Introduction

 Social protection involves multidimensional resources and strategies designed to minimise individual and collective social risks (e.g., unemployment, poverty, and social exclusion) within both the paid and unpaid spheres of labour and social life (Faist, 2019). Formal social protection depends on risk-reducing resources provided by nation-states and public organisations, such as older age survivor benefits and pensions, whereas informal social protection involves non-standardised repertoires of personal and family networks as a way of mitigating multiple social risks (Bilecen et al., 2019). For first-generation older migrants, their employment history, the welfare states they reside in, as well as the portability of certain rights between the countries of emigration and immigration, play important roles in defining their access to welfare benefits (Faist et al., 2014; Flynn & Wong, 2022). Informal social protection is conceptualised in this case as the available social support that first-generation older migrants have at their disposal that can be activated within their personal networks (Bilecen & Barglowski, 2014). Both levels of social protection are interdependent entities that form an assemblage where the boundaries are blurred and often subject to socially patterned negotiations (Bilecen & Barglowski, 2014; Mumtaz, 2021).

First-generation older migrants’ access to and use of formal and informal social protection and their agency in negotiations for its utilisation are highly determined by their personal situation, which interacts with changing relationship dynamics. These assemblages are situated within the wider hierarchies composed of gender, ethnicity, and class (Bilecen et al., 2019). Earlier research showed that material deprivation and structural barriers (Caner &Pedersen, 2019), language barriers (Hussein, 2013), difficulties in communication (Kristiansen et al., 2016; Nielsen et al., 2017), and a lack of information about available services (Liu et al., 2017; Topal et al., 2012) are among the major factors hindering first-generation older migrants’ access to formal social protection.

Although previous studies indicate older migrants have the same levels of needs for formal social protection in the realms of health and social care services as the majority population in the Global North, their equal access to health care services in the countries of immigration has been largely constrained (Hjelm & Albin, 2014; Saltus & Pithara, 2015). Structural barriers such as poverty, racism, and a lack of culturally sensitive services have been cited by numerous scholars across the Global North, resulting in older migrants’ lower levels of access to and satisfaction with formal care services (e.g., Ahmad &Atkin, 1996; Harries et al., 2019; Gee & Ford, 2011; Johnstone & Kanitsaki, 2008). Generally, previous studies have highlighted the role of older migrants’ personal networks in acting as a buffer against those barriers (Koehn & Badger, 2015; Simon et al., 2018).

Nonetheless, the availability of personal networks does not always translate into informal social protection. Spatial dispersion of older migrants’ personal networks across national borders may restrict an older person’s access to care from geographically distant informal carers, depending on the configuration of their network (Bilecen & Sienkiewicz, 2015; Fihel et al., 2021). Another factor influencing resource exchange within personal networks is shifting family values and norms after migration (Wali & Renzaho, 2018), leading to frictions and conflicts in intergenerational relationships (ten Kate et al., 2021; Tezcan, 2018). In addition to intergenerational conflicts, changing relationships between partners due to divorce or death might negatively influence older migrants’ access to informal care (Ciobanu & Fokkema, 2021; Gierveld et al., 2012).

Recent years witnessed a policy shift for formal social protection in the Global North, where active and successful ageing is promoted for older adults to be self-reliant (Crowther et al., 2002; Cylus et al., 2019). In other words, older adults are considered active agents who are able to make informed decisions around their health and social care arrangements (Harding, 2022; Gilleard & Higgs, 2017). However, the complexity of accessing and negotiating between formal and informal social protection in the era of older migrants has not received enough attention.

Against this background, this paper aims to investigate first-generation older migrants’ negotiation of social protection resources, mainly in the realm of care, based on the case study of the Turkish community in London. While migrants from Turkey are often well-researched in continental Europe, in the UK they are addressed as being a silent or invisible community (Dedeoglu, 2014). It might be explained by two ideas. First, because the UK has manifold international migration streams from different countries, migrants from Turkey do not represent one of the largest groups, as is mainly the case in Germany or Austria (Fassmann & Icduygu, 2013). Second, chain migration patterns of the Turkish community to London and stereotypes around the self-sufficiency of the community and strong kinship and social networks (Dedeoglu, 2014; Mehmet Ali, 2001). The findings highlight the complexities of accessing informal social protection and navigating formal care support in the UK for first-generation older Turkish migrants as a result of changing family relationships after migration and the role of the welfare state in the circulation of care.

