This thesis adopts a longitudinal approach towards examining the income mobility of older people aged 50 and over in England and aged 45 and over in South Korea over the period between 2006 and 2012, using panel data from the English Longitudinal Study of Ageing (ELSA) and the Korean Longitudinal Study of Ageing (KLoSA). This study of income mobility among older people points to pension income insecurity issues, which carry utmost significance when life expectancy and retirement duration are increasing. The comparative analysis brought insights into the ways in which different institutional settings may be responsible, and what policy reforms can be introduced to offset the adverse impact of income mobility on the wellbeing of older people. This research analysed the income mobility of older people using the unit of household equivalised disposable income and aggregate summary measures. The research also investigated the factors that significantly influence income mobility in old age at the microscopic level using multivariate analysis. The findings from the analysis of absolute income mobility suggest that older people in England show much more income stability than their Korean counterparts. From the relative income mobility analysis, older people in both countries experienced a low rate of change in their position in the income distribution over the measured period. In both countries, there was income rigidity among the high-income and low-income classes. The examination on what lies behind income mobility and the comparison of the determinants of income mobility in the two countries revealed that income growth has very little impact on aggregate mobility in England, while it is crucial for the mobility levels in Korea. Finally, the findings on the factors affecting income mobility of older people revealed that demographic characteristics, employment status, health status, educational level, and income attributes (welfare) are significantly associated with income mobility. A notable difference is that changes in living arrangements and a higher share of state benefits are associated with positive (upward) income mobility in Korea, whereas these factors are associated with downward income mobility in England. The transition into widowhood is associated with downward income mobility in England but has no significant effect in Korea. The empirical results highlight the benefits of cross-national comparative study on the income dynamics of older people, and how different contexts, welfare systems, and labour market affect the income mobility in later life. In Korea, the focus should be on finding the ways to expand social welfare services and income security policies so that the welfare state can be more responsive to income risk in old age. In contrast, means-tested income support policy in England should be investigated further in order to help middle-income class vulnerability in economic risks.

Mexico is still a "young" country with pressing burdens on education, especially at secondary and high school levels, and high percentages of the population entering the work force each year. Yet, it will complete its "demographic transition" in the next 20-25 years with a rapid increase in the percentage of population 65 years and older. As with most Latin American countries, Mexico is experiencing what experts call a "mixed" epidemiological transition with increasing trends in prevalence of chronic diseases and a marked decrease in communicable diseases in some areas, but with a continuing moderate or high incidence of the latter in some regions of the country. In addition, there are no long-term care programmes that cater to the specific health and social care needs of the older population. Services for the elderly are comprised of isolated strategies mainly recreational and information programmes, and health services similar to those provided to all other age/condition groups in the country. At the moment, social development and health sectors are unprepared to cater for the needs of the increasing elderly population. Currently, the majority of the older population live with their children, or other close relatives, and most of the care provided to them is done at home by their family members. Nevertheless, changes in fertility rates, constant rural-urban migration within Mexico and international migration, women's increasing participation in the labour force, among other factors have changed family size and composition and may pose future challenges to the availability of household care and support. Given the rapid ageing process Mexico is going through, the absence of dedicated strategies for the older population and the possible decrease in availability of informal care, there is a pressing need to have detailed information on the conditions of the older population and how they are experiencing the ageing process. Mainly, on their health and disability status, on their use of services by the elderly, and on the characteristics of the informal care that is provided to them. The main objective of this research is to generate significant information in order to provide health system institutions with information on specific needs and on the provision of social and health care services for the elderly in Mexico in the next decades. The aim of the thesis was to generate information on the dynamics of the ageing process in Mexico and how the Mexican population is facing old age. This was done by exploring four main topics. First, a comprehensive study of their health and disability status was done, including the generation of a Frailty Index in order to have an additional indicator of their overall health and frailty status at individual and population level. Secondly, overall survival in the Mexican ageing population was investigated. Through the analysis, possible differences between sub-samples of the population were explored. Given that there are no formal long-term care services for the older population in Mexico, the remaining topics are related to the care for this population group. On one hand, the thesis explores the use of health services by the ageing population in Mexico. This includes the use of different types of care such as general practitioner, specialist doctors, as well as inpatient and outpatient hospital visits. On the other hand, it explores the supply of informal care for the older population by their (co- resident and non-resident) children. The thesis then addresses future challenges regarding the ageing process and formal and informal care-giving. Finally, following the identified challenges, the thesis includes recommendations for future research and inputs for future - health and social-ageing policies and strategies in Mexico. Data for the research come from the two existing waves of the Mexican Health and Ageing Study, MHAS (2001 and 2003). This is a prospective panel study of health and aging in Mexico which includes a nationally representative sample of population 50 years and older.

