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This study explores policy makers’, health-care professionals’ and senior volunteers’ perceptions of senior volunteers. Two Norwegian government white papers regarding older adult care and welfare services, which were published over a period of 19 years, were selected for close examination. Furthermore, focus group interviews with a purposeful sample of five senior volunteers and 15 health-care professionals were conducted. The study explores the discursive formations of senior volunteers in the government white papers and how they are negotiated in the senior volunteers’ and the health-care professionals’ narratives. Two dominant discourses were presented in the white papers: a prevention discourse (in which volunteering was presented primarily as a means to prevent volunteers’ loneliness and need for care services) and a sustainability discourse (in which the volunteers were presented as instrumental in future sustainable care services). Both discourses echo a common overarching discourse about a capacity crisis due to the ageing population. The senior volunteers were positioned as partners and active agents in both their own narratives and the health-care professionals’ narratives. Their position as independent and as spokespersons for the less empowered were evident only in the senior volunteers’ own narratives. Only the health-care professionals referenced the prevention discourse and capacity issues. The senior volunteers presented themselves as competent, efficient political actors, and they resisted both the prevention and sustainability discourses. In the senior volunteers’ narratives, social and political participation were interrelated. The study demonstrates that new discursive landscapes must be created to capture the diversity among senior volunteers and their efforts. While senior volunteers must be meaningfully involved in decision making, planning and design, their positions as independent and active agents must also be ensured. Authentic partnerships between senior volunteers and public care services involve a balance between involvement and independence. [ABSTRACT FROM AUTHOR]

Building on the pioneering research of a small number of gerontologists, this paper explores the rarely trodden common ground between the academic domains of social gerontology and modern history. Through empirical research it illustrates the complex networking that exists through space and time in the relational making of people and places. Indeed, the study focuses specifically on the lived reality and ongoing significance of life on the small-town British coastal homefront during World War II. Seventeen interviews with older residents of Teignmouth, Devon, United Kingdom, investigate two points in their lives: the ‘then’ (their historical experiences during this period) and the ‘then and now’ (how they continue to reverberate). In particular, their stories illustrate the relationalities that make each of these points. The first involves residents’ unique interactions during the war with structures and technologies (such as rules, bombs and barriers) and other people (such as soldiers and outsiders) which themselves were connected to wider historical, social, political and military networks. The second involves residents’ perceptions of their own and their town's wartime histories, how this gels or conflicts with public awareness, and how this history connects to their current lives. The paper closes with some thoughts on bringing together the past, present and older people in the same scholarship. [ABSTRACT FROM PUBLISHER]

Care-home residents with dementia can experience behavioural and psychological symptoms such as aggression, agitation, anxiety, wandering, calling out and sexual disinhibition. Care-home staff have a duty to keep residents safe. However, residents with dementia can pose particular challenges in this area. In this paper, we draw on a study which explored how care-home staff manage dementia-related behaviours. In-depth ethnographic case studies at four separate care homes were conducted in England. These involved interviews with 40 care-home staff and 384 hours of participant observation. Our analysis showed that some residents with dementia experience behaviours which can either create risks for, or negatively impact on, themselves and/or other residents or staff members. It emerged that the consequences of the behaviours, rather than the behaviours themselves, created difficulties for staff. To cope with the risk and impact of behaviours, staff employed multiple strategies such as surveillance, resident placement, restrictions and forced care. Using the data, we explore how actions taken by staff to manage the risk and impact of behaviours in these communal settings relate to residents’ human rights. Our findings have particular relevance for care-home staff who need support and guidance in this area, for service development worldwide and for the global ageing population whose valued human rights may become under threat, if they require long-term care. [ABSTRACT FROM AUTHOR]

Older people living in long-term facilities (nursing and residential homes providing 24-hour care) spend the majority of their time inactive, despite the known health and wellbeing benefits of physical activity and reduced time spent sedentary. In order to successfully embed interventions that aim to increase physical activity or reduce sedentary behaviour, it is necessary to understand the features of the care environment that influence residents’ routine patterns of movement. Drawing on an organisational perspective, this paper explores the structures and mechanisms that shaped different care practices concerning residents’ movement in two contrasting care homes in the north of England. This study adopted an ethnographic approach, using a combination of qualitative observations, informal conversations and interviews. A grounded theory approach to data analysis was adopted. The findings illustrate the importance of translating espoused values of care into tangible and acceptable care practices, systems of management, staff training and development, and the use of care planning in residents’ routine patterns of movement. Understanding how organisational factors shape routine movement among care home residents will help inform the development of embedded and sustainable interventions that enhance physical activity and reduce sedentary behaviour. This study is part of a wider programme of research developing and testing a complex intervention, embedded within routine care, to reduce sedentary behaviour among care home residents. [ABSTRACT FROM AUTHOR]

