Falls in older adulthood can have serious consequences. It is therefore important to identify ways to prevent falls, particularly from the voice of older adults. Bottom-up qualitative exploration of the perspectives of older adults can provide rich insights that can help inform the development of effective fall prevention programmes. However, currently there is a dearth of such empirical data, especially among urban-dwelling older adults in high-density cities where fall rates are high. The current study aimed to examine qualitatively perceptions of neighbourhood physical environment in relation to falls, perceived risks and fear of falling, and strategies and behaviours for fall prevention in a sample of urban-dwelling older adults in the high-density city of Hong Kong. Face-to-face semi-structured in-depth interviews were conducted with 50 community-dwelling older adults. Interviews were transcribed verbatim and analysed using thematic analysis techniques. Five general themes were revealed: risks and circumstances of falls, consequences of falls, fear of falling and its consequences, neighbourhood environment, and strategies and behaviours of fall prevention. While older adults discussed the risks of falling and held a fear of falling, these beliefs were mixed. In addition to fall prevention strategies (e.g. keep balance), current findings highlighted the importance of establishing protective factors (e.g. flat and even walking paths) and reducing risk factors (e.g. neighbourhood clutter) in neighbourhood environments. For urban-dwelling older adults in high-density cities, current findings highlight the importance of focusing efforts at the built environment level in addition to strategies and behaviours of fall prevention at the individual level.

To create environments conducive to the wellbeing of workers, especially older workers, it is important to gain insight into ageism among young workers as a distinct segment in the workplace. However, this ageism remains unclear. This study explored the psychosocial predictors of discrimination against older Japanese workers by their younger male counterparts. Four models – Intergroup Contact Theory (ICT), Knowledge–Attitude–Behaviour Model (KABM), Terror Management Theory (TMT) and Frustration–Aggression Theory (FAT) – formed the basis of the study. All the models included positive and negative dimensions of stereotypes as mediators between predictors and discrimination. Data from 874 participants were obtained through a voluntary web survey for employees aged 25–39 years who lived in the Tokyo metropolitan area. A scale describing interactions with older workers (supportive, uncomfortable and avoidance), Facts on Ageing quiz, fears of being an older worker and a job dissatisfaction survey were employed to examine the hypotheses based on the above theories. The results supported the hypotheses based on ICT and FAT but not KABM. Higher supportive contacts were significantly related to lower discrimination mediated by a higher positive and lower negative dimension of stereotypes. Contacts characterised by higher discomfort were significantly related to higher discrimination mediated by a lower positive and higher negative dimension of stereotypes. Higher job dissatisfaction was related to higher discrimination mediated by lower positive stereotypes. Interestingly, higher fear of being an older worker was significantly related to lower discrimination mediated by higher positive stereotypes, contrary to the TMT-based hypotheses. Thus, ICT and FAT regarding ageism can explain young male workers’ discrimination against older workers in Japan, which differs culturally from Western countries. Furthermore, the results of the study suggest that boosting the quality of interactions as well as reducing bad interactions with older workers contribute to lower discrimination.

Meeting individuals' social care needs is a core element of UK social policy. However, the conceptualisation and operationalisation of ‘unmet need’ remain a challenge. This paper advances our understanding by incorporating a temporal dimension into the conceptual framework on unmet need to investigate the dynamics of met and unmet need for social care over time. Using data from Waves 8 and 9 of the English Longitudinal Study of Ageing, this paper examines five possible trajectories among individuals with a social care need for bathing or dressing at baseline: (a) no longer having such a need; (b) having continued needs met; (c) delayed needs met; (d) newly arisen unmet needs; and (e) repeated unmet needs. The results indicate that amongst those with need at baseline, unmet need has decreased over time – indicating that some needs for social care may be fulfilled with a delay. However, a significant proportion of older people experienced repeated unmet needs, particularly those who were younger, with no spouse or civil partner, and those whose activities of daily living index scores worsened over time. Understanding the dynamics of unmet need can support policy makers in better ensuring that those facing an elevated risk of repeated unmet need over time do not fall through the social care safety net.

