Some foundations are laid for a social-psychological theory of dementia care. Central to this is a conceptualisation of personhood, in which both subjectivity and intersubjectivity are fully recognised. Evidence is brought forward concerning relative well-being even in those who are, from a cognitive standpoint, severely demented. In the light of this it is argued that the key psychological task in dementia care is that of keeping the sufferer's personhood in being. This requires us to see personhood in social rather than individual terms.

This article is based on an international study which investigated innovations in home care for the elderly in three European countries:Sweden, the Netherlands and the United Kingdom. It is argued that the particular changes taking place in services for the elderly may be indicative of what will happen more generally throughout welfare systems. This is because patterns observed in an area of acute pressure are often precursors of further developments. Welfare systems change first at points of pressure where established policies and solutions are no longer working or cannot be sustained. Innovation and reform become necessary. This is certainly true of social care policies for the elderly in industrial countries. It is no coincidence that in each of the three countries we studied government has commissioned major inquiries into the operation of the care system and that the early 39905 will see the introduction of substantial reforms. We argue that the changes that are taking place, although mediated by particular national traditions and politics, have much in common. They are part of a shift away from the state-dominated post-war welfare settlements towards more diffuse and pturalist forms of social care. The frail elderly, for demographic and etonomic reasons, are in tne front line of this shift to new patterns.

The information reported here comes from a study of a random sample of adult deaths registered in 1987. Interviews were sought with the person who could tell us most about the last twelve months in the life of the person who died; 639 people took part in the study. Just under one in ten of the people who died had attended a day centre in their final year. Attenders were more likely to be aged 75 or over at death, to be women and to have been living alone. They were also more likely to have suffered from a number of long-term symptoms and restrictions. According to respondents it would have been helpful if a further 11% of those who died had attended a day centre in the last year of their lives. The most often stated reason for this was that it would have given the carer a break from the demands of caring. But the most often given reason why the person who died had not attended a day centre was that they had not wanted to – an indication of some conflict between family and friends providing care and those they cared for

The paper focuses on the provision of instrumental support provided to dependent elderly people in France, presenting information collected in social surveys conducted in three regions of the country. This information is considered in the light of the results of studies from other countries on instrumental social support to the dependent elderly which are reviewed. The data analysed included measures of the potential social network of the respondent based on household composition, marital status, number of living children and frequency of visits by family, friends and neighbours. Measures of instrumental support received were based on reported need for help for specific tasks, and the main source of help provided. The results reported here suggest that not all members of the dependent elderly person's social network were equally involved in providing instrumental help and supports a hierarchical model of the informal care structure with family members as the predominant source of help. The results also demonstrate the comparatively small role played by the formal caring services compared with the informal sector. The context of care for dependent elderly people in France is discussed and the implications of these results for social policy are considered.

The European Communities provide a contemporary naturally occurring laboratory for the comparative study of social policy formation and implementation. This is particularly the case regarding social policies for ageing populations. The substantive focus of this paper is long-term care policy and, more particularly, policy choices regarding relative emphasis on medical in contrast to social care of dependent older adults. The strategy of the paper is to discuss, first, the limits of comparative theories of social policy formation in predicting policies in a highly value-laden topic like long-term care. The paper then summarises factors which may explain the extraordinary but inconclusive attention given to long-term care policy in the United States. Finally, the paper outlines some questions about LTC policy in the EC which would benefit from comparative policy analysis. Particular attention will be directed to the balance of medical and social care for dependent elderly people, the role of housing policy in the context of general care policy, and the generic issue of public and private sector interaction in welfare states. Systematic exchange of LTC information among EC countries and between these countries and the US is encouraged.

Europe is experiencing a rapid increase in the numbers and proportions of the very old, and the number of older adults with chronic or longstanding diseases and functional limitations is rising. Between 1980 and 2025, the population aged 80 years and over is projected to increase 2·15 times, from in million in 1980 to 23·7 million. As those aged 80 years and over have been the most rapidly growing age-group, it is evident that the prevalence of physical and mental disabilities is of concern. Many suffer from chronic conditions which compromise daily living, although a substantial group are in good health and with little disability.203 Nevertheless as the average age increases, more people need some form of assistance with the activities of daily living, such as bathing, dressing, eating, preparing meals and errands (ADL). Reaching the age of 80 years does not necessarily mean losing one's independence; nevertheless the risk increases with age.