Methods

The sample for this study included older adults aged over 50 years old, born in Turkey or Cyprus and living in London, whose first or second language is Turkish. The sample also included managers, coordinators, advisors, and chief executive officers of all non- profit associations and organisations that provide services to older Turkish adults (including Cypriot associations with Turkish Cypriot clients and Kurdish associations with Kurdish clients from Turkey), to capture their knowledge and expertise in delivering care-related services to older Turkish migrants.

Two separate interview agendas, based on semi-structured individual interviews, were designed to collect evidence from older migrants and experts. The interviews with older migrants started with general questions around the participants’ background information and continued with questions revolving around their family situation and care relations, community support, and navigation of health and social care services in the UK. The length of the interviews varied from 21 to 54 min, with the average being 32 min.

The interview agenda with experts contained questions around their experiences working with older Turkish clients, and barriers and facilitators to effective service delivery for the community. The interviews ranged from 20 to 48 min in length. (average: 31 min). All participants provided either oral or written consent before the interviews, and to protect their confidentiality, pseudonyms were used in quotations.

Data collection took place between March and December 2017. Ethical approval was obtained from the Research Ethics Committee of Heriot-Watt University before the commencement of the data collection. The main methods of recruiting older Turkish migrants involved attending community events, local advertising, and the application of snowball sampling techniques. 45 semi-structured individual interviews were conducted with the first-generation older Turkish migrants in the UK. The majority of interviews with older Turkish migrants (36) took place at community centres, worship places, and Turkish/Kurdish associations in the greater London area that were visited during the fieldwork. The rest of the interviews (9) were conducted in other facilities belonging to the community, such as Turkish cafes and restaurants and participants’ private homes. Desk-based research was applied to recruit the managers and coordinators of registered Turkish, Kurdish, and Cypriot associations in London. In total, 13 interviews were conducted with expert participants, of which 11 took place at Turkish/Kurdish associations and other places preferred by respondents, and the remaining two were telephone interviews. All interviews were conducted in Turkish, recorded, transcribed and translated into English by the author.

The initial analysis of the data followed a rigorous process of qualitative data analysis documented in earlier relevant publications (Yazdanpanahi & Hussein, 2021; Yazdanpanahi & Woolrych, 2023a, b). For this research the generated codes and themes around care were revisited in consultation with an experienced qualitative researcher and the theoretical framework of assemblage theory was applied to the dataset to investigate the nuances of experiences of care and social protection amongst participants (Fig. 1). Some instances of these assemblages have been highlighted in the reporting of the data using case studies to provide a more illustrative picture of the dynamic interaction between components of care in participants’ daily lives.

Fig. 1
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Mind map for data analysis

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Findings

Two key domains emerged from the data and we consider these: "Personal Networks as Informal Source of Support" and "Challenges in Accessing the Formal Care".

Personal Networks as Informal Source of Support

Interviewees narrated their social ties with whom they exchange care relationships, and they attributed the most significance to their family members, followed by relatives (akrabalar in Turkish), neighbours, and friends. Family relationships gain more importance in older age when functional and emotional dependency on the younger generation of the family increases (Thomas et al., 2017). This is specifically true for older migrants who might have higher filial expectations from their offspring according to the cultural codes of their country of origin (Guo et al., 2020; Lin et al., 2016). For example, the following quote by a professional interviewee illustrates the gaps in intergenerational attitudes inside the Turkish community, negatively influencing older Turkish migrants’ experiences of ageing in London:

In fact, this age group experience a big disappointment …because…this age group are the first generation of Turkish migrants to the UK. They were born and raised in Turkey. They have come here with that cultural background and that culture has some sorts of expectations […] I mean […] some expectations like children giving care to them…but you know, these things are a little different in this country (the Chief executive officer of a Turkish association).

