Nursing Home and Aging Essay

Social Construction of Aging in Nursing Homes

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 the 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 socio-economic status issues might 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 can also be located subgroups, based on gender but also on other factors such as support groups for specific physical or mental health conditions, hobbies, or activities. This ethnography will take 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, will also be taken into account. Moreover, the nursing home becomes the new residential community for the individuals, who are physically removed from their families and communities of origin. They recreate new identities within the home, sometimes severing ties with the community outside. In other cases, rites of passage that would typically take place outside of the domain of the nursing home such as birthday celebrations or anniversaries, take place in the nursing home because it is 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 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 & Hepworth (1995) point out, the 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, falling and yellowing teeth, flaccid muscles, and poor posture. Young adults are warned against aging in a number of ways: avoiding the sun, avoiding alcohol and smoking. In addition to the negative imagery of aging perpetrated by the media and its corporate sponsors of magical anti-aging creams and surgical techniques, the media presents an equally as demeaning view of the subjective perception of aging. Aging entails a person becoming weak. The projection of weakness and frailty upon the elderly, regardless of their actual physical health or prowess, 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 systematic use of surveillance and social control within the nursing home institution (p. 45). Nursing homes observed for this ethnography concur, substantiating what Kaufman (1994) found in the earlier observations. Nursing home staff, reflecting the words of doctors and visitors to the nursing home, frequently as the residents if they can lift things, if they are alright to move something, and other indications that they are encouraging dependence and lack of autonomy.

Using a Foucault analysis of the nursing home as a social institution, it is clear that the home has been set up for surveillance and social control. The aging body can be seen by the constant paternalistic gaze of the nursing home staff. The movements of elders are monitored and proscribed; the residents are like inmates. They have schedules, routines. Dining takes place collectively, only the sick can have their food delivered to their bed in the room, where they are sometimes monitored by the nursing home 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 time, transgressions from the norm duly recorded. Recording in bureaucratic format takes place constantly, as nurses use graphs and charts to plot everything from what a patient eats to how many times they spoke in a group counseling session.

The aging body is asexual. For women past the reproductive age, the asexualization of the aging body is particularly problematic. The link between sexuality and sexual pleasure and childbirth is a patriarchal one; the woman has 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 "ugly," 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 who was interviewed for this report. Old men, on the other hand, are allowed to have younger partners, and are lauded for doing so. The film Harold and Maude subverted the norm, offering a positive aging framework within which to view female sexuality in particular. Another interview participant said that besides films like Harold and Maude, which is an exception to the rule, the movies and television shows that ever show older people having sex at all depict it as if it is a joke, or as something that is "disgusting." These comments are reflected in more systematic studies,…