Professor Sara Arber

This chapter discusses how the sleep of older people is linked to issues of autonomy and active ageing. For older people living in the community, this chapter demonstrates how the strategic use of napping is related to the goal of active ageing, discusses the reluctance of older people to take prescribed sleeping medication, and examines how care-giving can adversely affect the sleep of older people. For older people living in care homes, care home routines, staffing levels at night and night-time monitoring by staff can compromise the sleep of care home residents, which has implications for their daytime functioning. This chapter argues that poor sleep is often ignored by both the medical profession and by the general public, yet is fundamental in terms of optimising health and well-being in later life, and enabling older people to achieve independent and active lives.

This chapter examines the interrelationships of the three sets of resources showing how the resource triangle is gendered, with older women systematically disadvantaged in each of these three key resources. They are: first, the bodily resources of health and functional abilities of the individual and other household members; second, material or structural resources such as income, assets, car ownership, housing and the quality of the home environment; and third, access to personal, domestic and health care. Gender differences in self-assessed health are relatively modest in later life and are less important than differences associated with class. The chapter shows that how health in later life is closely associated with position in the labour market during adult life, those previously in manual occupations having the highest levels of physical disability and poorer self-assessed health. It provides a framework for understanding the interrelationship between health and other aspects of elderly women's and men's lives.

Objective: International differences in disease prevalence rates are often reported and thought to reflect different lifestyles, genetics, or cultural differences in care-seeking behavior. However, they may also be produced by differences among health care systems. We sought to investigate variation in the diagnosis and management of a "patient" with exactly the same symptoms indicative of depression in 3 different health care systems (Germany, the United Kingdom, and the United States).Method: A factorial experiment was conducted between 2001 and 2006 in which 384 randomly selected primary care physicians viewed a video vignette of a patient presenting with symptoms suggestive of depression. Under the supervision of experienced clinicians, professional actors were trained to realistically portray patients who presented with 7 symptoms of depression: sleep disturbance, decreased interest, guilt, diminished energy, impaired concentration, poor appetite, and psychomotor agitation or retardation.Results: Most physicians listed depression as one of their diagnoses (89.6%), but German physicians were more likely to diagnose depression in women, while British and American physicians were more likely to diagnose depression in men (P = .0251). American physicians were almost twice as likely to prescribe an antidepressant as British physicians (P = .0241). German physicians were significantly more likely to refer the patient to a mental health professional than British or American physicians (P < .0001). German physicians wanted to see the patient in follow-up sooner than British or American physicians (P < .0001).Conclusions: Primary care physicians in different countries diagnose the exact same symptoms of depression differently depending on the patient's gender. There are also significant differences between countries in the management of a patient with symptoms suggestive of depression. International differences in prevalence rates for depression, and perhaps other diseases, may in part result from differences among health care systems in different countries.

Family members (or health-care confidants) of incapacitated patients are often consulted by doctors when making life-prolongation decisions. Little research has been conducted on confidants' views on life prolongation and advance care planning. This study investigated the health-care confidant's view on life prolongation and their involvement in being a potential decision-maker for their relatives in the event of incapacitation. Confidants (N = 12) were interviewed and interviews were analysed using Interpretative Phenomenological Analysis. The analysis revealed three themes relating to their perception of being a potential decision-maker for a relative's life prolonging measures: “good” and “bad” death based on past experience and perceptions of quality of life, a sense that discussions were inappropriate at present, and strategies which might be used to encourage discussion. The implications of these findings for family involvement in life-prolongation decisions and how to encourage family discussions about life prolongation are discussed.

Aim The aim of this study was to undertake a detailed exploration of sleep in the context of 24 hours in a care home environment, exploring the subjective experience of residents and the perceptions of staff. Method Qualitative research in four care homes for older people consisting of semi-structured interviews and ethnographic observations. Interviews were conducted with 38 residents and 39 staff, and were analysed using a grounded theory approach. Findings The findings have highlighted some challenges and opportunities for developing practice in care homes to improve residents' sleep. In addition to pain and physical disabilities, the physical environment and practices in care homes can affect residents' sleep and night-time experience. Conclusion Improving our understanding of residents' and staff's experiences at night in care homes can inform the development of good practice in night-time care and contribute to a positive culture of person-centred care.© 2013 RCN Publishing Ltd. All rights reserved.

In divergent ways, both government policy and care home practices influence the everyday life of older people living in English care homes. The rhetoric of choice for care home residents may be in conflict with the reality of government policy-driven service delivery. The aim of the article is to examine the role of organised activities in facilitating choice and active ageing among care home residents. Findings from a study of ten care homes in South East England exemplify the conflict between government policy rhetoric and the reality of care home life. The indication is that the formality of the "activities of daily living" support procedures restricts residents' involvement in the organised social activities.Within the general provision of services, the organised "social activities" offered failed to meet the interest, cognitive and physical abilities of residents. The reality of "choice" is therefore questionable. Policy needs to support a transformation in the delivery of care to ensure it addresses the actual needs and expectations of older people experiencing care home life. © The Author.

This paper analyzes data from a nationally representative survey of adults in the United Kingdom (Understanding Society, N = 37,253) to explore the marital status/health nexus (using categories that include a measure of relationship distress) and to assess the role that sleep problems play as a potential mediator. Findings indicate how it is not just the "form" marital status takes but also the absence or presence of relationship distress that is essential to self-rated health. We demonstrate two further findings that: (1) sleep problems act as a mediator of the link between marital status/relationship distress and self-rated health, most notably for those in cohabiting relationships with medium/high distress or who have a history of relationship loss, and (2) the mediating role of sleep problems differs for divorced men and women.