Previous research has found varied effects of informal care provision on the carer's health status. Few studies have, however, examined this relationship dynamically. This paper is the first to analyse trajectories of care among men and women in mid-life and their impact on health outcomes using a nationally representative prospective cohort study. Data from three waves of the United Kingdom (UK) National Child Development Study (N = 7,465), when the respondents were aged 46, 50 and 55, are used to derive care trajectories capturing the dynamics of care provision and its intensity. Logistic regression investigates the impact of caring between the ages of 46 and 55 on the carers' report of depression and poor health at age 55. At age 46, 9 per cent of men and 16 per cent of women provided some level of informal care; rising to 60 per cent for both genders at ages 50 and 55. Just 7 per cent of women and 4 per cent of men provided care at all observation points, with the most common trajectory being ‘starting to care’ at ages 50 or 55. New carers experienced a lower risk of depression at age 55, reflecting that they may not have experienced the caring role long enough to have an adverse impact on their wellbeing. The findings highlight that the majority of individuals with surviving parents experience caring at some point during mid-life, underlining the need for further longitudinal research to better understand the complex relationships between care-giving and health for different groups of cares.

Previous studies on older adults' intention to adopt medical apps during irregular circumstances like the COVID-19 outbreak are still in its infancy. In order to fill this knowledge gap, we developed a theoretical framework based on the Unified Theory of Acceptance and Use of Technology (UTAUT) model and the Technology of Acceptance Model (TAM) to explain Chinese older people's willingness to use medical apps during the COVID-19 pandemic. We collected 1,318 online questionnaires during the first wave of the pandemic in China in early 2020. We employed structural equation modelling to analyse the data, and the results show that (a) attitudes towards using apps influence older people's intention to use apps significantly; (b) only two factors, perceived usefulness and facilitating conditions, which were proposed in the UTAUT model, significantly predicted the older adults' intention to use apps, but not others; and (c) perceived usefulness, perceived ease of use, subjective norm and facilitating conditions all significantly impact attitudes towards using apps. Further mediation analysis found that attitudes towards using apps significantly mediated the paths suggested in the original UTAUT model. Due to the online survey method we used, older people who do not use the internet were excluded from our sampling process. However, our timely research contributes to the existing literature by showcasing older people's usage of eHealth technology in public health emergencies. It also builds on the broader discussions on technology use by combining the TAM and the UTAUT model, highlighting the vital role of people's attitude towards using technology in shaping their intention to use it.

The number of older self-funders in England is growing in the context of tight eligibility criteria and fixed financial thresholds to access statutory adult social care. Older people who self-fund their social care fall largely under the radar of statutory services and of research. Our study aimed to listen closely to the stories that older people tell about finding, managing and paying for their care. We interviewed 65 older people living in the community who were funding all or some of their social care. This paper focuses on narrative analysis of selected transcripts from these interviews. It sheds light on how older people represent their experiences of self-funding and what underpins these constructions. A key finding is that the disjunctions within older people's accounts between the care they want and the care they receive reflect wider political and structural tensions in the funding and delivery of care. Older self-funders temper their expectations in light of their experience of shortfalls in the system. This enables them to adjust to the deficiencies but obscures and perpetuates poor care. The discussion considers the findings in relation to: the fundamental incompatability of body labour and commodified care; the shared precarity of older people and care workers; and the individualisation of risks that makes older people and their carers responsible for making a failing care system ‘work’. Our analysis adds to the case for major reform of adult social care, including a revaluing of the status and employment conditions of front-line care workers.