The majority of participants mentioned that the sense of security of living close to their children was the primary reason for staying in the UK. However, many were concerned about their excessive dependency on their children in later years of life and their children’s availability and capacity to provide care for them. Zehra, a 68-year-old female participant, is a case in point. She arrived in the UK 18 years ago from Turkey on a family reunification visa. She has two children: a son and a daughter. His husband left them in the UK and moved back to Turkey a few years ago. Zehra and her children ended their relationship with the father after his departure. Zehra would like to go back to her hometown, but back there she has neither a house nor social relationships she can rely on for support. She lives in a social housing unit in London and is dependent on older- age benefits to make a living. Zehra has been diagnosed with Alzheimer's disease and is very concerned about the advancement of her disease. Zehra’s daughter is married and lives with her husband in London. They help her out with her household chores, such as doing grocery shopping weekly or monthly, as Zehra cannot get on the bus without help and has difficulty navigating her neighbourhood by herself. Zehra lacks English language skills and needs someone to accompany her with a medical professional, for which she relies on her daughter regularly. Zehra’s son is single and lives with her. She has allocated her personal budget for social care to her son and introduced her son as her caregiver to the local authority. Yet, her son is not always around to help her. She has not applied for another professional caregiver due to her religious beliefs which prevent her from accepting a female care worker into her home as long as her son is single and living with her. When asked about her care plans for the next few years, she replied:

I am not sure if my son will live with me after getting married. I would like to live with him, but I am not sure if he would accept it or not. If he does not accept, I cannot complain. I cannot compel them to take care of me. I cannot compel my daughter to look after me (all the time) either. I hope that Allah will never make me needy of anyone (Zehra, 68 years old, 18 years in London).

Figure 2 illustrates Zehra’s assemblage of care. As the figure shows Zehra’s assemblage is composed of a variety of human and non-human elements. However, Zehra’s Alzhiermer disease and conflicting values both within the family and in relation to the formal care system act as destabilising factors, adding layers of uncertainty and complexity to Zehra’s care arrangements.

Fig. 2
figure 2

Zehra's assemblage of care

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Among the sample of this study, extended family members are also considered very important for their care. A significant number of interviewees had relatives living close by because of the chain migration they were engaged in over the years, as also indicated by earlier research (e.g., Dedeoglu, 2014). Some participants indicated that occasional hands-on care provided by relatives was regarded as an important source of informal social protection, complementing the social security provided by the welfare state. Dilan’s story illustrates this situation. Dilan is a 77-year-old female participant from the south-eastern regions of Turkey. She and her husband have worked as tailors in a Turkish clothing factory in the UK. They have been engaged in constant back-and-forth travel between Turkey and the UK for years. Her children live and work in Turkey. However, after her husband’s death, Dilan decided to permanently settle in the UK. For her, the main motivation to stay in the UK is her pension and the shelter provided by the council that makes her independent from her children, followed by the support received from her brother, niece, and nephews in the UK that help her with the navigation of the social welfare system, such as older people’s benefits, pensions, and housing, in addition to more informal tasks such as grocery shopping. Dilan’s house has stairs, and she has difficulty climbing them. Last year, she fell down the stairs and broke her leg. She preferred to stay in her brother’s home for a month, rather than receive the formal care to which she was entitled.

Neighbours are another and yet another important source of care for the participants in this study. In the traditional Anatolian culture, neighbours had an important place in the social protection of the elderly, preventing social isolation and providing hands-on care in the absence of family members. Many participants in this study mentioned having a closer relationship with their Turkish neighbours in London compared to their neighbours of other nationalities. This was mainly attributed to language and cultural connections.

However, the majority believed that neighbourly relations between Turkish-speaking community members were not as strong as neighbourly relations observed and done in Turkey, which can be considered an important source of care in older age.

In many cases, relationships between Turkish neighbours were confined to greetings in the neighbourhood or occasional visits at home. In only one case, a Turkish neighbour provided help for a disabled Turkish older adult living alone at home. The act of caregiving here involved home maintenance and cooking for the participant rather than personal care (e.g., help with taking a shower), which required more intimate care and a closer relationship with the individual.

In addition to neighbours, friends were also mentioned as an important source of support by our participants. Having friends was more prevalent among male members of the community than females. Some participants made friends through Turkish/Kurdish associations. However, these relationships were not necessarily seen as a source of care in older age, especially if the relationship did not have a long history. In the absence of family and other kin, long-term friendships were sometimes regarded as a source of emotional and financial support, for instance in cases such as helping with finding a job or providing temporary accommodation. This is reflected in Osman’s case, a divorced male participant in his early 50 s who does not have any family or relatives living in the UK. He had to leave the house provided by the council for his wife, and for years he had been homeless. His Turkish friends supported him very much by providing temporary accommodation for him. However, he admitted that these relationships were precarious and could not be regarded as a stable source of social protection but rather were built on reciprocity, which has its limits:

I am now living with a friend of mine. They used to stay at my house when they first moved to London. Now, I am staying at their house. For 25 years we have been friends. We spent many good and bad days together. I have many friends. But whenever I feel uncomfortable in a relationship, I end it (Osman, 53 years old, 20 years in London).

