semi-structured interview. The interview transcripts were analysed using a thematic analysis approach. We identified the factors that were frequently mentioned among the participants for each of the three healthcare technologies. The factors that older adults initially considered were familiarity, perceived benefits, perceived ease of use, perceived need for oneself, relative advantage, complexity and perceived need for others. Upon further reflection, participants considered advice acceptance, compatibility, convenience, facilitating conditions, perceived usefulness, privacy, subjective norm, and trust. We integrated the factors that older adults considered into the Healthcare Technology Acceptance Model (H-TAM), which elucidates the complexity of healthcare technology acceptance and provides guidance for future explorations.

In Sweden, sheltered housing is a housing model that provides accessible apartments with elevated social possibilities for older people. The environment within sheltered housing is expected to support resident health and reduce the need for care services. A previous study has shown that with increasing levels of depressive mood and decreasing levels of self-rated health and functional status, those residing in sheltered housing report higher levels of thriving compared to those ageing in place. Therefore, the aim of this study was to illuminate aspects of sheltered housing that are facilitators and/or barriers to thriving. Seven semi-structured group interviews in five different sheltered housing accommodations in Sweden were conducted between April 2019 and January 2020 (N = 38). The results, analysed using qualitative content analysis and presented in a model developed by Grol and Wensing, illuminate the four main categories of facilitators and barriers to thriving: individual factors, social context, environmental factors and organisational context. The results of this study show that the factors that influence experiences of thriving in sheltered housing are multifaceted and interconnected. Although the supportive environment provided in sheltered housing seems to contribute to thriving, the limited consideration towards the shifting health of residents is a barrier to thriving. The results of this study may assist in implementing tailored interventions to help support thriving on various levels.

Unnecessarily delayed discharges from hospital of older people living with frailty can have negative consequences for their health and add significant costs to health services. We report on an ethnographic study at two English hospitals and their respective health and social care systems where we followed 37 patient journeys. The study aim was to understand why delays occur. Our findings indicate that working practices in the study hospitals may have inadvertently contributed to delays. While many pieces of patients’ clinical and social information were collected, recorded and accessed in different ways by different professionals, to facilitate a discharge, these pieces needed to be re-found, integrated and re-constructed. A key component of this process was information related to patients’ social, family and functional background. This was often missing, not accessed or perceived to be of low value compared to other more readily available clinical information. Patients’ re-construction was thus often incomplete, or insufficient to reduce the clinical and prognostic uncertainty associated with frailty and to manage risks inherent in older people's discharge. Where this key component was present and integrated into decision-making in multi-disciplinary team working, uncertainty and risk were managed more constructively and sometimes avoided an escalation of care needs.

Across the world acute hospitals are under unprecedented pressures due to shrinking budgets and increasing demand, against this backdrop they are also experiencing record levels of activity in Accident & Emergency and delayed transfers of care. Reducing pressure on hospitals by avoiding unnecessary admissions and delayed discharges has risen up the global policy agenda. However, reviews of strategies and policies have rarely involved discussions about the role that hospital social workers play in achieving timely hospital discharge. Yet discharge planning has become a, if not the, central function of these professionals. This paper presents the results of a small-scale exploratory study of hospital social work in an acute hospital in Northern Ireland. The findings reveal that the work of hospital social workers is characterised by increased bureaucracy, an emphasis on targets and a decrease in the time afforded to forming relationships with older people. Hospital social workers highlight concerns that the emphasis on discharge planning and pressures associated with the austerity agenda limits their capacity to provide other more traditional roles such as advocacy and counselling. It is argued that hospital social work should not be narrowly defined as ‘simply’ co-ordinating discharge plans. The tension that arises between expediting hospital discharge and advocating for older people and their families is also discussed.

Bereavement and grief are frequently experienced during the COVID-19 pandemic given widespread mortality. However, losses extend beyond deaths to include cancelled plans and routines, separation from family and friends, and unemployment. It is essential to better understand the multifaceted and complex losses experienced by older adults throughout the pandemic. We analysed 2,587 open-ended survey responses collected online in May to July 2020 from the COVID-19 Coping Study, a mixed-methods study of US adults aged 55 and older. Participants were on average 67 years old (standard deviation = 7.2), over two-thirds female and largely white. Qualitative thematic analysis identified diverse sources of grief, sadness and loss. Themes ranged from death and bereavement to anticipatory grief, loss of agency, cancelled plans and missed milestones, losing social contact and physical touch, health struggles, loss of normalcy and daily routines, and societal and economic woes. The results highlight the varied and highly personal nature of everyday grief and loss among ageing adults during the COVID-19 pandemic. Sources of grief extended beyond death to include both tangible and intangible losses with expectations of long-term consequences. These findings may inform the development of family and community supports, including mental health services, to address complex subjective experiences of grief and loss since the pandemic onset. Interventions are needed to support healing and hope in vulnerable and resilient ageing populations.

