Purpose This paper aims to explore the perceptions and experiences of a group of extra care tenants, who, as novice internet users, began to maintain their social relationships online. Housing transitions in later life may jeopardise existing social relationships, leading to loneliness and social isolation. More recently, Covid-19 restrictions have limited familial face-to-face contact and wider social interactions. Thus, extra care tenants, who are not already online, may benefit from acquiring internet skills. This paper aims to enhance understanding of the participants’ transition from novices to experienced internet users and the impact on their social relationships and sense of self. Design/methodology/approach A longitudinal, hermeneutic phenomenological study was conducted over eight months in two extra care housing schemes in north east England. Ten participants (56–98 years) with age-related physical, sensory and cognitive losses were recruited to the study. A series of semi-structured interviews and participant diaries captured the participants’ experience as they developed internet skills and communicated online. Findings All participants, including a blind individual, learnt to communicate online. Personalised adaptive strategies, peer support, training and management involvement facilitated internet uptake. Participants felt their social relationships were supported, and they regained biographical continuity, through being and feeling they belonged in the modern digital world. Originality/value The online experiences of extra care tenants are rarely voiced. Their perceptions may assist others to engage online, maintaining social connections, which could otherwise be lost.

Marja Aartsen, NOVA, Norway. Irene Aboh, University of Cape Coast, Ghana. Anita Abramowska-Kmom, Warsaw School of Economics, Poland. Marianne Abramsson, Linköping University, Sweden. Margaret Adamek, Indiana University-Purdue Univesity, USA. Roberta Adami, University of Westminster, UK. Anne Adams, Georgia Institute of Technology, USA. Tindara Addabbo, University of Modena and Reggio Emilia, Italy. Maja Adena, Wisseschaftzentrum Berlin Fuer Sozialforschung, Germany. Mahjabeen Ahmad, Independent researcher, Australia. Anya Ahmed, University of Salford, UK. Iris Aguilar, University of California, USA. Arda Aktas, International Institute for Applied Systems Analysis, Austria. Isabelle Albert, University of Luxembourg, Luxembourg. Marco Albertini, University of Bologna, Italy. Nafhesa Ali, University of Sheffield, UK. Jonathan Allan, Brandon University, Canada. Kathryn Almack, University of Hertforshire, UK. Dalal Alsaeed, University College London, UK. Silvia Amorim, Federal Fluminese University, Brazil. Sidse Andersen, University of Copenhagen, Denmark. Barbara Anderson, University of Michigan, USA. Gavin Andrews, McMaster University, Canada. Nick Andrews, Swansea University, UK. Malin Andtfolk, Åbo Akademi, Finland.Shannon Ang, University of Michigan, USA. Ang Sun, Renmin University, China. Radoslaw Antczak, Warsaw School of Economics, Poland. José-Ignacio Antón, University of Salamanca, Spain. James Antwi, University of Ghana, Ghana. Kay Aranda, University of Brighton, UK. Pat Armstrong, York University, Canada. Bruno Arpino, University of Florence, Italy. Anthony Asher, University of New South Wales, Australia. Christian Aspalter, United International College, Hong Kong. Merih Ates, University of Mannheim, Germany. Rachel August, California State University, USA. Boucher Aurelien, The Chinese University of Hong Kong, China. Siobhan Austen, Curtin University of Technology, Australia.

Despite indications that Traveller Communities face particular vulnerabilities to fuel poverty, research on Travellers’ experiences of energy provision, consumption and advice is scant. We report on a qualitative case study evaluation of face-to-face energy advice for Traveller Communities in the north of England. The service was instrumental in building trust, facilitating access to entitlements, and increasing control over energy bills. However, the impact of the service was limited by structural and spatial constraints surrounding energy provision on the Traveller site that resulted in disproportionate fuel costs for residents.

Intravenous immunoglobulin (IVIg) is a common therapy for patients with immune thrombocytopenia (ITP). The initial response rate for IVIg is 80%[1][1] and is typically rapid, with some patients responding in 24 hours, although usually in 2–4 days.[2][2] When IVIg is used alone, the response is

Purpose Quality, accessible and appropriate housing is key to older people’s ability to live independently. The purpose of this paper is to understand older people’s housing aspirations and whether these are currently being met. Evidence suggests one in five households occupied by older people in England does not meet the standard of a decent home. The Building Research Establishment has calculated that poor housing costs the English National Health Service £1,4bn annually (Roys et al., 2016). Design/methodology/approach This paper reports on the findings of a participatory theatre approach to engaging with those not often heard from – notably, those ageing without children and older people with primary responsibility for ageing relatives – about planning for housing decisions in later life. The project was led by an older people’s forum, Elders Council, with Skimstone Arts organisation and Northumbria University, in the north east of England. Findings Findings suggest there is an urgent need to listen to and engage with people about their later life housing aspirations. There is also a need to use this evidence to inform housing, health and social care policy makers, practitioners, service commissioners and providers and product and service designers, to encourage older people to become informed and plan ahead. Research limitations/implications Use of a participatory theatre approach facilitated people to explore their own decision making and identify the types of information and support they need to make critical decisions about their housing in later life. Such insights can generate evidence for future housing, social care and health needs. Findings endorse the recent Communities and Local Government (2018) Select Committee Inquiry and report on Housing for Older People and the need for a national strategy for older people’s housing. Originality/value Although this call is evidenced through an English national case study, from within the context of global population ageing, it has international relevance.

