Social determinants of health (SDH) impact older adults’ ability to age in place, including their access to primary and community care services. Yet, older service users are infrequently consulted on the design and delivery of health services; when they are consulted, there is scant recruitment of those who are Indigenous, racialized and/or rural. This study aimed to identify SDH for socially and culturally diverse community-dwelling older adults and to understand their views on how primary and community care restructuring might address these SDH. We recruited a diverse group of 83 older adults (mean = 75 years) in Western Canada and compared quantitative and qualitive data. The majority resided rurally, identified as women, lived with complex chronic disease (CCD), had low income and/or lived alone; nearly a quarter were Indigenous or Sikh. Indigenous status correlated with income; gender correlated with income and living situation. Thematic analysis determined that income, living situation, living rurally, Indigenous ancestry, ethno-racial minority status, gender and transportation were the main SDH for our sample. Income was the most predominant SDH and intersected with more SDH than others. Indigenous ancestry and ethno-racial minority status – as SDH – manifested differently, underscoring the importance of disaggregating data and/or considering the uniqueness of ‘BIPOC’ groups. Our study suggests that SDH models should better reflect ageing and living rurally, that policy/decision makers should prioritize low-income and ethno-racial minority populations and that service providers should work with service users to ensure that primary and community care (restructuring) addresses their priorities and mitigates SDH.

There is little visibility for the voices of indigenous and Afro-descendant women in Latin America and the Caribbean (LAC), meaning that few studies offer information on mental health for this group. This study takes the Living Well (Buen Vivir) approach as a basis to examine the prevalence of depressive symptoms and their associated individual physical and social/cultural dimensions. Based on a national study involving the participation of a majority of Chilean peoples, 774 women identifying as indigenous (569 Andean indigenous and 146 other indigenous people) and Afro-descendant (59) were interviewed. The findings show that Andean and Afro-descendant women are more at risk of suffering depressive symptoms and that in general terms mental health should be understood from a holistic perspective, in addition to its being underpinned by several associations. Lower levels of depression were associated with older age, having a partner, independence in activities of daily living, social support from partner and being resilient. In contrast, higher levels of depression were associated with health problems, poor-quality relationship with grandchildren and loneliness. Out of the dimensions examined, resilience had a key influence on mental health among women. The findings are discussed in the context of a comprehensive view of wellbeing among ethnic minorities.

The ability to manage money is essential for independent functioning but highly sensitive to cognitive decline. Managing money involves more than deploying skills rationally; it is influenced by a range of emotional and psychosocial factors. There is relatively little knowledge about how older adults, families and care professionals working with older people navigate and experience potential challenges of declining mental capacity to manage money. This article draws on a UK-based study involving 13 older people and/or family members and 28 social sector professionals, and their experiences of supporting older people with cognitive decline to manage money, triangulated with public information resources from major national organisations across the health, care, consumer and charity sectors. It focuses on the emotive and personal nature of cognitive decline and money management. Declining mental capacity to manage money can strike at the core of people’s sense of who they are, leading to strong tensions and difficulties in discussing support. Support to manage money is often framed in discussions as ‘there if we need it’; this can be reassuring for people, but may be challenged if there are subsequent disagreements and changes in perspectives about the detail and timing of support. These nuances are not well reflected in public information resources, which largely emphasise administrative procedure. Financial organisations may lack empathy that declining mental capacity to manage money is extremely challenging. The article highlights a greater need for recognition of the emotional and psychosocial complexities presented by declining mental capacity to manage money in later life.

Despite the recognized importance of older adults ageing in their own homes, the role of public financing in mitigating unmet and under-met home care needs remains under-explored. This study addresses this gap by examining the impact of public financing on home care adequacy among English adults aged over 50, utilizing data from waves 6–9 (2013–2019) of the English Longitudinal Study of Ageing. Longitudinal fixed effects and pooled cross-sectional modelling are used to explore the impact of public financing of home care on the unmet and under-met needs of older people. Findings show that individuals with greater limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs), as well as those experiencing cognitive decline, are more likely to receive home care. Importantly, while receipt of publicly financed care is associated with a reduction in unmet needs, it does not necessarily translate to fully met needs, resulting in under-met need and highlighting a crucial distinction between access to and adequacy of care. Comparatively, transitioning from use of publicly financed home care to exclusively informal care is linked with lower odds of reporting under-met needs, suggesting variance in the quality of care provided across funding types. This study not only enriches the existing literature by describing the specific impact of different home care financing mechanisms (publicly financed care versus other types of care) on the unmet and under-met needs of older adults but also underscores the need for policies that ensure care adequacy, not just accessibility.