In many sub-Saharan African communities, caring for vulnerable children in the era of HIV/AIDS appears to be creating deep financial, physical and psychological strains for care-givers, the great majority of whom are ageing women or ‘grandmothers’. Yet, limited primary research has been carried out with older women in specific communities, and therefore grandmothers' collective responses, sources of support, complex lived experiences, and diverse family situations are not well understood. This paper presents the findings of research undertaken in four communities in KwaZulu-Natal, South Africa, between 2006 and 2010. The purpose was to understand the daily stresses, collective responses and mobilisations of older women in these communities. The research involved repeated focus groups, interviews and participant observation involving approximately 100 older women. In the analysis, attention is given to the diversities among participants, the ways in which HIV/AIDS intermingles with other stresses in their lives to drive their mobilisations, and their collective responses, even amidst highly constrained conditions. Through these lenses, the paper illuminates how older women in these communities are organising in response to the combined, devastating and diverse effects of HIV/AIDS, poverty, violence and illness. It also suggests that, counter to some stereotyping of ‘African grandmothers’ as frail or passive, these women are forming associations in order to generate incomes, resist stigma, connect with broader support networks and provide care to hundreds in their communities. [ABSTRACT FROM PUBLISHER]

This paper explores the impact of legal rights to housing for homeless people, focusing on the capacity of such rights to ‘empower’ those experiencing homelessness. Lukes’ (2005) three-dimensional view of power, complemented by Bourdieu's (1972) concept of ‘habitus’, is used to distinguish between conceptualisations of empowerment. A distinction is drawn between ‘traditional’ understandings of empowerment, which focus on people's capacity to realise their ‘subjective interests’, and on understandings that foreground ‘real interests’. These latter ‘radical’ perspectives direct attention to people's ‘habitus’ – their internalised dispositions to perceive situations and act in particular ways. Empirically, the paper draws on a qualitative comparison of approaches to homelessness in Scotland and Ireland. Whereas in Scotland virtually all those who are homeless now have a legal right to settled accommodation, Ireland has rejected such a ‘legalistic’ approach, pursuing a consensus driven ‘social partnership’ model. Based on primary research with national experts, service providers and homeless single men in both countries, it is argued that legal rights can effectively empower homeless people. These findings call into question popular and political understandings of the relationship between legal welfare rights and self-reliance. [ABSTRACT FROM PUBLISHER]

Background: Child maltreatment is a significant public health issue in the United States. Yet, fewer than half of pediatricians discuss behavioral, developmental, or parenting issues with parents. Objective: This paper describes the testing of bundles of tools and processes, part of a larger intervention, Practicing Safety , targeted at changing physician and staff behavior to identify families at risk for child maltreatment, provide anticipatory guidance, refer to community resources, and follow-up and track at-risk families. The intervention was implemented with 14 pediatric primary care practices throughout the United States; the study was completed in 2011. Methods: A within-subjects repeated measures pre-post follow-up design was used to evaluate the intervention. Baseline and repeated measurements of pediatric practices' processes were collected using qualitative and quantitative methods. In total, 14 core improvement teams from across the country tested three bundles of tools (maternal, infant, toddler) within a quality improvement framework over seven months. Results: Quantitative results showed statistically significant adoption of tools and processes and enhancement of practice behaviors and office environmental supports. The increase in tool use was immediate and was sustained for six months after implementation. Qualitative data provided insight as to how meaningful the intervention was to the core improvement teams, especially with more complicated behaviors (eg, engaging social workers or community agencies for referrals). Barriers included lack of community resources. Findings showed unanticipated outcomes such as helping practices to become medical homes. Conclusion: Lessons learned included that practices appreciate and can adopt brief interventions that have meaningful and useful tools and process to enhance psychosocial care for children 0–3 and that do not place a burden on pediatric practice. An innovative, quality improvement strategy, intuitive to pediatricians, with a brief intervention may help prevent child maltreatment. [ABSTRACT FROM AUTHOR]