In this paper we seek to understand the influence of gender on the different approaches to managing poor sleep by older men and women through the conceptual framework of existing theoretical debates on medicalization, healthicization and 'personalization'. In-depth interviews undertaken between January and July 2008 with 62 people aged 65-95 who were experiencing poor sleep, revealed that the majority of older men and women resisted the medicalization of poor sleep, as they perceived sleep problems in later life were an inevitable consequence of ageing. However, older men and women engaged differently with the healthicization of poor sleep, with women far more likely than men to explore a range of alternative sleep remedies, such as herbal supplements, and were also much more likely than men to engage in behavioural practices to promote good sleep, and to avoid practices which prevented sleep. Women situated 'sleep' alongside more abstract discussions of 'diet' and health behaviours and drew on the discourses of the media, friends, family and their own experiences to create 'personalized' strategies, drawn from a paradigm of healthicization. Men, however, solely relied on the 'body' to indicate when sleep was needed and gauged their sleep needs largely by how they felt, and were able to function the following day. © 2012 Elsevier Ltd.

Free time, that is, the time that remains at one's own discretion after conducting daily work and personal care activities, has been previously recognized as a ‘primary good’ and an important welfare resource that provides opportunities for participation in social life and leisure. However, recent years have witnessed an increasing preoccupation with the phenomenon of time poverty, drawing attention to the distribution of free time and its relationship to structural and family circumstances. In this article we propose a novel approach to the measurement of time poverty and document its occurrence amongst British workers. In line with previous literature, a conceptualization of time poverty as a relative lack of free time resources vis-à-vis other members of the community is adopted. However, unlike previous empirical studies, we investigate the differential configuration of time poverty on weekdays and weekend days, alongside indicators of the quality of free time, taking into account insights from theoretical and empirical work within the field of the sociology of time. Our analysis of the 2000 UK Time Use Survey highlights class and gender inequalities that have been missed by previous measurement approaches and demonstrates that, overall, working women experience multiple and more severe free time constraints, which may constitute an additional barrier for their leisure and social participation.

Work and family are two key domains of life among working populations. Conflicts between paid work and family life can be detrimental to sleep and other health-related outcomes. This study examined longitudinally the influence of work–family conflicts on subsequent sleep medication. Questionnaire data were derived from the Helsinki Health Study mail surveys in 2001–2002 (2929 women, 793 men) of employees aged 40–60 years. Data concerning sleep medication were derived from the Finnish Social Insurance Institution’s registers covering all prescribed medication from 1995 to 2007. Four items measured whether job responsibilities interfered with family life (work to family conflicts), and four items measured whether family responsibilities interfered with work (family to work conflicts). Cox proportional hazard models were fitted, adjusting for age, sleep medication five years before baseline, as well as various family- and work-related covariates. During a five-year follow-up, 17% of women and 10% of men had at least one purchase of prescribed sleep medication. Among women, family to work conflicts were associated with sleep medication over the following 5 years after adjustment for age and prior medication. The association remained largely unaffected after adjusting for family-related and work-related covariates. Work to family conflicts were also associated with subsequent sleep medication after adjustment for age and prior medication. The association attenuated after adjustment for work-related factors. No associations could be confirmed among men. Thus reasons for men’s sleep medication likely emerge outside their work and family lives. Concerning individual items, strain-based ones showed stronger associations with sleep medication than more concrete time-based items. In conclusion, in particular family to work conflicts, but also work to family conflicts, are clear determinants of women’s sleep medication.

Negative impacts of night work on employees are well documented, but little is known about immediate consequences for family members. This study examines how night work within a rotating shift pattern affects the sleep, mood and cortisol levels of female nurses, their husbands and children. Participants included twenty nurses (42.7 ± 6.5 years), their husbands and children (n=34, 8-18 years) who completed sleep diaries, rated their sleep quality, alertness and mood daily, and collected saliva samples each morning and evening for 14 days. Comparisons were made between night work and other shifts (Wilcoxon Signed Ranks test); and between periods preceding, during and following night shifts (repeated measures ANOVA with Tukey posthoc tests). Nurses’ sleep after the final night shift was significantly shorter (3h 58 mins ± 46 mins) and ended significantly earlier (13:28 ± 0:48h) than after the first night shift (sleep duration 5h 17 mins ± 1h 36 mins; wake time 14:58 ± 1:41h) (p

Background Studies using conventional socioeconomic indicators have reported inconsistent evidence on socioeconomic differences in complaints of insomnia. We lack studies using a comprehensive socioeconomic framework over the life course ranging from childhood to adulthood. This study therefore aimed to examine the associations of both past and present socioeconomic circumstances with complaints of insomnia. Methods Data were derived from cross-sectional postal surveys (2000–2002) representative of the staff of the City of Helsinki, Finland (n = 8960, aged 40–60 years). Socioeconomic circumstances were measured by parental education, childhood economic difficulties, own education, occupational class, household income, housing tenure, and current economic difficulties. Complaints of insomnia during the previous month were measured by difficulties initiating and maintaining sleep and non-restorative sleep. Logistic regression analysis was used, adjusting for age and marital status. Results Complaints of insomnia at least once a week were reported by 25% of women and 21% of men. Childhood economic difficulties showed associations with complaints of insomnia among both women (OR 1.52; 95% CI 1.31–1.76) and men (OR 2.25; 95% CI 1.67–3.02) even after full adjustments. Also current economic difficulties remained associated with complaints of insomnia, but only among women (OR 1.65; 95% CI 1.41–1.93). However, education, occupational class, and income showed only limited age-adjusted associations with complaints of insomnia and these associations disappeared after full adjustments. Discussion Past and present economic difficulties were strongly associated with current complaints of insomnia. Supporting both families with children and adults to cope with their economic difficulties might reduce complaints of insomnia in adulthood.

Sleep is fundamental to health and well-being, yet relatively little research attention has been paid to sleep quality. This paper addresses how socio-economic circumstances and gender are associated with sleep problems. We examine (i) socio-economic status (SES) patterning of reported sleep problems, (ii) whether SES differences in sleep problems can be explained by socio-demographic characteristics, smoking, worries, health and depression, and (iii) gender differences in sleep problems, addressing the relative contribution of SES, smoking, worries, health and depression in explaining these differences. Logistic regression is used to analyse the British Psychiatric Morbidity Survey 2000, which interviewed 8578 men and women aged 16–74. Strong independent associations are found between sleep problems and four measures of SES: household income, educational qualifications, living in rented housing and not being in paid employment. Income differences in sleep problems were no longer significant when health and other characteristics were adjusted. The higher odds of sleep problems among the unemployed and adults with low education remained significant following adjustment. Women reported significantly more sleep problems than men, as did the divorced and widowed compared with married respondents. Gender differences in sleep problems were halved following adjustment for socio-economic characteristics, suggesting that SES inequalities play a major part in accounting for gender differences in sleep problems. Our study casts doubt on the primacy of physiological explanations underlying these gender differences. Since disadvantaged socio-economic characteristics are strongly associated with sleep problems, we conclude that disrupted sleep may be a mechanism through which low SES is linked to poor health.

