The adequate care of older persons is a major global concern and countries are examining ways to respond to these needs, especially the needs of frail older persons in the care environment. Important strides have been made in developed countries but progress has been slow in less developed countries in the Global South and limited information exists on the care needs of frail older persons and lived experiences of formal and informal caregivers. This thesis examines the care needs of frail older persons in Namibia. Namibia has only recently been liberated from colonial rule by Germany and apartheid South Africa. During this time black communities were disenfranchised, resource-scarce and living under poor conditions. For older persons, this meant unequal treatment, social exclusion and denial of access to decent care. The aim of this study was to provide an in-depth understanding of the needs of frail older persons in the care environment in Namibia by examining the lived experiences of caregivers and analysing policy. Using a qualitative methodology, the study collected primary data from formal and informal caregivers based on semi-structured interviews and focus groups. The data analysis relied mainly on coding strategies under Atlas-ti and qualitative content analysis. The secondary data were collected from legislation, government policy documents, journals and other public reports. The finding revealed that Namibia's history has entrenched the current situation of unmet needs of frail older persons, exacerbated by inadequate policy protection. These limitations were highlighted by the Covid-19 pandemic. The study also found that the effective care of frail older persons is only possible through stakeholder engagement and cross-sectoral collaboration. The study therefore recommends that government should undertake a process of social reforms to ensure that the needs of this group are prioritised, that a performance framework should be implemented to ensure delivery and that all stakeholders should be mobilised. The study has contributed to these outcomes by suggesting a model for needs assessment of frail older persons, especially during the Covid-19 pandemic. This model could be used to improve care practices, serve government in evidence-based policy making and provide a useful analytical tool for scholarship.

An increasingly older population will most likely lead to greater demands on the health care system, as older age is associated with an increased risk of having acute and chronic conditions. The number of diseases or disabilities is not the only marker of the amount of health care utilized, as persons may seek hospitalization without a disease and/or illness that requires hospital healthcare. Hospitalization may pose a severe risk to older persons, as exposure to the hospital environment may lead to increased risks of iatrogenic disorders, confusion, falls and nosocomial infections, i.e., disorders that may involve unnecessary suffering and lead to serious consequences. Aims: The overall aim of this thesis was to describe and explore individual trajectories of cognitive development in relation to hospitalization and risk factors for hospitalization among older persons living in different accommodations in Sweden and to explore older persons' reasons for being transferred to a hospital. Methods: The study designs were longitudinal, prospective and descriptive, and both quantitative and qualitative methods were used. Specifically, latent growth curve modelling was used to assess the association of cognitive development with hospitalization. The Cox proportional hazards regression model was used to analyse factors associated with hospitalization risk overtime. In addition, an explorative descriptive design was used to explore how home health care patients experienced and perceived their decision to seek hospital care. Results: The most common reasons for hospitalization were cardiovascular diseases, which caused more than one-quarter of first hospitalizations among the persons living in ordinary housing and nursing home residents (NHRs). The persons who had been hospitalized had a lower mean level of cognitive performance in general cognition, verbal, spatial/fluid, memory and processing speed abilities compared to those who had not been hospitalized. Significantly steeper declines in general cognition, spatial/fluid and processing speed abilities were observed among the persons who had been hospitalized. Cox proportional hazards regression analysis showed that the number of diseases, number of drugs used, having experienced a fall and being assessed as malnourished according to the Mini Nutritional Assessment scale were related to an increased hospitalization risk among the NHRs. Among the older persons living in ordinary housing, the risk factors for hospitalization were related to marital status, i.e., unmarried persons and widows/widowers had a decreased hospitalization risk. In addition, among social factors, receipt of support from relatives was related to an increased hospitalization risk, while receipt of support from friends was related to a decreased risk. The number of illnesses was not associated with the hospitalization risk for older persons in any age group or for those of either sex, when controlling for other variables. The older persons who received home health care described different reasons for their decisions to seek hospital care. The underlying theme of the home health care patients’ perceptions of their transfer to a hospital involved trust in hospitals. This trust was shared by the home health care patients, their relatives and the home health care staff, according to the patients. Conclusions: This thesis revealed that middle-aged and older persons who had been hospitalized exhibited a steeper decline in cognition. Specifically, spatial/fluid, processing speed, and general cognitive abilities were affected. The steeper decline in cognition among those who had been hospitalized remained even after controlling for comorbidities. The most common causes of hospitalization among the older persons living in ordinary housing and in nursing homes were cardiovascular diseases, tumours and falls. Not only health-related factors, such as the number of diseases, number of drugs used, and being assessed as malnourished, but also social factors and marital status were related to the hospitalization risk among the older persons living in ordinary housing and in nursing homes. Some risk factors associated with hospitalization differed not only between the men and women but also among the different age groups. The information provided in this thesis could be applied in care settings by professionals who interact with older persons before they decide to seek hospital care. To meet the needs of an older population, health care systems need to offer the proper health care at the most appropriate level, and they need to increase integration and coordination among health care delivered by different care services.