Current conceptions of place and wellbeing in literature offer limited ways to think about the interrelationships of place and wellbeing as older people age and experience change over time. What is not clear is how wellbeing affects experiences and meanings of place and how, in turn, place mediates experiences of wellbeing. Through an investigation of older peoples’ experiences of living in a range of everyday settings (domestic, sheltered, very sheltered and residential care settings) the overall aim of this research is to explore what matters for the wellbeing of older people and how this might shape and be shaped by interrelationships of place and wellbeing. The study is qualitative and involves in–depth interviews incorporating a biographical perspective with 26 older people between the ages of 65-96 years living in different kinds of settings from across more and less affluent parts of Dundee, Scotland. The interviews are informed in part by a conceptual framework that draws upon strands from both place literature (drawing upon Massey 1995; Kearns and Gesler 1998) and Amartya Sen’s capability approach (2009). The conceptual framework is a starting point for exploring and interpreting the processes shaping older peoples’ experiences. The thematic data analysis builds on the Framework approach. A capability perspective and relational thinking in emphasising the dynamic and socially situated nature of place and wellbeing relationships show that older peoples’ experiences, the capabilities they have and the capabilities that matter are in a state of flux. My research findings suggest that a number of capabilities can matter to older people. Such valued capabilities are shaped by dynamic interactions between: a) age, health, and (or) place related changes; b) diverse socio-economic contexts; and, c) characteristic features of places and meanings attached to the place (at different scales of for example, the residence, neighbourhood, city). The findings also indicate that where older people have health related impairments, how interrelationships of place and wellbeing are framed and understood can have implications for who they are able to be and what they are able to do. This research has implications for both policy and practice. The findings suggest that a priori assumption about different kinds of settings as being enabling or disabling cannot be made. Rather, as the study demonstrates, paying attention to the complex and manifold processes that shape capabilities would permit nuanced insights into how, under what circumstances, and for whom particular place settings might generate enabling and (or) disabling encounters. Paying attention to the processes that shape capabilities also would allow researchers, policy makers, and practitioners to contribute positively to making informed judgements to support older peoples’ wellbeing both spatially and temporally.

Introduction: Population ageing and increasing urbanisation present challenges for public health policy and practice. Creating a supportive environment – as promoted by the WHO Age-Friendly Cities (AFCs) Initiative – is especially important for older people’s health. This thesis examines how views on strengthening respect and social inclusion in the urban setting differ among older people and city stakeholders, the extent to which their priorities are supported by evidence for health benefits, and the implications for public health policy. Methods: A systematic review was conducted of quantitative and qualitative evidence for the impact on health and wellbeing of interventions fostering respect and social inclusion in community-resident older adults. Photovoice was used to explore respect and social inclusion among 26 older people aged 60+ from four contrasting areas of Liverpool (UK). Perspectives on respect and social inclusion among 23 local policy makers and service providers were explored at interview. A photo-exhibition was then organised to generate meaningful discussions between the two groups. Synthesis compared findings for older people and city stakeholders, and assessed the extent to which priorities of both groups were supported by evidence from the systematic review. Results: Thirty-four quantitative evaluations included in the systematic review suggest that interventions on respect and social inclusion, particularly intergenerational and music and singing initiatives, may have an impact on psychological outcomes, wellbeing, subjective and physical health of older people. Fourteen qualitative studies identified some of the factors in the pathways to improved health outcomes (e.g. improved self-esteem and social relationships). Through photovoice methods, older people identified a wide range of enablers, barriers and potential solutions spanning services, the environment and city facilities. City stakeholders identified similar issues as older people, but were additionally concerned by impacts of budget cuts on provision and planning of respect and social inclusion. While some older people’s and city stakeholders’ priorities were supported by evidence (e.g. art and culture initiatives), there were no evaluations of the health/wellbeing impact of other important aspects for respect and social inclusion identified by older people and/or city stakeholders (e.g. attempts to promote affordability and accessibility of transportation). Discussion and Conclusions: Although city stakeholders appeared to understand many of the views of older people and vice versa, the former’s views were driven more by their need to address budgets constraints. Photovoice can be an effective tool to (i) engage older people, and (ii) incorporate their views into city planning. However, participants’ concerns about photographing difficult topics and producing ‘expected’ images need to be addressed. Future research should address previously neglected priorities identified by older people and city stakeholders. Systems thinking would help structure more inclusive evaluation of health impacts of AFC initiatives.

