Continuums of care (e.g., home-based services, assisted living, nursing homes) deliver essential health and social services for older people and are organized differently across healthcare settings. Informed by academic research and consensus-building sessions with policymakers and older people from two Canadian provinces, this article presents a typology of 12 dimensions that define how care continuums are organized and operationalized. Dimensions define the care provided by different services, including how they are accessed and their recipients; paid staffing, illustrating provider type, volume, and employment practices; funding, showing how care is paid for and additional client costs; and central governance, defining regulatory procedures, audits, standards, and data monitoring systems. This typology supports systematic comparisons across two Canadian provinces and helps to identify promising practices, care gaps, and reform ideas in each jurisdiction. Further application, expansion, and refinement of this tool is required to assess its value in other Canadian and international settings.

This cross-sectional study examined health and social concerns among community-dwelling older people, the resources they sought, and factors related to these concerns. A convenience sample of 222 Nova Scotians aged 65 or over completed a semi-structured interview using the ACT® Assess, which assess 53 common health and social issues across six domains. Each item was linked to a database of corresponding local resources. Over 40% of participants reported loneliness, moderate or greater pain, sleep problems, and/or bereavement – all within the Mental Health domain. However, only 32% sought Mental Health resources, compared to over 60% who sought resources for Accommodation and Finances. Participants receiving care showed greater challenges in activities of daily living and mobility. Findings suggest a high level of concern, even among a relatively healthy sample, and indicate a progression of concerns from psychosocial and home maintenance issues to mobility and functional challenges.

There is an increase in life expectancy in the Nordic countries. Research in health promotion is vital in the fields of aging and health to address present and emerging opportunities and challenges. This scoping review of doctoral theses with a health promotion focus was conducted by the ‘healthy ageing’ research group, which is part of the Nordic Health Promotion Research Network. The overall aim was to explore how research about older adults under the label ‘health promotion’ was undertaken in doctoral theses in a Nordic context, with a specific focus on the theoretical framework, and on participation, and empowerment – the guiding principles for health promotion. A scoping review following the guidelines of The Joanna Briggs Institute was carried out. Relevant databases in Denmark, Finland, Norway, and Sweden were searched for theses published between 2011 and 2021. In total 28 theses were included in the results. The results revealed that the number of theses identified with the word ‘health promotion’ in the title, as a keyword, or in the abstract varied considerably between the Nordic countries. Qualitative and quantitative methods were used, and data was collected mainly from healthy older adults living at home. Theoretical perspectives differed, and definitions of health promotion varied across the theses and were sometimes absent. In conclusion, doctoral theses within the field of healthy aging research could benefit from being more specific about the meaning and use of the concept of health promotion.

Behavioral and psychological symptoms of dementia (BPSD) are common in hospitalized older people and challenge acute care delivery. This study sought to identify available quality indicators (QIs) for BPSD, establish priorities, and explore perceived facilitators and barriers to their use. We conducted a cross-sectional electronic survey among physicians, nurses, and administrators in Quebec acute care hospitals (January–February 2025). The survey included open-ended questions analysed using Donabedian’s structure–process–outcome model. Fifty-five respondents generated 677 responses, yielding 59 themes, 44 deemed priorities. Key QIs included delirium screening, restraint and antipsychotic use, length of stay, adverse events, and resource availability. Participants emphasized the need for standardized, clinically meaningful QIs. Reported barriers included staffing shortages, fragmented technological systems, and limited institutional prioritization, while facilitators included leadership commitment, interdisciplinary support, and structured training. Embedding standardized QIs into electronic health records may enhance benchmarking, guide improvement, and promote safer dementia care.

Using different techniques to derive dietary patterns (DP) could evaluate real-world diet behaviours and provide DP recommendations. Therefore, we identified DP using hybrid methodologies and examined the associations of DP with all-cause and CVD mortality among older Chinese. Using data from the Guangzhou Biobank Cohort Study, dietary intake was assessed using a validated FFQ. DP were derived using hybrid methods including reduced rank regression (RRR) and partial least squares (PLS), focusing on nutrients commonly insufficient in Asian diets. Associations of the DP with mortality and CVD risk factors were examined using Cox regression and generalised linear models, respectively. Of 19 598 participants with an average follow-up of 15·8 years, 4966 deaths occurred. Two DP were derived based on the riboflavin-density, K:Na ratio and vitamin C-density. The DP derived from both RRR and PLS featured high intakes of green vegetables, yellow/orange fruits and whole grains and low intakes of refined grains and plant oils, with additional high intakes of fish identified by RRR and milk by PLS. These DP were associated with lower all-cause and CVD mortality risks. Compared with the lowest quartile, the highest quartiles showed lower risks of all-cause (hazard ratio (HR): 0·89–0·91, all P < 0·01) and CVD mortality (HR: 0·79–0·82, all P < 0·01). Moreover, both DP were associated with favourable cardiometabolic profiles, including lower systolic blood pressure, TAG and high-sensitivity C-reactive protein levels, and higher HDL-cholesterol levels. These findings suggest that nutrient-rich DP using hybrid methods may support the development of dietary recommendations to reduce mortality among older Chinese.

