Gerontological Social Work in Action

Anti-Oppressive Practice with Older Adults, their Families, and Communities

Wendy Hulko, Shari Brotman, Louise Stern, Ilyan Ferrer

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781351801539
• Edition: 1
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

Gerontological Social Work in Action introduces "anti-oppression gerontology" (AOG), a critical approach to social work with older adults, their families, and communities. AOG principles are applied to direct and indirect practice and a range of topics of relevance to social work practice in the context of a rapidly aging and increasingly diverse world.

Weaving together stories from diverse older adults, theories, research, and practical tools, this unique textbook prompts social workers to think differently and push back against oppressive forces. It pays attention to issues, realities, and contexts that are largely absent in social work education and gerontological practice, including important developments in our understanding of age/ism; theories of aging and social work; sites and sectors of health and social care; managing risk and frailty; moral, ethical and legal questions about aging including medical assistance in dying; caregiving; dementia and citizenship; trauma; and much more.

This textbook should be considered essential reading for social work students new to or seeking to specialize in aging, as well as those interested in the application of anti-oppressive principles to working with older adults and researching later life.

Part 1

Shifting our lens on gerontological social work

Chapter 1

Age/ism

Age as a category of difference

Questions to consider as you read this chapter

• Given the diversity of experiences of aging, how do we know when someone is considered “old”?
• What perceptions do we have of someone who is older?
• How do identity categories such as age, race, and gender distinguish people?
• What is ageism and age discrimination?
• How do we – as social workers – challenge dominant perceptions of aging and ageism?
• What role can older people’s counter-stories play in this process?

Maria is an undergraduate social work student who has been placed in an agency that provides services to older adults. Having spent most of her volunteer time and her first practicum experience working with children, Maria is upset about having to work with older adults. Maria does not know much about older people beyond what she sees in the news. She agrees with politicians who speak about a rapidly aging population and express concerns over current social and health care services not being able to care for the number of older community members. She associates aging with physical and cognitive decline and thinks all older people are frail and grumpy. Maria expects there to be less diversity amongst the older adult population than the children with whom she has worked and the work to be uninteresting. After several weeks at her practicum, Maria is surprised at just how different her clients are in terms of age, gender, class, sexual orientation, ability, interests, and experiences. For instance, she notices that there are older people who are in their 80s who do not require as much homecare assistance as their younger counterparts.

There is no question that the world is encountering a global aging demographic. Known as population aging, the median age of the global population is rising due to declining fertility rates and rising life expectancy (United Nations, 2017). A recent report by the United Nations’ Population Division of the Department of Economic and Social Affairs (2017) noted several trends within Global North and Global South societies (see textbox 0.4 in introduction):

• The global population of people aged 60+ years numbered 962 million in 2017. This is more than double the size recorded in 1980. The number of older people 60+ years is projected to double to nearly 2.1 billion by 2050.
• In many Global North and Global South societies, older persons are expected to outnumber children under age ten (1.41 billion versus 1.35 billion) by 2030. The number of persons 80+ years is projected to rise from 137 million to 425 million by 2050.
• Two thirds of the world’s older persons live in the Global South, and their numbers and growth are outpacing the number of older people in Global North societies. The United Nations projects eight out of ten of the world’s older people will be living in the Global South by 2050.
• The United Nations (2017) noted significant differences in the rates of intergenerational family cohabitation between Global North and Global South societies. For example, more than half of persons aged 60+ co-resided with a child in Asia, Africa, and Latin America and the Caribbean. However, only about 20% of older people lived with their children in Europe and North America. In general, older women are more likely than older men to live alone.

The fact that we are experiencing an aging society has implications for social workers in Canada and across the globe. When you read the statistics above, what was your initial reaction? Was it closer to excitement or closer to concern? The aging of the Canadian and global population should be taken as a success, yet it is often portrayed as problematic. Scholars have noted how society tends to view the aging population as an impending disaster that will negatively affect social and health care programs (Gee, 2002; Longin, 1995). This perspective is known as apocalyptic demography¹ (Robertson, 1991) and presupposes that an aging population will undoubtedly create challenges and burdens to society due, in large part, to significant and negative long-term effects on our economy (see textbox 1.1).

Textbox 1.1

Apocalyptic Demography uses demographic data and economic indicators to forecast that an aging population will create challenges for societal functioning. People living longer is seen to place a burden on society as an increase in the number of older people relative to younger people, especially those aged 19 to 64 years old, is believed to have significant and negative long-term effects on our economy. Economists and critical gerontologists have countered these assertions.

Apocalyptic demography is based on a figure called the “dependency ratio”, which is a calculation of the number of people under the age of 19 and over the age of 65 (“the dependents”) in relation to all those aged 19–64 years old (the working age population). Obviously, there are assumptions built into this (e.g., that all those aged 19–64 are (fully) employed and that all those under 19 and over 65 are not working at all). Yet, how many teenagers and older adults have you encountered in restaurants and stores (the service industry)? The labour force participation (and exploitation) of both younger and older people has grown in recent years since the introduction of training wages for the former and the elimination of mandatory retirement for the latter. Further, the “dependency ratio” does not reflect the volunteering and caregiving work performed by either group as this is not recognized as having economic value (see Who cares about caregiving?).