The active management of the experience of living with dementia appears to improve quality of life despite the lack of disease modification. However, research to date has been largely of modest scale and explanatory factors for improvements have been under-conceptualised. Thus, although promulgated through national strategies, the evidence base is relatively weak. This paper reports on a nation-wide study of the influence of the National Dementia Strategy for England in relation to Dementia Adviser and Peer Support Network services in 40 demonstration sites. The research aimed to identify ways in which the services contribute to the wellbeing and resilience of people with dementia and care partners. A mixed-methods research design collected data through: activity and outcome monitoring; organisational surveys; in-depth case studies, including qualitative interviews with people with dementia (N = 47) and care partners (N = 54), wellbeing and quality of life measures, and interviews with staff and other stakeholders (N = 82). Three themes are explored: addressing individual and community needs; promoting independence, control and choice; and getting a life back. Services promoted independence, control and choice, and consequently enabled people to re-narrate their lives as purposeful within their communities. Ways in which these are achieved resemble the public health model of lay health advisor and this research adds to the imperative to approach dementia as a key public health concern. [ABSTRACT FROM AUTHOR]

Awareness of risk factors for loneliness is a prerequisite for preventive action. Many risk factors for loneliness have been identified. This paper focuses on two: poor health and widowhood. Preventive action by developing a satisfying social network requires time and effort and thus seems appropriate for people unexposed to risk factors, i.e. third agers and non-lonely persons. The third age is the period in old age after retirement, before people's social relationships deteriorate. This paper addresses three questions: Are older adults aware of poor health and widowhood as risk factors for loneliness? Are there differences in awareness between third and fourth agers? Are there differences in awareness between lonely and non-lonely older adults? After being introduced to four vignette persons, 920 respondents from the Longitudinal Aging Study Amsterdam were asked whether they expected these persons to be lonely. Older adults, especially third agers, expected peers exposed to the risk factors to be lonely more often than peers who were unexposed. The results indicate that awareness of loneliness-provoking factors is high among third agers, which is a first step towards taking actions to avoid loneliness. Compared to lonely older adults, non-lonely ones expected peers to be lonely less often, suggesting the latter's lower awareness of the risk factors. The results provide evidence for policy makers and practitioners that combating loneliness might require early action. [ABSTRACT FROM PUBLISHER]

The current generation of older people who are approaching or recently experiencing retirement form part of a unique generational habitus who have experienced a cultural shift into consumerism. These baby boomers are often portrayed as engaging in excessive levels of consumption which are counter to notions of sustainable living and to intergenerational harmony. This paper focuses on an exploration of the mechanisms underpinning the consumption patterns of baby boomers as they retire. We achieve this through an understanding of the everyday practices of grocery shopping which have the potential to give greater clarity to patterns of consumption than the more unusual or ‘extraordinary’ forms of consumption such as global travel. In-depth interviews with 40 older men and women in four locations across England and Scotland were conducted at three points in time across the period of retirement. We suggest that the grocery shopping practices of these older men and women were influenced by two factors: (a) parental values and upbringing leading to the reification of thrift and frugality as virtues, alongside aspirations for self-actualisation such as undertaking global travel, and (b) the influence of household context, and caring roles, on consumption choices. We conclude with some tentative observations concerning the implications of the ways baby boomers consume in terms of increasing calls for people to live in more sustainable ways. [ABSTRACT FROM AUTHOR]

Concern about the increasing use of payday lending led the UK's Financial Conduct Authority to introduce landmark reforms in 2014/15. While these reforms have generally been welcomed as a way of curbing 'extortionate' and 'predatory' lending, this paper presents a more nuanced picture based on a theoretically-informed analysis of the growth and nature of payday lending combined with original and rigorous qualitative interviews with customers. We argue that payday lending has grown as a result of three major and inter-related trends: growing income insecurity for people both in and out of work; cuts in state welfare provision; and increasing financialisation. Recent reforms of payday lending do nothing to tackle these root causes. Our research also makes a major contribution to debates about the 'everyday life' of financialisation by focusing on the 'lived experience' of borrowers. We show that, contrary to the rather simplistic picture presented by the media and many campaigners, various aspects of payday lending are actually welcomed by customers, given the situations they are in. Tighter regulation may therefore have negative consequences for some. More generally, we argue that the regul(aris)ation of payday lending reinforces the shift in the role of the state from provider/redistributor to regulator/enabler. [ABSTRACT FROM AUTHOR]

