Care of older people in the East and West: What can we learn from other cultures?
Care practices in diverse parts of the world have more in common than we might expect
Nursing Older People readers are invited to respond to research findings on care of older people in different cultures
In the East, it is often claimed, families are strong, older people are respected and they are cared for at home until they die.
However, in the West, families are commonly presented as dysfunctional and older people are considered a burden and put into care homes at the earliest opportunity.
There is an even bleaker belief that Europeans use euthanasia to solve the problem of an ageing population.
We are interested to learn what readers think is behind such views and what we can learn from the practice of care in different parts of the world.
Comments were sought from experts in 11 countries
The population is ageing and the need for care in later years is growing (World Health Organization 2019). People aged over 60 comprise 13% of the world’s population – 25% in Europe – and it is projected that those aged 80 and over will triple from 137 million in 2017 to 425 million in 2050 (United Nations 2019).
Problematic cross-cultural assumptions and stereotypes exist, but our belief that there is much to learn from care practices in different countries led us to a research project: Roles, Responsibilities and the Future Care of Older People. We worked with researchers in China, convening focus groups with service users and practitioners, to produce four ‘typical’ case studies – two from China and two from the UK – relating to domiciliary and residential care aimed at capturing many of the real-world challenges facing those receiving and providing care in these contexts. Commentaries on the case studies were sought from experts in 11 countries, and we held a three-day meeting to share our findings.
Exploration of relationships between older people and their families
Each of the four case studies explored relationships between older people and their families. In the UK, Harry Jones had early stage dementia and his wife, Alice, and their daughter and sons were struggling to care for him at home.
A similar story from China explored how the Wu family found it challenging to manage the increasing physical care needs of older parents living at home with the family. The grown-up children in both families were negotiating work responsibilities and their own, their partners’ and their children’s care needs.
One of the Jones’s grandchildren, for example, had schizophrenia and one of the Wu daughters had coronary heart disease and arthritis.
Should family members engage in direct caregiving?
The UK residential care case study detailed the emotional cost for the Smith family of caring at home and of transition to a care home, particularly the effect on daughters. The Chinese story took a different turn, with Mrs Wang deciding to move into residential care so that her family was spared the burden of caring.
Written commentaries presented and discussed at the meeting focused on the challenges of negotiating family roles and responsibilities. We were reminded by a participant of the book Moral Boundaries by Joan Tronto (1993), which examined four aspects of care: caring about, taking care of, caregiving and care receiving.
Questions readers might like to reflect on include: Is it enough for families 'to take care of' older adults, for example by paying for domiciliary or residential care? And: Is it necessary for family members to engage in direct caregiving to meet their ethical responsibilities?
Care is often thought of as women's work
Other participants highlighted a challenging aspect of caregiving – that care is often thought of as women’s work. Maria, the daughter in the Smith family case study, felt guilt at her mother’s move to residential care.
Why might women feel an obligation to take on this responsibility and experience the emotional cost of care more acutely?
In all the case studies the role of sensitive, paid caregivers was critical in supporting the older people and their families. One of the caregivers, who we will call Beata, said: ‘The family are the keepers of the memories of that person… they’re trying to preserve what they feel their relative wants because that’s their memories of them, and I think they don’t want this tarnished.’
We would like to know whether, in everyday practice, this is a view that you agree with?
The use of technology in care is double-edged
Participants also felt that the use of technology in care practice is double-edged. For example, using a tablet device helps older adults keep in touch with family members. A more contentious issue is the role of cameras in care settings.
There are benefits in keeping people safe, but there is also a risk of breaching privacy and undermining their dignity.
A question for readers to discuss with colleagues and students is: Do the risks of cameras in care contexts outweigh the benefits?
Care practices around the world might have more in common than expected
Our project so far suggests that neither East nor West has a monopoly on good care or solutions to global demographic changes. That said, there is much to learn from people in other cultures.
We agreed that nurses and other residential and domiciliary caregivers play a critical role in advising families and in providing and sustaining good care for all. Care practices in diverse parts of the world have more in common than we might expect.
We continue to analyse the project data and look forward to presenting our insights in greater depth. Meanwhile we would welcome responses from readers of Nursing Older People and expressions of interest in working with us during the next phase of the project.
Ann Gallagher is professor of ethics and care in the Faculty of Health and Medical Sciences, University of Surrey. Email: firstname.lastname@example.org
Michael Dunn is a lecturer in health and social care ethics in the Nuffield Department of Population Health, University of Oxford. Email: email@example.com
- Tronto JC (1993) Moral Boundaries: a Political Argument for an Ethic of Care. Routledge, New York NY
- United Nations (2019) Trends in Population Ageing
- World Health Organization (2019) Ageing and Life Course
The authors wish to thank the Wellcome Trust, which funded this research, our co-researchers Professors Ma, Xu and Fang at Xiamen University in China’s Fujian Province, members of our international expert project group and service users and practitioners who assisted with developing and discussing the case studies