Autonomy is important to persons, including when they are living in nursing homes. Especially the relational dimension of autonomy is crucial for older adults with physical impairments. They generally have the decisional capacity to make choices about how they want to live their lives, but are often unable, or only partially able, to exercise these decisions themselves. To execute decisions, older adults are dependent on those who support them or care for them. However, little is known about how nursing home residents maintain autonomy in daily life and how others are involved in the decisions and execution of the decisions. To examine how older adults with physical impairments living in nursing homes maintain autonomy in daily life, shadowing, a non-participative observational method, was used. Seventeen older adults were shadowed during the course of one day. The observation ended with a brief interview. After the shadowing, the detailed observation notes were typed out, combined with the verbatim transcript resulting in one extensive report per shadowee. All 17 reports were coded and analysed thematically. Six elements for how older adults maintain autonomy in relation with others were identified, i.e. ‘being able to decide and/or execute decisions’, ‘active involvement’, ‘transferring autonomy to others’, ‘using preferred spaces’, ‘choosing how to spend time in daily life’ and ‘deciding about important subjects’. For all six elements established in this study, it was found that older adults with physical impairments living in nursing homes could only maintain autonomy in daily life when others, such as staff, family and friends, were responsive to signals of the needs of older adults.

Long-term care facilities are increasingly important places for palliative and end-of-life care provision in Japan. While the importance of culture has been noted for palliative and end-of-life care, an exploration of its influence on care provision in long-term care settings has received little direct attention in Japan. Exploring staff views and beliefs in palliative and end-of-life care in these settings can potentially enhance our understanding of culturally oriented care and facilitate the development of tailored and more effective support practices. This study aimed to explore the cultural views and beliefs regarding palliative and end-of-life care among the staff in Japanese long-term care facilities. A qualitative exploratory study was conducted using focus groups with facility staff (N = 71) and semi-structured interviews with facility managers (N = 10) in the Kanto region of Japan. Thematic analysis was conducted according to Braun and Clarke's approach. The findings are presented in five key themes: ‘Changes in society's and family's end-of-life perspectives’, ‘Values and beliefs regarding death and dying’, ‘Anxiety and regret’, ‘Tensions in doing the right thing’ and ‘Ways of alleviating pressure’. The findings indicate that the provision of palliative and end-of-life care is underpinned by cultural nuances that influence care providers' approach and delivery. Recognising and understanding the cultural beliefs of staff around death, dying and end-of-life care are important in meeting the needs of residents. Palliative care education for staff in these settings should include cultural considerations that reflect changing societal views on death and dying.

Being dependent on homecare potentially threatens a person's integrity and autonomy, particularly when people are dependent on help to manage basic bodily functions that involve intimacy and nudity, making the person vulnerable despite being in his or her own home. As the population continues to age and live longer, more people are expected to be dependent on homecare. The aim of this study was to investigate the phenomenon of dependence on homecare among people ageing at home. Individual in-depth interviews were used to explore 15 Danish and Norwegian homecare receivers’ experiences of dependence on homecare. Interview records were transcribed and analysed in a hermeneutical phenomenological process described by van Manen. First and foremost, the experience of dependence on homecare is a question of adaption. The older people in this study struggled to get used to their deteriorating body and at the same time they continuously had to negotiate to get care in accordance with their values. Being dependent on care could be experienced as being reduced to a task or a problem to be solved though the participants had a significant need for undivided mental attention. The presence of homecare staff in the participants’ homes could entail a change where the participants experienced that they lost control over the surroundings. According to the voices of the older people in this study, future homecare should be accommodated in an organisational set-up that gives priority to stability and continuity in the relation between the homecare receiver and the homecare staff. Also it is significant that homecare staff do not have a task-oriented approach to their job and are sensitive to the values of the homecare receivers.

Long-term care for older people is increasingly turning to consumer-directed approaches. As a case in point, the Hong Kong Government recently implemented a new voucher programme for community-based aged care based on a consumer-directed approach: the Community Care Service Voucher for the Elderly (CCSV). The objectives of this study were to explore the lived experience of professional workers vis-à-vis the new programme and to identify barriers to effective voucher use by older people in Hong Kong. In-depth individual interviews were conducted with 16 professionals who had primary responsibility for the voucher programme for community-based aged care. The interview guide covered five main areas: (a) professional's perception and experience on the voucher programme; (b) the decision-making process around the voucher programme; (c) personal capacities of older people; (d) family support and social networks; and (e) institutional support. Findings indicate several barriers to effective use of the CCSV including: lack of self-awareness of service needs, lower education level, poor health condition, lack of financial resources, lack of family support, inadequate family involvement in decision-making, lack of peer and professional support, lack of available services and poor service accessibility. Suggestions for strengthening the voucher programme include institution of a case management model and public education. Different factors or elements are required to facilitate older people to make sound and informed choices, and a case manager can assist in combining different resources and forms of support towards effective use of the CCSV.

