Explicit in the current construction of Alzheimer's disease is the assumption that memory impairment caused by cognitive deficiencies leads to a steady loss of selfhood. The insistence that selfhood is the exclusive privilege of the sphere of cognition has its origins in the modern western philosophical tradition that separates mind from body, and positions the former as superior to the latter. This dichotomy suggests a fundamental passivity of the body, since it is primarily cognition that is held to be essential to selfhood. In contrast to the assumed erasure of selfhood in Alzheimer's disease, and challenging the philosophical underpinnings of this assumption, this paper presents the findings of an ethnographic study of selfhood in Alzheimer's disease in a Canadian long-term care facility. It argues and demonstrates that selfhood persists even with severe dementia, because it is an embodied dimension of human existence. Using a framework of embodiment that integrates the perspectives of Merleau-Ponty and Bourdieu, it is argued that selfhood is characterised by an observable coherence and capacity for improvisation, and sustained at a pre-reflective level by the primordial and socio-cultural significance of the body. The participants in this study interacted meaningfully with the world through their embodied way of ‘being-in-the-world’.

Several recent studies have documented a negative relationship between informal care-giving and labour market attachment in Great Britain. This paper examines the relationship from a longitudinal perspective using data from the Great Britain 1994–95 Family and Working Lives Survey. The first part of the paper studies the timing of informal care-giving to a sick, disabled or elderly person. This information is used in the second part to examine the effects of caring on employment. The results show that most carers look after only one dependant during their lives, and only around one-fifth to one-third look after a second dependant before the age of 65 years. Of all informal carers, about one-third had not been employed when they started caring for the first time in their lives, another third said that caring had no effect on their work arrangements, and about one-third reported one or several effects on their work arrangements, most commonly that they stopped working. Multivariate analyses show that semi-routine and routine manual workers report the strongest effects of care-giving. Part-time workers were more likely than full-time workers to reduce their hours of paid employment when they started caring.

There is increasing recognition of the importance of social and cultural differences in shaping the diversity of the ageing experience in contemporary Britain. Various social and cultural factors, such as those associated with class, ethnicity, gender and disability, influence people's living circumstances and sources of support in later life. While they have been the subject of considerable speculation, ageing in a non-heterosexual context remains remarkably under-studied. This paper examines the difference that being non-heterosexual makes to how people experience ageing and later life. It draws on quantitative and qualitative data gathered for a British study of the living circumstances of non-heterosexuals aged between the fifties and the eighties. Previous work has overwhelmingly emphasised how individuals manage their sexual identities, but this paper focuses on the factors that shape the non-heterosexual experience of ageing and later life. Particular attention is paid to the relational and community contexts in which non-heterosexuals negotiate personal ageing. This not only provides insights into the specific challenges that ageing presents for non-heterosexuals, but also offers insights into the challenges faced by ageing non-heterosexuals and heterosexuals in ‘detraditionalised’ settings.

The purpose of this study is to examine whether the co-residence of spouses and children affects self-reported general health among older men and women in a rural area of Bangladesh. Binary logistic regression has been used to explore the impact of spouses and children on self-reported health, with particular attention to the gender of children and interactions with chronic disease. The data are from the Matlab Health and Socio-Economic Survey. A sample of 765 women and 979 men aged 60 or more years with at least one surviving child was available. The principal result is that for an older woman, optimum self-reported health is most likely when a spouse and at least one son and one daughter are present. Any deviation from this family pattern (either no spouse or children of only one sex) leads to a significantly increased risk of poor self-reported health. On the other hand, among older men there were no differences in self-reported health among the various spouse-child combinations. The relationship between a balanced gender distribution of children and optimum self-reported health among older women may explain the levelling out of fertility at roughly three children per women despite intensive family planning promotion in the area. Further reductions in fertility (an important policy concern) may depend on improving the substitutability of sons and daughters in the support of their elderly mothers.

This article examines the relationships between support networks, ethnicity and the utilisation of formal care services, taking into account background characteristics and functional health status among 3,403 older people in Israel. Data were drawn from a national survey in 1997 of people aged 60 or more years. The outcome variable was the use of publicly-financed personal care or homemaking services. About 15 per cent of the study population made use of such home care. Six informal support network constellations were identified by applying cluster analysis to key criterion variables that reflect the inter-personal milieu. The resultant network types were: community-clan, family-focused, diverse, friend-focused, neighbour-focused, and restricted networks. Binary logistic regression revealed that the use of formal home-care services was significantly associated with a respondent's age, gender, functional level and informal support network type (Nagelkerke R2=0.39). No association was found between home-care utilisation and a respondent's ethnicity (Arab, Jew, and new Russian immigrant), income or education. The results show that publicly-financed formal care services were utilised more frequently by older-old persons, women, functionally impaired individuals and people embedded in the neighbour-focused and restricted networks (and to a lesser degree, in the diverse and friend-focused networks). Neighbour-focused and restricted network types were characterised by fewer informal support resources at their disposal than the other types. Thus, formal home care was sought more often in cases in which the informal sources of support had less capacity to provide ongoing informal care.

Older people living in residential and nursing care homes spend a large proportion of their time within the boundaries of the home, and may depend on the environment to compensate for their physical or cognitive frailties. Regulations and guidelines on the design of care buildings have accumulated over time with little knowledge of their impact on the quality of life of building users. The Design in Caring Environments Study (DICE) collected cross-sectional data on building design and quality of life in 38 care homes in and near Sheffield, Yorkshire. Quality of life was assessed using methods which included all residents regardless of their frailty, and staff morale was also assessed. The physical environment was measured on 11 user-related domains using a new tool, the Sheffield Care Environment Assessment Matrix (SCEAM). Significant positive associations were found between several aspects of the built environment and the residents' quality of life. There was evidence that a focus on safety and health requirements could be creating risk-averse environments which act against quality of life, particularly for the least frail residents. Staff morale was associated with attributes of a non-institutional environment for residents rather than with the facilities provided for the staff. The new tool for assessing building design has potential applications in further research and for care providers.

Mike Davis. Dead Cities: A Natural History. New Press, New York, 2002. 288 pp., pbk $16.95 ISBN 1 56584 844 6.

Eric Klinenberg. Heat Wave: A Social Autopsy of Disaster in Chicago. University of Chicago Press, Chicago, 2002. 320 pp., pbk $15.00 ISBN 0 226 44322 1.

Katherine S. Newman. A Different Shade of Gray: Midlife and Beyond in the Inner City. New Press, New York, 2003. 400 pp., hbk $29.95 ISBN 1 56584 615 X.

The environmental context of ageing, and issues relating to place and location in particular, has re-surfaced as a major theme within gerontology (Kendig 2003; Wahl, Schiedt and Windley 2003; Wahl and Weisman 2003). Drawing on classic studies from Rosow (1967), Rowles (1978), Lawton (1980) and others, the mission of environmental gerontology has been viewed as understanding a number of key tasks facing older adults in diverse physical and ecological settings. These include: ‘preserving as-independent-as-possible everyday life in the face of physical and mental impairments by using environmental resources outside the home environment (‘ageing in place’), initiating processes of relocation if desired or necessary, and adapting to new living environment settings (such as nursing homes or other planned housing) after relocation' (Wahl and Lang 2003: 7).