The examples above illustrate the types of older Turkish adults’ social ties as potential sources of support and the potential significance of these networks in gaining access to various forms of social protection in older age. These relationships are not fixed, as reflected in Osman’s and Zehras’s stories, where both kin and non-kin relationships are shown to be in a constant state of flux that makes the securing of social protection subject to negotiations.

Participants’ narratives also showed that the important part of formal social protection is the built infrastructure and associated policies such as access to age-friendly housing and transport options, determining older adults’ levels of independence and care relations with personal networks (Yazdanpanahi & Hussein, 2021). Having a shelter in the UK was the main motivation for Zehra and Dilan to select the UK as their older age destination, despite their desire to return to Turkey. Besides the function of the house as a shelter, architectural features and the levels of person-environment fit played a role in participants’ levels of dependency on their personal networks. In Dilan’s case, living in a two-story house with interior stairs had caused an accident that increased her levels of dependency on her relatives.

Personal networks played a significant role in helping older adults navigate other formal forms of social protection, such as access to health care services in the UK, where the personal network’s proficiency in English language skills was used to compensate for participants’ lack of English language skills and the absence of translation services in hospitals and other health care centres. Personal networks' capacity to negotiate the built infrastructure both inside and outside of the home was also applied to compensate for the poor levels of person-environment fit experienced by participants, such as help with daily tasks inside the house and navigation of environments that did not fit participants’ physical and mental capacities. Generally, individuals with higher levels of access to informal social protection better navigated the different forms of formal social protection, including health care services and other types of welfare. However, in terms of care at home, the same rule did not always apply. Zehra’s case showed the negative impact of the presence of her son on her access to formal care services. Many other factors were identified as barriers to older Turkish adults’ access to formal care, which will be unpacked in the next section.

Challenges in Accessing the Formal Care

Participants’ conceptualization of formal care in the majority of cases was not in agreement with the care providers’ definition of this concept. For care workers and private/public organisations that, through them, care was channelled, formal care at home focused on standardised physical tasks developed based on a one-size-fits-all approach that often did not take clients’ demands into account. Many participants felt a lack of control over the care received and the care workers’ lack of attention to their personal needs and cultural demands. The following extract from an interview with the manager of a care-giving organisation explains the conflict between a care system focused on undertaking specific care tasks and the need for cultural and personal aspects of caregiving, which are important in the lives of older Turkish migrants:

Generally, our Turkish community expects a lot from a caregiver. What caregivers are supposed to do is quite restricted and predefined […] For example, they might help the client to take a shower or give them food but we cannot cook for them. We only heat the food that is available at home for them […] We do not have such a time. The time spent at clients’ home is 30, 45 minutes to an hour generally... (Manager of a private care company)

The above-mentioned statement is reflected in Nurgul’s story. Nurgul is a 55-year-old female migrant from Turkey. She arrived in the UK 26 years ago, when she was 29, as a married woman. She has three children, two sons and a daughter. She divorced her husband two years ago and now lives with her youngest son, who attends a university outside of London. Her daughter went to Turkey after graduation to find a job. Her eldest son is married to a non-Turkish woman who is registered as Nurgul’s main care giver. They live in London and are now expecting twins. For nearly 3 years, Nurgul has suffered from rheumatism that has restricted her ability to undertake her daily activities by herself. She needs some help with activities like taking a shower, climbing the stairs inside her house and out-of-home tasks such as visiting her GP, grocery shopping, etc. She is dependent on her sons and daughter-in-law to run her daily errands. She had applied for a professional care worker in the past to reduce the burden of care on her family, but she was disappointed with the quality of the services provided when she first met her care-giver:

They introduced me to someone. I talked with her, but I became very nervous after that. I told her, “I'll give you 56 pounds a week for 2 hours, and all you do for me is take me to the bathroom once a week. You won't clean my house, you won't do my stuff, so why should I give you this money? “ Rules of this country seem so strange to me. Carer means that she/he has to come every day. If you want to take a shower, she does it for you. She changes your clothes. If you need food, she cooks for you...

