Aging population is increasing in Canada because of low fertility and high life expectancy. Particularly, females live longer than males. In Manitoba, the life expectancy of females in 2006 is 81.7 years, while the males’ is 76.8 years in 2006 (Ready, 2010). Podnieks (2008) states that this demographic change carries “the important of understanding the experiences, situations and challenges faced by various cultural or other subgroups within communities…Elder abuse and neglect is one such concern” (p. 127).
Most older adults are satisfied with their lives, and get emotional or financial support and comfort from their families. Nevertheless, many academic researchers have been concerned about abuse against older adults. One national survey, which was quoted by The Age and Opportunity in Winnipeg, tells that “at least four percent of older Canadians living within our communities have experienced some form of abuse” (n.p.). Further, one research study in Quebec found that the majority of abusers were males and the majority of victims were females (Novak & Campbell, 2010). It is shocking to know a result of this study that most abuse come from families, such as spouses or adult children. Despite a number of debates in academia, and resources of social services, such as support groups, and counseling for older adults, why does such abuse still exist among older adults? To help better understand elder abuse, I will firstly explore how researchers classify categories of abuse. I will discuss a specific category of abuse: verbal and emotional abuse by providing two examples from my practicum. However, I should ask readers to consider if my two examples are really abuse against older adults.
Although there is no specific definition of elder abuse, many scholars define abuse or neglect as any harmful action or inaction towards older adults who are vulnerable. Podinieks, Pillemer, Nicholson, Shillington, and Frizzel (Podnieks et al., 1990) classify four categories of abuse: Material (financial) abuse, chronic verbal aggression, physical abuse, and neglect (as cited in Novak & Campbell, 2010). According to Novak and Campbell (2010), one random sample study in the United States reveals that most of abuse cases in the study include emotional, financial, passive, and verbal abuse, rather than physical violence or neglect. These authors note that the majority of abuse is verbal, emotional, or financial abuse rather than physical violence or neglect.
One of the ways I have witnessed possible form of verbal abuse in my practicum is through the use of names, such as honey, dear, sweetheart, mom, or mommy. A policy in my field placement prohibits calling residents using these terms. I thought calling with these terms was abuse for older adults because of the lack of respect. However, I think about it again that calling residents using these terms may not abuse older adults. Even though most all staff is trained to call residents’ first names, some staff still uses these terms, while others put Mr. or Mrs. before residents’ names, especially in morning meetings. Interestingly, I find that some staff who comes from other countries and are from different cultures usually use these terms.
As a Korean-Canadian, I understand that they may feel more comfortable when they use these terms. For the staff, calling residents “honey”, may be a friendly expression to show their compassion and care. In my home country, almost all people never directly call older adults’ first names. Instead, they use another term, such as grandma or grandpa. Specifically, if you, as a young girl, visit a personal care home, and meet a group of older women, you may greet to them during the breakfast like this: “Hello, Gandma. How is a grandma’s breakfast?” In this dialogue, you will see the term ‘grandma’ and ‘grandma’s’ instead of the term ‘your’. As this, Koreans never call older adults using ‘you’ as well as first names. Even if you have never met these older women before, you should call them grandma instead of calling their first names. This expression is one of the respectful manners towards older adults in Korea.
Of course, some people may ask me that I am living in Canada as a Canadian citizen. They, therefore, may tell me that I should follow a Canadian way. However, let’s think about this situation. If I meet a Korean older adult who speaks little English in the facility, should I call him using his first name? I am sure that I cannot call his first name. I may avoid calling him. If I call him using an alternative term “grandpa”, I will against a policy in my field placement. Do I abuse him if I call him as grandpa?
Straka (2010) states that infantalization, which means to treat older adults like a child, is one of the forms of elder abuse. I understand the infantalization is verbal and emotional abuse. However, let’s think about a situation. A resident asks staff “what I am going to do?” Staff answers “Snack is coming around. You can take snack, honey”. I have observed this staff member uses the resident’s first name all the time. If she says like this sometimes, does she abuse the resident? Is she infantilizing to an older adult? Although I understand these terms’ real meanings, I doubt myself this is a real abuse case for older adults because her expression is used as a sign of friendship.
Names are very important for everybody especially in personal care home because names generally not only present residents’ appearances or characteristics, but names also help staff or other residents remind who is who. Calling people using their first names is common in Canada even if they are old. It may be very convenient for staff to find someone by calling their names. However, I am sure that this policy is not very familiar with immigrants who did not learn this manner and had different cultures, especially who came from Asian countries.
The other example I am confused whether it is abuse or not is relating to a language barrier. One day, I found an Asian resident, who could not speak English, was cleaning up in the dining rooms and a lounge. Since she could not talk with others in English, she looked boring and lonely. To me, she looked like a bird in a bird cage. I thought that she might feel she was in an invisible prison. I understood her situation how a language barrier made it hard for her to get involved in activities or programs. This language barrier leads her to be isolated from other residents, and leaves her alone in her room. She is silent most of the time. Even though she lives in the facility, she is not accepted by others. She may get emotionally hurt very much when she is frustrated with herself because she cannot speak English. If she is not given an opportunity to speak her first language for many years, isn’t she marginalized from dominate groups which consists of Caucasians? I assume that she needs to speak her first language. If she speaks her first language freely, her life in this facility will be better. Even if she is always provided appropriate care like other residents, her real needs are not met yet.
