Developing Services for Older People and Their Families edited by Rosemary Bland Highlights in Social Work 29 Chapter 1 The Social Construction of Old Age New Perspectives on the Theory and Practice of Social Work with Older People Chris Phillipson and Neil Thompson Introduction ii? Impact of an ageing population has caused considerable debate discussion over the past few years. These discussions have HT^ed against a background of rapid change in terms of the context ageing. Three important features may be identified here: first the th iii public awareness and interest- in ageing issues - these Iflrpencd by concerns over the ability of governments to provide • hi "in 1.11 security for future generations of pensioners (Phillipsnn 1991, fo'iignlmi ,md Achenbaum 1993). Second, in the case of Britain, the lutein dl legislation in the field of community care and the movement iBWflrd'i a mixed economy of care (Phillipson 1994). Third, the growth it.....\\ leliivmcn! and the l-vi Iving concept oi Lin third agef, fllifl i Hies .ihuut changes in policies and attitudes to realise the full pllvnll.il i-l [.iter life (Midwinter 1992) I In ill - oiuexl of ageing has itself mfluented debates within the Ml 1 I.......■■! cernntology. In particular, in the lySOs an importaiit ■ i" I ' !■ 11 lie emerged focusing on the social construction of old I he lltPtiies associated with this perspective highlighted the extent h ili. ^ ii hi social and political environment influenced tile lives people ['his was analysed in terms of an-as such as the Ittn ill poverty in old age (Walker 1993), in the development of (HvlUtv.h 1'i*M); and the experience of marginalisation within II mil 11 Milential homes (Biggs 1993, Kingston and Pcnhale ■ llu- value of the social construction approach, this II fli«l. review '.1111»' of the key arguments arising from this 14 Developing Services for Older People and their Families The Social Construction of Old Age 15 perspective; second, consider some implications for social work practice with older people; third, review some emerging issues in the study and experience of old age. The social construction of later life The social construction perspective was developed by a number of researchers during the late 1 970s and early 1980s. The model grew out of the politicisation of issues surrounding old age, together with the problems faced by traditional theories in developing an effective response to the unfolding crisis in public expenditure. Early studies using this perspective included: The Aging Enterprise by Carroll Estcs (1979); 'The Structured Dependency of the Elderly' by Peter Townsend (1981); 'Towards a Political Economy of Old Age' by Alan Walker (1981); Chris Phillipson (1982); Political Economy, Health and Aging by Estes, Gerard, Zones and Swan (1984), Old Age in the Welfare State by John Mylss (1984), and Ageing and Social Policy by Chris Phrllipsonand Alan Walker (1986). A general review of the arguments adopted has been brought together in a collection edited by Minkler and Estes (1991) entitled Critical Perspectives on Aging. Later studies influenced by this approach include those by Bernard and Meade (1993), Biggs (1993), Arber and Ginn (1991), Hugman (1994) and Biggs, Phillipson and Kingston (1995). A major concern of these studies has been to challenge a view ol growing old as a period dominated by physical and mentaldecline (the biomedical model of ageing). This model was attacked for its association of age with disease, as well as for the way that it individualised and medicalised the ageing process. The approach taken by what may be termed critical gerontology is a view that old age is a social rather than ^ioJQgically constructed^tams^lnjhe light ofjhis, many of the experiences affecting older people can be seen as a product of a particular division of labour and structure of inequality, rather than a natural part of the ageing process. Alan Walker (1980) elaborated thir. perspective with his concept of the 'social creation of dependency' in old age, and Peter Townsend (1981) used a similar term when In-descrihedthe^'structured dependency' of older people. This depend ericy w^s7seen"fo be the consequence of the forced exclusion of older people from work, the experience of poverty, iostitutionalisation and restricted domestic and community roles. The paradigm developed by critical gerontology is shared by developments in the study of other age groups. For example, many of the themes in the collection of essays edited by James and Prout (1991) Constructing and Reconstructing Childhood, explore Issues debated in social gerontology in the 1980s. The connections between age groups have been further explored by Hockey and James (1993) in Growing Up uuti Crowing Old. A central theme of this study is the extent to which lower is lost and gained at different points through the life course, and 11 ii- possibility of both young and oldeT people being affected by I >m k i-.si's of infantilisation (see further below). In respect of social construction or critical gerontology, the main themes of this approach have been concerned with: l lullenging a form of biological reductionism, whereby the real physiological and biological