She will undergo a surgical operation soon. This will make her more dependent on her daughter-in-law and bedridden for a while. She is concerned about her daughter-in-law’s wellbeing, given her additional caring responsibilities for her new-born babies in the near future. On the other hand, due to her unpleasant experience with previous caregivers, she does not want strangers as her care givers anymore. She asked her daughter in Turkey to move back to London for a few months to help her during the recovery process rather than reapply for formal care services.

Challenges and gaps in terms of the type of services provided, hours of work and costs of formal care were also present in Ahmet’s accounts, a 73-years-old male participant diagnosed with cancer and in need of intensive care:

I was sent a caregiver from the council […] Caregiver was not trained…she was not able to look after me. The price was so expensive for that service. I told them to not send her to my house. She only washes my feet that she cannot do it well. I can put my legs in a tube of water myself and by moving them they are washed, there is no need for a caregiver! (Ahmet, 73 years old, 25 years in London)

Some professionals mentioned a lack of information among older Turkish adults about care-providing organisations, which is indicative of the lack of communication between these organisations and older Turkish adults, resulting in a lack of awareness about different care options and compromising choice within the care process:

…In the past, local authorities and the central government used to cover the cost of care received at home, but now... this budget depends on you. Let’s imagine that you are in a hospital and want to be discharged. They tell you there are these organisations that give care at home. Which one would you like to select? But when you do not have any knowledge about these organisations, you cannot select one. (Coordinator of a Turkish/Kurdish association)

This was evident in many participants’ accounts who neither had any plans for their older age nor were aware of the care options available for them:

I am not aware of the care system here. I am not aware of any Turkish care-giving organisation, but I think after a certain age, when you need care, the government looks after you... (Ekrem, 69 years old, 18 years in London)

As the quotes above indicate, reformation of care policies over the last decades has resulted in standardisation, marketization, and fragmentation of care services (Norman et al., 2016). This adds to the complexity of the navigation of health and social care services for older Turkish migrants who, on the one hand, feel current services are not sensitive to their personal and cultural demands; on the other hand, may experience higher levels of difficulty in accessing these services due to lower levels of financial security, a lack of English language skills, and familiarity with the welfare structure of the host society and their entitlements.

Discussion

Migration pathways and adaptation to the new environment were an ongoing process for participants in this research, experienced through changing family dynamics and social relationships in a new cultural context and encountering different social institutions than in their homeland. This influenced older Turkish adults’ experiences of care and access to social protection, as reflected in the previous research with other groups of older migrants in the Global North (e.g., Arora et al., 2020; Koehn, 2009; Liversage, 2023; Victor et al., 2018).

For the majority of participants in this research, living in close proximity to personal networks and access to higher levels of formal social protection compared to Turkey was the main motivation to stay in the UK, despite their desire to age in Turkey. Yet, changing family relations as a result of migration and the failure of the formal care sector to meet older Turkish adults’ demands made access to adequate care difficult (Tezcan, 2018). Fading family traditions such as filial piety, perceived precarity of family relations, and fears of being an excessive burden on their children made many participants rethink their expectations of their children and consider other resources, such as those provided by the formal sector and governmental organisations, to access social protection. However, family and kin remained an important part of the care received in older age that could hardly be substituted by the care received from non-kins and care workers (Fihel et al., 2021). Access to formal social protection in the majority of cases was dependent on older Turkish adults’ access to some levels of support from their personal network given their lack of English language skills, unfamiliarity with the rules and regulations of the UK and the bureaucratic process of application to formal support, reinforcing the complementary roles of formal and informal care in older Turkish adults ‘assemblages of care (Bilecen & Barglowski, 2014; Liu, 2021).