This thesis fills an important research gap in the sociology of ageing and life course, and the sociology of sexualities and intimacies by exploring the understudied experience of singlehood among older gay men. It is a qualitative study based on semi-structured in-depth life story interviews conducted with 25 self-identified gay men over the age of 50 who live in England and have been single for most of their lives. The primary objective of the study is to investigate how older single gay men interpret and assign meanings to their lives in later life. In considering the role of narratives in bridging structure and agency, the thesis suggests that the older gay men’s narratives of singlehood need to be understood with reference to the master narrative in society that privileges couplehood. The master narrative undoubtedly informed and at times overshadowed the ways in which the older gay men understood their lives. But at the same time this thesis finds that the research participants engaged with the master narrative in a variety of creative ways – they did not only adopt, but also adapted and subverted the dominant story line. These counter-stories do not only reproduce, but have the potential to reinvent, the meanings of relationships in contemporary societies. To achieve this, resources were needed in reframing the master narrative. From a life course perspective the thesis suggests that the older gay men’s earlier life experiences and current social locations influenced the narratives they told. Only some of the older single gay men were able to (re-)claim sexual citizenship while others were denied this. In addition, the older gay men’s story-telling was filled with ambivalence and ambiguities. As a whole, the thesis sees the older gay men’s stories as displaying agency within structure.

This thesis is based on four studies that explore accessibility for older adults during whole trips by public transport. The overall goal was to gain knowledge of the interrelationships among key variables and to develop a conceptual model of the overall accessibility of public transport. More specifically, the research goals were: (a) to explore links among the key variables postulated to be involved in overall accessibility and to explore the links between these variables and railway accessibility; (b) to gain a deeper understanding of links between critical incidents in traveling and travel behavior decisions; and (c) to develop a conceptual model of overall accessibility. The key variables contributing to overall accessibility are functional ability (depending partly on the person’s functional limitation or disease), travel behavior, and barriers encountered during whole-trip traveling involving train. Respondents with more than one functional limitation or disease reported lower functional ability than did those with only one such limitation and respondents with low functional ability were less frequent travelers than were those with high functional ability. Frequent travelers reported railway accessibility to be better than did those who traveled less frequently. The main barriers were ticket cost and poor punctuality, but respondents with the lowest functional ability attributed the barriers encountered to their own health. The critical incidents most frequently reported were found in the categories “physical environment onboard vehicles” and “physical environment at stations or stops”, as well as in the “pricing and planning during ticketing” phase of the trip. Five themes of reactions to critical incidents were identified that had resulted in behavior change: firm restrictions, unpredictability, unfair treatment, complicated trips, and earlier adverse experiences. A conceptual model of overall accessibility was developed, grounded in the empirical research results. This model is summarized in the following propositions: Overall accessibility is a reciprocal relationship among the barriers/facilitators encountered, functional ability, and travel behavior. Accessibility emerges in the person–environment interaction. To understand accessibility, past experiences and future expectations should both be considered, because both will guide travel decisions. / Measurements enable future train travelling for everybody

