Mental health articles

Reconsidering generalizations about family care and modernization

family care and urgent medical vancouver wa.The previous section, describing the effects ofvarious forces on the ability and willingness of thefamily to care for their elderly supports some of theideas in the influential theory of aging andmodernization, presented by Cowgill and Holmes and revised by Cowgill. This theory,which states that "with increasing modernization* thestatus of older people declines", has beenfrequently criticized as proposing overly broadgeneralizations and an oversimplified vision of reality. Thus, in this section wereconsider several ideas about family care born from the theory of aging and modernization in order to clarify some popularly held but question able generalizations.

One common view derived from this theory is that families in many societies in developing countriesrespect and revere their elderly and care for them,whereas the societies of highly industrialized countriestend to neglect their older members and place them ininstitutional care settings. Accordingto this view, modernization causes the familyto leave older people behind. A related generalizationholds that the elderly tend to have high status inagricultural societies, where the extended family ismore common, and lower status in urbanized societies,where the nuclear family structure is said to be moreprevalent. The main, andpossibly insidious, implication for policy is that thefamily cares for its elders in developing countries andthere is less need for formal services with publicfunding.

Such assertions are oversimplified for severalreasons. First, many researchers have contested theideas that the multi-generational family was the normfor traditional societies and that the modern nuclearfamily equates to poorer care for the elderly. Some researchers haveargued that, contrary to popular conception,multi-generational families may be more likely to existin industrialized countries, that have already experiencedthe demographic transition with its mortalitydeclines and increasing life expectancies, than in less industrialized countries. Analysis ofhistorical evidence indicates that in England, theUnited States  and China  multigenerational families were less common in the past in part dueto higher mortality throughout the life cycle, meaning that fewer people reached old age. In addition to thenuclear family, kin and wider social groups, including friends, are alsoimportant in caregiving and vary in composition both within and between societies to the extent that some authors take issue with overly simplistic generalizationsbetween developed and developing countries. Moreover, where the nuclear family predominates,it often holds the financial resources to create asituation in which the elderly can live independently.Lee points out that "the research picture on the role of the family in supporting the elderly in Western nationsshows that while the nuclear family.., may be the most common family form, this has not led to any decline inthe family's role in the lives of the elderly".Second, the automatic ascription of power andrespect to the aged in rural, less modern societies maynot be uniform and widespread. There is real variationin any society among the aged, for example, betweenthe ill and the healthy, the ancient and the elder, therich and the poor. Control by a privileged groupof elderly men cannot be equated with high status forall elderly, and each social group has some memberswho have little status or power at any age. As seenearlier, Glascock and Fineman's systematic reviewof ethnographic data from 57 non-industrializedsocieties generated several propositions including theextensive variation of treatment of the aged, multipletypes of treatment within a single society andwidespread non-supportive treatment of certainsubgroups of elderly, specifically the frail.Third, the elderly do not rely entirely on thegoodwill and affection of the family for care in anysociety, and economic considerations often liebehind certain behaviors, such as co-residence ofgenerations, that are assumed to be natural indeveloping countries fordiscussion). Mechanisms in different societies toensure that younger family members will care for theelderly have included the use of threats bysupernatural powers, the arousal of social criticism,instilling guilt feelings, and inheritance mechanisms. Martin argues that the "status ofelderly South Asians appears not to be guaranteed byvirtue of their age or coresidence with offspring" butrather by their "sex, health, and economic resources". Also, patterns of co-residence may bedetermined more by economic conditions than bychoice and many older family members would preferto live alone. For example, Ramos  clearlydescribes this situation in a comparison of family carefor the elderly in three neighborhoods of differentsocioeconomic status in So Paulo. Elderly in the highincome neighborhood possessed the desire as well asthe necessary resources to live apart from theirchildren. Goldani states that Brazilian elderly"commonly share households not only for culturalreasons but also for lack of economic resources tomaintain their own" and that thisexplains the high percentage of extended and complexfamily arrangements in Brazil as compared to theUnited States. In some parts of rural China where thecommodity economy has developed, the majority ofelderly prefer to live independently because of theirdecreased status in the family as it becomes moreyouth-oriented, their increased earnings, and newgenerational differences in lifestyle. In Shanghaithree quarters of the elderly live with their families,although this may only be a reflection of the acute lackof housing, as rates are much lower in Beijing andTianjin where more housing stock is available.Sankar points out that not all research from Chinais consistent regarding elderly preferences forco-residence, but in some cases it undoubtedlypromotes conflict, rather than harmony, acrossgenerations.

Finally, in some cases, effective care for the elderlymay persist, although possibly altered, in the face of'modernization' and its accompanying social change.For example, Peil emphasizes the preservation of theimportant moral norm of providing for the elderly insouthern Nigeria. She says that "family supportnetworks are still strong" and that, "Economicassistance to elderly people is widely acknowledged tobe less than optimal, but there is no evidence that it wasadequate in the past". Moreover, in arandom sample of elderly over 55 in Seoul, 94% citedthe family support network as the one they would turnto most often for help. Despite the dramaticpopulation shift in South Korea from only 28.3%urban in 1960  to 73% urban in 1991 (largely because of migration of the young tocities for job opportunities in the rapidly industrializingeconomy), the patrilineal stem family resisteddisintegration and continues to offer income and laborfor the maintenance of the aged in rural areas.The family has retained its ability to provide supportthrough changes in behavioral norms, such as a delayin the age of retirement among rural elderly and theadoption of different strategies to diversify householdlabor. However, despite the overall conservation offamily function, change has exacted a cost from theelderly. Sorenson says that "industrialization ofsociety has reduced the importance of their [theelderly’s] control over the land and made theirtraditional knowledge obsolete".In sum, the modern/urban/nuclear and traditional/rural/extended characterizations of family caresystems are generalizations that, by nature, do notcapture the myriad possibilities of the process of familyadaptation that can arise in different cultural settingsin response to the forces of change reviewed in theprevious section. Inter- as well as intra-societalvariability exists in the way in which families react tostressors affecting their ability to care for elders.

 

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