Course 4: Culture, Health and Aging

| Aging, Culture and Experience | The Universal Experience of Aging |
| Aging and Culture | Culture, Health and Aging |

GRADES
REQUIRED READING
CLASS SCHEDULE
APPENDIX I
APPENDIX II

 This course was designed for Masters and Ph.D. students whose interests lie in health and aging. Students typically come from graduate programs in anthropology, gerontology, public health, nursing, social work and psychology. As students come from so many different backgrounds I usually provide focus questions to help students prepare for class partic ipation. I give the students the option of doing either a major research project or a hypothetical grant proposal. To help those doing grant proposals I place on reserve several examples of successful grant applications I have written or ones from colleagues. Students who take this option are asked to visit the campus office of sponsored research and get the actual forms appropriate to the agency for whom they will be writing the hypothetical grant. Parts of several classes are spent discussing the ideas for these projects. I encourage students to do research or write grants related to their career goals or community based interests. For example, one Public Health Ph.D. student wrote an excellent proposal for her church to expand outreach health services to the elderly in her parish.

Culture, Health and Aging: Global and Cross-Cultural Perspectives

Professor Jay Sokolovsky Spring 1997

ANT 4930/6469

GEY 4935/6

NRG 6931

PHC 6934

This is truly the age of aging. We are on the leading edge of a demographic and health transition revolution which will globally shape almost all aspects of life, such as perceptions of the life cycle, the organization of health care systems; intergenerational relations; the nature of family life; the structure of communities and attitudes toward death.

This course will investigate health issues related to aging and cultural context in a world-wide sample of cultures. Special Topics to be considered include: the dimensions of a qualitative gerontology; integrating qualitative methods into health and aging research; the demographic revolution and the health implications of population aging:the cultural context of health and disability in late adulthood; cross-cultural and cross-national perspectives on dementia; health problems and the self-help movement; caregiving environments; social support networks and community; gender, health and aging; ethnicity and long-term care.

We will also attempt to apply the concerns of anthropological and qualitative research to the problems of aging in our own society.  This should always be a goal in the back of your mind when you are reading the assignments.  You should come to class prepared to discuss the readings. Class participation will count toward your grade. The classes will run in seminar fashion but will include a combination of lectures, discussion and occasional audiovisual presentations. 

Grades will be based on the following: top of page

Expert Panels Focus Papers (2): 30%

Mid-term 15%

Term Paper or grant proposal: 25% (for graduate students only)

Take Home Essay Final Exam: 20

Seminar Participation: 10%

NOTE ON RELIGIOUS OBSERVANCES: STUDENTS WHO ANTICIPATE THE NECESSITY OF BEING ABSENT FROM CLASS DUE TO THE OBSERVATION OF A MAJOR RELIGIOUS OBSERVANCE MUST PROVIDE NOTES OF THE DATE(S) TO THE INSTRUCTOR, IN WRITING, BY THE THIRD CLASS MEETING.

Required Readings: top of page

1) Albert, S. and Maria Cattell. Old Age in Global Perspective1994. New York: G.H. Hall

2)Population and Health Transitions. Washington, D.C.:U.S. Department of Commerce, Bureau of the Census, 1994.

3) Joel Savishinsky The Ends of Time: Life and Work in a Nursing Home. New York: Bergin and Garvey. 1991.

4) Sokolovsky, Jay, ed. 1997. The Cultural Context of Aging. Westport, CT.:Greenwood

NOTE: You will be assigned other reading and you will either get these as a class handout or from library reserve.

Class Schedule top of page

Jan 16: Introduction: Aging, Health and Culture - taking an inside cultural view.

1) Pp. 1-15, Ch 4.

Handouts:

4) Sokolovsky: "Starting Points: A Global, Cross-Cultural View of Aging"

Reserve Resource:

Abel, E. and A. Sankar, ed. 1995. "Qualitative Methodology" Special Issue of Research on Aging. 17:1.

Hurwicz, M.-L. ed. 1995. "Cultural Contexts of Aging and Health." Special Issue of Medical Anthropology Quarterly. 9:2.

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Focus questions for 1/16

1) How can we apply the anthropological paradigm to understanding health and frailty among the TIWI - is it fair to compare covering up to nursing home placement?

2) What is qualitative gerontology - how does Fisher apply it in her study of adult mothers and daughters - how might her approach be extended to studying the caregiving process?

3) What are some ways in which different cultures think about the lifecourse and aging - how might that influence the perceptions of health problems and frailty in late life?