Recent literature has highlighted the sociological significance of sleep and has suggested that sleep offers a ‘window’ onto the gendered nature of our lives. Yet within this body of work men's sleep has been largely ignored. This paper seeks to rectify this omission and situates itself at the intersection between literature on the sociological aspects of sleep and social-constructionist-orientated writings on men's health. It draws upon qualitative data from 40 men to investigate male understandings of, and attitudes towards, sleep. At first glance, it could be suggested that men have little regard for sleep, and are prone to taking risks with their dormancy. Viewed in this way sleep becomes an instrument used in the negotiation of status and power and intrinsically bound up with the demonstration of masculinities. Yet, men's relationship with sleep is more complex than this. Amongst other things, the men within the present study were embroiled in a function/non-function dichotomy. Sleep was seen as needed for the praxis of ‘father’, ‘worker’, ‘husband’ and ‘mate’ but was also considered as something which should not get in the way of performing these roles.

Everyday social order is said to be based on appropriate bodily conduct. The emphasis on day raises at least two questions for the sociological study of sleep: the first concerns the existence of a ‘sleep habitus’ and whether sleeping bodies can ever be ‘unruly’. The second involves the possibilities for breaching or mediating any such ‘sleep habitus’. What we suggest here is that any ‘sleep habitus’ does appear to be limited. If a sleeper is considered to be ‘unconscious’, in a private space, and in an intimate relationship with his or her audience, bodies appear free to do anything without invoking the need for embarrassment. However, at the same time, couples do suggest that sleeping bodies can feel embarrassed, and thus can experience failed ‘impression management’. Gender and length of relationship appear important factors here. For example, as a relationship becomes ‘routinized’ couples learn to ‘fit together’, and to ‘mutually adapt’. Although, this fitting together negates the requirement for ‘private’ embarrassment, it may actually increase the likelihood that the private is ‘leaked’ into the public domain and thus, augment the possibilities for ‘reputational’ embarrassment.

Cardiopulmonary resuscitation (CPR) may be used by default on patients suffering a cardiac arrest in hospital in the UK unless there is an order that specifies otherwise in the patient's notes. Guidelines recommend that the decision involves competent and willing patients or, in the case of incapacitation, their families. In practice, patient autonomy is often compromised. Ideally, discussion of preferences for end-of-life care should take place prior to hospitalisation. The majority of research on this topic has been conducted on hospitalised patients, so little is known about the views of older, but healthy, people about resuscitation decision-making. The present study was designed to address this gap. A series of eight focus groups involving a total of 48 participants over the age of 65 was conducted to explore people's views about the factors guiding resuscitation decision-making. A qualitative analysis, which emphasised the dilemmatic nature of resuscitation decision-making, identified two broad thematic dilemmas that subsumed six specific themes which contribute to resolving the dilemmas: quality of life (medical condition, mental versus physical incapacity, age and ageing, and burden), and the involvement of others (doctors and families) versus loss of autonomy. The dilemma underlying quality of life is that an acceptable quality of life after CPR cannot be assured. The dilemma underlying the involvement of others is that individual autonomy may be lost. The themes and subthemes provide the basis for guiding these difficult discussions in advance of serious illness.

The power of medical technologies to extend the final stages of life has heightened the need to understand what factors influence older people's wish to use such medical technologies. We analyse gender differences in such views, based on audio-recorded interviews with 33 men and 36 women (aged 65–93) in south-east England. Older women were twice as likely as men to oppose using medical technologies to extend life. More older women voiced ‘other-oriented’ reasons for their opposition, particularly not wanting to be a burden on others. Older men's attitudes were primarily ‘self-oriented’, reflecting a concern to stay alive for as long as possible, with fewer expressing concern about consequences for others. Women's greater life course involvement in caring and empathising with the wishes and concerns of others underlay these gender differences. Thus, women were ‘performing gender’ by putting others before themselves, even at this critical juncture in their lives.

This paper examines the amount of time that care-home residents spend in bed at night, focusing on how residents' bedtimes and getting-up times are managed. Using a mixed-methods approach, diary data were collected over 14 days from 125 residents in ten care homes in South East England. The findings indicate that residents spent, on average, nearly 11 hours in bed at night, significantly more time than was spent sleeping. There was greater variance in the amount of time residents who needed assistance spent in bed than there was for independent residents. Detailed investigation of six care homes, each with 8 pm to 8 am night shifts, showed that bedtimes and getting-up times for dependent residents were influenced by the staff's shift patterns. Analysis of qualitative interviews with 38 residents highlighted a lack of resident choice about bedtimes and many compromises by the residents to fit in with the care-home shift and staffing patterns. The social norm of early bedtimes in care homes also influenced the independent residents. It is argued that the current system in care homes of approximately 12-hour night shifts, during which staff ratios are far lower than in the daytime, promotes an overly long ‘night-time’ and curbs residents' choices about the times at which they go to bed and get up, particularly for the most dependent residents.

Within western societies it is commonplace for couples to share a bed. Yet there has been remarkably little research carried out on couples’ sleep. This paper draws upon actigraphy, audio diary and questionnaire data from both partners in 36 heterosexual couples (age 20-59) and aims to quantify the extent to which it is important to take the dyadic nature of sleep-wake cycles into account. It achieves this through two interrelated aims: (i) to use Hierarchical Linear Models to measure dyadic interdependence in actigraphically recorded variables; and (ii) to investigate how much of this dyadic interdependence truly results from couple dynamics. The variables with the most significant couple interdependency were ‘Actual bed time’, ‘Sleep latency’, ‘Light/Dark ratio’ and ‘Wake bouts’. The paper concludes by suggesting that interdependence may be the defining feature of couples’ sleep and that we need to employ analytic approaches which both acknowledge this and which are sensitive to the possibilities that not all aspects of sleep will behave in the same way.