changes which take place with ageing lire often used as a justification for denying old people the right to I llrticlpateMn decisions which affect their lives. Showing that age must be seen in relation to the individual's I- '■ .iii- hi within the social structure, including factors such as; race, ■ I i ■. gender, and the type of work (paid and unpaid) performed l-v .in individual through his or her life. ..... Ir.it ing that later life is a time of reconstruction, with older i • '| li ii live in the search for meaning -through work, leisure and I.......in It inuhhips. ''ii.. Ilv-.n1 ul dor people may be seen to be in tension with the '.....i i iipil.ilism as an economic and social system, with the ■1 mI older people, their exclusion from work and their image till......i .«1« irty, illustrating this relationship. .......'Hi', will now be assessed as regards their implica- ■ I wilh older people, with particular emphasis on i itl di'iriniination experienced by older people in t h|i I. . [iDMple ........111 iL Irl has certainly been fruitful in terms of the 1 'iii.m economic and macro-social levels. At the nl ii Im in ul oppression identified from the way in I- .1 \\,v. identified in the form of ageism. First 16 Developing Services for Older People mid their Families coined by Robert Butler (1963), the concept increased in popularity with the growth of such social movements as the Grey Panthers in the LIS (Kuhn, 1977). Ageism is defined, according to Butler (1987, p.22): 'As a process of systematic stereotyping and discrimination against people because they are old, just as racism and sexism accomplish this for skin colour and gender...Ageism allows the younger generation to see older people as different from themselves thus, they suddenly cease to identify with, their elders as human beings and thereby reduce their own fear and dread of ageing,.. At times ageism becomes an expedient method by which society promotes viewpoints about the aged in order to relieve itself from responsibility towards them.' Biggs (1993) notes that ageism is now established as a starting point for investigations into older age. Although a number of criticisms have been made of this concept (Kogan 1979, Bytheway 1994), it has been valuable in providing connections with the activities of institutions on the one side, and beliefs about old age on the other. Ageism finds institutionalised expression through job discrimination, loss of status, stereotyping and dehumanisation. It focuses on the way in which old age is transformed from a gain and extension of the life course, into an economic and social problem or burden. At the same time, it also opens out the possibility of links with different forms of professional practice with older people. To assess how these might be developed, the next section of this chapter considers the implication of an anti-ageist perspective for social work practitioners. Developing anti-ageist practice The development of anti-ageist practice involves addressing a range of important issues that influence, constrain or facilitate good practice These factors can be seen to apply at Four levels: social work practice at the individual level; influencing and shaping the practice of other social workers; influencing policy and agency procedures; and theory development. This section will address each of these in turn, with a view to moving towards an understanding of anti-ageist practice. T T7ie Soeial Construction of Old Age 17 Patterns of individual practice Traditional practice with older people relies heavily on assumptions that, on closer critical scrutiny, reveal themselves to be reflections of Cigeist ideology. A basic component of anti-ageist practice, therefore, is a w illingness to subject our own practice to critical review - a prepar-eilnessto reconsider established patterns of practire. Such a rrview ran In- addressed in terms of a number of key concepts, namely: empowerment, partnership, and challenging destructive processes such as ml.i utilisation and dehumanisation. We shall consider each of these in turn. empowerment refers to the process of helping people increase the ; of control they have over their lives. It involves: Henging stereotypes of dependency. A focus on empowerment Reeks to ensure that older people are nni madn dependent on workers or services. The concept of 'interdependency' (Phillipson l*'Hin is :i useful Ane insofar as it acknowledges that older people i ■ ■ ■ nol only needs but also positive strengths to offer. ■Kg people choices. Instead of acting as the 'expert' who lias all the ■wwrft/ a more appropriate approach is one in which we help to lit 11y choices, and support the older person through the process i upon options and carrying them through. ,■ on self-esteem. The negative stereotypes of ageism tend to n.iliM'd by older people. This internalised oppression can *vc .1 detrimental effect on confidence and self-esteem in I>'>'i). Empowerment can counter the potential nega-• I i il iigeism on self-worth. , ,' ■ ■■/-•n. Traditional approaches can be criticised for ......