AimThis paper reports on the findings from a qualitative study exploring the experiences of teenage mothers using a nurse-led, home-based contraceptive service designed to prevent repeat unplanned pregnancies. The aim was to understand if, and how the service was effective in equipping teenage mothers to make informed choices about contraception, thus preventing a second pregnancy.BackgroundUnplanned teenage pregnancy remains a significant focus of health and social policy in the United Kingdom (UK). Despite the long-term pattern of declining conception rates, the UK continues to report higher rates than comparable countries elsewhere in Europe. Current estimates suggest that approximately one fifth of births amongst under 18’s are repeat pregnancies (Teenage Pregnancy Independent Advisory Group, 2009). Services that are designed to reduce second unplanned pregnancies are an important element in promoting teenage sexual health. However, there has been no UK research that explores this kind of service and the experiences of service users.MethodsWe conducted a qualitative interview study. From 2013–2014 we interviewed 40 teenage mothers who had engaged with the nurse-led, home-based contraceptive service.FindingsThe data demonstrates that the service was effective in preventing repeat pregnancies in a number of cases. Among the aspects of the service which were found to contribute to its effectiveness were privacy, convenience, flexibility, appropriately timed access, the non-judgemental attitude of staff and ongoing support. [ABSTRACT FROM PUBLISHER]

Later-life loneliness is becoming an area of great concern in Uganda in light of gradual weakening of extended family as a source of old-age human support. Although information about the effects of feeling lonely exists, little is known about the associated risk factors within the country's social and cultural setting. This paper discusses prevalence and correlates of feeling lonely among older persons. An interviewer-administered questionnaire was used to collect data on 605 older persons in a 2012 cross-sectional study. Respondents were asked to evaluate how they felt in terms of loneliness during the administration of the questionnaire. A total of ten focus group discussions and 12 key informant interviews were also conducted to collect qualitative data. Binary logistic regression was used to predict factors affecting loneliness. Findings indicate that approximately seven in ten older persons felt lonely. Elderly people residing in the urban area were more likely to be lonely than their counterparts staying in the rural environment. In comparison with married older persons, elderly people who were widowed were more likely to be lonely. Absence of a television and pension benefits and prevalence of limb joint ill-health predicted loneliness. The findings have several implications, including developing age-friendly urban centres, encouraging old-age social organisations, decentralising the elderly health-care system and establishing a special old-age fund. [ABSTRACT FROM PUBLISHER]

Background. Routine mood screening is recommended after stroke. However, clinicians report difficulty selecting appropriate tools from the wide range available. We aimed to systematically review the psychometric properties and clinical utility of mood screening tools for stroke survivors. Method. Electronic databases (AMED, EMBASE, CINAHL, Medline and PsycINFO) were searched to identify studies assessing the sensitivity and specificity of mood screening tools. Tools that demonstrated at least 80% sensitivity and 60% specificity with stroke survivors with identifiable cut-off scores indicating major and/or any mood disorder in at least one study were selected and clinical utility was assessed. Those with high clinical utility (against predefined criteria) were selected for recommendation. Results. Thirty papers examining 27 screening tools were identified and 16 tools met the psychometric and clinical utility criteria: 10 were verbal self-report tools, four were observational and two incorporated visual prompts for those with communication problems. Only the Stroke Aphasic Depression Questionnaire -Hospital version (SADQ-H) met all the psychometric and utility criteria. The nine-item Patient Health Questionnaire (PHQ-9) can detect major depression and the 15-item Geriatric Depression Scale (GDS-15) can identify milder symptoms; both are feasible to use in clinical practice. The Hospital Anxiety and Depression Scale (HADS) was the only tool able to identify anxiety accurately, but clinical utility was mixed. Conclusions. Valid and clinically feasible mood screening tools for stroke have been identified but methodological inconsistency prevented recommendations about the optimal cut-off scores. [ABSTRACT FROM AUTHOR]