The present article aims to highlight methodological aspects related to understanding and conceptualising social capital for the purposes of population research as well as describing the key challenges in the harmonisation process of indicators of social capital. The study was conducted in the frame of the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project. After a review of social capital theories developed in social science and a subsequent review of the documentation of 18 international cohorts, decision trees of the harmonisation of social variables were developed. The known-group validity was verified. The results focused on generalised trust, civic engagement and social participation are presented. The summary of the availability of any indicators of these concepts is classified in seven domains (generalised trust, political participation, religious participation, senior-specific participation, participation in sport groups, participation in volunteer/charity group activities, any participation) across surveys. The results of the analysis for known-group validity support the construct validity of the harmonised variables.

To live in a good mood is not only a key consideration for future age-friendly communities, but also a critical necessity for positive ageing. Despite growing evidence of correlations between contact with nature and stress reduction, little is known about the effect of nature integration in indoor environments. Thus, this study aimed to answer the following research questions: (a) How do biophilic characteristics of home environments correlate with older adults’ experience of the multiple levels of the theory of gerotranscendence? and (b) What is the relationship between these experiences and the mood states of these older adults? The study was based on a comparative analysis to scrutinise the impact of the COVID-19 pandemic on these questions. The data were gathered through questionnaires with 450 older adults aged between 65 and 95 years, and stratified by the biophilic characteristics of their living environments: indoor biophilic, outdoor biophilic and non-biophilic. Two sets of data were collected with the same participants, respectively, before the COVID-19 pandemic (June to October 2018) and during the COVID-19 pandemic (June to October 2020). It found that the biophilic characteristics of home environments are correlated dynamically with older adults’ ageing experience and mood states. The study indicates that outdoor biophilic features facilitate the recovery of tension mood effects of the COVID-19 pandemic, whereas indoor biophilic features facilitate recovery from depression and anger.

Policy responses to population ageing have focused on lengthening working lives, overlooking inequalities in older adults’ participation in unpaid activities. This paper examines participation in paid and unpaid activities between the ages of 55 and 70 to answer two questions: how do people navigate pathways of paid work, informal care, volunteering, civic participation and housework in mid to later life?; and how do these pathways relate to gender, socio-economic and health inequalities? Two-staged latent class analysis was used to identify activity pathways using data from the British Household Panel Survey (1996–2008). Multinomial logistic models assessed associations between latent pathways and socio-demographic and health characteristics. Three pathways were observed: full-time work to low activity (49%), part-time and in-home work (34%) and multiple activities (16%). Aside from retirement from full-time work, the pathways of participation in paid and unpaid activities were characterised by continuity; substitution between different forms of paid and unpaid work was not observed. Participation in multiple paid and unpaid activities was more common for respondents in better health and of higher socio-economic status. Since the promotion of paid work and volunteering in later life may mainly benefit individuals in advantaged circumstances, policies should avoid taking a blanket approach to encouraging participation in multiple activities, a key component of active ageing.

The primary aim of this scoping review was to explore the contribution of housing adaptations to supporting everyday life for people with dementia living at home in the community. The study adopted a scoping review methodology which was guided by the Joanna Briggs Institute Reviewers Manual. Four review questions were developed which subsequently informed the inclusion criteria and search terms. Eight databases were searched resulting in 2,339 records, with 13 papers being included in the review. Evidence from the review found that the most common adaptations were recommended and/or implemented to compensate for a person's physical limitations and for safety reasons, rather than adaptations to support activities of daily living for a person with dementia. Support to implement adaptations was provided by a range of professionals coupled with ‘trial and error’ approaches adopted by the person themselves, and these were seen as key enablers. Barriers to implementing and using adaptations were fourfold: (a) access to information, (b) knowing when to make changes, (c) carer resistance, and (d) the unsuitability of the home. It would appear that housing adaptations have a positive impact on both the person with dementia and the carer (where one is present), with some adaptations having a relatively sustained impact and being particularly effective if implemented early in the lived trajectory of dementia.