■ i ii i' i hi' significance of oppression. For example, in ■ iii i'lhnic minorities, a common misunderstanding is 1 Mi i In Iie.it everyone the same' (the 'colour-blind' ■ i,k kage of care". The professional follows or tracks what the illliľľ [iĽiiple say and communicate. To lead is to assume that the I 'n ilľľi.'iitinul knows where to go, and often this will be straight to i i . ■ iu'-led response' 1 ■ l>.nij.',o mnilel illustrates working in partnership, and helps to rffllllv wh.il is involved in replacing unsatisfactory traditional models Hl j k i. in ■■ xv ■ 111 .in approach premised on anti-ageism. imIki important aspect of anti-ageism is a preparedness to '■ .....live prut-esses We shall focus on two in particular. >),inlilr..i[iona]iddehumanisation. Infantilisation refers to the i n. ,i mLI.t people us itthe\ ciiilil:-e:i. I his involves 11'• m n<...../ultingthemandgencrallydisregardingtheir Citizens (Thompson 1992) Hockey and James (1993) M m which metaphors of childhood are used tn shape til rigeing and, in so doing, contribute to the social dependency. Practitioners therefore need to be very ili.ii 1 biL- l,iii|',u,ij',i- used, attitudes adopted or .steps mli .r Hull i':. practice needs to be premised on a lit- jik adults with rights, rather than 'second gen- 'iilh-n 1« .i parallel process in which older people are nhji'i i.....ilu-i than subjects, and seen as distinct from !.■ S......1 tn,'. i l i I liiimpson {1993, p.86). ľliif.u ,il tendency to dismiss older people, to ii mil s IVe fiiuinl a good example of this in an ■ ■t .i ln> .i': "AK ohol Forum". The author, a ■ Hi)-. ■ .,ile limit-; lor weekly alcohol consump- 20 Developing Services for Older People and tlieir Families The Social Construction of Old Age 21 Hon when he comments thai: "Safety limits are proposed in terms of alcohol units per week (10) but these limits are for males or females, not for the elderly'. Although the good intentions of the author are apparent elsewhere in the article, the common tendency to distinguish between "ordinary people" (that is., males and females) and "the elderly" is clearly in evidence.' Anti-ageist practice therefore requires a sensitivity to such dehumanising tendencies so that we do not lose sight of the fact that older people are people first and last. Influencing the practice of others While a review of our own practice is a necessary condition for developing anti-ageism, it is not a sufficient condition. We also need to consider influencing the practice of others. This is because discrimina- ( tion and oppression are not isolated incidents of misfortune or bad practice; they are fundamental aspects of the way in which society is organised {Thompson 1993). It is for this reason that we need to develop practice that is antj-discrimina lory, rather than simply non-discriminatory. That is, it is not enough to seek to eradicate discrimination from our own practice while condoning it in the practice of others. Practitioners therefore need to develop the skills of: • recognising examples of agi-ist practice in the work of colleagues • challenging in sensitive and constructive ways; • promoting an ethos in which anti-ageism is taken seriously and respected, • being able to deal assertively and constructively with 'counter challenges'. Fortunately, although challenging others may be difficult, its impaOl can be significant. Often, people respond very positively to challenges that are sensitive, constructive and couched in respectful terms, ratlu i than in terms of a personal attack. Influencing agency policy The policy level is one that has major implications fur practice instil,u I as it sets the parameters and ethus that underpin practice. Then' therefore an important role for practitioners in challenging age aspects of policy or procedures, and pressing for the development an explicitly anti-ageist policy. Admittedly, organisational power structures are likely to be resistant to bottom-up change and, realistically, major changes may not be possible, in the short term at least. I lowever, there is a danger of adopting a defeatist attitude. Acknowledging that change may be difficult, slow and gradual should not be equated with seeing cliangc as a vain hope or impossible dream. An important strategy is to seek out all possible means of influenc-g policy. This may be through correspondence (both individually and lectively) with managers, participation in working parties or plan-y groups, trade union activities and so on. The primary skill is that L'ing an 'organisational operator' - developing a good under-riding of how organisational power structures and channels of e operate; and recognising opportunities fur playing a strategic 1 taking them in an anti-ageist direction. Ef efforts in this regard can, potentially at least, be supplemented e of service users- While working in partnership on a Que basis is an important part of developing anti-ageist prac- I.....t iplfe can be extended to include the notion ol 'participa- iri participation implies being involved at a number of levels, i Hi.in .imply planning one's own care These include planning, ■ 'tin)-, iind evaluating services, contributing to policy develop-iin utilisation and review, and perhaps also contributing to f »v*i\ staff recruitment. Where such participation can be I 11 n 11 j:; ,i higher likelihood