In this phenomenologically grounded study I draw on PCS analysis (Thompson, 2011a) to explore the relationship between how individuals make sense of their experience of reciprocity while in receipt of formal eldercare delivery, prevailing discourses about old age and dependency, and the significance attached to age as a social division. In addition to applying the PCS framework in an innovative way, I propose a further innovative analytical framework to highlight that meaning making around reciprocity is informed by the significance of space, time, discourse and institutionalised patterns of power. Findings that emerged from the narratives of elders in the UK and India reflect that, while older people dependent on formal care may desire opportunities to give as well as receive, opportunities for giving tend not to be facilitated, and the dimension of future aspiration tends to be neglected. In exploring the sociological and phenomenological implications of the findings, and raising the profile of reciprocity in the theorising of eldercare, I highlight their positive potential to contribute to a better understanding of the spiritual well-being of individuals dependent on formal care and to provide a challenge to deficit models in the theorising of dependency in old age by emphasising a future orientation.

The oldest old, defined variously as those aged '80 and over' or '85 and over', are the most rapidly expanding age group across most of the world. The potential for very old age to be accompanied by high morbidity and dependency is a source of concern for policy makers, health and social care providers, and society as a whole. Research evidence concerning the oldest old is limited. There is a pressing need for robust information on the diversity of their health and needs. This thesis brings together a series of eight publications from my work in the Newcastle 85+ Study, a population-based longitudinal study undertaken in the 1921 birth cohort living in North-East England. A detailed examination of the health status and care needs of very old people was conducted. Study participants were recruited at a mean age of 85.5 years (standard deviation 0.4). Comprehensive multidimensional health assessment was performed in the home setting. General practice medical records were reviewed for disease, medication and service use data. The main findings were: Levels of morbidity and healthcare use were high. A substantial proportion of morbidity remained undiagnosed. Despite the high morbidity burden, participants generally managed well with daily activities, and the majority lived in non-supported housing. Self-rated health was generally good. However, one-fifth of participants required frequent daily or 24 hour support, and one-tenth were resident in care homes. Women out-numbered men, yet were generally in poorer health. Inflammatory biomarkers were associated with frailty; and telomere length, a cellular ageing biomarker, was associated with cardiac function. This work provides a comprehensive evidence-base on the health and needs of very old people. It will inform effective planning of current and future services. Potentially causal associations between inflammatory and cellular ageing biomarkers and health status in the very old have been identified.

is project investigates patient centred care on an acute older persons' unit in a NHS Trust in the UK. It uses a method based on grounded theory, integrated with an ethnographic approach to examine the knowledge, beliefs and behaviour of staff working on an acute older persons' unit regarding patient centred care. The data was gathered over a period of one year using interviews and participant observation. The National Service Framework for Older People produced by the Department of Health (DOH) is the first ever, comprehensive strategy to ensure fair, high quality, integrated health and social care services for older people. It is a 10 year programme of action linking services to support independence and promote good health, specialised services for key conditions, and culture change so that all older people and their carers are always treated with respect, dignity and fairness (DOH 2001). Patient-centred care is central to this strategy, however Nolan & Davies (2002) suggest that patient-centred care may not be the panacea that it is held up to be and may perpetuate, rather than eliminate poor standards of care for older people. Nolan et al (2002) stated that although 'patient-centred care' has challenged many negative stereotypes and lies at the heart of the NSF for older people, it presents a rather limited vision. They instead promote 'relationship-centred care' initially proposed by the Tresolini and Pew-Fetzer Task Force (1994), this focuses on the relationships that form the context of care. McCormack in his 2004 review observes that patient-centred practice is a recurring theme in the gerontological nursing literature, there are many descriptive accounts of attempts at developing patient-centred practice but in reality there are few studies that identify the benefits of this way of working. He raises the question that perhaps good quality care for older people and patient-centred care may indeed be the same thing, suggesting that we shouldn't chase after an ideal of patient-centredness, but instead strive for a constant state of 'becoming more patient-centred' in our practice. Dewing (2004) looked at five frameworks that appear to promote patient-centredness in nursing which for the for the most part, are all conceptual and all advocate the alues of patient-centred care. Dewing questions the collective belief that person-centred care is now being achieved when the degree to which practitioners knoW the older person is actually very limited, claiming that this is exacerbated by the limited vision of patient-centred care set out in the National Service Framework for Older People. Dewing recommends further work into translating the complex conceptual frameworks into ones that are meaningful to older people and the nurses working with them. In her conclusion Dewing suggests that when frameworks are used in a technical way, the older person and/or oneself is made to 'fit' into the framework. The challenge of nursing older people in a patient or relationship-centred way is often aggravated by trying to consciously and intentionally use frameworks. As patient-centred care is the central philosophy around which services for older people are being developed and how they are likely to develop in the future, it is prudent to look at whether this way of caring translates from theory into practice and how it affects the patient experience. Semi-structured interviews were conducted with staff nurses and healthcare assistants on the three wards on the older persons unit. 60 'personalmemos' and field notes were recorded in over 100 hours spent on the wards as a participant observer. The interviews and field notes were analysed. Quotes and pertinent material that related to each other were sorted by hand into eight initial categories. These categories were analysed further and sorted into four final themes. The themes identified from the data were used to form a descriptive analysis. The results of the study generated insights into the nature of patient centred care in the acute care of older people. The four major categories which emerged from the findings, are discussed and analysed in this thesis. These were 'it's about the individual', 'if only we had time', 'it's 98% relationships' and' too posh to wash'. The conclusions describe the factors affecting patient centred care and how these are related to practice and policy. Evidence of patient centred care was observed on the ward and also relationship centred care was recorded. While many nursing activities 5 ere consistent with patient centred care the study results also highlighted factors influencing these activities and suggests opportunities to perhaps help improve nursing practice. To ensure patient centred care remains at the core of nursing practice on the OPU nurses should carry out ongoing assessment of patients needs in relation to their care and try to encourage patients to participate actively in their care. From these findings it is apparent that a patient centred approach would have to involve practitioners having appropriate space and support to enable them to work in this manner. This may require the provision of clinical supervision and training and space for reflection on their work with older people. They themselves would need to feel valued and recognised both by t~eir colleagues and the organisation that they work for.