JAN 23: THE DEMOGRAPHIC REVOLUTION AND THE HEALTH IMPLICATIONS OF POPULATION AGING // GERONTOLOGICAL INFORMATICS

1) Review Chap 4; Ch. 2, 3.

2) 1-30

4) Ch.1

Focus questions:

1) WHAT HEALTH ISSUES ARE RELATED TO THE WORLD DEMOGRAPHIC TREND IN POPULATION AGING?

2) WHAT ARE THE DEMOGRAPHIC AND EPIDEMIOLOGIC TRANSITIONS?

JAN 30 STUDYING HEALTH, AGING AND DEPENDENCY IN CULTURAL CONTEXT

2) FINISH BOOK

1) Chap 9

4) Ch. 2

Library Reserve: (1) V. Velkoff and Kevin Kinsella; "Mortality and Health: A Closer Look" from Aging in Eastern Europe and the Former Soviet Union, 1993. (2) M. Jylha and J. Jokela "Individual Experiences as Cultural - A Cross-Cultural Study on Loneliness Among the Elderly" (Ageing and Society, 10, 1990.)

Focus questions:

1) FOCUS ON YOUR REPORTS - I WOULD LIKE SOME TO BE READ IN CLASS.

2) BE ABLE TO DISTINGUISH BETWEEN IMPAIRMENT, DISABILITY AND HANDICAP IN RELATION TO OLDER ADULTS.

3) HOW DO HEALTH AND DISEASE PROFILES IN LATE LIFE DIFFER IN COUNTRIES LIKE RUSSIA, S. KOREA AND THE U.S. - WHAT ARE SOME IMPLICATIONS FOR HEALTH CARE POLICY FOR OLDER ADULTS?

4) HOW DOES CULTURE IMPACT ON #2 - USE THE TWO HANDOUTS TO TALK ABOUT THIS ISSUE

PROJECT 1 Due Jan 30

Expert Panel Focus Papers : You are asked by the United Nations Center on Aging in Vienna to use the data in Population and Health Transitions, to write a 3-4 page focus paper to be sent to key Schools of Public Health or Health Ministries in Third World countries with relatively young populations. In your report: 1) could you convince them to be concerned about health and aging in countries such as Mexico, Indonesia or Kenya which are still demographically young?; 2) How should the issue of disability in late life relate to #1; 3) Come up with a brief plan of action to attack what you see as the most pressing problems related to the health of the aged. [Note: feel free to speculate even if the data, for a specific issue is not as complete as you would like]

3-4 PAGES DOUBLE SPACED -

Library Reserve Resources:

Aging Trends: Indonesia - A. Adlakha and D. Rudolph 9:1 1994

Aging Trends: Kenya - Kevin Kinsella

Dowd and Manton 1992. J. of Cross-Cultural Gerontology, 7:3: "Projections of Disability Consequences in Indonesia"

K. Avlund, M. Luck and R. Tinsley, "Cultural Differences in Functional Ability Among Elderly People in Birmingham, England and Glostrup, Denmark." J. of Cross-Cultural Gerontology, 11:1:1-16, 1996.

FEB 6 Dementia - How scarred should we be? Cross-national and cross-cultural perspectives.

GUEST LECTURE: DR. AMY GRAVES - THE US/JAPAN CROSS-NATIONAL STUDIES OF DEMENTIA

Film "The Spirit Possession of Alejandro Mamani"

1) PP. 199-202 ("Measuring Cognitive Impairment..)

Handouts:

Graves, A. et al. "Cross-cultural Research and Perspectives..."

4) Ch. 24

Recommended for graduate students:

Library Reserve: Graves, A. Prevalence of Dementia and its Subtypes in the Japanese American Population of King County, Washington - The Kame Project" American J. of Epidemiology 144(8): 760-771

FEB 13 Working with Families and the Community to Combat Health Problems

Slides: "The role of public health students in promoting rural health among the aged in Croatia"

Readings: 1. Pp. 81-84; Ch 5, 6 (pay special attention to 128-38 on family caregiving)

4. 10

Handout: (1) Sokolovsky, J., Z. Sosic and G. Pavlekovic. "Self-help Hypertensive Groups in Yugoslavia: How Effective Are They?" Journal of Cross-Cultural Gerontology, 6:3: 319-30, 1991.

Recommended for graduate students:(1) Schoenberg, N. 1997. "A Convergence of Health Beliefs: An 'Ethnography of Adherence' of African-American Rural Elders with Hypertension. Human Organization 56:2:174-81; (2) Hennessy, C.H. and R. John. 1995. "The Interpretation of Burden among Pueblo Indian Caregivers." Journal of Aging Studies 9(3):231-44. (3) Long, S. and P. Braudy-Harris. "Caring for Bedridden Elderly: Ideals, Realities, and Social Change in Japan." in Aging: Asian Experiences Past and Present, S. Formanek and S. Linhart, eds. 1997.