Despite the recent theoretical focus on the emergence of the Third Age as a period of fulfilment and an ongoing engagement with an active leisure lifestyle, there is a dearth of quantitative studies on how older people spend their time. Few studies of later life capitalise on time-use surveys, which constitute the most widely employed and accurate methodology for collecting data on everyday life. This article analyses data from the 2000 UK Time Use Survey in order to operationalise the concept of the Third Age and test theoretical propositions regarding the irrelevance of social divisions in the formation of an active leisure lifestyle after retirement. The analysis focuses on a subsample of 1615 people over the age of 64. An index of active leisure activities is constructed in order to estimate the proportion of third agers amongst British retirees. Logistic regression models are specified to examine the relative influence of socio-demographic characteristics on the probability of a person being a third ager. Strong effects of structural factors and health are found, which do not support arguments suggesting a minor influence of social context in lifestyle choices after retirement. 'Active' ageing appears to be the province of those who are culturally and materially advantaged, and it is the healthy, educated, upper-class and middle-class men that are more likely to engage in a Third Age leisure lifestyle.

The relationship between health and income is well established, but the link between subjective financial wellbeing and self-assessed health has been relatively ignored. This study investigates the relationship between health, subjective financial wellbeing and income in mid-life and later life in Britain. Analysis of the General Household Survey for 2006 examined these relationships at ages 45-64 (n=4639) and 65 and over (n=3104). Logistic regression analysis was used to adjust for income and other socioeconomic factors linked to self-assessed health. Both income and subjective financial wellbeing are independently associated with health in mid-life; those with lower incomes and greater subjective financial difficulties had higher risk of reporting ‘less than good’ health. In contrast in later life, subjective financial wellbeing was associated with health, but the effect of income on health was mediated entirely through subjective financial wellbeing. The poorer health of the divorced/separated was also mediated entirely by differences in subjective financial wellbeing. Research on health inequalities should pay greater attention to the link between subjective financial hardship and ill-health, especially during periods of greater economic difficulties and financial austerity.

Caregiving research has rarely examined the nature and impact of care provision at night. This paper analyses indepth interviews with 24 older people in England whose sleep had been adversely affected by providing care at night. A framework is proposed that illustrates how six aspects of caregiving can disrupt carers' sleep quality: first, attending to the night-time physical needs of the care recipient; second, anticipation of their night-time care needs; third, ‘monitoring’ their relative at night; fourth, disruption from relatives who are awake for long periods at night, wandering or shouting; fifth, undertaking emotional support, and worries or anxieties related to their relative; and finally, the legacy of caregiving may continue to disrupt sleep after caring ceases, because of painful images of their relative's suffering or feelings of guilt. Adverse effects on carers' sleep are greatest for co-resident carers, especially when caring for a spouse or relative with a life-limiting illness or dementia.

Sleep disturbances are a common problem among institutionalised older people. Studies have shown that this population experiences prolonged sleep latency, increased fragmentation and wake after sleep onset, more disturbed circadian rhythms and night-day reversal. However, studies have not examined the extent to which this is because of individual factors known to influence sleep (such as age) or because of the institutional environment. This paper compares actigraphic data collected for 14 days from 122 non demented institutional care residents (across 10 care facilities) with 52 community dwelling poor sleepers aged over 65. Four dependent variables are analysed: i) the ‘interdaily stability’ (IS); ii) the ‘intradaily variability’ (IV); iii) the relative amplitude (RA) of the activity rhythm; and iv) the mean level of activity during the 24 hour day. Data are analysed using a fixed effects, single level, model (using MLwiN). This model enables comparisons between community and institutional care groups to be made whilst conditioning out possible ‘individual’ effects of ‘age’, ‘gender’, ‘level of dependency’, ‘level of incontinence care’, and ‘number of regular daily/prescribed medications’. After controlling for the effects of a range of individual level factors, and after controlling for unequal variance across groups (heteroscedascity), there is little difference between community dwelling older adults and institutional care residents in IS score; suggesting that the stability of day to day patterns (such as bed times, get up times, lunch times etc) is similar within these two resident groups. However, institutional care residents do experience more fragmented rest/wake patterns (having significantly higher IV scores and significantly lower mean activity values). Our findings strongly suggest that the institutional care environment itself has a negative association with older people’s rest/wake patterns; although longitudinal studies are required to fully understand any causal relationships.

To understand how the physical body, and changes in the physical body, influence peer and intimate relationships and parenting in young adults on renal replacement therapies (RRT).

Differences in daily light exposure profiles have been reported, with younger M-types shown to spend more time in bright light, especially in the morning, compared with E-types. This study aimed to investigate how patterns of daily light exposure in older non-resident M-types and E-types compare. Sleep diaries were kept during actigraphic measurement of activity and light using the Actiwatch-L for 14 days in 12 M-types [eight females, mean ± standard deviation (SD) Horne–Östberg Morning–Eveningness Questionnaire (HÖ MEQ) score 75.2 ± 1.6] and 11 E-types (seven females, HÖ MEQ 41.5 ± 4.8), over 60 years old, living in their own homes. Light data were log-transformed, averaged over each hour, and group × time analysis of covariance (ancova) performed with age as a covariate. M-types had significantly earlier bed and wake time than E-types, but there was no significant difference in sleep duration, sleep efficiency or time spent in bed between groups. Daily exposure to light intensity greater than 1000 lux was compared between the two groups, with no significant difference in the duration of exposure to >1000 lux between M-types and E-types. Twenty-four-hour patterns of light exposure show that M-types were exposed to higher light intensity at 06:00 h than E-types. Conversely, E-types were exposed to higher light intensity between 22:00 and 23:00 h than M-types. These findings show that differences in daily light exposure patterns found previously in younger M-types and E-types are also found in older M-types and E-types, but at an earlier clock-time, confirming the tendency to advance with ageing.

