Along with population ageing, the health and social care labour force is also growing older. However, despite evidence of the characteristics and factors that relate to older workers in general, there is a dearth of empirical evidence relating specifically to the older health and social care labour force (aged 50 years and over). With rising longevity, there is increasing demand for efficient and effective health and social care provision that is delivered by a skilled, experienced and capable labour force. To manage such demand, the Government introduced measures under the extending working lives (EWL) agenda to encourage older workers to remain in work for longer. These measures included the removal of the default retirement age, increases to the State Pension Age (SPA), and the development of anti-discriminatory legislation. This thesis furthers our understanding of the characteristics of this labour force aged 50 years and over, and establishes factors that are associated with the decision to work part-time at and beyond the SPA. Using merged cross-sectional data (2009-2013) from the Labour Force Survey (N=10,123), descriptive and multivariate (binary logistic regression) analyses were conducted. The results indicate that the older health and social care labour force comprised individuals aged 50 and 84 years and that the majority (86 per cent) were women. Among this labour force, 48 per cent worked as health and care professionals and 52 per cent were employed as health and care support staff. The findings show that the likelihood of working part-time increased with increasing age. For example, among individuals aged 65 to 69, and those aged 70 years and over, the odds of working part-time at and beyond the SPA were 2.26 and 3.34 times respectively the odds among those aged 60 to 64. Ethnicity, marital status and earnings were also found to be significantly associated with working part-time at the SPA and over. Under the auspices of EWL, these results have important implications for national and organisational policy development, and for the development of effective workforce planning in health and social care.

The funding of long-term care arose on the political agenda during the early and mid 1990s. This debate often focused on the role of individuals in making financial provision for such care that might be required in their own later life. The establishment of a Royal Commission on Long-Term Care for the Elderly in 1997, and the Government's eventual response in 2000, has seen the debate move forward but not die down. This thesis examines the broad context within which the debate initially developed and reports on survey research, conducted in the mid 1990s, which focused on long-term care funding. Attitudes towards state, family and individual provision of care in old age were examined by a nationally representative survey of adults aged 25-70 in England and Wales. Financial behaviours are examined amongst a sub-sample selected on the basis of four contrasting attitudes. Public opinion, and attitudes and behaviours towards the funding of social care in later life were therefore explored during a period when the issue was being fervently debated in the UK. The findings are presented with close reference to the policy context within which the research was conducted. The full analysis presented focuses on attitudes, behaviours and intentions towards personal financial planning for care needs through pensions, housing assets and long-term care insurance. Implications of the findings for both current policy developments and future research are considered. The research methodology is discussed alongside the contributions of other academic domains, which points to the importance of further developing a life-span perspective in social policy attitudes research. This could support greater interdisciplinary working in this area.

Increasing numbers of older adults require help with personal or practical tasks because of disease, disability or age related health limitations. Commonly it is their partner who fulfils some, or all, of this caring role. Taking on this type of caring role is associated with poorer psychological health and changes in personal relationships. What remains unclear is the nature by which personal relationships with the care recipient, other family members, and friends change when older adults take on a caring role for their partner, and how this links to health. A mixed methods approach was used to explore changes in personal relationships and health for partner caregivers in later life. Seven older partner caregivers were interviewed about their experiences of caring for their partner, focusing on changes they experienced in their health and personal relationships when taking on the role. Waves 1 to 5 from ELSA were used to explore associations, both at one time point and changes over time, between health outcomes and personal relationship types, for older adults moving into the partner caregiver role. Synthesising the results suggest that connections between transitions in health and personal relationships, for older adults moving into a partner caregiver role, differ for different relationships. Relationships with partners and friends before becoming a partner caregiver were found to be most associated with change in health and quality of life when moving into this role. Relationships with children and family appeared to be more stable during the transitioning into the caregiver role, while partner relationships were more likely to suffer, and friendships seemed to experience most change. Positive associations found between different personal relationship types suggest a subset of particularly vulnerable partner caregivers who are in difficult partner relationships and have little support available to them from family or friends.