How to promote wellbeing in old age is an issue that is drawing increasing attention as populations age in societies around the world. This study explores arts participation in later life and creative ageing through artistic engagement. We focus on potential participants who have had little prior experience with the arts, examining their journey through artistic activities, and the broader benefits to society of a creatively engaged population. We applied an action research methodology by designing two phases of arts workshops, one focused on hands-on creation activities and the other on appreciation of professional artists' works. This approach yielded the following findings. First, facilitation is key to initiating and sustaining artistic engagement among older adults, in part by helping them adapt to a changing society. Second, potential participants should be centred in discussions on creative initiatives. In particular, still active pre-seniors have much to offer in developing creative ageing initiatives. Third, arts participation for creative ageing goes far beyond the individual; it promotes community wellbeing and contributes to creating social value. Finally, we make an actionable suggestion that ‘facilitation for arts participation’ be developed as a specialised professional field.

In the absence of broad-based formal health insurance and social protection systems in much of sub-Saharan Africa, the family acts as the key provider of support to older people. This paper furthers our understanding of family support mechanisms in the context of low-income countries by focusing on support from outside the household, which has been less studied so far. By using the data of 3,114 people aged ≥50 from the second round of the Senegalese Poverty and Family Structure Survey, the paper examines how the living arrangements of older people are associated with receiving transfers from non-coresident kin. Our findings highlight a net advantage of women receiving net positive family transfers compared to men for some living arrangements. Results also indicate that living without a husband or an adult significantly increases the likelihood of older women receiving support from non-resident family members compared to those who live with both spouse and a younger adult child. However, these differences are not significant among older men. These results suggest that in constrained settings, decision-makers should consider older people's living arrangements and potential external family support when designing public policies towards them, so as to optimise the impact of policy and interventions on their welfare.

Independent mobility is an important component of healthy ageing. Public transit may be an affordable way to achieve independent mobility, and yet little is known about older adults’ transition to public transit. This paper addresses this research gap by providing an exploration of older adults’ experiences transitioning to public transit use, and by comparing these experiences to those of older people who have always travelled using transit. Twenty-four older adults (65+) living in Hamilton, Canada, who use public transit completed semi-structured interviews during which they discussed their experiences when they first began to use transit. These experiences are framed herein with the concept self-efficacy, i.e. how one's belief in their ability to complete a task shapes their ability to complete said task. Results indicate that most older adults acquire skills to transition to public transit, such as trip planning, boarding, knowing where to sit and exiting the bus. These skills are developed through practice. As one gains experience, one becomes more confident in their ability to meet their daily travel needs using transit. Therefore, the transition to public transit as an older adult can be more challenging for those with little experience using public transit. This paper highlights the danger of assuming all older adults will effortlessly take up transit and stresses the importance of older adults gaining experience using public transit.

Leisure participation in older age has principally been researched from individual-level theoretical perspectives that view leisure as reflecting adaptations to ageing-related losses and change. Recent orientations to later-life leisure participation, such as innovation theory, emphasise positive developmental aspects and uses of older individuals' leisure pursuits, driven by personal agency. Moreover, the potential of later-life leisure activities to contribute to community is conceptualised in social capital theory perspectives that bridge individual- and community-level functions of leisure participation. This paper presents findings from qualitative thematic analysis of oral histories on leisure conducted with 58 persons aged 60 and over in rural south-west England, to examine the personal uses and functions of their leisure occupations in older age, and the role that these activities play in connecting older individuals to their communities. While participants described lifetime patterns of leisure characterised by a core set of activities and interests, later life was a period of leisure transitions in which they actively used new and continuing pastimes to adapt to changing personal circumstances, abilities and aspirations. The findings also demonstrate how participants' leisure activities – ranging from avidly pursued hobbies to formal volunteering – served individual adaptive and developmental purposes, and were a means of fostering social connectivity and contributing to rural community life. Implications of these findings are discussed in regard to leisure theory, policy and practice. This paper adds to the literature on ageing and leisure by identifying the benefits of examining older persons' leisure participation from a combined conceptual perspective that can elucidate its functions at both the micro- and meso-levels of society.

