Chapter 4: Family Dynamics – Working with Seniors
When working with immigrant seniors, it is important for practitioners to have not only an understanding of settlement challenges, but also to know how to approach communication with elders, particularly from cross-cultural and intercultural frameworks. Refer to “Chapter 5: Intercultural Competence and Communication” for more information. The Gerontological Society of America (GSA) (2012) notes several recommendations for communicating with adults to improve interactions (p. 1). We will examine a few case studies based on the GSA’s evidence-based approach to communicating with older adults. It is important to note that language and intelligence does not decline as elders age; knowledge remains stable (Gerontological Society of America, 2012, p. 4). However, hearing loss is the third most common condition among people who are 65 to 75 years of age, followed by vision loss, which can limit the ability to drive at night, and a reduction in the speed and process of language (pp. 4–5).
The global aging population is expected to increase by 21.1% by 2050 (Likupe, Baxter, & Jogi, 2018, p. 180). This can be attributed to better health care that may extend the life cycle. Sadarangani and Jun (2015) examine the impacts of late-life migration on newly arrived elderly immigrants using three theories, Life Course Theory (Clausen, 1986), Continuity Theory (Atchley, 1989), and Exchange Theory (Pyke, 1999). These theories have been summarized in Table 1. Models of Late-Life Migration and can also be applied to working and communicating with immigrant seniors (Sadarangani & Jun, 2015, pp. 115–117). Life Course Theory surmises that immigrant seniors emigrate late in life because of historical, social, and political factors of that time. This could include economic crises or war. On the other hand, Continuity Theory is embedded in the idea that an immigrant senior who stayed behind in their country of origin would be worse off psychologically because their family bond with the younger generation would be lost, so migration is a better option. Finally, Exchange Theory evaluates the cost versus benefits of a senior migrating or remaining in their country of origin. For example, an immigrant senior may be concerned about who would take care of them as they age. Table 1. Models of Late-Life Migration summarizes the assumptions and impacts of late-life migration on the life of immigrant seniors.
Table 1. Models of late-life migration
|Theory||Assumptions||Impact of Late-Life Migration|
|Life Course Theory
|Life is shaped by history.
Decisions are based on individual choice.
Social relationships are integral to one’s life.
Transition is based on physical and social time of life (p. 115).
|Elderly newcomers are motivated by political forces, individual agency, and familial obligations. This varies from cultural experiences of aging to socio-political forces in the immigrant senior’s country of origin (e.g., war, economic or political crises, or environmental impacts).|
|Builds on Life Course Theory.
Life is not predictable in terms of one’s environment as one settles.
The focus is on preserving familiar structures such as culture and heritage.
|Familial attachments will supersede the desire to stay in one’s country of origin; country of origin becomes less meaningful if one is not with family who has migrated. This idea is at odds with Western ideals on familial bonds. The idea is that migration is moral and the right thing to do to maintain cultural traditions. Some immigrant seniors will state that they emigrated because they wanted to preserve their cultures and traditions.|
|Members of the household with the most resources control relationships and household dynamics.||Adult children provide financial support and manage the personal affairs of elders. In exchange, elders care for grandchildren. “Elders must concede power to children (p. 115).”|
Note: This table summarizes the various theories that impact the late-life migration to Canada of immigrant seniors.
Communication Accommodation Theory
On one hand, elder immigrant newcomers may see themselves as the knowledge keepers and preservers of cultural norms and heritage, but at times, they may feel frustrated, angry, or resentful that their traditional norms of power and independence may become weakened once they migrate to Canada. Communication is the best tool for supporting elderly newcomers because language barriers in communication can result in poor health care (Likupe, Baxter, & Jogi, 2018, p. 181). This is where stereotyping occurs among settlement practitioners and health, public or social service workers when dealing with elderly newcomers, and microaggressions begin to expose the assumptions of service providers. Note, for the purposes of this chapter, a microaggression is defined as a verbal statement or action that is hostile, derogatory, or negative towards someone. Microaggressions can be subtle, indirect, or unintentional, and occur against marginalized groups of people.
One framework to consider in providing ethical, effective, and respectful communication is Communication Accommodation Theory, otherwise known as CAT (Momand & Dubrowski, 2020, p. 3.). In this theory, service providers reflect on the social differences in communicative behaviour using two assumptions. First, behaviour changes based on the communicator and the recipient of the communication, and second, perception is directly correlated to how well the communicator and recipient are attuned to the conversation (p. 3). The following convergence method is used to provide effective communication between practitioner and elderly clients:
- Speak clearly.
- Give the client time to ask questions.
- Ask one question at a time and speak slowly when doing so.
The divergence approach happens when practitioners speak too quickly, provide too much information at one time, and do not give the receiver (the client) time to respond. Look for non-verbal cues from the receiver such as disapproval, confusion, or head shaking “no”—all signs that the receiver is confused, uncomfortable, or not understanding the message. When considering convergence, use CAT, which includes the following:
- Be empathetic
- To build trust, look for things that they like in the room or space if in the individual’s home
- Use culturally appropriate eye contact for men and women (based on social norms)
- Use an interpreter, if applicable
The convergent approach is more appropriate to use over the divergent approach because it builds rapport between the settlement practitioner and the client. In contrast, the divergent approach may be seen by the client as dismissive and confusing, whereas the convergent approach demonstrates respect and active listening.
Elisabeth is a case worker who is meeting with Eyerusalem for a follow-up appointment. Elisabeth tends to play soft music just before she meets her clients and keeps a whiteboard and markers out in case she needs to communicate using visual imagery. Eyerusalem has been living in Lethbridge for the past three years. Lately, she has begun to feel isolated. There are not many individuals living in the city from her home country, and her children are always travelling out of town for work. She loves her three grandchildren, ages 12, 9, and 6, but she longs to spend time with her peers. Eyerusalem does not drive and speaks a moderate level of English. Her hearing has started to deteriorate, and she was given a hearing aid. She does not like to wear the aid. Eyerusalem is excited to be able to get out of the house today to meet with Elisabeth, but she is cautious about what she shares because she does not want to be judged for her feelings of loneliness. To prepare for the meeting, Elisabeth reviews her notes from Eyerusalem’s last visit. She remembers that Eyerusalem was given a hearing aid and seemed saddened when she had to end the appointment. She also recognizes that Eyerusalem is taking some English classes to improve her communication.
- What is your initial reaction?
- What assumptions could you make about Eyerusalem’s late-life migration? How can each of the three theories inform the settlement practitioner about Eyerusalem’s late-life migration experience?
- How can Elisabeth prepare for today’s visit?
Although this activity can work well in an in-person think-pair-share format, it could also work well as an online discussion forum topic.