Language can shape and reinforce attitudes and stereotypes about living with dementia. This can happen through use of metaphors. However, common metaphors may not capture the complexity of experience of dementia from the perspective of the individual person or a family carer. This paper presents an alternative metaphor – that of a theatre production – based on the strategies used by carers to support people with dementia to live well in the community. We conducted face-to-face semi-structured interviews with 12 family members caring for someone with dementia in the community in Queensland, Australia. Our aim was to explore the strategies these carers used to provide support. Interview recordings were fully transcribed and thematically analysed. We identified positive care-giving strategies that described multiple roles that carers fulfilled as they felt increasingly responsible for day-to-day decision making. Family carers explained how they supported the person with dementia to remain a central character in their life and continued to support the person to be themselves. To achieve this, family carers embodied roles that we identified as similar to roles in a theatre production: director, stage manager, supporting cast, scriptwriter, and costume designer and wardrobe manager. Our metaphor of a theatre production offers a fresh perspective to explore the experience of informal care-giving in the context of dementia.

Older people's ability to thrive independently of their adult children is an important feature of a universalistic welfare system. However, population ageing puts this notion under stress. In separate multinomial logistic regression models for older men and women, we examined whether adult children's gender, number and proximity were associated with older parents’ relocations into residential care facilities, and whether the effects of these children's characteristics on older parents’ institutionalisation vary by parents’ severe health problems, operationalised as closeness to death – specifically, dying within the two-year observation period. Analyses were based on the Swedish register data between 2014 and 2016 (N = 696,007 person-years). Older parents with at least one co-resident child were less likely to move or become institutionalised than those without a co-resident child. We did not find a relationship between older adults’ institutionalisation and the closest child's gender. The negative effect of having a non-resident child living nearby on the likelihood of becoming institutionalised was more pronounced for mothers than fathers. Having a child nearby decreased the likelihood of moving to an institution more for mothers who had severe health problems than for those in better health. We found no evidence of a relationship between number of children and likelihood of institutionalisation.

Ageing Europeans are today healthier than previous generations and often manage to live independently up to a high age. The proportion of people 80 years of age and older has increased significantly, and with high age the risk of multi-illness and dementia increases. Strong urbanisation processes have changed the demographic structure in rural areas, and young women and men have migrated towards the urban areas to study and work, while older persons have remained behind. This demographic challenge of increasing numbers of persons older than 80 years with care needs living in remote rural areas has become a major European social problem. In tackling this dilemma, many European countries have high expectations for eHealth, digitalisation and welfare technology. In this comparative study of policy debates in Italy, Finland and Sweden, we analyse how – between 2009 and 2019 – the issues of eHealth have been articulated in national and regional policies of the three countries with deep differences in terms of digitalisation and health systems, but with similar ageing populations. We identify in the documents three core topics – the role of technology, the rural issue and responsibility for care. These topics are treated in the documents with differences and similarities between the three countries. Beyond the differences and similarities, the documents reveal both a certain techno-enthusiasm about the role of eHealth in the life of the older adults as well as a limited understanding of the complexity (relationally as well as spatially) of the digital landscape of caring for older adults.

Individuals with Alzheimer's disease and related dementias often require substantial support from other people. Much of the care-giving is from family members who eventually experience physical, emotional and financial stress, depression and fatigue. In Uganda, families are a cornerstone in providing care to individuals with dementia. However, little is known about the psychosocial supports available to the care-givers in their care-giving role. We assessed the psychosocial supports available to care-givers of individuals with Alzheimer's disease and related dementias in southwestern Uganda. We conducted 34 in-depth interviews at three referral hospitals at which care-givers identified by the treating clinicians were approached for informed consent. The interviews were conducted until thematic saturation was reached, and the interviews were translated and transcribed. Thematic content analysis was used to analyse the data. Care-giver supports were structured into two major themes: medical supports utilised and supports beyond the medical care system. Medical supports highlighted information provided by medical professionals. Supports beyond the medical care system included emotional and instrumental supports provided by religious leaders, the local communities and family members. Care-givers for individuals with dementia in southwestern Uganda receive educational support from medical practitioners, and unstructured emotional and instrumental supports from the family and community.