Critical and feminist ageing scholarship has drawn attention to how dominant discourses of ageing negatively impact older women's identities and social lives. While research intersecting migration and ageing has broadly focused on older immigrants' settlement experiences, very little is known about the discursive influences over older immigrant women's sense of agency and social relations. To address this knowledge gap, this study explores the subjectivity-formations of older South Asian Muslim women engaged in transnational migration. Narrative and discourse analysis principles were used to conduct and analyse life story-based interviews with 15 South Asian Muslim older women who recently migrated to Toronto, Canada. Findings indicate that participant subjectivity-formations are shaped by: (a) discourses of ageing; (b) socio-cultural–religious discourses; and (c) discourses of transnational migration. In response, participants engaged in dynamic strategies including conforming, negotiating, creating alternative narratives and/or resisting these discourses to organise their lives. These findings reinforce the continued need to trace the governmentality of structural conditions over ageing migrant women's lives and their responsive strategies to manage these impacts.

In recent years, various authorities launched projects that aim to make their cities more age-friendly. Designing age-friendly cities is a complex and context-dependent process that requires clear implementation guidelines for policy makers. As one of the eight domains of age-friendly cities, transportation is a critical component of making our cities more liveable for older adults and their families. This paper contributes to the literature by exploring the travel behaviour of older adults with a focus on the factors that lead to sustainable mobility patterns. Our empirical analysis is based on survey data collected from 1,221 older adults as part of the Age-Friendly Columbus project in Columbus, Ohio in the United States of America. We develop multinomial logistic regression models to investigate the travel mode choices of older adults (auto only, non-auto options only and multimodal (auto and at least one non-auto option)). We include age and built environment characteristics as the key variables, with lifestyle-related factors and socio-demographics as controls in our analysis. We find older respondents were more likely to use autos only compared to younger respondents. Our analysis also reveals significant associations between built environment characteristics and travel mode choices. Interaction effects show that the relationships between built environment characteristics and travel preferences differed by age cohorts among older individuals. The primary contribution of this study is that it provides evidence on what built environmental improvements help to promote sustainable travel among older adults in mid-sized and auto-dependent metropolitan cities. We argue that these improvements contribute to older adults' sustainable mobility, as well as out-of-home activity behaviour, social engagement and individual health. The results of this study may especially benefit non-driver older adults who lack reliable non-auto alternatives for their daily travel.

By the year 2030, 19–21 per cent of the population of New Zealand (NZ) is projected to be aged 65 and over. Like many countries, life expectancy in NZ differs by gender but also ethnicity: in 2019, life expectancy for Māori (indigenous) women was 77.1 years compared with 84.4 years for non-Māori women. If Māori and NZ European women are to flourish in later life, examining the factors associated with their wellbeing is paramount. The current study draws on the Life Course Perspective to explore how wellbeing is associated with age-related life events among mid- to later-life NZ women. The women in this study (N = 19,624) are participants in the 2018 wave of the New Zealand Attitudes and Values Study, a national probabilistic 20-year longitudinal study (mean age = 55.62; Māori = 10.8%, NZ European = 89.2%). We found that stressful life events were negatively associated with life satisfaction but positively associated with meaning in life. Māori women exhibited lower levels of life satisfaction but there were no ethnic differences for meaning in life; however, Māori and NZ European women showed different patterns of significant correlates associated with meaning in life. Findings highlight the necessity of an intersectional approach to the study of mid- to later-life wellbeing and the utility of measuring wellbeing in more than one way within NZ's unique cultural-historical context.

