This paper seeks to identify specific problem behaviours related to the distress experienced by informal caregivers of dementia victims. Analyses are conducted using a random sample of caregivers rather than a restricted clinical sample. Distress is measured in terms of both depression and caregiver burden. The findings reveal that specific behaviours on the part of the care receiver are strong correlates of the distress experienced by caregivers. In particular, aimlessness, aggressive behaviours, forgetfulness, and restlessness are correlated with heightened feelings of burden. Apathy or a lack of interest in daily activities is strongly correlated with both feelings of burden and depression. The identification of specific problem behaviours suggests where efforts should be placed in order to alleviate the distress experienced by informal caregivers.

This paper reviews the empirical literature on social isolation and loneliness and identifies a wide range of published correlates. Using data from a study conducted in North Wales, which included many of the same correlated variables, a statistical modelling technique is used to refine models of isolation and loneliness by controlling for co-variance. The resulting models indicate that the critical factors for isolation are: marital status, network type and social class; and, for loneliness: network type, household composition and health.

In the context of demographic transition, one would expect public health planners to allocate resources according to changing needs. This paper explores the effects that definitions of population ageing have on the images of, and subsequent responses to, demographic transition in the United States. Data are drawn from the 1988 U.S. Census and from a 20-percent national random sample of Medicare patients during the same period (n = 1.9 million). Main findings are that supply and use of acute services do differ according to definitions and the way in which population ageing has occurred; that, regardless of definition, older people in high-ageing states make far greater use of posthospital home health care than in low-ageing states; and that, although individual-level clinical factors appear central to rehabilitative decisions, all states seem to use very old age (85-plus) as a proxy to determine who goes where, with low-ageing states also affected by structural constraints at the hospital and market levels.

Critical gerontology may be seen as evolving along two paths simultaneously, one embracing a broad political economy of ageing framework, and the second emerging from a humanistic orientation. This paper will present and highlight the special contributions of each of these pathways to the understanding of ageing and growing old. Emergent feminist perspectives on ageing, and ‘culturally relevant ways of thinking’ about ageing and diversity will then be presented as complementing and extending critical gerontology. The concept of empowerment will be seen as linking all four of these conceptual approaches, and case studies and examples will be used to illustrate the relevance of these alternative perspectives for better understanding and addressing the problems and challenges facing gerontology in the years ahead.

The focus in the United States on ‘setting limits’ to the provision of such services as health care for old people may be spreading to Europe. This article points up the empirical deficiencies in some of the unexamined assumptions in such proposals, especially the belief that an inordinate share of medical expenditures occur in the final weeks or months of elderly patients. The setting-limits doctrine is viewed as a subset of broader socio-political-ideological thrusts aimed at (or resulting in) anti-elderly, intergenerational-conflict policy proposals. Such proposals should be evaluated in terms of their social constructionist, partially contrived, and historically distorted bases. Apocalyptic gerontology needs to be weighed in terms of its moral implications.

A narrative understanding of clients is needed to supplement traditionally developed research for making clinical judgments about which approaches should be used in working with older adults. Narrative biographical knowledge of clients integrates the historical events and happenings of their lives with the social and cultural contexts through which they attribute meaning to their distresses and symptoms. Applications based on narrative knowledge differ from those based on the conventional model. The conventional model draws on general knowledge of what interventions are likely to be effective in treating particular diagnoses. Narrative understanding is concerned in knowing the configuration of past events and present tasks that compose individual lives. Expert practitioners make use of a narrative understanding of their clients in judging their intervention activities. Development of a narrative understanding of present clients can be assisted by consulting narratives of clients with whom a practitioner has previously worked. Narratives are remembered as stories, retaining the patterns and details of the individual clients’ lives. Through experience, practitioners develop a collection of remembered narratives of the clients they have assisted. A practitioner's experiential collection of narratively known clients can be supplemented with narrative biographies and case studies of clients treated by other practitioners. When working with a new client, practitioners can draw on these narratively retained past understandings by comparing the similarities and differences of their present client to a remembered past client. The process of comparison with past narratively understood clients helps the practitioner compose a new narrative that expressly captures the individual life of the present client. This narrative understanding of the client provides an integrated view of the influence of general social and biological contexts with the unique values, aims, and history of the client.