Social integration is a critical predictor of health and wellbeing for older people, yet limited research examines how older people experiencing homelessness navigate social integration and what their needs are. This study explores how 20 older adults with lived experiences of homelessness and housing precarity perceive and experience social integration in an independent housing setting with on-site support. Additionally, it aims to identify the factors that facilitate and promote social integration for this population. Drawing on semi-structured lifecourse interviews and photovoice sessions, reflexive thematic analysis identified four key themes: (1) From isolation to inclusion: narratives on social integration; (2) Space, place and social integration; (3) Unlocking pathways to deep and meaningful social interactions; and (4) Navigating social integration: the vital role of autonomy and choice. The findings reveal that social integration exists along a continuum. While some participants valued solitude and independence, others actively sought meaningful connections, or occupied a middle ground, engaging in casual interactions. Social integration was influenced by three factors: the built and natural environment, opportunities for deep and meaningful interactions, and individual autonomy and choice. These findings add to the knowledge and debate surrounding the definition of social integration and its contributory factors, especially for older adults with experiences of homelessness and housing precarity. The study underscores the need for different housing models and environments to accommodate and cater across the social integration continuum, ensuring that everyone can find their place within the community and engage in a way that feels comfortable and fulfilling for them.

Persistent concerns about loneliness and social isolation in later life have prompted increasing attention to the social and environmental factors that enable or constrain connection. Yet, while previous research has identified community and societal determinants of social connection, little is known about how these factors interact dynamically with individual and interpersonal circumstances to shape older adults’ lived connection experiences. This study addresses this knowledge gap by examining how older Australians perceive and experience environmental influences on their social connectedness, and how factors across multiple ecological levels work together to create or hinder opportunities for connection. Four focus groups were conducted with 15 participants, aged 60 years and over, from metropolitan and regional areas in New South Wales, Australia, to explore how participants described the role of different factors in their connection experiences. Participants identified a range of influences across individual, interpersonal, community and societal levels, including meaningful roles, community spaces, local businesses and transport accessibility. Three patterns of cross-level interaction were revealed: the interplay between personality and community infrastructure; the multi-level role of digital technology; and the cascading influence of policy frameworks shaping community participation opportunities. By uncovering how factors interact dynamically across social-ecological levels, this study advances understanding of the contexts that foster or constrain social connection in later life. The findings contribute to ongoing debates in social gerontology by demonstrating that loneliness and social isolation are best addressed through coordinated, multi-level interventions that align individual, community and policy environments to promote healthy ageing in place.

Unmet socio-emotional needs are a significant concern in ageing societies since they affect individuals’ health and wellbeing. This study focuses on the concept of socio-emotional care poverty, where people in need of social and emotional support do not receive sufficient support from either informal or formal sources. The research investigates whether older people have a higher, moderate or lower risk of socio-emotional care poverty. The study also explores how the composition of and the contact frequency with their social network members are associated with this phenomenon. This study used a national-level survey collected in Finland between October and December 2020 among people aged 75 years and above living in their own homes (N = 2,585). The results showed that 7 per cent (n = 175) of respondents are at high risk, while 26 per cent (n = 684) are at moderate risk of socio-emotional care poverty. The high-risk group has less frequent contact with children, siblings, relatives and friends. Relationships with both family and non-family members significantly impact socio-emotional care poverty in older people. Obtaining emotional support from family members or others outside of one’s immediate family in today’s society is becoming increasingly challenging owing to changing family structures and reduced health and social care support. Therefore, special attention should be given to older people in high-risk and moderate-risk groups to ensure that their basic care needs are met, allowing them to maintain a good quality of life.

Despite the global spread of age-friendly cities and communities (AFCC), little is known about how these programmes address place-based inequalities. This article addresses this gap by applying a ‘spatial justice’ lens to examine AFCC initiatives in seven cities centred on the interrelated components of equity, diversity and co-production. It examines how older people participate in decision making (co-production), how resources and opportunities are distributed and accessed (equity) and how the identities and needs of diverse groups are recognised (diversity) within AFCC initiatives. The article uses a multiple case study approach to examine seven cities – Akita, Bilbao, Brno, Brussels, Manchester, Oslo and Quebec – drawing on city profiles and 44 semi-structured interviews with stakeholders. The findings show that co-production occurs through universal participation structures involving residents of all ages, and through targeted structures designed specifically for older people, with the latter placing greater emphasis on representing the increasing diversity of older people. Equity is addressed through initiatives aimed at improving access to local infrastructure and services, although their redistributive effects remain unknown owing to limited evaluation and data. Diversity is reflected in targeted programmes for racially minoritised groups, sexual and gender minorities and people living with dementia. This article contributes to critical social gerontology by showing how a spatial justice lens supports a critical examination of age-friendly initiatives (AFIs), focusing on how older people are involved in decision making, who benefits from AFIs and which groups of older people remain excluded.