Independence for older people has emerged as an increasingly important policy priority. This policy imperative has been driven by demographic and economic concerns at the forefront of policy debates in the UK and internationally. The aim of this thesis was to gain an insight into the meaning of independence for older people through reviews of the English policy context and existing national and international evidence and interviews with older people. The UK policy context illustrates three, sometimes conflicting, interpretations of independence. These contrasting ideas were also found in the evidence although there is limited empirical research that elucidates the meaning of independence directly from older people. A constructivist grounded theory methodology was used to enable theoretical and empirical exploration. This inherently iterative approach informed the choice of methods and how the primary data was collected and managed. Analysis of the findings showed that independence is individually constructed and comprises a number of different dimensions. These dimensions can be grouped into two distinct, but interlinked core categories - ‘a sense of independence - dynamic and interactive identity’; and ‘the practice of independence - dynamic and interactive agency’. The salience of these categories was shaped by older people’s life experiences, personal characteristics and wider social/cultural discourses and could change depending on individual circumstances, preferences and context. These findings have implications for policy and practice. First, the value that older people attribute to independence is compatible with that evident in current policy. However, the points of dissonance between policy interpretations of the meaning of independence and older people’s constructs of independence could have serious implications for how older people experience policy, service provision, practice. Second, policy and practice interpretations of independence should aim to be consistent with the aspirations of older people accessing services so that they are able to experience the ‘independence’ they desire.

Due to the high incidence of ill health and disability amongst their contemporaries, older people are likely to be involved in informal caring relationships. Due to the limited nature of post-retirement incomes, such carers are also likely to be relatively poor. In spite of this, little attention has been given to the role of older carers or to the influence of material deprivation upon this role. Drawing on fieldwork interviews with a sample of older co-resident carers and the secondary analysis of official statistics, this research aims to redress this ‘ageless’ and ‘classless’ analysis of informal care. While the original intention of the research was to focus solely on the way in which material resources went on to affect caring in older age, subsequent analysis revealed a complex interaction between material circumstances, physical pathology, culture and attitude. The concept of resources was therefore broadened to incorporate these issues and the study’s materialist focus has been supplemented by a consideration of the age-based specificity in the way in which respondents manage and experience their financial situation and caring role. The thesis concludes with a consideration of the implications of these findings for future policy, literature and research. Thus, it is suggested that in view of the high degree of interdependence in caring relationships, intervention should focus less on the conflicting needs of care providers and care receivers and more on their commonality and their shared need for adequate and appropriate support. Similar synthesis is required in the exploration of poverty, older age and caring and also in the three generations of thought that have engaged in this exploration. In the light of this synthesis, it is argued that the ‘relative autonomy’ of the age dynamic should be recognised and responded to by researchers, practitioners and policy makers alike.

Iran has recently undergone an exceptionally fast fertility transition. The Total Fertility Rate decreased from 7 in 1980 to 1.8 in 2006 along with declines in adult mortality rates. Consequently, Iran is currently experiencing rapid population ageing. As these demographic changes are intertwined with huge social changes, some major challenges may be anticipated in future. One important concern is that the health status of older people, particularly their mental well-being, may be adversely affected if fewer children lead to a reduction in the support available to older people. The aim of the research described in this thesis was to examine direct and stress-buffering associations between social support and mental health in older age groups. Potential differences between men and women in the associations and the role of different sources of support were also examined. A review of the existing literature indicated that this topic is under-researched in Iran or culturally similar countries. A quantitative cross-sectional survey of a random sample of 800 people aged 60+ years resident in Tehran was conducted. In total, 644 people responded. Multilevel mixed-effects models were used to examine the hypotheses. The findings supported the hypothesis of a direct association between functional aspects of social support and mental health but not that of an association between structural aspects of social support and mental health. No strong evidence of a stress-buffering effect of social support in the association between physical functioning and mental health was found, except in the case of receipt of social support with transportation. The only type of support that showed a significant interaction with gender was receipt of support with paperwork. The source of support did not seem to matter. Implications of these findings for older people currently living in Tehran are considered and recommendations for appropriate social support interventions, taking account of the results, are made.