Drawing on the accounts given by 163 relatives, friends and others who knew a sample of people who lived alone in the last twelve months of their lives, this paper examines a variety of strategies used by speakers to maintain their moral identities. Respondents sought to locate themselves as members of a community of care by stressing their activity in surveillance of the living conditions of those who lived alone, describing their part in the orchestration of help by members of a team of professional and lay carers, and in conducting negotiations over the placement in institutions of people who failed to maintain adequate reputations for independent living. A variety of strategies for justifying or excusing placement decisions—including criticisms of the behaviour of the people who lived alone—are described. At the same time, the accounts are read as a resource for understanding the perspective of the people who lived alone. People who live alone towards the end of life face particularly pressing threats to their capacity to maintain meaning and purpose. Declining physical capacity threatens loss of control and the onset of social death, conspiring to undermine ontological security. The struggle to maintain a reputation for independence in the face of neighbourly surveillance for signs of slippage is described. The paper concludes by identifying a central dilemma for carers: how to provide care that allows its recipient to manage self-identity independently.

This paper considers the role of contemporary consumer culture in helping older people re-fashion their own identity in later life. As a result of the expanding role played by consumption in modern mass societies, adult identities now are being denned as much by how people spend their time and money as by the goods and services they can produce. An increasing number of retired people are able to participate in this consumer culture, and in doing so are creating new possibilities of being ‘old’. The contemporary period, whether deemed ‘late’ or ‘post’ modernity, seems to present a growing challenge to the dominance of structures of age, class and gender in defining the nature of our personal identity. There is more emphasis upon the exercise of choice and agency across all periods of the lifespan. The means by which this process is enacted in the lives of pre- and post-retired people should become central to a new, culturally focused social gerontology.

Communication between elderly people and their health care providers is becoming more important due to the chronic nature of geriatric health problems and their impact on quality of life. At the core of the challenge of improving this dialogue are factors related to essential human values and the clash between two different cultures – one scientific and the other personal. Only by gaining an understanding of this clinical decisionmaking interaction can new approaches to bridge the communication gap be developed. The purpose of this paper is fourfold: (1) to summarise the fundamentally different bases for communication between health care provider and patient, (2) to discuss the shortcomings of various methods (such as advance directives) to embody patients’ wishes about their care, (3) to review new models of geriatric care that have implications for this communication process, and (4) to develop a framework – based on biographical methods and the concept of empowerment – that suggests some potential solutions to these communication problems. Such methods reflect new approaches to developing life stories and themes suggestive of ways to retain the personal life voice of the individual in the development of a clinical partnership with the health care provider.

Recent work on family life in old age may be considered in several dimensions. First, it encompasses different substantive areas: parentchild relationships, care-giving, changing family forms. Second, it involves different types of discourse, which variously reflect social policy considerations, legal and ethical debates, academic discourses and prescriptive writing for professionals and older people. A third dimension consists of methodological and theoretical variations. These include synchronic and life history approaches, quantitative and qualitative methods, positivistic and phenomenological research paradigms, and cross-cultural and historical comparisons.

Income in retirement does not normally feature in national headlines, but scandals such as the misuse of the company pension fund by Robert Maxwell, and the financial advice given to join personal pension schemes have done just that. The ‘demographic time bomb’ has become a media cliché. In this first of two reviews of the incomes and financial circumstances of older people we examine the influence of these headlines and clichés on present and future incomes. To set the scene, the current levels and sources of income for older people are outlined and compared with those of the younger population. The following section describes the trends and changes in pensioners’ incomes and what has influenced these trends. The next sets out the main issues in providing a secure income in old age, and finally the current policy debate is reviewed and some questions are identified for re-examination in two years’ time.