Older people, even those living with long-term conditions or poor mobility, can be supported to live well at home, through adapting their home to meet changing need. Installing home adaptations, from grab rails to walk in shower rooms, is cost effective, may prevent falls, reduce social isolation and improve self confidence. Despite austerity cuts to public spending, the UK government increased home adaptations' funding. However, not much is known about older people's experiences and understanding of acquiring and living with home adaptations and uptake of home adaptations could be improved. Using wearable camera and face to face interview data, this qualitative study explored a diverse group of older people's retrospective experiences (n = 30). Focus group discussions were also carried out with a wide range of professionals involved in the provision of home adaptations (n = 39). Findings suggest people may delay having adaptations, because of perceived stigmatising associations with decline and vulnerability. As delaying the installation of home adaptations until crisis point is known to reduce their effectiveness, such associations need to be challenged.

Background: The visually impaired have a higher risk of falling and are likely to avoid activity. Objectives: To adapt the existing Falls Management Exercise (FaME) programme, which is delivered in the community, for visually impaired older people (VIOP) and to investigate the feasibility of conducting a definitive randomised controlled trial of this adapted intervention. Design: Phase I – consultation with stakeholders to adapt the existing programme. Two focus groups were conducted, each with 10 VIOP across the study sites. Phase II – two-centre randomised pilot trial and economic evaluation of the adapted programme for VIOP versus usual care. Phases III and IV – qualitative interviews with VIOP and Postural Stability Instructors regarding their views and experiences of the research process, undertaking the intervention and its acceptability. Intervention: This was adapted from the group-based FaME programme. A 1-hour exercise programme ran weekly over 12 weeks at the study sites (Newcastle upon Tyne and Glasgow) and was delivered by third-sector organisations. Participants were advised to also exercise at home for 2 hours per week. Those randomised to the usual activities group received no intervention. Outcome measures: These were completed at baseline, week 12 and week 24. The primary potential outcome measure used was the Short Form Falls Efficacy Scale – International. Secondary outcome assessment measures were activity avoidance, current activity, balance/falls risk, physical activity, loneliness, anxiety and depression, work and social adjustment, quality of life and economic costs. Participants’ compliance was assessed by reviewing attendance records and self-reported compliance with the home exercises. Instructors’ compliance with the course content (fidelity) was assessed by a researcher attending a sample of exercise sessions. Adverse events were collected in a weekly telephone call for all participants in both the intervention and control arm. Findings: An adapted exercise programme was devised with stakeholders. In the pilot trial, 82 participants drawn from community-living VIOP were screened, 68 met the inclusion criteria and 64 were randomised, with 33 allocated to the intervention and 31 to the usual activities arm. A total of 94% of participants provided data at week 12 and 92% at week 24. Adherence to the study was high. The intervention was found to be both safe and acceptable to participants, with 76% attending nine or more classes. Median time for home exercise was 50 minutes per week. There was little or no evidence that fear of falling, exercise, attitudinal or quality-of-life outcomes differed between trial arms at follow-up. Thematic analysis of the interviews with VIOP participants identified facilitators of and barriers to exercise, including perceived relevance to health, well-being and lifestyle, social interaction, self-perception and practical assistance. Instructors identified issues regarding level of challenge and assistance from a second person. Limitations: The small sample size and low falls risk of the study sample are study limitations. Conclusion: Although adaptation, recruitment and delivery were successful, the findings (particularly from qualitative research with instructors and participants) indicated that VIOP with low to moderate falls risk could be integrated into mainstream programmes with some adaptations. A future definitive trial should consider graduated exercises appropriate to ability and falls risk within mainstream provision. Other outcome measures may additionally be considered. Trial registration: Current Controlled Trials ISRCTN16949845. Funding: This project was funded by the NIHR Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 4. See the NIHR Journals Library website for further project information.

