Who cares for our frail older populations and where is fast becoming a critical issue for policy-makers and practitioners in many high income countries as they grapple with the economic and welfare implications of increasing longevity. This demographic shift is, of course, a major success story. However, increased life expectancy is also bringing with it a growth in those numbers of older people, particularly the oldest old, who are experiencing multiple morbidities and a declining ability to undertake those instrumental activities of daily life (IADLs) that are so important to maintaining independence and dignity in later life. At the same time, policy and practice has shifted away from residential or institutional care for our older population to focus on ‘ageing in place’. Here, older people are to be supported to remain within their own homes for as long as possible. Conceptually, this has meant that services and care previously delivered within a single institutional environment, have been redesigned for delivery within domestic settings where frail older people would also benefit from the informal care support from family, friends and neighbours. On the one hand, this has meant that many older people have benefited from the familiarity, sense of safety and support that care provided within the domestic setting has engendered; on the other, changing family structures, a decline in community and sweeping health and welfare cuts in an era of economic austerity have left growing numbers of older people increasingly lonely, isolated and at risk. Understanding who cares, where, the form that care takes and how this is being differentially experienced by our older populations have been issues of growing concern for geographers interested in health and ageing. In this paper I review the current ‘state of the art’ of geographical gerontology around informal care and the home and illustrate how those working in this field are making an important contribution to multidisciplinary debates around care of our older populations.