Sleep is functional for individual and societal well-being, with partial sleep deprivation associated with adverse health and safety consequences. Surprisingly, sleep is absent from work—life balance debates and has remained largely under-researched by sociologists. This article examines the relationship of insufficient sleep duration with occupational circumstances and family responsibilities, providing a contribution to the examination of the health consequences of working patterns in the UK. We analyse time use data from 2000, focusing on a sub-sample of workers aged 20—60 years (n = 2882). Nested logistic regression modelling is used to identify the segments of the working population getting a short sleep duration that if sustained may have negative health outcomes. An inverse relationship between working hours and sleep duration is found, which is stronger for men than women. Shift work and social class are also significant predictors of short sleep for men.

The study of sleep has been neglected within sociology, yet may provide insights into fundamental aspects of the nature of gender inequalities. This article examines how, for couples with children, sleep is influenced by the gendered nature of caring. A key concern is not only who gets up to care for children's physical needs at night, but whether this changes with women's increased role in the labour market. Of concern also is how changes in the nature of caring for older children, as opposed to young children, may impact on parents’ sleep. This article analyses qualitative data from an ESRC funded multi-disciplinary project on couples’ sleep based on in-depth audio-tape recorded interviews with 26 couples (aged 20–59) with younger and older children. Additionally, one week's audio sleep diaries were completed and follow up in-depth interviews were undertaken with each partner on an individual basis. Physical and emotional care for young children at night was largely provided by women, with a lack of explicit negotiation between partners about who provides this care, even when women return to employment. Thus, considerably more women than men continued their daytime and evening shifts, as well as undertaking an ongoing third shift of sentient activity for their family, into the night. This resulted in a fourth night-time shift where physical caring, and sentient activities continued. As a consequence, women were more likely to subjugate their own sleep needs to those of their family. Fathers did not, in general, undertake this fourth night-time shift. Those that did were more likely to be the fathers of young adult children who were staying out late at night, with the focus of their concerns being the safety of their children.

There is a lack of research into 25-hydroxyvitamin D (25(OH)D) status, light exposure and sleep patterns in South Asian populations. In addition, results of research studies are conflicting as to whether there is an association between 25(OH)D status and sleep quality. We investigated 25(OH)D status, self-reported and actigraphic sleep quality in n = 35 UK dwelling postmenopausal women (n = 13 South Asians, n = 22 Caucasians), who kept daily sleep diaries and wore wrist-worn actiwatch (AWL-L) devices for 14 days. A subset of n = 27 women (n = 11 South Asian and n = 16 Caucasian) also wore a neck-worn AWL-L device to measure their light exposure. For 25(OH)D concentration, South Asians had a median ± IQR of 43.8 ± 28.2 nmol/L, which was significantly lower than Caucasians (68.7 ± 37.4 nmol/L)(P = 0.001). Similarly, there was a higher sleep fragmentation in the South Asians (mean ± SD 36.9 ± 8.9) compared with the Caucasians (24.7 ± 7.1)(P = 0.002). Non-parametric circadian rhythm analysis of rest/activity patterns showed a higher night-time activity (L5) (22.6 ± 14.0 vs. 10.5 ± 4.4; P = 0.0008) and lower relative amplitude (0.85 ± 0.07 vs. 0.94 ± 0.02; P ˂ 0.0001) in the South Asian compared with the Caucasian women. More South Asians (50%) met the criteria for sleep disorders (PSQI score ˃5) than did Caucasians (27%) (P = 0.001, Fishers Exact Test). However, there was no association between 25(OH)D concentration and any sleep parameter measured (P ˃ 0.05) in either ethnic group. South Asians spent significantly less time in illuminance levels over 200 lx (P = 0.009) than did Caucasians. Overall, our results show that postmenopausal South Asian women have lower 25(OH)D concentration than Caucasian women. They also have higher sleep fragmentation, as well as a lower light exposure across the day. This may have detrimental implications for their general health and further research into sleep quality and light exposure in the South Asian ethnic group is warranted.

The critical shortage of cadaveric donor organs for transplant purposes is a worldwide concern. The disparity between the number of cadaveric organs donated for transplant purposes and those patients awaiting transplant operations continues to widen. This article reports on the findings of an audit of deaths undertaken in 10 accident and emergency (A&E) departments in North Thames region, UK. The audit itself was borne out of informal anecdotal accounts from colleagues working in the A&E department who suggested that there was a potential pool of organ and tissue donors that were not being realized. The article discusses how those audit findings helped shape the current A&E education strategy in the North Thames region. The result has been that the North Thames region has seen a dramatic increase in the number of referrals from the A&E departments, resulting in solid organ transplantation. Although the results are very encouraging, the program is still very much in its infancy and a long way from the desired 100% referral rate. In order to maximize the number of organs from the potential donor pool, the transplant community needs to focus more attention toward donation from the A&E departments.

Healthy dietary profiles contribute to successful aging, and dietary intake is dependent upon food procurement capabilities. Both formal and informal social networks can contribute to grocery shopping capabilities and methods of food procurement. This investigation explores the role of informal networks in food procurement methods among adults aged 65 years and older, and compares differences across eight European countries. Food shopping ways (FSW), identified by quantitative analysis (cluster analysis and correspondence analysis), guided the content qualitative analysis which was carried out addressing three main research questions addressing food shopping routines, feelings of dependency and needs of informal support for shopping, and differences between past and present food shopping behaviours. Living circumstances influence food shopping habits. Informal networks differed between two groups of individuals: those living alone and those living with others. Gender differences emerged in shopping pleasure. Geographical factors were associated with preference for shopping companions, attitudes toward receiving support, and availability of a car for shopping. The importance of living circumstances (i.e., alone vs. with others) in FSW was revealed. Informal social networks may play an important role in public health and welfare policies, particularly given the increase in this demographic group. Assistance with grocery shopping and the availability of trained personnel could widen informal networks, and effective informal networks may be an important supportive service for older adults. The comparison across countries highlighted relationships between food procurement capabilities and social networks. These findings may be used to develop resources to better meet the nutritional needs of older adults.