Background: Numbers of dependent older people will increase in low and middleincome countries (LMIC) with population ageing. Healthcare services do not meet their needs, and little attention has been given to developing age-appropriate services. Research described in this thesis is formative to development of World Health Organization WHO-COPE clinical intervention guidelines for prevention/management of dependence among older people in LMIC. >Method: Predictive validity of frailty indicators was tested by analysing 10/66 Dementia Research Group population-based cohort study data from Latin America, China, and India. Field research was conducted in Goa to train Community Health Workers (CHWs) for case-identification and assessment of frail/dependent older people. Case-identification and impairment classifications were compared with local clinician judgment. Clinical intervention guidelines were developed using WHO methodology (scoping questions/systematic reviews/expert consensus). Qualitative interviews in Goa with CHWs, doctors, and dependent older people and their carers assessed implementation issues for WHO-COPE guidelines. Results: Frailty indicators (weight loss, inactivity, exhaustion, slow gait speed, undernutrition, cognitive and sensory impairments) are consistent predictors of dependence and mortality. Goan CHWs accurately identified older people with multimorbidity, impairments, polymedication, disability and dependence. Agreement with clinicians for specific impairments was moderate, but the COPE assessment positive predictive value was high. It identified those with more pronounced disability. Systematic reviews found moderate quality evidence (from developed countries) for effectiveness of interventions for frail/dependent older people; e.g. exercise, nutritional supplementation/dietary advice, and prompted voiding for incontinence. Consensus guidelines are drafted for most intervention domains. Frail/dependent older people receive little attention in Goan primary healthcare. Home-based assessment and management was endorsed by healthcare professionals, but role definitions, referral options, limited knowledge and skills constituted important obstacles. Discussion: WHO-COPE assessment and multi-component intervention may address the needs of frail/dependent older people. However, feasibility, acceptability, fidelity, and effectiveness should be evaluated when administered by CHWs in the community.

This study explores the ways in which learning might take place in a reminiscence group for older people who are moving towards the end of life. The overall aim was to seek a greater understanding of the processes underpinning reminiscence groups as well as the benefits - to individuals and the wider community - of such learning opportunities. This is a piece of practitioner research with the author combining the roles of facilitator of the themed reminiscence groups and observer. The study used a qualitative methodological approach from a social constructivist perspective, relying on observation and follow-up individual interviews to build ‘cases’ of the learning journeys of seven participants. The findings suggest that reminiscence is a potentially useful route to and catalyst for learning about the self and others, with the thesis being structured around the four main research questions which focus on whether learning is taking place, its nature, and the potential outcomes and benefits of such learning to both individual participants and wider society. The study, situated within what is recognized as ‘an ageing society’, hopes to demonstrate the value of learning through group reminiscing in later life and provide encouragement to local councils and their Adult Education teams (the predominant providers of such programmes in the UK) to continue to fund and support such activities. Furthermore, the insights gained make a potential contribution to wider understandings of the individual and social benefits of informal education for older adults in ways which may be useful to policy-makers seeking to promote the wellbeing of an ageing population.

This report contributes just over a third of the contribution to the researcher's D.Prof programme. It is a synthesis of many different activities and avenues of investigation and learning. This report is about one specific project and is focused on the ways to support the spread and adoption of innovative practices. It is not intended to be a report of the entire D.Prof Programme as the other areas are covered separately (see Exhibits Ai for D.Prof Programme Design). The literature review threw up a number of conflicts of definitions and perspectives, especially in the terminology that can be applied to 'spreading good practice' and 'social marketing'. The many paradoxes and contested concepts are highlighted in the review and the discussion that follows. Whilst this part of the D.Prof programme is centred on a work-based project - The Trent Region Older People Services Programme (TROPSP) - it has been difficult to separate learning in this project from other work based experiences in the same period. The deliverables and outputs generated (see Part B Exhibits) demonstrate both the breadth and depth of the researcher's experience and learning during this D.Prof programme. The experiential nature of action-based research is highly subjective as the researcher is an active participant in the investigative process, where personal actions immediately affect and have consequences on the context and subject matter under investigation. This report, therefore, needs to be read in the light of its context for the researcher, and understood as a piece of qualitative, action orientated research, rather than an analysis driven by more positivist or scientific values. The literature review, assessment of the TROPSP project and discussion about the researcher's personal learning themes, combine to produce a set of conclusions and recommendation as diverse and contested as is the topic of interprofessional social marketing itself. The paradoxes and tensions include: how different theories and frameworks can form unhelpful (or helpful) mental models; the importance of context, perspectives and expectations and how they can influence strategy and implementation of good practice; the tension between the individual and the organisation; how working with key influencers can be as damaging as it can be as supportive; and finally, the issue of whether the aim in social marketing is to spread good practice (Push out) or to enable adoption (Pull in). The work summarised in this report has received national and international recognition. The contribution to the modernising the NBS has been significant and there is much interest from other countries in using some of the techniques developed and used in the TROPSP work based project. The implications for professional practice, for those working with modernising healthcare as well as specifically for the researcher, are important.

