Organisational priorities for health care focus on efficiency as the health and care needs of populations increase. But evidence suggests that excessive planning can be counterproductive, leading to resistance from staff and patients, particularly those living with cognitive impairment. The current paper adds to this debate reporting an Institutional Ethnography of staff delivering care for older patients with cognitive impairment on acute orthopaedic wards in three National Health Service hospitals in the United Kingdom. A key problematic identified in this study is the point of disjuncture seen between the actualities of staff experience and intentions of protocols and policies. We identified three forms of disjuncture typified as: ‘disruptions’, where sequenced care was interrupted by patient events; ‘discontinuities’, where divisions in professional culture, space or time interrupted sequenced tasks; and ‘dispersions’, where displaced objects or people interrupted sequenced care flow. Arguably disruption is an integral characteristic of care work; it follows that to enable staff to flourish, organisations need to confer staff the autonomy to address systemic disruptions rather than attempt to eradicate them. Ultimately, organisational representations of ‘good practice’ as readily joined up, impose a care standard ‘stereotype’ that obscures rather than clarifies the interactional problems encountered by staff.

Self-integrity plays a vital role in the psychological wellbeing of older adults. The present study investigated whether or not the confrontation with negative, self-stereotyped information leads to a deterioration of older adults' self-integrity. Additionally, the current study attempted to examine the mediating effects of sense of coherence and empathy on the relationship between self-stereotype and self-integrity. A total of 825 Chinese older adults aged 55 or above from Xi'an and Beijing were recruited as research participants. A self-stereotype scale, sense of coherence scale, interpersonal reactivity index and self-integrity scale were used. Results showed that self-stereotypes are negatively associated with sense of coherence, empathy and self-integrity. Furthermore, sense of coherence and empathy are positively associated with self-integrity and played important roles in mediating the relationship between self-stereotype and self-integrity. Findings of this study can contribute to an improved understanding of the mechanism of associations between self-stereotype and self-integrity in older adults. Lastly, results obtained can provide guidance for effectively improving older adults' self-integrity to limit the negative effects of self-stereotypes.

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.

Quantitative research on how grandparents fare when looking after grandchildren has mainly focused on general wellbeing indicators, showing that grandparenting is linked to higher wellbeing. However, global assessments of wellbeing reveal little about activity-specific experiences and only indirectly provide insights about how grandparents experience grandchild care. Whereas qualitative studies have observed diversity in grandparenting experiences, quantitative insights regarding potential strains of grandparenting are scarce. This study examines directly to what extent grandparents experience supplementary grandchild care as burdensome and obligatory, and tests – building on role strain theory – how differences in grandparents' characteristics can explain these experiences. Analyses are based on data collected in 2015 and 2018 among 3,429 Dutch grandparents who look after grandchildren. Descriptive findings show that 20 per cent of the studied grandparents experienced grandparenting as fairly/very burdensome and 8 per cent as fairly/very obligatory. Ordinal logistic regression models with random effects show that more-intense grandparenting situations were linked to higher levels of burden and obligation. Moreover, grandparents in poor health, higher education and those with other responsibilities (e.g. paid work) were relatively more likely to experience higher levels of burden and obligation. Our findings imply that the understanding of non-custodial grandparenting as only rewarding might be one-sided, as positive and negative experiences can go together. There appears to be substantial heterogeneity in how grandparents experience looking after their grandchildren.

Quizzes are a ubiquitous part of the dementia social care landscape. This article explores why. Using an ethnographic approach which draws on close analysis of communication, we examine dementia quizzes as a ‘social practice’, and what such a lens can tell us about their popularity in social care settings. Vignettes of real interactions drawn from ten different quizzes recorded in four different group settings attended by 28 people living with dementia and 15 staff members are presented to highlight particular issues. We show that the conditions of post-diagnosis dementia social care are uniquely well suited to an activity such as quizzes which are malleable, requiring little preparation or materials, and impose a communication framework which can help to organise the interactional space. Quizzes also draw on previously forged interactional competences, such as turn-taking and question–answer sequences, a skill that has been shown to persist even as dementia progresses. Finally, we argue that the meaning of quizzes with people with dementia feeds into wider societal values and associations attached to memory, dementia and personhood. The extent to which quizzes are akin to a ‘test’ or a fun and enjoyable social activity rests in how they are enacted. We suggest that practice can be adapted, developed and made more inclusive through input from people living with dementia themselves.