Available Open Access under CC-BY-NC licence. With an increasingly diverse ageing population, we need to expand our understanding of how social divisions intersect to affect outcomes in later life. This edited collection examines ageing, gender, and sexualities from multidisciplinary and geographically diverse perspectives and looks at how these factors combine with other social divisions to affect experiences of ageing. It draws on theory and empirical data to provide both conceptual knowledge and clear 'real-world' illustrations. The book includes section introductions to guide the reader through the debates and ideas and a glossary offering clear definitions of key terms and concepts.

Introduction: Sleep plays a significant role in the lives of older people experiencing institutional long-term care. It relates to their well being yet may also indicate a lack of stimulus and motivation to stay alert and participate in everyday life. However, to date the importance of sleep in this context has not been widely addressed. Research: This research identifies the determinants of poor sleep in care homes as part of a four year New Dynamics of Ageing Collaborative Research Project, SomnIA (Sleep in Ageing), which addresses practice and policy relevant issues arising from the nature, impact and management of the sleep-wake balance in later life. Using multi-methods data was collected in ten care homes. Over a two-week period, sleep and activity diaries are collected from 140 residents, supported by 275 h observational studies, and interviews with residents (n=40) and staff (n=78). Results: A conflict between meeting care needs and the facilitation of sleep has been identified and the findings aim to inform the future development of the care home environment and provide an evidence base from which practitioners can reconfigure the delivery of care to enhance the sleep of older people living in care homes.

This chapter examines sleep of women in Northern Italy. In depth qualitative interviews with 40 women aged between 40 and 80 years enabled examination of the intimate aspects of sleep and how these are related to the social and family context of Italian women. The aim of this chapter is to examine the meanings that Italian women attach to sleep, and their perceptions of one of the key factors that influence their sleep. The dominant theme that emerged from the interviews as influencing women’s sleep was their care-giving roles, although the interview guide was not specifically designed to examine care-giving. For this reason, the chapter focuses on how Italian women’s care-giving roles shape their sleep patterns and definitions of their sleep quality. Italy provides an important case study for examining the ways that care-giving roles structure women’s sleep because of the fragmented welfare provision for both childcare and eldercare. The particular intensity of family connections in Italy and close intergenerational exchanges of informal care puts into sharp relief how caring delineates the extent and continuity of women’s sleep, highlighting how family roles and relationships interact and intersect with sleep. The chapter first provides a brief review of research on women’s sleep, which hitherto has primarily focused on sleep in the UK. We then provide a review of care provision, family culture and the Italian welfare state. After outlining our methodological approach, we present data on women’s understandings and meanings of sleep, before examining how Italian women’s care-giving roles impact on their sleep at various stages through their life course.

The concept of ‘active ageing’ has received much attention through strategic policy frameworks such as that initiated by the World Health Organisation, and through government and non-governmental organisation initiatives. The primary goal of these initiatives is to encourage older people to be active and productive, and to enhance quality of life, health and wellbeing. It is well known that with increasing age, night-time sleep deteriorates, which has implications for how older people maintain activity levels, and leads to an increased propensity for day-time sleep. Using data from 62 interviews with people aged 65–95 years living in their own homes who reported poor sleep, this paper explores the meanings of day-time sleep, and how the attitudes and practices of ‘active ageing’ are intricately linked to the management of day-time sleep and bodily changes that arise from the ageing process. The desire to be active in later life led to primarily dichotomous attitudes to day-time sleep; older people either chose to accept sleeping in the day, or resisted it. Those who accepted day-time sleep did so because of recognition of decreasing energy in later life, and an acknowledgement that napping is beneficial in helping to maintain active lives. Those who resisted day-time sleep did so because time spent napping was regarded as being both unproductive and as a negative marker of the ageing process.

Sociology almost entirely neglects later life. This contrasts with social policy where elderly people are largely seen as a burden on society and their carers. The article examines three areas of sociological enquiry and suggests reasons for the omission of elderly people. Parallels are drawn with sociology's earlier neglect of women. The feminist agenda has largely excluded the concerns of elderly women and at times has contributed to the pathological image of elderly people as burdens to be shouldered by their daughters. We argue that sociological theories would be enriched by incorporating the experiences of elderly people within their theoretical net. Reprint of article first published in The Sociological Review, 1991, 39(2), 260-291. DOI: 10.1111/j.1467-954X.1991.tb02981.x

Over the last 30 years, the field of aging has been the site of an exceptional growth of research interest, yet it is only really within more recent social gerontology that the many varied experiences of older people are being acknowledged and explored through the intersection of race, ethnicity, sexuality, class, and, as many have argued, most importantly, gender. This chapter will show the importance of recognizing the gender dimension within the study of aging by exploring how using a “gendered eye”, or adopting a “gender lens” (Calasanti & Slevin, 2001) not only reveals neglected issues for older people, but is also fundamentally important in thinking about the study of old age at a time when the growth in the aging population is unprecedented. The chapter commences by stepping back 30 years to reflect on theoretical approaches to the study of aging and approaches that initially neglected gender. We then move on to demonstrate how the contribution of feminist scholarship raised awareness of the need to identify and address the neglected are of older women’s issues, and at the same time, neglecting older men’s issues (Thompson, 1994). Next, we consider how this approach ultimately evolved to take account of the interlinkages between age and gender relations in recognition of the need to examine men’s and women’s experiences relationally. Emerging issues within this new era of age and gender relations are introduced in the form of the changing nature of roles, relationships, and older people’s identity. The following section focuses on the aging, gendered body through discussion of the tension between aging identities and narratives of bodily decline as experienced differently by men and women (Gullete, 1997). Finally, the chapter concludes by highlighting challenges for the future of aging for men and women, such as the growing numbers of the oldest old, who are predominantly widowed women, implications for unmarried or childless older men and women, and the policy implications of such challenges.