BACKGROUND:The needs of older people in Black Minority and Ethnic (BAME) communities require culturally appropriate services provision, but little is known about how BAME older people support themselves and others, what they perceive to be their "needs", and, critically, the extent to which they feel such needs are being appropriately met.OBJECTIVE:To enable older women from a BAME community to work with health and social care professionals and organisations, to support independent living.METHODS:In 2016, all 15 members of a BAME older women's social group attached to a Women's Centre in the North East of England, approached the research team to support achieving this objective. They did not wish to be co-researchers. A collaborative participatory inquiry was carried out. The research team and the older social group designed, together, 4 workshops that explored (1) health and well-being; (2) home and housing; and (3) services and support. There was also an evaluative session with stakeholders, and the research team managed research processes.FINDINGS:Most of the women described living with mobility and health challenges requiring change and adaptation. Language and literacy might be barriers to building confidential professional relationships with primary care professionals. The women emphasised needing a "little bit of help" in the home, that is affordable, culturally appropriate, and on their terms. They stressed such help would make them less reliant on busy family members and restore status, purpose, and standing.CONCLUSION:Findings do not address all BAME older people's needs. They do, however, have implications for how health and social care services can work with older people from BAME communities, to promote and maintain meaningful independence, on their terms.

We report the case of an 84-year-old male, who presented with septicaemia, abdominal and back pain. The patient had a background of oesophageal carcinoma and had undergone previous oesophagectomy and gastric pull-up operation 10 years ago. A computerised topography scan demonstrated a probable gastro-vertebral communication with a destructive process at the T8/T9 vertebral level. Further evaluation with MRI clearly showed the tract between the two structures and confirmed the diagnosis of spondylodiscitis at the adjacent spinal level. The patient was resuscitated, treated with intravenous antibiotics and kept nil by mouth. A subsequent gastroscopy demonstrated an eroding gastric ulcer at the enteric opening of the tract between the tubal stomach and the spinal column. The diagnosis was discussed with the patient, his family and the surgical multidisciplinary team. Given the extent of disease and his multiple medical co-morbidities, the decision was made for conservative management and symptom control. This is the first case of a gastro-vertebral communication causing spondylodiscitis to be described in the literature.

In general, households rely on energy providers to supply essential energy services such as gas and electricity. It seems reasonable to assume that it is mutually beneficial to have a customer and supplier relationship invested in trust. Key findings from the qualitative evaluation findings of a UK Comic Relief-funded energy services and managing money better programme, suggest that the programme’s effectiveness was strongly affected by negative narratives about energy suppliers. Such narratives, rooted in feelings of being labelled a ‘cheat’ or incapable of sorting their own affairs on one side and views of energy providers being exploitative and profit-hungry on the other, engendered a common, oppositional ‘united against them’ culture, built on reciprocal mistrust and disrespect. This analysis is not unique to our research, as nationally, at least and within the last decade, there has been a decline in public trust of energy providers, with a suggestion that profit has come before people. The 3-year evaluation carried out by Northumbria University, UK with the research led by a North East England registered credit union and social landlord, assessed the quality of life impacts of a face-to-face energy advice service. Expert Energy Advisors offered free home visits and gave people aged 50 and over the tools to reduce and manage energy usage, question energy companies about tariff terms and conditions and ensure maximum take up of benefit entitlements. Whilst findings point to positive health and social benefits, including reducing high anxiety about unmanageable bills, being able to question and challenge energy providers ‘high’ bills and tariffs and passing on such skills to others, there remained a ‘taken-for-granted’ mistrust of energy providers. We argue that for public good to come from public health research, we need to understand and appropriately address the roots of such cultural narratives.

This chapter explores older people's experiences of resilience in their neighbourhoods through a creative, participatory approach. Creative participatory engagement can help to translate public conversations into public policy and practice. The chapter argues that solutions cannot all be created within the neighbourhood. The notion that ageing and living well in neighbourhoods is down to individual capability, or can be managed collectively at a local level, is an abdication of state responsibility. If resilience is built from the situated self, then neighbourhoods need to be ‘ready for ageing’ and to recognise that older people wish to remain involved, connected, and engaged with all generations. Such resilient neighbourhoods should enable everyone to age well in place, particularly if influenced by a responsive policy landscape and strong lobbying for appropriate resources.

This report summarises the findings from recent research conducted on the lived experiences of home adaptations, funded by the Centre for Ageing Better. It draws on the views of both people in later life and practitioners to explore the home adaptations journey, including triggers, access, installation and outcomes. Given that most older people live in mainstream accommodation and wish to continue living in their current property, the ability to modify one’s home environment to meet changing needs is central to facilitating healthy ageing in place. The report highlights the importance of how personal contexts exhibit influence over each stage of the journey and recommends that delivery of home adaptation services and their future evaluations consider important contextual factors.