Through the lens of Institutional Entrepreneurship, this paper discusses how governments use the levers of power afforded through business and welfare systems to affect change in the organisational management of older workers. It does so using national stakeholder interviews in two contrasting economies: the United Kingdom and Japan. Both governments have taken a ‘light-touch’ approach to work and retirement. However, the highly institutionalised Japanese system affords the government greater leverage than that of the liberal UK system in changing employer practices at the workplace level. [ABSTRACT FROM PUBLISHER]

This paper examines differences in work restrictions of midlife family carers of older people in terms of prevalence, gender and explanatory variables, in six European countries: Germany, Greece, Italy, Poland, Sweden and the United Kingdom. A sample of 2,897 carers aged 45–64 was extracted from the EUROFAMCARE (Services for Supporting Family Carers of Older People in Europe: Characteristics, Coverage and Usage) European project database, in order to analyse four possible work restrictions experienced in connection with the activity of care-giving: the reduction of working hours; giving up working; difficulties in career developments and forced occasional work. The results show that work restrictions are experienced differently between countries especially by women: they are reported to a higher degree in the United Kingdom, Germany and Greece, less so in Italy, and seldom in Poland and Sweden. Gender differences within countries are not so marked. Country differences are explained in the light of the different welfare regimes characterising the countries under investigation, in order to elucidate how policy makers may act to improve working carers' conditions through appropriate policies. [ABSTRACT FROM PUBLISHER]

Meetings between advisers and claimants are central to many welfare-to-work programmes. These ‘street-level’ exchanges between clients and staff are critical to the implementation of policy. When talking to welfare claimants, it becomes clear that contact with welfare bureaucrats is constitutive of their experience of policy and it is not until parent and adviser meet and negotiate that the policy is truly enacted. The policy comes into being through an exchange between advisers and parents, who interact, albeit unequally, to shape the proceedings. This paper examines the experience of parents claiming income support who faced compulsory employment measures. Drawing on research with claimants of teenage children, I examine the adviser meeting as an interpellative interaction. The state addresses mothers as workers and welfare claimants in an interpellation which is mediated by the adviser in dialogue with the mother. This analysis demonstrates how the notion of interpellation can inform research on street-level interactions. [ABSTRACT FROM PUBLISHER]

This paper investigates the trend in sport participation among retirees between 1983 and 2007. Sport participation is important for retirees because of its health benefits and the opportunities it offers for social interaction. Factors that influence sport participation such as educational level, physical limitations, and occupational background have changed during the last decades, possibly accounting for changes in sport participation. Data are from the Amenities and Services Utilization Survey (AVO), a nationally representative Dutch survey with seven observations between 1983 and 2007. The trend in sport involvement, sports club membership, and competition was investigated in a sample of 2,497 male and 1,559 female retirees aged 58–67 years. Increases in participation were observed in sport involvement and sports club membership. This trend can partially be explained by increases in educational level, decreases in the number of retirees with physical limitations, and in those retiring from sedentary jobs. Yet, sport participation seems to have increased for all retirees, regardless of their socio-economic background and health status. Alternative explanations for the observed trend are discussed. [ABSTRACT FROM PUBLISHER]

Background. Suicide rates increase following periods of war; however, the mechanism through which this occurs is not known. The aim of this paper is to shed some light on the associations of war exposure, mental disorders, and subsequent suicidal behavior. Method. A national sample of Lebanese adults was administered the Composite International Diagnostic Interview to collect data on lifetime prevalence and age of onset of suicide ideation, plan, and attempt, and mental disorders, in addition to information about exposure to stressors associated with the 1975-1989 Lebanon war. Results. The onset of suicide ideation, plan, and attempt was associated with female gender, younger age, post-war period, major depression, impulse-control disorders, and social phobia. The effect of post-war period on each type of suicide outcome was largely explained by the post-war onset of mental disorders. Finally, the conjunction of having a prior impulse-control disorder and either being a civilian in a terror region or witnessing war-related stressors was associated with especially high risk of suicide attempt. Conclusions. The association of war with increased risk of suicidality appears to be partially explained by the emergence of mental disorders in the context of war. Exposure to war may exacerbate disinhibition among those who have prior impulse-control disorders, thus magnifying the association of mental disorders with suicidality. [ABSTRACT FROM AUTHOR]