Participants’ non-kin relations also exhibited the same pattern as intergenerational relations. As discussed throughout the paper, many participants believed that neighbourly relations in London were different from traditional neighbourly relations observed in Turkey which led them to adjust their expectations from their neighbours and reevaluate their roles in the provision of informal support. For those older Turkish adults whose networks were more reliant on non-kin relations, neighbours provided occasional support with the instrumental activities of daily living rather than other kinds of social support that required closer relationships between care givers and recipients such as personal hygiene and eating (Edemekong et al., 2023). In our sample, none of the participants received hands-on care from friends. This phenomenon can be attributed to the structure of older Turkish adults' social networks and the cultural norms that shape care relationships, which assign a less prominent role to friends in caregiving compared to their western counterparts (Kalwij et al., 2009). Although in recent years there has been a growing recognition of the role of non-kin care givers in the provision of informal care for older adults in the western countries (e.g. Zhang, 2023), there is a prevailing consensus on the supplementary rather than compensatory role of the care provided by non-kin care givers to formal care services (Barker, 2002; Lapierre & Keating, 2013; Lowers et al., 2022; Pfabigan et al., 2023; Pleschberger & Wosko, 2016).

These shifts in family and community values amongst the Turkish community in London have assembled with neoliberal policies in social care and successful ageing discourse over recent decades that regard older adults as consumers of care with the ability to make informed choices (Mol, 2008; Ward et al., 2020). Increasing personal choice and autonomy has been at the heart of the policy rhetoric (Kogan et al., 2016; Tieu et al., 2022). However, marketization and privatisation of care and decreased governmental support have been recognised to have a detrimental impact on vulnerable groups (Isaksen & Näre, 2022; O'Dwyer, 2013), especially among older adults from ethnic minority backgrounds, who often happen to have lower levels of financial security (Mcmaughan et al., 2020), education, and knowledge about different health care options available to them, compromising their real choice (Peterson & Brodin, 2022; Williams & Rucker, 2000). Lack of clarity in the definition of care as recurring themes in older Turkish adults' and formal care providers’ accounts further indicates the negative assemblage of the current marketized and standardised care models with migrant older adults’ shrinking personal networks (Glasdam et al., 2015; Isaksen & Näre, 2022).

Built infrastructure as public goods and material manifestations of welfare policies (Swenarton et al., 2015) formed an important part of older Turkish adults’ assemblage of care. It was the combination of health care services, housing, and transport policies that determined older adults’ levels of independence and care needs. A lack of fit between available housing and transport options and participants’ physical and mental capabilities made them dependent on their personal networks to navigate social protection in the UK (Yazdanpanahi & Hussein, 2021). Poor housing quality and low levels of person-environment fit could also increase the levels of dependency on other forms of social protection, such as home care services, and lead to early institutionalisation as an undesirable form of care for the majority of older adults (Stones & Gullifer, 2016).

The findings above articulate the agency and interdependency of different components of care, composed of human and non-human elements in the assemblages of care. Assemblage thinking enables the care policy to pay closer attention to older adults’ lived experiences and realities of daily life, in which the multiplicity of human and non-human relationships shapes older adults’ experiences of care. Findings also show the potentially negative effects of one-size-fits-all approaches to policy development and ideals such as successful ageing, adding to the complexity of access to adequate care and social protection for more vulnerable groups of older adults. Care policy needs to be framed in the broader picture of assemblages of formal and informal social protection, integrated with other formal spheres of social protection such as housing and transport policy, and sensitive to individuals’ personal resources, including social networks.

Limitations

Recognising the fact that the current research focuses on a specific ethnic community in a specific context, the findings of the study may not be transferable to other ethnic communities or other contexts. However, assemblage thinking can be applied in the study of first-generation older migrants’ care relations and access to social protection in other welfare systems across the Global North.

The influence of researchers’ personal characteristics, such as age, gender, and ethnicity, on all stages of qualitative research is undeniable. The author does not deny that this research might not have resulted in the same findings if it had been carried out by other researchers. However, attempts were made to reduce these limitations and increase the credibility, dependability, and confirmability of the study findings through prolonged engagement with the community and reflexivity throughout the data collection and analysis.

Conclusion

Older Turkish migrants draw on various resources to form assemblages of care. Changing family relationships, care needs, and ageing policies demand constant negotiations on older adults’ behalf to form desirable assemblages of care. These complexities are felt more strongly for first-generation older migrants, who often experience sharper transitions in family relations and institutions after migration. Built infrastructure and social care policies have a crucial role in easing the burden on older adults by reducing their extra dependency on their personal networks. Hence, more age-friendly and integrated social care, housing, and transport policies tailored to individuals’ resources, demands, and capabilities are required to form positive assemblages of care for diverse groups of older adults.