The aims of this thesis were to investigate the neuropsychological, neurophysiological, and cognitive contributors to mobility changes with increasing age. In a series of studies with adults aged 45-88 years, unsafe pedestrian behaviour and falls were investigated in relation to i) cognitive functions (including response time variability, executive function, and visual attention tests), ii) mobility assessments (including gait and balance and using motion capture cameras), iii) motor initiation and pedestrian road crossing behavior (using a simulated pedestrian road scene), iv) neuronal and functional brain changes (using a computer based crossing task with magnetoencephalography), and v) quality of life questionnaires (including fear of falling and restricted range of travel). Older adults are more likely to be fatally injured at the far-side of the road compared to the near-side of the road, however, the underlying mobility and cognitive processes related to lane-specific (i.e. near-side or far-side) pedestrian crossing errors in older adults is currently unknown. The first study explored cognitive, motor initiation, and mobility predictors of unsafe pedestrian crossing behaviours. The purpose of the first study (Chapter 2) was to determine whether collisions at the near-side and far-side would be differentially predicted by mobility indices (such as walking speed and postural sway), motor initiation, and cognitive function (including spatial planning, visual attention, and within participant variability) with increasing age. The results suggest that near-side unsafe pedestrian crossing errors are related to processing speed, whereas far-side errors are related to spatial planning difficulties. Both near-side and far-side crossing errors were related to walking speed and motor initiation measures (specifically motor initiation variability). The salient mobility predictors of unsafe pedestrian crossings determined in the above study were examined in Chapter 3 in conjunction with the presence of a history of falls. The purpose of this study was to determine the extent to which walking speed (indicated as a salient predictor of unsafe crossings and start-up delay in Chapter 2), and previous falls can be predicted and explained by age-related changes in mobility and cognitive function changes (specifically within participant variability and spatial ability). 53.2% of walking speed variance was found to be predicted by self-rated mobility score, sit-to-stand time, motor initiation, and within participant variability. Although a significant model was not found to predict fall history variance, postural sway and attentional set shifting ability was found to be strongly related to the occurrence of falls within the last year. Next in Chapter 4, unsafe pedestrian crossing behaviour and pedestrian predictors (both mobility and cognitive measures) from Chapter 2 were explored in terms of increasing hemispheric laterality of attentional functions and inter-hemispheric oscillatory beta power changes associated with increasing age. Elevated beta (15-35 Hz) power in the motor cortex prior to movement, and reduced beta power post-movement has been linked to age-related changes in mobility. In addition, increasing recruitment of both hemispheres has been shown to occur and be beneficial to perform similarly to younger adults in cognitive tasks (Cabeza, Anderson, Locantore, & McIntosh, 2002). It has been hypothesised that changes in hemispheric neural beta power may explain the presence of more pedestrian errors at the farside of the road in older adults. The purpose of the study was to determine whether changes in age-related cortical oscillatory beta power and hemispheric laterality are linked to unsafe pedestrian behaviour in older adults. Results indicated that pedestrian errors at the near-side are linked to hemispheric bilateralisation, and neural overcompensation post-movement, 4 whereas far-side unsafe errors are linked to not employing neural compensation methods (hemispheric bilateralisation). Finally, in Chapter 5, fear of falling, life space mobility, and quality of life in old age were examined to determine their relationships with cognition, mobility (including fall history and pedestrian behaviour), and motor initiation. In addition to death and injury, mobility decline (such as pedestrian errors in Chapter 2, and falls in Chapter 3) and cognition can negatively affect quality of life and result in activity avoidance. Further, number of falls in Chapter 3 was not significantly linked to mobility and cognition alone, and may be further explained by a fear of falling. The objective of the above study (Study 2, Chapter 3) was to determine the role of mobility and cognition on fear of falling and life space mobility, and the impact on quality of life measures. Results indicated that missing safe pedestrian crossing gaps (potentially indicating crossing anxiety) and mobility decline were consistent predictors of fear of falling, reduced life space mobility, and quality of life variance. Social community (total number of close family and friends) was also linked to life space mobility and quality of life. Lower cognitive functions (particularly processing speed and reaction time) were found to predict variance in fear of falling and quality of life in old age. Overall, the findings indicated that mobility decline (particularly walking speed or walking difficulty), processing speed, and intra-individual variability in attention (including motor initiation variability) are salient predictors of participant safety (mainly pedestrian crossing errors) and wellbeing with increasing age. More research is required to produce a significant model to explain the number of falls.