Focus questions::

1. How does the organization of household living arrangements and family organization influence the perceptions and behaviors involved with caregiving for the elderly?

2. Why are such a high percentage of the very frail elderly in Japan cared for by their daughters-in-law? How Does Japanese culture influence the nature of that care?

3. Why did the public health system in Croatia feel it was necessary to alter the way hypertension was treated? What are the key lessons learned from the study of the self-help groups?

FEB 20 Social Networks and Health Among the Elderly:

Slides: "Health and Social Support Among the Poor Inner-city Aged in New York"

Readings: 4. Ch. 16, 22

Handout: (1) Sokolovsky, J. and C. Cohen "Being Old in the Inner City: Support Systems of the SRO Aged."in Dimensions of an Anthropology of Aging, Christine Fry (ed.). Praeger, 1981.(2) Jerrome, D. "Frailty and Friendship" JCCG 5:1:51-64, 1990.

Library Reserve:

(1) Scharf, T. and C. Wenger. 1995. International Perspectives on Community Care for Older People. Aldershot: Avebury.(2) Wenger, C. 1992. "Support Networks and Dementia: Aging in Liverpool." Working Paper 4, Bangor: University of Wales, Centre for Social Policy Research and Development. (2) Cohen, C and J. Sokolovsky "Clinical Use of Network Analysis for Psychiatric and Aged Populations," Community Mental Health Journal, 15 (3) :203-213, 1979

Focus Issues:

1) WHY HAVE SOCIAL NETWORKS BECOME SO IMPORTANT IN THE STUDY OF AGING?

2) HOW ARE HEALTH ISSUES, SUCH AS FRAILTY, CONNECTED TO VARIATIONS IN SOCIAL NETWORKS?

3) HOW MIGHT THE LESSONS FROM SOKOLOVSKY ET AL'S WORK IN CROATIA BEEN APPLIED TO HENDERSON'S PROJECT IN TAMPA?

Recommended for Graduate Students:

(1)Wenger, C. "Social Network Research in Gerontology: How Did We Get There and Where Do We Go Next?" In Sociology of Ageing. V. Minichiello, N. Chappell, A. Walker and H. Kendig, eds. Melbourne, AUS: International Sociological Association, 1996. (2)

Becker, G. 1993. "Continuity After a Stroke: Implications of Life-Course Disruption in Old Age." Gerontologist, 33(2):148-58. (3) Diana Shye, John P. Mullooly, Donald K. Freeborn and Clyde R. Pope. "Gender Differences in the Relationship Between Social Network Support and Mortality: a Longitudinal Study of an Elderly Cohort." Social Science & Medicine 41(7): 935-947, 1995.

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FEB 27 SPECIAL EVENT - Panel on Assisted Suicide: Larry Polivka; Rosalie Kane, Howard Tuck, Prof Sandy Schuh - (6-8PM, 130 DAVIS HALL) - mandatory attendance - there will be a sign in sheet for students - but no class after panel discussion.

Readings: 4. Ch. 3

Handouts: (2) Seth Mydans "Australia, Edgy, Faces Reality of Assisted Suicide," NY Times.

***MIDTERM EXAMS ARE DUE.

They are to be placed in the envelope on my office door no later than 8:45pm on 2/27/

MIDTERM: Answer 2 of the following 3 essay questions in about 2-3 double spaced typed pages each - BE SURE TO INTEGRATE SPECIFIC STUDIES INTO YOUR ANSWER.

1) What are the most important ways culture impacts health issues affecting the elderly?

2) The disablement process is an increasingly important international issue for understanding late adulthood. How can cultural variation help us understand the distinction between, impairment, disability and handicap.

3) Why has the study of variations is domestic settings and social networks become so important in studying the support of the elderly? What are the most important factors accounting for support as the elderly become increasingly frail?

MAR 6 Ethnicity, Context, and Health - GUEST LECTURE - Charles Barresi (co-editor of Ethnic Elderly and Long-Term Care)

Readings: 4. Ch. 12, 14, 15

Handouts: (1) Yeo, G. "Ethnogeriatrics: Cross-Cultural Care of Older Adults" Generations Winter: 72-77, 1996/7; (2) Barker, J. Recognizing Cultural Differences: Health-Care Providers and Elderly Patients." Gerontology and Geriatrics Education, 15(1):9-21, 1994.