Previous research was not able to identify an effect of the COVID-19 pandemic on family care-givers' wellbeing due to cross-sectional data structures, care-giver-specific samples or non-probability sampling designs. In this article, by drawing on longitudinal data from a random and representative sample of the German population aged 40 and older, we overcome methodological limitations of previous research. We examine the impact of the COVID-19 pandemic on the wellbeing (life satisfaction, depressive symptoms, loneliness) of different groups of family care-givers (new care-givers, continuous care-givers, past care-givers) and non-care-givers in Germany. We derived a balanced sample of n = 3,875 individuals aged 43–97 (mean = 66.5 years, standard deviation = 10.2 years) from the German Ageing Survey (DEAS) to explore changes in wellbeing between 2017 (pre-pandemic) and June/July 2020 (pandemic). Using a first-difference approach, we found that the pandemic has a negative impact on both non-care-givers' and family care-givers' wellbeing, with increased levels of depressive symptoms and loneliness compared to pre-pandemic times. Changes in depressive symptoms of family care-givers did not significantly deviate from non-care-givers. However, continuous care-givers showed more pronounced increases in loneliness compared to non-care-givers. Our results suggest that family care-givers' wellbeing merits particular attention when considering the long-term consequences of the COVID-19 pandemic on individuals' wellbeing.

Only a few studies have been conducted so far on the long-term impact of war. We investigated whether a life-long impact of the war experiences could be detected in advanced-agers who have successfully overcome all life's challenges. The participants in this study were oldest-old (80+ years) residents of retirement homes in Zagreb (Croatia), who were divided into two groups – ‘war-exposed’ and ‘not-exposed’ – according to their direct war experience (First World War, Second World War, Croatian Homeland War). Within this 1906–1928 birth cohort, a higher percentage of participants with war experiences reached extreme longevity (95+ years). We found no significant difference (p < 0.01) between the two groups concerning demographic and socio-economic characteristics, their life satisfaction, their self-rated current health and functional ability status. Despite numerous similarities, several traits related to life-history, current quality of life, attitudes and reflections distinguish the group of participants with direct war experience. The kind of war involvement – active military service, imprisonment in concentration camps or prisons, forced migration due to war and war-related death of close family members – stretched through various aspects of the life-history features, quality of life and attitudes. It differed for men and women, so it is no wonder that the significance pattern in the two genders mostly seems mutually exclusive. Socio-economic situations strongly differed by gender and according to the kind of war exposure, amplifying the differences within the ‘war-exposed’ group in terms of the life-long impact of wars on their lives. Therefore, we could claim that the war experiences were not the same for everybody, and that they had lasting consequences on the lifecourse of persons who directly faced war-related events. The results also point to the high resilience capacity as a common feature among persons who survived direct exposure to at least two wars and yet survived to exceptionally old age.

The Sociocultural Stress and Coping Model focuses on the role of cultural values in shaping the stress and coping process for family care-givers of frail older adults. The literature suggested ethnic group-specific values as influences. The current study explored care-givers’ perceptions of values influencing caring to identify values not addressed in quantitative studies of cross-cultural care-giving. Seventeen family care-givers from Australian Aboriginal, Romanian-Australian, Pacific Island and white non-immigrant Australian backgrounds participated in semi-structured interviews about their care-giving experience and the role that values played in caring for a frail older adult. Thematic analysis of the interview transcripts led to identification of themes of cultural values of familism and care for frail older adults, religious values of filial piety and religious coping, love, reciprocity and responsibility/obligation. While cultural values influenced family care versus institutional care, religion was a more clearly identified source of values. Care-givers mostly shared values of love, reciprocity and responsibility/obligation rather than endorsing culture-specific values, with potential variations in expression between individualist and collectivist cultures. These findings suggest that the focus on cross-cultural differences may have missed core values shared across cultural groups and underestimated the influence of religion on care-giving values. Future research could focus on these perceptions of care-givers themselves rather than external perceptions of researchers and service providers.