Social Construction of Aging in Nursing Homes

Introduction: Aging as Social Construction

Aging is socially constructed. Using the perspective of symbolic interactionism, it is possible to show the precise processes whereby the social construction of aging takes place inside specific institutional contexts, like the American nursing home. The American nursing home offers insight into the culturally constrained concept of aging, for attitudes towards aging bodies and aging as a philosophical concept are informed by cultural milieu, worldview, and value construction. Biological aging is not social aging. The positive aging movement and the harmonious aging movement offer counterpoints to traditionally antagonistic and negative views of aging. Especially as the population of the United States and other industrialized nations shifts towards the older end of the age spectrum, it becomes important to reconsider the biological, psychological, and social processes and functions of aging.

The nursing home offers the opportunity to examine aging from a multidisciplinary perspective, while using ethnography as a primary methodology. A nursing home is a community and a subculture, separated from the rest of society not because of gender or ethnicity but because of age. While economic and socioeconomic status may impact the subculture of the nursing home, many nursing homes are government-subsidized and remain one of the few domains in which the boundaries of race, class, and gender become dissolved. Age is the primary demographic factor contributing to the construction of individual identities and community identities.

Within the nursing home, subgroups can also be identified, based on gender but also on other factors such as support groups for specific physical or mental health conditions, hobbies, or activities. This ethnography takes into account the ways residents of a nursing home are treated by staff, illustrating power differentials in a presumably paternalistic — if not outright patriarchal — healthcare system. The reinforcement of aging stereotypes, and what Kaufman (1994) refers to as the social construction of frailty, is also examined. Moreover, the nursing home becomes the new residential community for individuals who are physically removed from their families and communities of origin. They recreate new identities within the home, sometimes severing ties with the outside community. In other cases, rites of passage that would typically take place outside the nursing home — such as birthday celebrations or anniversaries — take place within it, because it has become the community hub. As seniors relocate to the nursing home community, a new type of population migration takes place, as nursing homes have also become a global phenomenon.

Older Bodies

The ideal body phenotype for any gender or ethnicity is young. An older body is therefore viewed as subversive and deviant. Positive aging entails an empowerment of the senior community and of the individual senior to control how images of the aging body are portrayed in the media. The positive aging movement has permeated some age-specific media, such as magazines that target the senior community and which are typically on hand in nursing homes. As Featherstone and Hepworth (1995) point out, efforts at generating a positive aging framework have been stymied by the corporate media, which continues to deliver images of ideal aesthetics and idealized health. Youth is signified in a number of different ways, whereas aging is portrayed as monolithically negative: wrinkles, age spots, yellowing teeth, flaccid muscles, and poor posture. Young adults are warned against aging in various ways, including avoiding sun exposure, alcohol, and smoking.

In addition to the negative imagery of aging perpetuated by the media and its corporate sponsors of anti-aging creams and surgical techniques, the media presents an equally demeaning view of the subjective perception of aging. Aging is associated with weakness. The projection of weakness and frailty upon the elderly, regardless of their actual physical health or capability, was the subject of a study by Kaufman (1994), who observed a senior community in the United States. Results showed that frailty was presumed and projected by the medical community and by outsiders, leading to "increased dependence" and the systematic use of surveillance and social control within the nursing home institution (p. 45). Nursing homes observed for this ethnography substantiate what Kaufman (1994) found in earlier observations. Nursing home staff, reflecting the attitudes of doctors and visitors, frequently ask residents whether they can lift things or whether they are all right to move something — indications that they are encouraging dependence and limiting autonomy.

Using a Foucauldian analysis of the nursing home as a social institution, it becomes clear that the home has been set up for surveillance and social control. The aging body is subject to the constant paternalistic gaze of nursing home staff. The movements of elders are monitored and constrained; the residents are akin to inmates. They have schedules and routines. Dining takes place collectively; only the sick can have food delivered to their rooms, where they are sometimes monitored by care staff. Cameras complete the surveillance system. Installed "for patient safety," as one nurse stated, the cameras ensure that the population is monitored at all times and that transgressions from the norm are duly recorded. Bureaucratic recording takes place constantly, as nurses use graphs and charts to document everything from what a patient eats to how many times they spoke in a group counseling session.