Resources for graduate students:

On reserve:

(1) Hopper, S. 1993. "The Influence of Ethnicity on the Health of Older Women." Clinics in Geriatric Medicine: Care of the Older Woman 9:231-57; (2)Barresi, C. and J. Skinner. 1994. "Overview of Health and Minority Elders" from Health and Minority Elders: An Analysis of Applied Literature, 1980-1990. Washington, DC: American Association of Retired Persons.

SPRING BREAK - NO CLASS MARCH 13

MAR 20 Community, Environment and Health

GUEST LECTURE, JOAN BEZON - SOCIAL NETWORKS AND HEALTH IN A TAMPA HOUSING COMPLEX.

Film: "Mr. Nobody"

1) Ch 7,

4) Ch. 7, 21, 23

Handouts:(1) Minkler, M., Roe, K and M. Price " The Physical and Emotional Health of Grandmothers Raising Grandchildren in the Crack Cocaine Epidemic" Gerontologist, 32:6:752-761, 1992.(2)

(2) Yee and G. Weaver, "Ethnic Minorities and Health Promotion", Generations Spring 1994.

Library Reserve: (1) Focus Group report on quality of life among older residents in a Tampa housing project;(2) Damron-Rodriguez, J., S. Wallace and R. Kington. "Service utilization and Minority Elderly..." Gerontology and Geriatrics Education, 15(1):45-63, 1994.

Come prepared to discuss the focus group report: You are to read the Focus Group report by a faculty at FMHI on the problems of the elderly at an apartment complex in the Tampa area. Use the other readings to frame an action plan to assist the Elder Care Clinic - stressing how knowledge about ethnicity might be a factor in what you propose. (Hint: you will have to write this up as part of the final exam)

MAR 27 SPECIAL EVENT - CLASS WILL BE HELD AT Suncoast Manor a "Life Care" Community in St. Petersburg. It will include a tour, presentation by the director, Will Michaels and a small focus group discussion with residents.

Readings: 4. Ch. 5, 18

Handouts: (1) Polivka, Sims and Salmon "Assisted Living and Extended Congregate Care: The Florida Experience." Florida Policy Exchange Center, 1996:(2) von Meering and Neff."Joining a Life Care Community: an Alternative to 'Frailing' into a nursing home in the USA" Journal of the British Society of Gerontology, 3:4:93 (3) Victor Regnier "Are They Smarter than we or what?"

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APR 3 - HEALTH, AGE AND ENVIRONMENT

**Be prepared to talk about you health and environment projects Due April 10.

Film: On Lok: A Chinese Day Care Center

Readings: 4. Box 1, ch. 5, 17

Handouts: Elliot, C., et al. 1996.(1) "Working with Chinese Families in the Context of Dementia" in Aging and the Dementias; (2) J. Gubrium - "Welcome to the Real World" From The mosaic of Care. (3) Reserve: Kane, R., L. Hixon Illston and N. Miller. 1992. Qualitative Analysis of the Program of All-Inclusive Care for the Elderly (PACE)." Gerontologist 32, No. 6, 771-780.

Reserve:

Diamond, T. 1992. Making Gray Gold: Narratives of Nursing Home Care. Chicago: University of Chicago Press.

APR 10 Guest Lecture: Neil Henderson - "Things you really did not expect to see in nursing home environments"

PROJECT 2 ASSESSMENT OF LIVING IN A COMMUNITY ENVIRONMENT (SEE APPENDIX) IS DUE!

Readings: 3. chaps 1-4

4. Ch. 24, 25

Handout: Henderson: "The Culture of Care in a Nursing Home: Effects of a Medicalized Model of Long-Term Care." from The Culture of Long-Term Care, Henderson and Vesperi, eds, 1995.

Library Reserve: Doty, P. "International Long-Term Care Reform: A Demographic, Economic, and Policy Overview" Journal of Cross-Cultural Gerontology, 8:447-61, 1993.

APR 17 The Last Hello: Late Life in Institutional Care

Slides: "The evolution of environments for the frail aged in Great Britain."

Readings: Finish Savishinsky book; Albert and Cattell text, 229-36

4. Ch. 24

GRADUATE STUDENTS: HAND IN TERM PAPER

TAKE HOME FINAL GIVEN OUT - DUE BY 6PM APRIL 24 IN MY MAILBOX (258 DAVIS) OR IN THE ENVELOPE ON MY OFFICE DOOR - 214 COQ

On reserve: (1) Haven, B., ed. 1996. "Long-Term Care in Five Countries" Special Issue, Canadian Journal on Aging 16(1). (2) Kagawa-Singer, M. 1994. "Diverse Cultural Beliefs and Practices About Death and Dying in the Elderly" Gerontology and Geriatrics Education 15(1):101-116.