In this chapter we show how the complexity of everyday household living arrangements influences how and when we sleep, and even where we sleep. Sleeping for members of a household containing teenagers and young adults is at best subject to occasional interruptions, and at worst, frequent and chaotic disruptions. However, whilst our focus is on interruptions to the suggested appropriate requirement of seven to eight hours’ sleep at night, we also demonstrate that for both parents and young people household noise and activity may sometimes have a positive effect on sleep, by affording a sense of security, comfort and reassurance. The aims of this chapter therefore are to examine how parents and young people interact with each others’ sleeping space and sleep time. First, by exploring the influence on parents’ sleep of having teenagers and young adults living in the home. Second, to look at sleep from the perspective of young people, by examining how parents, other household members and technologies, such as mobile phones, influence their sleep. Finally, the positive aspects of sleep interruption expressed by both parents and young people will be examined, as, for example, when entering each others’ sleeping space and time provides peace of mind and security, and can, in some instances, facilitate sleep.

This article presents the key findings from an extensive research project aiming to identify the determinants of poor sleep in care homes. A mixed methods study was conducted in 10 care homes in South East England. This included 2-week daily diaries completed by 145 older residents and interviews with 50 care-home staff. This research demonstrated that the regular surveillance by qualified nurses and care assistants at night seriously impedes the quality of sleep experienced by older people living in care homes. However, nurses and social care workers have a duty of care, which would not be fulfilled if regular checks were not undertaken at night. There is a need for care-home staff to strike a balance between enabling older people living in care homes to have a good night's sleep and adhering to their own professional duty of care.

Whilst most academic literature on food is written from a nutritional perspective, over the last three decades there has been increasing sociological interest in the meaning of food from a social interactionist approach. This interest was stimulated by the burgeoning feminist examination of the gendered domestic division of labour within households (for example Arber, 1993; Oakley, 1975). Cooking and its allied tasks: menu choice, shopping, preparation and clearing up afterwards, continues to be carried out mainly by women (DeVault, 1991; Sullivan, 1997). Since the 1980s, there have been changes in the gender dynamics of responsibility for meal preparation associated with age, class, educational level and presence of children within relationship units (Kemmer, 2000; Warde and Hetherington, 1994). The negotiation of food habits and behaviours of heterosexual couples entering into a relationship, whether cohabitation or marriage, has been investigated by Kemmer et al (1998) and Lake (2006), but less attention has been paid how food is linked to older people’s negotiations and adjustments to life events such as widowhood and new partnership formation. This chapter sheds light on the enduring importance of food as ‘social glue’ in old age, and how gendered food practices play a pivotal role in the maintenance of roles and identities in later life. Food practices expose social relations as they reflect, and are used to perform, social roles and identities. Life events such as widowhood in later life impact on the social roles of older people which in turn are reflected in food related behaviour such as the responsibility for food and food preparation. Continuities and discontinuities are experienced differently by older men and women, and the strategies employed to deal with them reflect perceptions of traditional cultural and gender roles. The chapter firstly examines sociological literature around food and the gendered division of labour in the kitchen, and discusses the sparse literature on ageing, social networks and food behaviours. Secondly, it discusses the methodology of our qualitative research project. Thirdly, it analyses our data to examine traditional notions of age related feminine and masculine identities and their impact on food related behaviours despite, and as a result of late life-course transitions.

Aims To understand sleep as part of the 24 hour provision of resident care by viewing it in the wider social context within the care home, exploring both the subjective experience of residents and the perceptions of staff. Methods Qualitative research in four care homes for older people consisting of semi-structured interviews and ethnographic observations. Interviews were conducted with 38 residents and 39 staff, and were analysed using a grounded theory approach. Findings The findings have highlighted some challenges and opportunities for developing practice in care homes to improve residents' sleep. In addition to pain and physical disabilities, both the physical environment and practices in care homes can affect residents’ sleep and night-time experience. Conclusion Improving our understanding of residents’ and staff experiences at night in care homes can inform the development of good practice in night-time care and contribute to a positive culture of person-centred care.

Grandparenting in the 21st century is at the heart of profound family and societal changes. It is of increasing social and economic significance yet many dimensions of grandparenting are still poorly understood. Contemporary Grandparenting is the first book to take a sociological approach to grandparenting across diverse country contexts and combines new theorising with up-to-date empirical findings to document the changing nature of grandparenting across global contexts. In this highly original book, leading contributors analyse how grandparenting differs according to the nature of the welfare state and the cultural context, how family breakdown influences grandparenting, and explore men's changing roles as grandfathers. Grandparents today face conflicting norms and expectations about their roles, but act with agency to forge new identities within the context of societal and cultural constraints. Contemporary Grandparenting illuminates key issues relevant to students and researchers from sociology and social policy, including in the fields of family, childhood, ageing and gender studies

This article illustrates the ways that sociological research can inform an understanding of sleep. We emphasise the value of qualitative studies of sleep, by reviewing recent research on the ways that gender and co-sleeping influence sleep, and the influence of caregiving at night on sleep. We then consider large-scale quantitative studies of sleep, drawing on data from the UK Understanding Society 2009 survey (n=14,746). We show how providing care to an elderly or disabled relative in the home is linked to reported sleep problems which is only marginally attenuated following adjustment for disadvantaged socio-economic characteristics and poor health.

Grandparenting is a dynamic family practice that varies over time and between cultural contexts, and is shaped by material and structural factors such as social class, demographic change, and the welfare state context. Gender norms exert a strong influence on grandparenting practices and their negotiation across the dyadic grandparent-grandchild relationship and the triad of grandparent–adult child–grandchild. Cultural norms and expectations associated with grandparenting may be in conflict, and grandparents use agency to negotiate the balance between norms of ‘being there’ (to assist), ‘not interfering’, and drawing boundaries around their involvement in the lives of younger family generations.

