In the United Kingdom (UK) and elsewhere, little is known about problematic drug use among older people (defined here as aged 50–74 years), either because few older drug users exist or because they represent a ‘hidden’ population. In this paper, we show that the average age of drug users in contact with treatment services and agency-based syringe exchange programmes (SEPs) in the counties of Cheshire and Merseyside in northwest England is rising. Between 1998 and 2004–05, the number of older male drug users in treatment increased from 80 to 310, and the number of older females rose from 46 to 117. Consequently, the median age rose from 30.8 years in 1998 to 34.9 years in 2004–05. Similarly, between 1992 and 2004, the number of older injectors accessing SEPs increased from three to 65 men and from one to nine women. The median age of SEP attenders was 27.0 years in 1992 and 34.9 years in 2004. Drug use amongst older people is associated with poor physical and psychological health and longer hospital stays. The future cost of the ageing of drug users may be considerable. Detailed research is needed to identify the characteristics and health needs of this vulnerable population.

Few studies have investigated how outdoor environments might disable people with dementia. The issue is rarely considered in planning and design guidelines and not at all in regulations, despite dementia being within the scope of disability discrimination legislation in the United Kingdom and other countries. This article reports a study that involved older people with mild to moderate dementias taking two walks, one in a real town centre and one in a virtual reality (VR) simulation. Adaptations were made to the VR simulation to test possible design improvements. Overall, the town centre posed relatively few problems for the 38 older people with dementia who participated, although more difficulty was evident with greater impairment. Some features of particular places were liked more than others, particularly the segregation of spaces from motor traffic. There were measurable benefits from using clear textual signs to support wayfinding and to identify objects and places in the environment. Diminished outdoor activity is likely to be experienced as a decrease in quality of life and may accelerate the progression of dementia. We conclude that older people with mild to moderate dementia should be encouraged to be active outdoors and that this can be facilitated by small environmental modifications. Some limitations of the VR technology used for the study are also reported.

This paper presents findings from a national survey of quality of life (QoL) in older age. The main aim of the analyses was to examine the definitions of quality of life given by people aged 65 or more years and the underlying reasons. Open-ended questions were used to elicit their perceptions of QoL. These were followed by structured measures of self-rated QoL overall, and of domains of QoL commonly reported in the literature. The main things said by the respondents to give their lives quality were categorised into ‘themes’. These were: social relationships; social roles and activities; leisure activities enjoyed alone; health; psychological outlook and wellbeing; home and neighbourhood; financial circumstances; and independence. The reasons people gave to explain why these things were important to their QoL focused on: the freedom to do the things they wanted to do without restriction (whether in the home or socially); pleasure, enjoyment and satisfaction with life; mental harmony; social attachment and having access to companionship, intimacy, love, social contact and involvement, help; social roles; and feeling secure. This paper also presents data that demonstrates the ability of theoretically informed, structured survey indicators of QoL to predict respondents' self-rated overall QoL. Logistic regression analyses showed that most of these indicators were strong, independent predictors of self-ratings of QoL, although those that were not significant in the model did not fully incorporate lay reasons of QoL in their measurement scales. In conclusion, the indicators which were not significant in the model did not fully incorporate lay values in their measurement properties. It is also likely that those indicators that were significant could have been improved.

The present and future security of employee-pension funding remains at the forefront of public debate across Europe and beyond. In the United Kingdom, to finance future pension entitlements it has been suggested that the state pension age be increased. This paper presents the results of analyses of four major national social surveys that have explored the working and living conditions of workers in paid employment after the state pension age. Comparing the circumstances of these workers with workers just below that age illustrates the extent to which it constitutes a break in the working and domestic lives of older people. The findings suggest that, in order to accommodate older workers in the workplace, more attention may need to be placed on informal as well as contractual arrangements of flexible working. Beyond part-time working, older workers rarely take up additional or alternative flexible working arrangements. At the same time, older workers continue to experience housework as burdensome, while in partnered households the gendered division of domestic labour prevails. Research and policy have yet to consider in depth these risks associated with working longer in life.

This paper reports a study of the religious, spiritual and philosophical responses to spouse bereavement. Twenty-five bereaved spouses aged 60 or more years living in the south of England and from Christian backgrounds were followed from the first to the second anniversary of the loss. The participants expressed a range of attitudes, from devout religious belief to well-articulated secular conceptions of the meaning of life, but the largest group had moderate spiritual beliefs that were characterised by doubts as much as hopes. Uncertain faith was more often associated with depressive symptoms and low levels of experienced meaning. Nine case studies are presented that illustrate different levels of adjustment to bereavement and both changing and stable expressions of faith across the one year of observation. Attention is drawn to the importance of both secular agencies and religious organisations developing a better understanding of older people's spiritual responses to loss. Although to many British older people, practise of the Christian faith may be less evident now than in their childhood, quality of life assessment should not ignore sources of spiritual satisfaction and dissatisfaction. Moreover, previous and especially early-life religious experiences provide useful points of reference for understanding present religious and spiritual attitudes. The study suggests that there may be a substantial need for pastoral counselling among today's older people, especially those of uncertain or conflicted belief.

Older people who become homeless have attracted increasing attention in North America, Western Europe and Australia over the last 20 years, but there have been few projects dedicated to their support, and even fewer studies of the outcomes. This paper reports a longitudinal study of the resettlement of 64 older people who were rehoused into permanent accommodation from homeless people's hostels in England. Their progress was monitored for two years by face-to-face interviews. The theoretical model was that the outcomes of rehousing are a function of personal factors and behaviour, the support that people receive, and the characteristics of the new home. After 24 months, 28 respondents were housed and ‘settled’, 10 were housed but ‘unsettled’, 11 had abandoned their accommodation, and six had been evicted (nine had died or ceased contact). The factors that significantly associated with remaining housed and settled included: previous stable accommodation histories, revived contacts with relatives, taking up activities, and regular help from housing-support workers. Unsettledness and tenancy failure associated with prolonged prior homelessness, worries about living independently, and continuing contacts with homeless people. Rehousing older homeless people successfully is difficult, particularly among those with long histories of homelessness and instability, and more needs to be known about the types of accommodation and the types of support that promote tenancy sustainment.

Large surveys of the general population's perceptions of the neglect and mistreatment of older people are few. This article provides evidence about the public's awareness of ‘elder abuse’ at a time of considerable media and political interest in the subject in many countries. It presents the findings of a survey of 1,000 adults' knowledge of the neglect and mistreatment of older people in the UK. Descriptive and multivariate analyses were used to examine: variations in the perception of the existence of neglect or mistreatment of older people, the perceived relative prevalence of knowing an older person who had been subject to such experiences, the type and place of such experiences and knowledge of sources of help in such circumstances. The key findings are that older people believed that there is less neglect and mistreatment of older people than younger people, that women perceived more than men, and that there were regional variations in these perceptions. One-quarter said they knew an older person who had experienced neglect or mistreatment, and such reports were most likely among the middle aged and women. The most frequently reported locations of abuse were care homes and hospitals, and the most commonly reported form was inadequate or insufficient personal care. Most people said they would contact social services or paid carers if they encountered neglect or mistreatment. The findings are discussed in the light of increased policy attention to the safeguarding of vulnerable adults, and the implications for research, practice and campaigning organisations are considered.

Several professional groups present themselves as ‘waging war’ on old age. They construct old age as a naturalised, self-evidently negative, biological phenomenon, which must be attacked and defeated. These groups make different claims to technical expertise and their ability to control natural phenomena, and use different weapons to defeat ageing. There are those who focus on cosmetic interventions, that is, the control of the body and the removal or masking of the signs of ageing. There are those who equate old age with ill-health and identify themselves as warriors in a battle with disease, and others whose objective is to understand the fundamental intra-cellular processes of ageing and what controls the human life span, and then to extend its limits. A fourth group aims to make human immortality possible. Examination of the language and symbolic practices of these groups reveals that they share a dominant cultural view that devalues old age and older people. The use of military metaphors to describe the importance and difficulties of their task is most prolific among the first and fourth of these groups. The second and third groups disguise a contradiction in their aim of understanding the diseases and disorders of old age by advocating the goal of an extended ‘healthy life span’, which avoids having to confront the moral dilemmas of extending the lifespan for its own sake.