Driving is the preferred mode of transport for many older drivers, providing mobility to maintain independence and quality of life. The loss of driving privilege has negative psychosocial consequences, including depression. Early discussions and planning for driving retirement are therefore essential. Driving retirement, however, is typically a taboo topic for older drivers and their support networks. To understand why discussions and planning about driving retirement are avoided, 43 semi-structured interviews were conducted with older drivers in New South Wales, Australia. Drawing on Löckenhoff's ageing and decision-making framework, thematic analysis of transcripts offers insights into why discussions and planning for driving retirement are avoided or facilitated. The findings reveal most older drivers had not discussed or planned for driving retirement. Barriers to discussing and planning for driving retirement included: perceptions of loss, change, death and denial. Facilitators to discussing or planning for driving retirement included: declining health and driving confidence, medical advice, age or car accident. Driving retirement in car-dependent societies is a major life event, symbolising an end-of-life stage for many older people. This paper calls for strategies to encourage early and regular discussions about driving retirement with older drivers. To support older drivers’ transition to driving retirement, an understanding of the value and meaning placed on driving in the context of the individuals' identity and lifestyle is recommended.

Research concerning the reciprocal influence of relationships and dementia largely focuses on dyadic relationships despite evidence that whole families are affected. Furthermore, such research generally considers more common forms of dementia such as Alzheimer's disease. Behavioural variant fronto-temporal dementia (bvFTD) primarily although not exclusively affects people below the age of 65 and is distinctly different in its impact from more common forms of dementia, affecting social cognition and therefore relational functioning. We aimed to develop a detailed understanding of intergenerational family experiences of bvFTD over time. We adopted a social constructivist and pluralist approach, using Narrative Thematic Analysis and Grounded Theory. We interviewed seven families in their own homes, including the person with bvFTD, at up to three time-points every six to nine months from 2012 to 2014, resulting in 46 interviews with 19 family members. Three super-ordinate themes were identified: Theme 1: We before bvFTD: cohesive and connected – disconnected and distant; Theme 2: Challenges experienced by us; and Theme 3: Relational outcomes: a changing we – an entrenched we. Results emphasise bvFTD brought early and significant disruption to family relationships. The interplay of prior relational functioning, involving the nature of the relationship for family members, the specific impact of bvFTD on these relationships and family member's understanding of bvFTD was critical to how each family fared over the duration of the research, and the relational outcomes they experienced. These findings suggest health-care practice could enhance its support for families living with bvFTD, through the development of tailored, family-oriented approaches to assessment and practice. Such approaches are necessary to understand how families work together and identify interventions that address the family-specific challenges bvFTD brings. The provision of tailored, relational-focused and specialised information concerning the experience of living with bvFTD is needed to flexibly address families' needs and expectations.

Experiencing a change in partnership status at older ages might have detrimental effects on an individual's habits, including eating behaviours. Prior studies presented evidence that widowhood is related to altered diets with a decrease in the amount of protein consumed, which is considered to be an important risk factor of frailty among older people. Using data from Waves 4–8 of the Survey of Health, Ageing and Retirement in Europe (N = 134,313), we investigate the association between stability and changes in partnership status and changes in the frequency of protein consumption at older ages. We also explore the potential moderating role played by changes in economic resources. Having never been married, being divorced and being widowed were significantly associated with a lower frequency of protein consumption among both men and women. The transition to widowhood was significantly associated with a reduction in the frequency of protein consumption, while this same association was not found in the transition to divorce. Subjective evaluation of economic resources did not moderate the relationship between changes in partnership status and frequency of protein consumption. In short, changes in eating behaviours after having experienced the loss of a partner due to widowhood might contribute to accounting for health differentials between those ageing alone and those with a partner.

Although volunteering is considered a good strategy for successful ageing, not many older adults are engaged in voluntary work and those who are do so mainly sporadically. This study focuses on time invested in volunteering rather than on doing voluntary work or not, as is often done in studies so far. By combining the theory of resources for volunteering with a functional and structural approach to volunteering, this cross-sectional study seeks to shed light on a wide range of factors associated with the intensity of volunteering. The study is based on a sample of 1,599 volunteers aged 50 and older participating in the Norwegian study on Life Course, Ageing and Generation Study (NorLAG). The survey includes, among others, detailed information about demographics and time invested in voluntary work and questions about attitudes, motivations, structural and other potential barriers to volunteering. Multivariate linear regression analyses indicate that a religious attitude is associated with elevated hours spent on voluntary work, while co-habitation is associated with a decreased engagement in voluntary work. In addition, people who are motivated to volunteer because they find it interesting and because volunteering allows them to use their competence spend more time volunteering. Human capital, i.e. education, income and subjective health, are not associated with the number of hours invested in voluntary work. The likelihood of contributing more volunteering hours of older men is 17.5 per cent higher than that of older women. We found no indication of a relation between work status, functional limitations, urbanisation or ethnicity and voluntary work engagement. Policies aiming to increase time investment of volunteers should strive for an optimal fit between the nature of the voluntary work and the interests and skills of the volunteers. In designing interventions to stimulate higher engagement in voluntary work, one should further promote strategies for flexible time commitment.