The thesis is concerned with relationships between different conceptualizations and understandings of gender mainstreaming in Oxfam GB during 2001-2006 and focuses on two sites of policy and practice: Oxfam House and an Oxfam project in Cambodia. Drawing on anthropology of development literature, I observe that while the mainstreaming strategy was becoming further embedded in the organisation, it also evolved differently in each research site. Gender policy and practice were not necessarily linked, and policy did not drive practice; different drivers were at play. In Oxfam House, understandings of gender mainstreaming among senior managers were informed by perennial feedback that the organisation's gender work was wanting and perceptions that previous gender efforts were overly critical and uninspiring. These understandings influenced inter-related imperatives, pursued by senior managers, of assuming organisational leadership for gender and making “gender accessible”. Both of these contributed to rendering the promotion of gender equality a contested process. In contrast, the project case study in Cambodia, which Oxfam viewed as a “successful” gender mainstreamed model of community-based disaster management, demonstrates a process of taking on gender issues characterised by mutual benefit and reciprocity. Regional gender advisors and project staff needed to work together to secure their places in Aidland. Unlike the drivers of policy in Oxfam House, the drivers of gender mainstreaming practice were the demands and uncertainties of Aidland and, in the light of these, the maintenance of project relations and reproduction of “success”. They also concerned localised contingencies of social relations of gender and relations of aid. I conclude that while gender mainstreaming policy and practice are connected by formal organisational structures, they can also be unrelated due to different micro politics within these respective sites and, relatedly, from the varying degrees of autonomous decision making exercised by Oxfam staff and their understandings of gender and their particular interests.

This thesis contends that older persons, whose mental capabilities remain intact, are capable of expanding their conscious awareness; they have not necessarily passed their prime as they begin the process of retiring. They may be showing a worn and weakened package but this does not mean they cannot live a fulfilling life. This is the reason for the development of a new form of therapy, called 'Trans-subjective Therapy', because it combines the objective and the subjective with the trans-personal, or unconscious levels of consciousness. Trans-subjective therapy connects the various systems of objectivity, subjectivity, and the transpersonal, or unconscious, so that the client can be facilitated into clearer, deeper understanding of themselves and others, and expand their conscious awareness in a wholesome, fulfilling manner. This thesis describes development and testing of this new therapeutic approach, which is designed specifically to enable older persons to experience more fulfilling and aware lives. Although building on existing therapeutic modalities, this new formulation is unique in that every feature of its design was selected, developed and tested with the specific needs of older persons in mind. This approach emphasises the personal responsibility of the client to expand his/her conscious awareness in the direction of personal choice. This has particular application to the needs of older persons, most of whom are at a stage in life where meaning and purpose have either become clarified or a sense of meaninglessness and resentment dominates their lives. Quotes from the transcripts of the author's testing of this approach with 12 individuals who undertook training in this methodology have been used throughout the text to illustrate the application of this approach. Its effectiveness is inferred from the manner in which each person in this group has expressed him/herself at a level of consciousness freely chosen and individually experienced in a manner that will be novel or completely new to the person involved. / Doctor of Philosophy (PhD)