The concept of security, with its various dimensions, is fundamental to the field of ageing literature. However, feeling safe does not always equate to feeling at ease or being comfortable with people and places. Building on these premises, this article presents and analyses the factors involved in the perception of security and social safeness among women ageing in a top-down co-housing project and a nursing home in Italy. This country has one of Europe’s oldest populations, and the ageing population phenomenon is particularly notable in the Veneto region. In response to changing demographics, the search for alternative housing solutions and associated innovative paradigms of care and support has been gaining ground in recent years. Our study analysed data gathered from women who decided not to age in place. Fieldwork was carried out in one of the most densely populated provinces in the Veneto region during 2022 and 2023. The methodology was qualitative and consisted of in-depth interviews, a focus group and a workshop. Participants were 11 self-sufficient older women, aged 75 and over, living in these facilities. Among the elements that contribute to the perception of social safeness, the following stood out: material and structural factors, physical and emotional factors, relational factors and factors linked to independence and autonomy. Finally, the article stresses the need to study social safeness in greater depth, as it could become a new line of social science research capable of providing relevant information on the housing needs of older adults.

Ageing-in-place for persons with dementia and informal care-givers is encouraged by governments and society. However, individuals with non-Western migration backgrounds are at higher risk of dementia yet underrepresented in research and care. This study aims to identify ageing-in-place care preferences of persons with dementia and their informal care-givers in the Netherlands. Semi-structured interviews (n = 8 participants with dementia, n = 20 informal care-givers) were analyzed using reflexive thematic analysis. Findings reveal that informal care-givers feel a strong duty to care, assisting with various daily tasks. While they desire shared care with professionals, identifying concrete care needs is challenging, highlighting the need for proactive professional support. Participants also emphasized the importance of culturally sensitive in-home care, home adaptations, social care and accessible dementia information. Additionally, the emotional impact of dementia on care recipients and care-givers underscores the need for emotional support. These insights enhance understanding of the care preferences of persons with dementia and their informal care-givers, aiding more efficient and culturally responsive health service planning.

People from different ethnic minorities in the UK are experiencing a steeper increase in dementia diagnosis compared to their white counterparts but are more likely to have a higher risk of dementia, to be diagnosed at a younger age and to die earlier from the condition. These disparities suggest the need for urgent interventions to prevent and reduce dementia risk. Despite the significant presence of Chinese people in the UK, there has been little dementia research involving them, so this study is the first in the UK to focus on Chinese communities living in five major cities. Using a cultural adaptation theoretical framework, we adapted Alzheimer’s Research UK’s virtual dementia prevention campaign Think Brain Health to meet the needs of Chinese people. We used a mixed methods approach to evaluate knowledge of dementia and brain health activities, and intention regarding help-seeking. We performed descriptive, chi-square and thematic analysis; 54 Chinese people completed the intervention, with 85 per cent aged over 60 years. Over half (56%) could not speak, read or write in English. Our results showed significant improvements in knowledge of dementia and brain health, and an improved intention to seek help and information. All participants reported a positive experience of the culturally tailored intervention and valued working with dementia researchers who were able to deliver the intervention in Chinese languages. Future work involving Chinese communities in the UK will need to identify an appropriate but non-stigmatizing Chinese term for dementia.

Colonization and ongoing colonial policies and practices are contributing to increased dementia rates in Indigenous populations. This health inequity could be addressed by implementing culturally safe dementia interventions specifically designed for Indigenous people. We conducted a scoping review of culturally safe dementia care interventions for Indigenous populations. Databases searched included OVID (Medline, PsycINFO, Embase, Healthstar), Informit Indigenous Collection, JBI EBP, Scopus/Elsevier and PubMed. Eligibility criteria included studies in English, interventions designed specifically for Indigenous persons living with dementia and evaluative outcomes of the intervention. In total, 2,259 articles were identified. After removing duplicates, 1,394 titles and abstracts were screened and 54 studies were screened for eligibility. Of these, no studies were eligible for inclusion. This empty review reveals a massive and inexcusable gap in knowledge around developing, implementing and evaluating culturally safe Indigenous-specific dementia care interventions. Future directions for research include working with Indigenous peoples to determine what culturally safe interventions for dementia look like, implementing high-quality studies with evidence-based measures and outcomes, and improving efforts to get this important work published to inform future studies.