Novak and Campbell (2010) pointed out that any forms of mistreatment are abuse against older adult. Especially, these authors emphasized to older women, who were cognitively impaired or physically frail were at the high risk of abuse. I do not know whether my examples are really abusive cases or not. Nonetheless, I think that the study of emotional abuse based on different cultural and ethnic backgrounds will be valuable in the future. I recognize that how language barrier leads someone to be isolated, and marginalized. Neglect or mistreatment of a resident’s needs is also abuse.
References
Age and Opportunity. (n. d.). Community services: Elder abuse
Novak, M., & Campbell. L. (Eds.). (2010). Aging and society: A Canadian perspective. United States: Nelson Education.
Podnieks, E. (2008). Elder abuse: The Canadian experience. Journal of Elder Abuse & Neglect, 20(2), 126-150
Ready, A. E., (2010, September 21). Demographics and theories of aging. Presented at KIN/ NURS 2610 lecture at the University of Manitoba, Winnipeg, MB.
Straka, S. (2010, September 27). Online transactions [Infantilization of older adults by professionals]. Message posted to http://swrk4200.blogspot.com/2010/09/infantilization-of-older-adults-by.html
By Eunkyeong
Thank you Eunkyeong,
ReplyDeleteThe reality of having various cultures in personal care homes in Manitoba with the use of different languages from English needs to be addressed. We are assuming that if you live in Canada then you must speak English. I believe as a practical place to start we ask the client the person. What they like to be addressed as, I have had some residence like Mrs. Smith, Stan, and others say their role, Grandpa, Nana. I believe in always giving option and letting the person decide. I do agree that patronized older people is not a respectful way to conduct our selves, however I do know it happens at our PCH as well.
As for abuse of older adults, we as social workers need to be mindful if we suspect any abuse of power going on and act on it. Now this does not mean we rush in like a night on a horse but thoroughly investigate all parties involved and include protection services. If there is no abuse detected then we have covered a person’s fundemental rights. Furthermore, social workers, nutrtionists, physicians, psychologists, and police officers need to be aware of their bias (ageisms) with regards to older people and need to understand the larger, macro-levels that impact elderly people’s health and the way they are living throughout the world. Veronica
I think you raise some interesting points here Eunkyeong.
ReplyDeleteFirst, you highlight the fact that a lot of older adult abuse is verbal, psychological, and financial – rather than merely physical. This means that it is often harder to detect and perhaps taken less seriously by society and the justice system. These forms of abuse are too often (and too easily) characterized as a private family issue. I’ve noticed this in my own placement. For example, I often see these sorts of red flags negated based on a person’s competency. I hear things like “Well, he’s a grown man and he knows what’s happening. He can say no if he wants to”.
As future social workers I think we have a responsibility to watch for and explore warning signs of potential abuse. The National Centre on Elder Abuse has a good FAQ page which includes a list of warning signs of elder abuse:
http://www.ncea.aoa.gov/ncearoot/main_site/FAQ/Questions.aspx
You also raise the important issue of cultural differences with respect to how we address older adults. There are definitely cultural variations in terms of relating to and showing respect to older adults; and although that fits perfectly fine in an individual’s personal interactions, I feel very strongly that there has to be some degree of respectful consistency when it comes to health care facilities. Names, phrases, and terms you and I might consider terms of endearment or respect are not necessarily received that way by our clients and in the end it is their feelings and interpretations that matter – not ours. I agree with Veronica in that we should always take our lead from the client. The best way to do that is to default to the most suitable manner of addressing people, which shouldn’t involve infantilizing terms.
Personally, I would find it patronizing and rude to have a medical professional refer to me as honey or sweetheart. We don’t refer to young adults in this way. I mean, can you imagine referring to your 29 year old female client as “sweetheart” or “honey”? It’s wildly inappropriate. I imagine many older adults feel the same way but perhaps feel uncomfortable expressing their feelings about it because they do not want to be accused of overreacting. There are whole lines of research exploring infantilization as a form of abuse and I’m convinced that this is a difficult topic of discussion for older adults in that it’s awfully hard to complain about being negated with what everyone else seems to think is harmless.
Thanks for reading,
Carrie
This post was very interesting for me, as well, and I find myself agreeing 100% with what you wrote, Eunkyeong, about cultural differences being important when it comes to determining what is, and what is not, acceptable ways to call seniors. In my own culture, as well, there various traditional ways to refer (respectfully) to older people which would probably be considered as infantalization in Canada. What really strikes me as interesting, though, is that this particular care home felt it needed to make a policy against doing so. Whereas I understand the reasoning that would lead to a policy, to me the fact that such a thing needed to be written down is actually subtle evidence of something much sadder.
ReplyDeleteIn every form, abuse is a sign of the absence of respect. In a loving marriage or a close family, for example, there isn't a written rulebook of procedures and policies because there doesn't need to be. Family members respect each other and this guides their behaviour in millions of situations that no rule book could begin to cover. If that respect is not present, then the marriage or the family loses the connection it once had.
The same thing applies here. I think it is probably safe to say that if a person has a genuine, honest respect for the seniors in the home, there shouldn't need to be rules against something like infantalization because it would just feel wrong. Likewise, if seniors enjoyed the same respect in society that they do, for example, in more traditional societies, a government wouldn't need to enact laws about elder abuse because societal pressure would accomplish that goal without legal intervention. To me, these kinds of rules and laws are well-meaning but ultimately hollow, since they only represent an attempt to treat signs of the disease, but not the disease, itself. The only long-term sustainable way to actually address the problem will be through cultural change, not legislation.