<p>This thesis deals with a very important issue in South African society, i.e. the provision of financial and non-cash support to older persons. Older persons in South Africa can be described as a sizeable but vulnerable group requiring specific protection. Section 27 of the South African Constitution of 1996 obliges the state to take reasonable legislative and other measures within available resources to progressively realise the right of access to social security. Hence, the steps taken by the state to promote older persons&rsquo / right of access to social security and to protect their right to dignity need to be evaluated. The legislative framework for the provision of financial and non-cash support to older persons currently is fragmented into various statutes dealing with retirement income, state grants to older persons and care and support services for older persons. Therefore, the current legislation lacks an integrated approach to the provision of support and care to older persons, as well as a central principle on which to base future legislation concerning older persons. One such principle that could potentially be adopted is intergenerational solidarity, which can be described as the solidarity between the active working-age population, as one generation, from which benefits flow to older persons as the other. This thesis evaluates whether intergenerational solidarity should form the basis of South African legislation on the provision of retirement income and the provision of care and support to older persons, and if so, whether it in fact does. If the answer to the latter is in the negative, the thesis further examines whether the current process to reform the retirement income system and related legislation in South Africa would be a suitable platform to introduce the concept of intergenerational solidarity to legislation concerning older persons.</p>

Background: Malnutrition is a major problem in Bangladesh. One third of the population in Bangladesh is malnourished, but figures for older persons specifically are scant. Aims: This thesis describes the nutritional status of individuals aged 60+ years, living in a rural community in Bangladesh, with particular focus on the impact of demographic, health and social factors on nutritional status. A main aim is to examine the magnitude of malnutrition in this population. Second, the thesis focuses on the impact of demographic, health and social factors on nutritional status. Third, this thesis also aims to investigate the influence of nutritional status on functional abilities. Methods: A cross-sectional study of people aged 60+ years was conducted in Matlab, a rural area in Bangladesh during 2003-2004. Data were obtained through home interviews, clinical examination and cognitive tests. Nutritional status was assessed using a modified form of the Mini Nutritional Assessment. Physical function was measured by self-reported and performance-based instruments. Cognitive function was assessed using general and specific cognitive tasks. A total of 850 individuals were randomly selected for the purpose of the study, of which 625 participated in the home interviews and 473 underwent clinical examinations and cognitive tests. Information on complete nutritional status was available for 457 individuals. Results: About 26% of older people living in a rural community in Bangladesh were malnourished and 62% were at risk of malnutrition (Studies I-IV). Self-reported health problems (Study I), physician’s diagnoses (Study II), food expenditure (Study I), literacy (Studies I, II), personal income (Study II), female gender (Studies I, II) and financial support (Study II) were significantly associated with nutritional status. Health indicators accounted for the largest variations in nutritional status compared to demographic and socio-economic indicators (Studies I, II). Nutritional status was directly associated with self-reported and performance-based physical functions (Study III), as well as general and specific cognitive functions (Study IV). Conclusion: In low income countries, nutritional status of older persons needs to be addressed both from a health and a socio-economic perspective. Good nutritional status is essential for older persons to be functionally active, both physically and cognitively.

<p>This thesis deals with a very important issue in South African society, i.e. the provision of financial and non-cash support to older persons. Older persons in South Africa can be described as a sizeable but vulnerable group requiring specific protection. Section 27 of the South African Constitution of 1996 obliges the state to take reasonable legislative and other measures within available resources to progressively realise the right of access to social security. Hence, the steps taken by the state to promote older persons&rsquo / right of access to social security and to protect their right to dignity need to be evaluated. The legislative framework for the provision of financial and non-cash support to older persons currently is fragmented into various statutes dealing with retirement income, state grants to older persons and care and support services for older persons. Therefore, the current legislation lacks an integrated approach to the provision of support and care to older persons, as well as a central principle on which to base future legislation concerning older persons. One such principle that could potentially be adopted is intergenerational solidarity, which can be described as the solidarity between the active working-age population, as one generation, from which benefits flow to older persons as the other. This thesis evaluates whether intergenerational solidarity should form the basis of South African legislation on the provision of retirement income and the provision of care and support to older persons, and if so, whether it in fact does. If the answer to the latter is in the negative, the thesis further examines whether the current process to reform the retirement income system and related legislation in South Africa would be a suitable platform to introduce the concept of intergenerational solidarity to legislation concerning older persons.</p>

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