APPENDIX 1 top of page

PROJECT II ASSESSMENT OF LIVING IN A COMMUNITY ENVIRONMENT

The purpose of this assignment is to encourage you to have some contact with elderly persons in order to assess the role that the physical and social environment plays in conditioning his or her life and perception of health in late adulthood. I would like you to contact and arrange to interview a two persons (1 male and 1 female) over 65 years of age. It is not essential that you already know this person well. However, you may find it easier to talk with a relative, friend, or other old person with whom you are already familiar. You should anticipate two interviews per person of about an hour's length each, so that you can gain a feel for some of the subtleties of your subject's lifestyle. However, the length of the interview will vary considerably according to individual circumstances. In talking with this person I would like you to focus on two issues.

1. HOW MIGHT THEIR PHYSICAL AND SOCIAL ENVIRONMENT INFLUENCE PERCEPTIONS OF HEALTH AND FUNCTION IN LATE LIFE?

You should attempt to obtain information on: the nature of the neighborhood (urban? rural? suburban? small town?); the characteristics of the person's residence (small run-down house? large apartment? mobile home?, etc.); the individual's living arrangements (alone? with family? with a live-in companion?, etc.); and any other features of the person's living situation and physical environment (including interior of their residence) that you consider relevant; the kinds of people in the immediate area. Use your observational skills here. Be sure to find out how long the person has been in the current environment and where they last resided. Was the most related to any changes in physical status or health concerns or has there been a change since they moved there?

2. ARE THERE ANY ASPECTS OF THEIR CURRENT HEALTH CONDITION WHICH THEY ATTRIBUTE TO AGING AND BEING AN OLDER ADULT? . When and how did they first notice the health problems they relate to aging. How have these health concerns affected how they interact with their physical and social environment (e.g. limit things they do or people or social groups they interact with)? What kinds of adaptations has the person made to changes in their health? (e.g. bought a hearing aid, installed safety devices in their house, seen a doctor).

Note: it might be helpful to take them through a typical day during the last week.

In talking with the older person you should try to identify particular problems that may have emerged as the individual has grown older (for example, difficulty in climbing stairs, inability to walk to the store, unsteadiness resulting in the need to arrange furniture so that there is always a chair, table or other item to hold on to, etc.. The intent is for you to gain a feel for the degree to which the older person's physical environment is supportive or provides limitations on activity.

Paper: 3-5 page paper comparing and analyzing what you found. Are there any implications of gender for how health impacts on their interaction with their environment. Compare your results with any relevant class materials - DUE 4/3

APPENDIX 2: TERM PROJECT OPTIONS: top of page

A. Research Paper. As part of your grade you will be expected to hand in a 12-15 page (double spaced - not including bibliography, endnotes or appendix materials) paper on some topic related to aging, culture and health. The paper can involve either pure library research or a combination of qualitative interviewing and observation combined with library research. I would particularly encourage students to think about doing a paper relevant to your current work situation if this is part of your career plans. If you are planning to do a paper involving original research it will be important to start almost immediately and it is mandatory that you discuss the project with me before starting. Two very important books for those considering such a project are:

1) Gubrium, J. and A. Sankar (Eds.). 1994 Qualitative Methods in Aging Research, Newbury, CA: Sage.

2) Fry, C. and Keith, J., New Methods for Old Age Research, Bergin and Garvey, 1986.

In terms of citation of references and bibliography for the style found in your text - Old Age in Global Perspective.

Students who have done papers for related classes may continue working on the same topic from an expanded perspective or different angle after showing me the paper.

Please note that to be able to help you with the papers I would like you to hand in no later than FEB 20, the paper title, a paragraph description of the direction of your paper or grant proposal and the key resources looked at to date. This should in no way inhibit you from coming to see me to discuss the paper at any time.

Some General Topics for Papers:

Impact of Aids //drug abuse on minority populations

Community Based Long-Term Care

Interaction of Poverty and Health Risks

Health Promotion - e.g. pharmaceuticals versus holistic health

Self-Help Groups

Homelessness/ housing

Social Support Systems

Ethnic perceptions of health and health seeking behaviors

Ethnic use/barriers to health service use

Effectiveness of interventions

Gender and the informal care system

Elder Abuse

B. Hypothetical Grant Proposal. This option asks you to write up a hypothetical grant proposal which will be submitted to a specific agency or foundation. On library reserve you will find examples of successful proposals which should serve as a guide to how yours should be prepared.

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