Undernutrition is common amongst older people and can lead to adverse health outcomes and increased dependence. This review focuses on an aspect of undernutrition that is often overlooked, namely loss of appetite, and will discuss the challenges in this under-researched field from the perspective of geriatric medicine. Appetite decline is common in later life and predicts undernutrition in older populations. As such, timely identification and intervention on poor appetite could delay onset or progression of undernutrition to optimise healthy ageing and maintain independence. In addition, management of undernutrition ultimately requires the individual to meet their nutritional requirements. However, unless attention is paid to mitigating appetite decline, strategies to improve intake are likely to be ineffective. Treatment for appetite decline is challenging due to the multiple and complex underlying mechanisms. Current evidence is limited to a few trials targeting older people including flavour enhancement and fortification or supplementation, lifestyle measures such as increasing physical activity and social interaction, and medications, all with mixed results. Progress on treatments for appetite decline has been hampered by a lack of distinction from undernutrition but also perhaps the approach to it as a concept. Categorising appetite decline in ageing as a geriatric syndrome could aid progress in the unification of approaches to mechanistic research, assessment and management strategies, which are likely to be most effective when in multi-component form and underpinned by the principles of Comprehensive Geriatric Assessment (CGA).

This article explores the experiences of social participation among Indigenous, migrant and older people with disabilities in Chile. While substantial evidence shows the importance of social participation in ageing policy, research on how diverse groups of older people in Latin America and the Caribbean (LAC) perceive and engage in it is limited. The article examines the participatory practices of these populations and the challenges they face in accessing and being included in their chosen spaces of engagement. Six focus groups were held with key informants from government offices and community-based organizations, and individual in-depth interviews were conducted with older people. The collected data were then analysed using an inductive content analysis approach. Findings show that several historical and structural factors influence social participation among the three studied groups, particularly their vulnerability to precarity and discrimination in the Chilean context. The dominant perspective of key informants on social participation – as a means of staying healthy, keeping busy and finding contentment – should be contrasted with the actual social, cultural and economic circumstances. Indeed, most of the older participants in this study stated that they use social participation as a means of exercising agency, as it allows them to develop significant and supportive relationships that facilitate their daily lives and provide opportunities for individual and collective empowerment. This article contributes to the development of social gerontology in the Global South by integrating diversity into research design and enhancing understanding of the conditions under which people in Chile age and participate in society.

Older people want to live at home for as long as possible and expect a system of care to enable this. This desire is also recognized in many national policies, where ageing in place with the support of informal caregivers is increasingly seen as a viable solution to institutional care. Despite this, refusal of such care at point of delivery can create further health issues for individuals as well as organizational challenges for care providers. This study aims to explore older people’s perceptions of why homecare is, or may be, refused. It builds on a quantitative study, where 18 per cent of instances of non-delivery of homecare in one major care provider in Scotland were categorized as ‘Service Refusal’. Data from a convenience sample of 17 people, aged 65 years and older, with experience of homecare, from the Greater Glasgow and Clyde area in Scotland, underwent framework analysis. In contrast to the quantitative study, this study uncovered an unexpected propensity for service acceptance; living at home was the presiding value and the main motivating factor to accept homecare, irrespective of its quality. This study provides a deeper understanding of the complexities of homecare from those who receive it, highlighting critical insights to inform governmental initiatives and homecare service providers. Allowing people to remain at home for as long as possible with appropriate and sustainable homecare should be central to national outcomes in Scotland, with the findings of this study also providing useful insights for homecare providers internationally.

Informal care for older people living with chronic life-limiting illnesses is associated with difficulties. The informal care system built around generational values and cultural norms is steadily weakening in rural Ghana because of economic challenges, migration, urbanisation, and changing family structure. In responding to this knowledge gap, we aimed to ascertain how the immediate family, extended family and community support impact on mechanisms underlying provision of informal care for older people living with chronic life-limiting illnesses. Ethnographic interviews were conducted amongst fifteen older people; fifteen informal caregivers; ten health care professionals, after participatory observations during six months of fieldwork utilised to gather the needed data. This study is guided by altruism, empathy, responsibility, self-interest, and social values theories, which provide a very significant structure to understand care relations in rural Ghana. While we find that informal care is sustained by cultural values, it is experiencing financial and human resource challenges.