of agcist policies and practices dr.! in.!, li.ulenged. I Hi. itry ii'ili-i Is ,i medical model of ageing in terms of .....wlv i>ii biological aspects of ageing. However, this is ......ii ilii'in-y has no value whatsoever. It is possible for I ■ i li idKitmat theory to be reworked within ananti-dis-Wfltowiirk We shall give two brief examples to illustrate . i I'l'ii |.p 15-16) presents a case for 'revitalising' tradi-t by amending its basic principles to make them ■ li - i.....ti.ilory practice: trUU theory can be criticised for adopting a pre-'lilli- mi.iilli'-ikiss male perspective on a range of 22 Developing Services for Older People and their Fmnilics issues which relate very closely to structured inequalities and the oppressive social divisions which stack the odds against certain groups in society. An understanding of social disadvantage and discrimination must be incorporated into the theoretical framework if a new crisis theory is to replace the old and thereby make a contribution to anti-discriminatory practice.' Similarly, Tvlullcndci and Ward (1991) argue the case for 'self-directed groupwork' as an approach lo groupwork that incorporates anti-oppressive issues and values, and therefore goes beyond the traditional confines of groupwork theory. These examples demonstrate that some theories at least can and should be developed to incorporate anti-discrirninatory practice and, in so doing, present an important challenge to both theorists and practitioners. Conclusions This chapter has provided a brief review of some of the challenges posed by the social construction perspective within gerontology. Bv way of conclusion, some comments will be made about future issues in the experience of old age. First, over the pasl five years (and partlv through the influence) of critical perspectives, greater attention has been given to the extent of diversity within the older population. For example, Blakemore and Boneham's (1993) Age, Race Oltd Ltinuctiy. is an important review of the reality of ageing in a multi-racial society I documents the various responses to growing old amongst nunoril groups, and demonstrates the urgent need for more detailed survi-and ethnographic research on this topic. Studies in relation to gendi-and ageing by Arber and Ginn (1995), and by Bernard and Mead (1993), have also provided valuable perspectives on contrasts betwen men and women, especially in areas such as ihc experience of povoru caring and personal relationships. More generally, however, there is. dearth of studies dealing with social class differences in the experic-n.. of growing old. Surveys such as the General Household Survey (Ol \ 1 1996) give a hint of Some of the material differences in the lives u Britain's older people (as do comparable surveys). However, then1 i an urgent need for more detailed studies which show the extonl l< which growing old is shaped by the cumulative advantages and dlfl advantages of particular class positions. Such investigation is ni.nli The Social Construction of Old Age 23 •specially urgent given the growth of inequalities over the past 10 years, especially amongst the older age groups (Rowntree, 1995). Second, significant changes are also underway in respect of the Nell-identity of older people. A majoT component here is the growth of Murly retirement or early exit from the workforce. At the beginning of (lie twentieth century, the majority of people continued to work or to look for work until ill-health set in or they reached the point of exhaus- i..... Ai ihc end of the twentieth century, the majority are leaving paid i Oipluymcnt well before tins point with a rapid expansion in the number of years currently spent in the period defined as retirement fUc/.ko and Phillipson 1991). Old age has been dramatically recon-tlrui teil in the absence of full employment. This change-in the context ■ l i |"'.| industrial world - is almost certainly irreversible. It is trans-1111 j' 111 ■1 livvsor all older people; it will also affect those who work m. 'Lin flic opportunities for professional social work with older |>i > >v i II be substantial, albeit that it will be of a very different nature ■.......iv In, li li.is characterised the past two decades. This chapter ■ i., i. U less some of the questions which a future snci.il work ......diln'SH, especially one which challenges the discrimina- i ■ i <|>i-' .■ ľ 'ii i.iced bv man}1 older people. ^Hfel *hil< .tmi, 1 iľ"] i (snder vu1 ! iter life London Sagi. ^Hm* IIMHihm. I 11 '^': * 11 i viT^'Lf ľ"^' (.-- j'iv Milton Keynes ■ess. (Athfnbflum, V.W (1993) The Omtging Contract Across 4fW Yurk Aldeue dc Gruyter. MfMir, K [IWÍ) Women Coming of Age. London Edward Uňiíf rilnii.ilfji; Airing: linage*, Attitudes and Professional l i , m ■> i i|iin I Inivcrsity I'ress. i .h,. I Kingston, ľ. (1995) Elder Abuse in Perspective. < I llllVl'i'-.llV I'lVSS ■ ■ ' i. in, M (I'J'U) Ay;,-. Race and ttimtrity Milton nsvli'w nnd InlorpretaHnnofrerniniBwn^intlw D I in wi /up 'ilm i Ageing '"id Society [pp.2BO-83). London: Sage. .mil A [ IW3)'Empowerment and oppression:An r|ntiHii^. lor I'Linti'mpoTary social work.' In J. Walms-luy etal. » and t'rui Hi r Reflecting on Roles and Relationships. London: