The fourth age remains a poorly understood phenomenon and there is a lack of understanding of the perceptions of those who might be considered to be living in it. This article draws on findings from a study of dignity in later life which examined the day-to-day experiences of participants who were in need of support and care because of failing health. It discusses their accounts of the changes to their sense of self and their identity that came about as a result of their ageing and health problems and looks also at the ways in which the support and care they received helped to shape their adjustment to those changes. The accounts given by participants reveal a great deal about the physical, mental and emotional effort entailed in maintaining a sense of self and highlight the essential role played by social relationships in the maintenance of identity. These findings are analysed by reference to emerging theories of the fourth age.

The long-term care sector is generally characterised by low pay and difficult working conditions. Understanding pay structures and differentials within this sector is important in enhancing recruitment, retention, quality of care and productivity. This article uses new national data on the long-term care workforce in England to investigate employer and individual effects on pay levels and differentials, using mixed-effects modelling controlling for region, sector and employer hierarchical factors. We further examine whether gender and ethnic pay gaps exist among different groups of workers. The results indicate a significant relationship between sector and pay across different job roles. The analysis further identifies ethnic and gender pay differences even after controlling for the effects of sector and individual employers. The implications of this are discussed in relation to sustaining the care workforce in the context of an ageing society and the potential for structural employment marginalisation to reflect the marginalisation of older people receiving care.

This paper discusses the origins and development of Universities of the Third Age (U3As) whilst also forwarding suggestions for possible roles, opportunities and directions in the future. The U3A has been rightly described as both an idea and movement, as each centre has a local foundation and relatively unique features. Whilst some U3As are attached to traditional universities and colleges, others are sturdily autonomous and wholly dependent on the efforts of volunteers. One also finds a variety of ethos, ranging from the provision of a traditional type of liberal-arts education, to the organisation of interest-group activities conducted through peer learning, to showing solidarity with vulnerable sectors of the older population. Academic commentaries on the U3A movement have been both supportive and critical. Whilst U3As have been lauded for leading older learners to improved levels of physical, cognitive, social and psychological wellbeing, other reports emphasise how many centres incorporate strong gender, social class, ageist and ethnic biases. One hopes that in future years the U3A movement will continue to be relevant to incoming cohorts of older adults by embracing a broader vision of learning, improving the quality of learning, instruction and curricula, as well as a wider participation agenda that caters for older adults experiencing physical and cognitive challenges.

Having a fall and then lying on the floor for an hour or more is known as a ‘long lie’, which is associated with serious injury and an elevated risk of admission to hospital, long-term care and death. Personal call alarms are designed to prevent long lies, although little is known about their use. Using cross-sectional data from the English Longitudinal Study on Ageing, this study investigated the proportion of self-reported users of personal call alarms among 3,091 community-dwelling adults aged 65+ who reported difficulties of mobility or activities of daily living. The characteristics of users were then explored through logistic regressions comparing those living alone with those living with others. One hundred and eighty people self-reported using a personal call alarm (6%). Multivariate regression found the following to significantly predict personal call alarm use among both those living alone and with others: greater difficulty with activities/instrumental activities of daily living, older age, and for those living with others only: lower score on the quality of life subscale for control. Personal call alarm use may be markedly lower than the 30 per cent annual incidence of falls among community-dwelling older people. Better understanding is needed of the reasons for low usage, even amongst those at highest falls risk for whom such alarms are most likely to be beneficial.

The significant time older people typically spend at home affects both their level of physical activity and quality of life. This prospective cohort study was designed to identify the effects that living in a high-rise residence retirement community has on physical activity and quality of life in older people with leprosy. The relocation group was comprised of study participants who had relocated voluntarily to a high-rise apartment building. The comparison group was comprised of study participants who had chosen not to relocate to that building. Data were collected using a personal information survey, Modified Baecke's Questionnaire, and the brief version of the World Health Organization Quality of Life assessment (WHOQOL-BREF). The groups were significantly similar in terms of household activities, leisure time activities, total physical activity score, and quality of life physical and social aspects, and significantly different in terms of quality of life overall (F=7.864, p=0.006), psychological (F=5.403, p=0.021) and environmental (F=23.099, p=0.000) aspects. This study indicates that living in a high-rise apartment environment does not decrease physical activity and may promote overall quality of life, and psychological and environmental aspects, in retirement community residents. The findings enhance understanding of the effect of different living environments on physical activity and quality of life. Greater health professional participation in retirement community design to ensure such designs facilitate residents’ health and quality of life is recommended.

Scholars and policy makers have expressed concern that social and economic changes occurring throughout Asia are threatening the wellbeing of older adults by undercutting their systems of family support. Using a sample of 1,654 men and women aged 45 and above from the Chitwan Valley Family Study in Nepal, we evaluated the relationship between individuals' non-family experiences, such as education, travel and non-family living, and their likelihood of receiving personal care in older adulthood. Overall, we found that among individuals in poor health, those who had received more education, travelled to the capital city, or lived away from their families were less likely to have received personal care in the previous two weeks than adults who had not had these experiences. Our findings provide evidence that although familial connections remain strong in Nepal, experiences in new non-family social contexts are tied to lower levels of care receipt.

This paper examines the relationship between age and training in the 15 European Union countries (EU-15) that were member states prior to the 2004 enlargement. The analysis is carried out using European Union Labour Force Survey data. We report cross-country comparisons of the training undertaken by older people (aged 50–64) and younger people (aged 20–49). We extend previous research by adding an analysis of the training undertaken by non-workers as well as that of workers. We also consider whether training is work-related, whether it is undertaken during normal work-hours and the time spent in training. Our results show that across the EU-15 not only are older people less likely to participate in training in general but, more importantly, they are less likely to participate in work-related training. Our evidence suggests that there is considerable scope for raising the training rates of older people and particularly older people who are out of work.

The introduction of cash-for-care schemes such as individual or personal budgets in England has been seen as central to the personalisation agenda for reforming the delivery of adult social care. However, despite there being 5.2 million carers in England and Wales, the initiative concentrates predominantly on the needs of the service user. The implementation of individual budgets (IBs) was piloted within 13 local authorities during 2005–2007 and the Department of Health commissioned an independent evaluation of this pilot (IBSEN). The focus was only on the service user in the evaluation and therefore a separate but linked study was set up to evaluate the impact and outcomes of IBs on carers. Carers of service users who had consented to take part in the main IBSEN study were identified and invited to participate in a follow-up study aimed at exploring how IBs impacted on carers and the caring role. The study found that the receipt of the budget was significantly associated with positive impacts on carers' reported quality of life and, when other factors were taken into account, with social care outcomes. These outcome gains were achieved despite no higher costs being incurred to the public purse, thus suggesting that IBs for service users are cost-effective for carers.