This thesis examines the lives of older people in the former mining communities of the East Durham coalfield (the former District of Easington). The study considers whether there are unique challenges faced by older adults in an area that is classed as deprived in national measures of socio-economic disadvantage. This qualitative research explores the quality of later life for older people in Easington and, against the backdrop of the life course theory, addresses the broad question: what has the Easington context, with its historic mining culture, contributed to older residents’ experience of ageing?” The study found that the”lived experience” of older people in Easington is influenced by their own personality, family structure and life opportunities (in education, employment and retirement), each of which have contributed to participants’ experience of ageing. Study results also confirmed the positive and negative effects neighbourhood,”place” and social networks have on older peoples’ overall quality of life. The sense of social connectedness is an important factor relating to a positive quality of later life. An important finding was that loss of community infrastructure resulting from closure of the mines has profoundly influenced the ageing experience of older people in Easington. This research confirms previous studies which highlight the fact that older people residing in such socio-economically deprived areas are at increased risk of social exclusion. The thesis ends with a discussion of some implications from the study for ageing policy and service development.

This study investigates the relationship between mortality and a number of factors drawn from existing administrative databases including gender, housing tenure, council tax bands (a proxy of wealth) and three popular causes of hospital admission (falls, strokes and ischemic-heart disease) for Camden residents aged 50 years and older. The study also includes an assessment of information on social service contact in order to identify the potential and/or the effectiveness ofservice delivery. .\ . i;' Existing data sources are merged using a relational database management systems approach. Risks of mortality are examin~d fOf different combinations of factors (Risk Ladders). The relative importance of risk factors are assessed by logistic regression and the model's ability to discriminate between' 'those subjects who experience the outcome of interest versus those who do not', are also evaluated by use of Receiver Operating Characteristic (ROC) Curves. The risk of mortality is more likely to occur for people living in social housing and lower council tax bands (A-C) t~an private housing and higher tax bands (D-H) and for men rather than women. However, the effect of tenure varies for different age groups, gender and tax band. The risk of mortality significantly increases for those groups of individuals who had at least one hospital admission for any of the three causes during 2002-04. Our results show the extent to which contact with social services is aligned with mortality risk among this age group with consequent implications for how social services are organised and delivered.

Background and aims. This thesis took a life course approach to examining inequalities in quality of life in early old age using the French occupational cohort GAZEL. The cohort combines company administrative records with information from annual questionnaires for 20 625 electricity and gas industry employees. The thesis aimed to examine whether current circumstances, retirement routes, mid-life working conditions or occupational grade were associated with subjective quality of life, measured with CASP-19, in retired participants. Results. Cross-sectional and change analyses using multiple regression demonstrated that social support, financial adequacy and, above all, mental and physical health were strongly associated with quality of life. There was a graded relationship between occupational grade in mid-life and quality of life following labour market exit, a relationship which was largely accounted for by health and financial circumstances in retirement. After adjusting for occupational grade and social class, exposures to physical hazards and ergonomic strain were associated with lower quality of life following retirement; accumulated exposures to carcinogens were not. Pathways from working conditions to poorer quality of life via physical and mental health accounted for the associations between earlier strenuous and dangerous working conditions and quality of life following retirement. Retiring tended to improve subjective quality of life, particularly if it was from difficult psychosocial working conditions. Retiring in ill health was associated with worse quality of life; this retirement route was more likely for individuals who had poor working conditions. Continuing professional activities after retirement was associated with better quality of life, a retirement route more likely for individuals working in higher grades. Conclusions. The thesis demonstrated small but persistent life course influences of employment characteristics upon quality of life which appeared to be mediated via current determinants of quality of life.

The research question addressed is whether a relationship can be shown between fuel poverty and the health of older people in Newham, using morbidity data. The aim is to help develop a methodology to measure effects of fuel poverty for evaluating outcomes of investment III domestic energy efficiency and affordable warmth: a complex, multi-disciplinary problem. First government references to fuel poverty were peripheral to environmentally driven energy conservation targets, designed primarily to reduce carbon dioxide emissions to meet national climate change commitments. However, these targets can militate against solving immediate needs of the fuel poor. Those who cannot afford sufficient fuel tend to 'take back' part of the gain from energy efficiency measures as increased comfort, so that minimal energy savings result from interventions to fuel poor homes. Potential cost savings from associated health benefits of environmental targets are disregarded, partly because there is currently no means of measuring them. This problem importantly contributes to the motivation behind the research. Here, as a new indicator for measunng health outcome of fuel poverty, an excess winter morbidity ratio is proposed, rather than the conventionally used ratio of excess winter mortality. Records of seasonal deaths are more easily accessible than disease episodes, but numbers are fewer and represent only extreme outcomes of cold-related health effects. Perhaps health gains could be more readily measurable in terms of reduced morbidity, over a shorter period, than from reduced mortality statistics, following energy efficiency improvements for a given population. An epidemiological approach was taken, using Newham borough as the research sample, but focussing on the population over 64 years old as the most vulnerable to cold homes. A small area index of Fuel Poverty Risk (FPR) was derived from the combined factors of low income, home energy ratings (a measure of energy efficiency), population age, household size and underoccupation of housing. This was mapped and compared with the incidence of emergency winter hospital admissions for cold-related disease in the older population, as indicated by the calculated Excess Winter Morbidity Ratio (EWMbR). A significant positive correlation was found between the FPR and the EWMbR, adding to the evidence-base of links between fuel poverty and health. The mapped analysis is illustrated using GIS software, which is helpful for presenting multidisciplinary data and is a common epidemiological tool. The proposed methodology could predict cost benefits to the health services of investment in domestic energy efficiency measures and be used in monitoring and evaluation. The FPR Index could help local authorities to identify areas of fuel poverty risk for prioritising action towards achieving affordable warmth in homes.