Despite consensus that quality of life (QoL) in later adulthood is multi-dimensional, scholars’ perceptions of the dimensions the construct comprises differ. Under the premise that models and measures of QoL should correspond with lay perspectives to have relevance to the targeted population, we investigated the constituents of QoL in later adulthood as perceived by middle-aged and older laypersons. We fielded a factorial design vignette experiment among 2,544 respondents aged 50+ participating in the Dutch Longitudinal Internet studies for the Social Sciences panel to assess how 11 dimensions identified from four established QoL instruments designed for older people (WHOQOL-OLD, CASP-19, OPQOL, ICECAP-O) influence QoL evaluations. The study extends prior work on lay perspectives on QoL by combining the internal validity of an experiment with the external validity of a true population sample. All dimensions considered significantly impacted the QoL ratings in the expected direction. Enjoyment and social participation had a significantly larger contribution than the other dimensions. Models stratified by age group showed a strong degree of similarity, suggesting a high level of consensus across age groups about the constituents of QoL in later adulthood. The study highlights the necessity of capturing a broad range of dimensions when conceptualizing QoL in later adulthood. Our finding that dimensions that were omitted in selected established instruments still contributed substantially to QoL evaluations arguably implies that these instruments may have suboptimal content validity. The insights gained from this study are important for developing and evaluating policies aimed at improving QoL for the ageing population.

The ageing population is anticipated to encounter several challenges related to sustainability. While policies such as ageing in place can benefit older adults in terms of familiarity and independence, these policies can also lead to increased social isolation. To facilitate ageing in the right place, it is crucial to understand how the design of environments promotes social sustainability. This article presents a scoping review of empirical research focused on the characteristics of housing and surrounding environments that support social integration, cohesion and participation of older adults. The search strategy was conducted in five databases, resulting in 20,477 articles. After screening 7,550 titles and abstracts based on predetermined inclusion and exclusion criteria, 19 articles were selected. The findings of these articles are presented across three themes: (1) housing environments, (2) environments beyond the home and (3) the social environment. Although there is no one-size-fits-all housing model for older adults, the authors suggest that ageing in place policies should be reconceptualized as ageing in ‘places’ and ‘spaces’, emphasizing the diversity of social needs of older adults. Understanding the environmental characteristics, the role of accessible and safe environments beyond the home, and how people and culture support a sense of belonging provides a policy direction for how to design socially sustainable environments for older adults in the future.

An increasing number of older adults require residential care. Concurrently, older adults’ alcohol use is increasing. This review explored the perspectives of all relevant stakeholders on older adults’ alcohol use within residential care settings, through a systematic review and thematic synthesis of qualitative studies. Eight databases were searched for qualitative studies focusing on older adults’ alcohol consumption (defined as aged ≥ 50) within residential care settings, sampling any involved stakeholders, published up until January 2024. Quality appraisal utilised the Critical Appraisal Skills Programme checklist and included 15 studies of mainly moderate quality across seven high-income countries, reporting data from a range of stakeholders and representing varied older adults’ alcohol histories. Three themes were identified: alcohol use by older adults is socially acceptable and purposeful in residential care settings; alcohol helps in the pursuit of an ‘ideal’ outcome; and decision-making around older adults’ alcohol use varies depending on the involvement, knowledge, skills and beliefs of the participating stakeholders, who also vary. Reports of problematic alcohol use were rare and older adults in residential care settings should be supported to exercise their own choice in determining their alcohol use. However, residential care settings face particular challenges in managing the alcohol intake of older adults with limited mental capacity and alcohol dependency; owing to a lack of guidance, front-line staff make subjective decisions. Future research should develop guidance that involves all relevant stakeholders, including family members. Limitations include lack of generalisability to low- and middle-income countries and limited availability of raw data.

The global population is ageing rapidly, emphasising the need to understand the decision-making processes of older adults regarding potential care transitions. Gerontological research has focused on healthcare decisions, with less information on living situation choices of older adults. This review explored older adults’ experiences with their involvement in decision-making processes related to transitioning into care facilities in the United Kingdom. From a systematic search of articles, nine were reviewed using thematic narrative synthesis. Four themes with nine subthemes were identified: Involvement in decision-making (Exclusion of older adults, Usefulness of involvement), The necessity of moving (Triggers for moves, The role of family), Timely planning (Helpfulness of planning, Planning avoidance), and Factors for choosing a care home (Non-quality factors, Quality factors, Continuity of life). These themes highlighted the issue of inadequate involvement of older adults in decision-making, often resulting in negative consequences like regret and difficulty settling into new care settings. The necessity of moving arose from sudden events or increased support needs. Some older adults acknowledged the necessity due to declining health or to spare family burden, while relatives grappled emotionally, postponing the choice. Timely planning was found to be beneficial practically and emotionally, facilitating smoother transitions. However, participants would rarely plan and discuss such matters early. Older adults focused on personal experiences and trusted sources rather than publicly available information when considering Factors for choosing a care home. The findings show the need for greater inclusion of older adults in decisions related to their care and the importance of early planning and providing preferred types and formats of information to aid decisions. Future research should focus on a better understanding of older adults’ preferences for successful involvement in care decisions, with support and guidance for others involved in the decisions.