Sleep, which is vital for health and wellbeing, is influenced by a complex array of (neuro)biological and social factors. Previous research has suggested that these factors vary across the life course, as well as being affected by transitions, such as parenthood, care-giving and widowhood. This research has also suggested that many of these transitions have a greater affect on women’s sleep. Yet much of this research has focused on women and one-sided reports of partner behaviours. This paper draws on data from Wave 1 of the Understanding Society Survey to examine gender differences in sleep maintenance within younger and older heterosexual couples. Data were collected in 2009 from a representative sample of households in Britain with a response rate of 59%. Sleep maintenance, namely waking on 3 or more nights per week, was included in a self-completion module. A series of logistic regression models are run using sleep maintenance as a dependent variable; i) a two level model for couples where the male is aged 50 or less (n=2452 couples); ii) a two level model for older couples where the male is aged above 50 (n=1972 couples); iii) bivariate models which allow for odds to be calculated separately for male and female partners. Results from the couple level models illustrate how both younger and older women have increased odds of difficulties with sleep maintenance (as compared to their male partners). Poor sleep maintenance is also associated with poor health, own unemployment, dissatisfaction with income, having had a previous cohabiting relationship and having younger children for both men and women. Reports by the husband of frequency of coughing/snoring at night is significantly associated with their wives’ sleep maintenance among younger couples and vice versa; but among older couples there is only a significant association of husband’s snoring on wife’s sleep. Whilst the current analysis is cross-sectional, further understanding of the dynamic relationships of sleep will be revealed through longitudinal analysis as Understanding Society moves through future waves.

The worldwide trend towards ageing of societies is well documented with extensive discussions of support and care needs for frail older people. There is less discussion of the implications of gender differences in later life for access to support in the event of frailty or disability. Although, marital status is fundamental to well-being in later life (Arber and Ginn, 1991, 1995; Gaymu et al., 2008), there has been less appreciation of the scale of gender difference in marital status in later life, variations between societies, and their implications. It is important to consider the interaction between gender and marital status and the ways this may change over time (Arber, 2004a; Arber, 2004b; Manning and Brown, 2011). The focus of this chapter is to examine the intersection of gender and marital status in later life across societies, how this links to inter-generational relations, and how global changes make it increasingly important to consider the implications of the gender and marital status interaction when studying access to caregivers and social support in later life.

This chapter demonstrates how sleep is inextricably linked to ‘society’. Part 1 illustrates how sleep and its disorders are historically and culturally divergent and that ‘where’, ‘why’ and ‘how’ we sleep differ depending on the society in which we live. Part 2 focuses in more detail on the ‘private’ nature of Western sleep. Sleep is affected by the social context where it occurs, and is thus influenced by household composition, power, gender, social roles and life course position. Finally, we examine sleep in care-giving and institutional contexts, where sleep is not only ‘observed’, but may be disturbed by those undertaking care or surveillance at night. Sleep is also socially patterned with the socially disadvantaged most likely to report sleep problems.

This chapter discusses the practical issues and considerations that students need to take into account when selecting and analysing data from existing survey datasets. A discussion of what is meant by ‘secondary’ analysis, and why one might want to undertake such analysis, is followed by a summary of the major types of survey dataset that are available. Differences between panel, cross-sectional and continuous surveys are highlighted and examples of these are discussed. There then follows a discussion of some of the advantages and also pitfalls of using secondary data sources for sociological analysis, followed by a guide to locating and obtaining datasets. The chapter concludes with a brief discussion of methods that can be used for the analysis of survey data and some ideas for student projects. Government and other large surveys, as well as the increasing number of panel/longitudinal studies, provide very rich sources of data for secondary analysis. Many of these are under-analysed, from both a statistical and a theoretical viewpoint. This chapter argues that secondary analysis requires sociological imagination and that the secondary analysis of large, primarily government, surveys has untapped potential as a source of sociological insights.

Debate about elderly people has been dominated by stereotypical images, while profound inequalities in the circumstances of elderly people have been neglected. This paper examines one aspect of inequality, that of personal income, showing that elderly people span the gulf between affluence and poverty, and that ageist representations of pensioners mask structured inequalities which have arisen during the working life. The paper focuses on gender inequality of occupational and private pension income and assesses the effects of the sexual division in the labour market ('the price of being female') and of women's role in the domestic economy ('the cost of caring'). Gender and marital status as well as class are found to be crucial factors in understanding income inequality among elderly people. Occupational and personal pensions are the chief means of perpetuating these divisions into later life. The paper uses data from the 1985 and 1986 General Household Survey, which provides a representative sample of over 7000 people over age 65. Reprint of article first published in The British Journal of Sociology, 1991, 42(3), 369-396. Available at: http://www.jstor.org/stable/591186

Over the past decade, sociological studies have convincingly demonstrated that sleep is a socially, culturally and historically variable phenomenon. How we sleep, when we sleep, where we sleep, what meaning and value we accord sleep, let alone with whom we sleep, vary around the world, both past and present, within and between cultures and within different segments of society. This chapter outlines two interrelated strands of recent sociological work; how (i) sleep is a ‘practice’, which is ‘done’ and ‘negotiated’ with others; and (ii) the problems and prospects surrounding the medicalisation of sleep. The concluding section summarises the importance of sociological studies of sleep for public health.

Activity patterns after retirement have always constituted a theme of central interest for social gerontology. However, despite the recent theoretical focus on the emergence of the Third Age as a period of self-fulfilment and an ongoing engagement with an active leisure lifestyle after retirement, sociology's knowledge regarding everyday life in older ages remains limited as there is a dearth of social surveys on how older people spend their time. Furthermore, the majority of existing studies on the topic rely on data from conventional interviewer-administered questionnaire surveys that do not provide a holistic account of everyday activities and also have certain methodological weaknesses. Few studies capitalize on data from time-use surveys, which currently constitute the most widely employed and accurate methodology for collecting information on daily activities. The aim of this chapter is to introduce time-use methodology to researchers in the field of aging and to discuss the contributions that analyses of time-use data can bring in the field of social gerontology in the era of the Third Age. The first part of the chapter reviews the basic methodological aspects of time-use surveys and provides a discussion of their advantages over alternative methods of data collection on individuals' time allocation. In the second part an example of a time-use analysis is provided: British data from 2000 are analyzed to examine the socio-demographic correlates of participation in ‘active’ and ‘passive’ leisure activities for people over the age of 64.