Within popular media, there are references to a silver tsunami, which present the aging population as an incoming tidal wave that will not only overburden sites and sectors of health and social care but also destroy our welfare state. Most concerns about an aging population position older people as chronically ill, using up health care resources like hospital beds with the pejorative term “bed blockers” being applied to the latter stereotype. Take for instance, the following excerpts from well-known newspapers and note how their focus is on the costs of taking care of our aging population.

• Media Snapshot 1: “The older they get, the more they cost” (The Economist as cited in Martin, Williams, & O’Neill, 2004).
• Media Snapshot 2: “Given that they all agree that a demographic ‘pension time-bomb’ is ticking, Europe’s policy makers have done remarkably little to diffuse it” (The Economist as cited in Martin et al., 2004)
• Media Snapshot 3: “Far too many people, including health professionals and policy-makers, believe that older people are hopeless and burdensome, so they make little effort” (Globe and Mail as cited in Fraser, Kenyon, Lagace, Wittich, & Southall, 2016).
• Media Snapshot 4: “There is much angst these days about the impact of the aging population on health care utilization and spending” (Globe and Mail as cited in Fraser et al., 2016).

Apocalyptic demography and the silver tsunami are predominant interpretations of what it means to have an aging society and how we as a society should respond to this contemporary phenomenon. The problem with these kinds of perceptions is that they essentialize, overgeneralize, and treat older people as a burden to society. In addition, perceptions that frame “aging as a burden” categorize older people as passive members of society who hold little to no agency and who contribute very little to society. Reflecting on these media portrayals, do you think these assumptions about our aging population are accurate? Social gerontologists have criticized apocalyptic demography arguments by suggesting that perceptions of “aging as a burden” are incorrectly predicated on highly speculative as well as biased economic predictions and inaccurate and damaging portrayals of older people (see endnote 1 and Barusch, 2013).

Before we proceed further, ask yourself: What do I know about aging? And more importantly, how do we know when people are older? These questions and others will be addressed in this opening chapter that critically examines current demographic trends in and across Global North and Global South societies, including the aging and diversification of the Canadian population. This chapter also examines and problematizes age as a form of social division, or what we call a category of difference, where older adults are seen as a homogenous group with similar experiences and needs (see textbox 1.2). These perceptions are oftentimes reinforced by societal and personal beliefs regarding aging and working with older people.

Textbox 1.2

A category of difference refers to characteristics, identities, and traits that can be used to distinguish and categorize a person, people, or community. Examples include race, gender, age, sexual orientation, class, and dis/ability.

This chapter outlines some of the ways in which these assumptions and understandings contribute to age as a category of difference and underpin ageism. We then situate the field of social work within historical and contemporary forms of aging and ageism and the ways in which older people are discriminated against as they reach and live through their later lives. Age being a category of difference has also contributed to ageism in the lives of older adults, which when combined with other identity positions (or categories of difference such as race, gender, sexual orientation, gender identity, and class) contributes to multiple and interlocking oppressions of older adults. We conclude this chapter with a discussion of the life course perspective, including the original formulation by Elder (1974) and a recent update by social work scholars that integrates intersectionality, diversity, and subjective interpretations to ensure our understandings of aging reflect the heterogeneity and complexity of older adults as a cohort and the socio-cultural and geo-political contexts in which they live.

The objectives of this chapter are to

• Understand shifts within the aging population in Canada and across the globe;
• Acknowledge and discuss how age is a category of difference and ageism is a form of oppression;
• Understand the life course and intersectionality and their interrelationship; and
• Consider the ideologies that shape and structure expectations of aging.

Age as a category of difference and distinguishing older people as “old”

We begin this chapter by exploring the ways in which older people have been defined in research and practice. While there are distinctions between younger and older people, have you ever wondered how we determine when someone can be classified as “older”? Is there a magic threshold after which one becomes “old”? Do we recognize people according to physical markers such as greying hair and wrinkled skin? Does old age depend on when people require care? Or does the federal and provincial government have a say in how we distinguish older people from the rest of society? Society tends to see people as old in a myriad of ways, which include societal expectations, professional approaches common to the field of aging (such as social work, nursing, and medical professions), and personal and cultural values/experiences of growing old. Within Global North societies, there are a number of ways to categorize and perceive someone as older. An early conceptualization was that of Bytheway (1997) who suggested six common ways of thinking about aging and questions that are or could be asked.

1. Chronology: How old are you in years?
2. Description: What words describe how old you are?
3. Relations: How do other people affect your experience of aging?
4. Body: How are changes in your body affecting your sense of aging?
5. Pressures: How do social expectations and institutional regulations regarding age affect your experience of aging?
6. Biography: How do you view your past and your future?

The most common of these are likely chronology, body, and biography, which align with the three categories in the model proposed by Grenier and Ferrer (2010): (1) chronological age, (2) functional age, and (3) life stage. The sections that follow are based on the model developed by these two social work scholars though we have integrated the work of other critical gerontologists on ways to think about or conceptualize aging, as well as our own thoughts and examples.

Chronological, functional age and life stages

When we think about the study of aging, the fields of geriatrics and gerontology come to mind.

Geriatrics focusses on the health, biological, or physical aspects of aging (e.g., longevity, morbidity). On the other hand, gerontology examines the social, cultural, and psychological aspects of aging. While the foci of geriatrics and gerontology are different, both fields tend to classify age a...

Table of contents

• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of tables and figures
• Preface
• Acknowledgements
• Introduction
• PART 1: Shifting our lens on gerontological social work
• PART 2: Doing AOP social work with older adults
• PART 3: Revisioning gerontological social work
• Concluding thoughts
• Index