Loneliness among older adults is a significant predictor of morbidity and mortality, and is therefore increasingly recognized as a major public health problem. Whilst mechanisms underpinning the development of loneliness in later life are poorly described, it has been associated with reduced levels of social participation outside the home. This thesis therefore sought to explore barriers to social participation among older adults. Part 1 comprises a systematic review of older adults’ subjective experiences of barriers to social participation. Fifteen qualitative studies were identified and assessed using Thematic Analysis (Braun & Clarke, 2006). Whilst results aligned with previous findings, they also emphasized several novel barriers that may guide future research, including: local population turnover, perceived neighbourhood danger, ageism, economics and power, social skill and confidence problems, identity processes, and adaptation to age-related changes. Part 2 comprises an empirical study of barriers to social participation in a sample of lonely older adults living independently in London, England. Here, particular attention was paid to processes of identity, which may hold particular influence over social participation. An inductive qualitative approach, based on semi-structured interviews and Thematic Analysis (Braun & Clarke, 2006), was employed. Findings highlighted that lonely older people commonly minimise the difficulties they face alone and avoid social opportunities, due to significant fears about the possibilities of social rejection and/or losing valued aspects of their identities. Part 3 comprises a discussion of issues pertinent to the conduction of research in this field. Topics explored include: the effects of personal assumptions upon qualitative findings, the management of emotional responses to interviews with very lonely older people, ideas for future research, and the impact of the present work on practice.

This thesis aims to develop greater understanding of older people's livelihood strategies in Latin America. It asks whether their contributions to household and family are reciprocated with care and support. The thesis analyses the informal livelihood strategies used by poor older people in urban Bolivia in relation to the household, community, labour market and wider political environment. Drawing on a combination of the sustainable livelihoods and life course perspectives, the thesis examines the multiple survival strategies used by older people and analyses the factors affecting their access to different assets. The primary data come from a year's fieldwork in three contrasting urban zones of La Paz, where 600 household surveys, 16 focus groups and more than 40 semi-structured interviews were conducted. The thesis highlights the heterogeneity of older people in La Paz and the broad range of strategies used to maintain their livelihoods in the absence of state support. It shows that family support is not the reliable source of security that it is generally thought to be and that older people often continue to support their descendents rather than vice versa, in cash or in kind. It stresses the importance of continuing reciprocity: few older people can rely on receiving support from others unless they too continue to contribute. Adult children may have to continue relying on their parents because of the high cost of housing and scarce employment opportunities. The rise in single-parent families and increasing labour migration mean that older people may also be responsible for raising their grandchildren. After a lifetime of balancing family and work obligations, women may be better than men at combining different strategies in old age, and they have stronger social networks. Men's lifelong focus on income generation makes it harder for them to devise other survival strategies in old age.

At the current time, people aged 85 years and over are identified as the fastest growing sector of our ageing population and generally assumed to be the most demanding for care. This thesis challenges this stereotypical assumption and aims to address the gap in current knowledge, bringing a detailed understanding of the influences contributing to ‘ageing well’ by including the voice of older people themselves. Applying a convergent parallel mixed methods approach containing two theoretical strands of data: (i) quantitative from ‘The Newcastle 85+ Pilot Study’, comprising structured interviews with n=116 participants [47 male/69 female]; and (ii) qualitative from additional in-depth interviews with n=17 of these participants [9 male/8 female]. All data collection took place within the participants’ usual place of residence [own home/care home; nursing/residential] and analysis was according to the theoretical foundation of each strand. Meta-inferences were led by qualitative themes with quantitative findings providing context. All participants were born in 1918 and permanently registered with a general practice within the City of Newcastle upon Tyne, North East of England. Findings revealed: (i) past life experiences have relevance as an influencing factor for ‘ageing well’; (ii) perspectives of the older individual need to be included when exploring health needs and planning resource allocation; (iii) the contribution of social connectedness and informal support should be considered as influencing factors of ‘ageing well’. An overarching discussion concluded that ‘ageing well’ is a fluid concept, sensitive to the lived context and history of an individual. Examining ‘ageing well’ in this way not only provides opportunities for future research and practice but also contributes to the development of overall knowledge.

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