The aging body is rendered asexual. For women past reproductive age, the asexualization of the aging body is particularly problematic. The link between sexuality, sexual pleasure, and childbirth is a patriarchal one; the woman is seen to have lost her power of agency in sex once she moves past the age of childbirth. Bereft of her sexual power, the aging woman is portrayed in the media as unattractive — someone a young person would never want to have sex with, and even someone an older man is not supposed to want to have sex with, according to one woman interviewed for this report. Older men, on the other hand, are permitted to have younger partners and are frequently lauded for doing so. The film Harold and Maude subverted this norm, offering a positive aging framework within which to view female sexuality in particular. Another interview participant noted that, besides films like Harold and Maude — which is an exception — movies and television shows that depict older people having sex at all portray it as a joke or as something "disgusting." These comments are reflected in more systematic studies, such as the surveys conducted by Featherstone and Hepworth (1995).

In an attempt to reclaim power from the media, seniors in the nursing home need to adopt a proactive stance that situates the senior body separately from media representations. This is something that can potentially be achieved in a progressive nursing home. A positive aging framework, or a "harmonious aging" framework as suggested by Liang and Luo (2012), can be employed. Harmonious aging goes beyond positive aging to reverse the Cartesian duality of body and mind. Moreover, harmonious aging is not culturally specific, whereas the concept of "successful" aging operates within a Western hegemonic framework (Liang & Luo, 2012, p. 327).

Rites of Passage for the Elderly

In the nursing home environment, residents frequently undergo rites of passage that might typically take place outside the community, in their communities of origin. Some of these rites are even nursing-home specific, such as anniversaries of their entry into the community. The removal of the elder from their community of origin is a means of social control; the migration of the individual to the nursing home functions as an exodus and an exile of the aging body. As Saxena (2016) points out, age has become a direct cause of social inequality. Far beyond the simple biological concept of aging, the ways in which the media and mainstream society project negative connotations onto aging individuals cause those individuals to be exiled to the nursing home in a final rite of passage — from the community of origin into what is widely believed to be a final resting place before death. Entering the nursing home is itself a newly socially constructed rite of passage specific to old age, one that never existed before the advent of the nursing home. As life expectancy grows, the frequency of this rite of passage will also increase, until it may become as commonplace as divorce.

Within the nursing home, several social celebrations that commemorate rites of passage take place that would typically occur outside of it. This shifts the geo-spatial dimensions of those particular rites. For example, birthdays and wedding anniversaries are marked within the nursing home. A birthday or a wedding anniversary is not itself a rite of passage, but it commemorates the original event — birth and marriage, respectively. The death rite of passage can also take place in the nursing home, often without the broader community support system that would extend beyond the subculture. Without friends, family, or colleagues from outside the nursing home, each resident comes to rely on the internal support system as a surrogate family.

Conclusion

The seniors in nursing homes who are offered the opportunity for positive aging can indeed find ways to subvert patriarchal medicine and the social construction of aging, and to reconstruct their own understanding of how the aging process should be experienced.

References

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Featherstone, M., & Hepworth, M. (1995). Images of positive aging. In Images of Aging. Taylor & Francis.

Gergen, K. J., & Gergen, M. M. (2000). The new aging. In Social Structures and Aging. Springer.

Katz, S. (2005). Cultural Aging. Canadian Journal of Sociology Online, Jan–Feb 2006.

Kaufman, S. R. (1994). The social construction of frailty. Journal of Aging Studies, 8(1), 45–58.

Liang, J., & Luo, B. (2012). Toward a discourse shift in social gerontology: From successful aging to harmonious aging. Journal of Aging Studies, 26(3), 327–334.

Saxena, R. (2016). Social construction of aging. The International Journal of Indian Psychology, 3(4), 64.