The aim of this study was to examine sheltered housing tenants' views of health and well-being, the strategies they adopted to support their well-being, and their use of health and social care services through a Health Needs Assessment. Sheltered housing in the UK is a form of service-integrated housing for people, predominantly over 60. The study used a parallel, three-strand mixed method approach to encompass the tenants' perceptions of health and well-being (n = 96 participants), analysis of the service's health and well-being database, and analysis of emergency and elective hospital admissions (n = 978 tenant data sets for the period January to December 2012). Tenants' perceptions of well-being were seen to reinforce much of the previous work on the subject with strategies required to sustain social, community, physical, economic, environmental, leisure, emotional and spiritual dimensions. Of the tenants' self-reported chronic conditions, arthritis, heart conditions and breathing problems were identified as their most common health concerns. Hospital admission data indicated that 43% of the tenant population was admitted to hospital (886 admissions) with 53% emergency and 47% elective admissions. The potential cost of emergency as opposed to elective admissions was substantial. The mean length of stay for emergency admissions was 8.2 days (median 3.0 days). While elective hospital admission had a mean length of stay of 1.0 day (median 0.0 days). These results suggest the need for multi-professional health, social care and housing services interventions to facilitate sheltered housing tenants' aspirations and support their strategies to live well and independently in their own homes. Equally there is a need to increase tenants' awareness of health conditions and their management, the importance of services which offer facilitation, resources and support, and the key role played by prevention and reablement.

Introduction: In the UK, 1 in 5 people aged 75 and over live with sight loss. Visually impaired older people (VIOP) have an above average incidence of falls and 1.3-1.9 times more likely to experience hip fractures, than the general population. Older people with eye diseases are similar to 3 times more likely than those with good vision, to limit activities due to fear of falling. This feasibility study aims to adapt the group-based Falls Management Exercise (FaME) programme to the needs of VIOP and carry out an external pilot trial to inform the design of a future definitive randomised controlled trial.Methods and design: A UK based 2-centre mixed methods, randomised, feasibility study will be conducted over 28 months. Stakeholder panels, including VIOP, will make recommendations for adaptations to an existing exercise programme (FaME), to meet the needs of VIOP, promoting uptake and adherence, while retaining required effective components of the exercise programme. 80 VIOP aged 60 and over, living at home, ambulant with or without a walking aid, will be recruited in Newcastle (n=40) and Glasgow (n=40) through National Health Service (NHS) Trusts and third sector partners. Participants randomised into the intervention arm will receive the adapted FaME programme. Participants randomised into the control arm will continue with usual activity. Outcomes are, recruitment rate, adherence and validated measures including fear of falling and quality of life. Postintervention in-depth qualitative interviews will be conducted with a purposive sample of VIOP (N=10). Postural stability instructors will be interviewed, before trial-specific training and following the intervention.Ethics and dissemination: Ethics approval was secured through the National Research Ethics Service (NRES) Committee North East, Newcastle and North Tyneside 2. Glasgow Caledonian University was approved as a non-NHS site with local ethics approval. Findings will be disseminated through peer-reviewed journals, national and international conferences.

There has been little research that addresses the importance of place in enabling resilience and citizenship – most to date focussing on these as a characteristic of the individual. This paper reports on findings from a qualitative study that aimed to explore the everyday experiences of living with dementia within rural and semi-urban communities. Data collection included a sequence of four research diaries and interviews with 13 families living at home with dementia and interviews with service providers and commissioners (a total of 57 diaries, 69 interviews with people living with dementia and 6 interviews with service providers and commissioners). Key themes identified included: Others Knowing and Responding; Socially Withdrawing and Feeling Excluded; Sustaining and Changing Activities; Belonging and Estrangement from Place; Engaging Services and Supports. The study found that familiarity with people and place can be supportive, and these factors support a narrative citizenship in which people can tell a story of inclusion and feeling on the inside. However, this familiarity with place may also create a social barrier and a sense of estrangement, or being on the outside. Narrative citizenship allows us to explore how people with dementia position themselves in relation to others and in so doing, negotiate their own and other’s understandings of dementia. It also allows for people to tell stories about themselves in relation to their sense of belonging in a social and physical place, which augment the personal and political approaches to citizenship and thus offers an approach that enhances individualised yet collective understandings of living with dementia.

Purpose – The purpose of this paper is to report on a small telehealth pilot in local authority sheltered housing in NE England. This explored the training and capacity building needed to develop a workforce/older person, telehealth partnership and service that is integrated within existing health, social care and housing services. Design/methodology/approach – A qualitative case study approach on the implementation and deployment of a pilot telehealth service, supporting sheltered housing tenants with Chronic obstructive pulmonary disease (n=4). Findings – Telehealth training and capacity building, needs to develop from within the workforce/older person partnership, if a usable and acceptable telehealth service is to be developed and integrated within existing health, care and housing services. To be adaptable to changing circumstances and individual need, flexible monitoring is also required. Practical implications – Service users and workforces, need to work together to provide flexible telehealth monitoring, that in the longer term, may improve service user, quality of life. Originality/value – The pilot explored a workforce/older person partnership to consider how to add and implement telehealth services, into existing health and housing services.