The aim of this research was to investigate the possibility of adopting the lens of fashion and clothing in order to explore the older men’s experience of ageing. In this vein, as a creative practitioner, I sought to explore the vantage point and the relationship between fashion and clothing, embodiment and the physical and social processes of growing older in relation to individuals' experiences. A multi-disciplinary literature review revealed that fashion and clothing is a significant, yet often overlooked, element of individuals' experiences of ageing. Furthermore, this contextual review exposed an array of various influential stereotypes especially in regards to gender and ageing. Notably, the topic of older men and fashion seems to intersect two stereotypical assumptions; firstly, that fashion is a sphere exclusively reserved for women; and, secondly, that individuals' interest and engagement with fashion ceases significantly as they grow older. As a consequence, the majority of the existing studies investigating this phenomenon tend to focus on older women, their experiences and expectations towards clothing. While there is no doubt that such scholarship is valuable, such an imbalance needs to be addressed. Via this thesis I aim to contribute to the fulfillment of this identified gap in knowledge. In this research, I have developed a novel hybrid methodology, Arts-Informed Interpretative Phenomenological Analysis. Rooted in phenomenology and arts, this methodology put to the test the concept of 'making' as a valid way of data analysis, equal to writing. My research process built on the concept of the hermeneutic circle; the subsequent activities of writing and making allowed me to constantly move between different elements of the participants' experiences, which in turn facilitated the conditions for more in-depth and holistic understanding and enhanced interpretations. In addition, such an approach gave me the opportunity to utilise my skills and sensibilities as an artist and designer and to blur the boundaries between the artificially disconnected domains of fashion research and practice. This research found that ageing, fashion, clothing, men and masculinities are not disjointed. Fashion and clothing was not only revealed as a valid and useful lens through which individuals' experiences of ageing can be analysed and interpreted but also the experiences of men in this study proved to be rich and meaningful. This research culminated in a unified body of work that has relevance to the fields of psychology, sociology, as well as art and design. A composition of the research outcomes consisted of a series of suit jackets, short films and written accounts offering novel insights into a particular sample of men's individual and shared experiences of ageing. In addition, such a multi-layered composition of research outcomes has the potential to reach audiences beyond academia. Contributions to knowledge are claimed in the three following areas: . The novelty of the topic of investigation into mature men's experiences of ageing through the lens of fashion and clothing; . The uniqueness of the developed hybrid methodology, Arts-Informed Interpretative Phenomenological Analysis; . The originality of the outcomes arising from this investigation.

Objective: This research investigates how older women understand their social roles, and the part that social roles play in their well-being, to underpin the development of interventions aimed at increasing social role participation in order to improve the well-being of older women in the United Kingdom. Methods: Five focus groups were analysed using Inductive Thematic Analysis. Snowball sampling was used to identify 20 female participants, residing in the United Kingdom, aged 60 and above. Results: The analysis generated four themes: the nature of a social role; social roles support well-being in older age; societal expectations of age and gender lead to role loss; and freedom to choose meaningful social roles leads to well-being. Conclusions: Participants reported that social roles facilitate well-being through the prevention of isolation, increased levels of activity, improved cognitive health through brain activity, and increased confidence and flexibility. Freedom to choose meaningful social roles was reported as having the most positive impact on well-being. Results provide a framework from which to design social role interventions that facilitate choice of meaningful social roles, which can be facilitated through joined-up working with external agencies, including those that provide volunteering opportunities. Appropriate psychological interventions include those that address relationships with others, such as Interpersonal Psychotherapy.

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