Academic journal article Health Sociology Review

Informal Caregiving: Cross-Cultural Applicability of the Person-Environment Model

Academic journal article Health Sociology Review

Informal Caregiving: Cross-Cultural Applicability of the Person-Environment Model

Article excerpt

Introduction

It seems safe to say that three themes will characterise the fi rst decades of the 21st century: global ageing, the global economic crisis, and continued globalisation in all spheres of life. The sheer demographics of global ageing imply that nearly every nation is or soon will be confronted with the increased pressures of providing economic security and health care for rapidly growing populations of elders. Gerontologists, demographers, economists and other social scientists have been aware of this and have been sounding the warning for decades, often to little avail. The current global economy, while affecting some nations more severely than others, has generally resulted in declining fi nancial resources at a time of rising social need. This makes meeting any demographic challenges more diffi cult; in particular, programmes and services for elders must vie for funding with programmes and services for non-elders in an increasingly competitive era. Finally, continued globalisation, assisted by newer communication technologies, interconnects nations in more ways than ever before. While this has some negative ramifi cations (see 'global economic crisis'), it also facilitates international and crosscultural social science inquiry and research.

One aspect of international/cross-cultural collaboration is the search for 'modifi ed cultural universals': fi ndings, theories, or programmes that have high applicability across many nations/ cultures. In relation to applied gerontology, for instance, which has the overall goal of enhancing the lives of elders, knowledge would be sought that leads to programme development that enriches elders' lives across a variety of nations and/or cultures. While acknowledging the uniqueness of cultures, some commonalities of the human condition are also recognised. It is these commonalities that 'modifi ed cultural universals' uncover and describe. Just as the preferred theory is the most parsimonious one, explaining the most variation with the fewest concepts, the preferred social programme in a global sense is the one that addresses the greatest proportion of needs, multi-nationally, with the fewest variations or adaptations.

The topic of this paper is eldercare. While 'old age' and the indicators of its onset can be defi ned according to different criteria (e.g. chronological age, functional age), every society has an age group considered 'old', and every society must, one way or another, determine and provide for the welfare of this group. (In some nations with high life expectancy, middle-aged persons will spend more years providing eldercare than they did childcare.) After a discussion of eldercare generally and in Thailand, we will describe the Person-Environment (P-E) Model (Lawton and Nahemow 1973) and test its utility to explain informal caregiving in rural Thailand. We will then discuss the extent to which the P-E Model can be employed cross-culturally to explain the degree of success of various cultures' eldercare structures. In addition to the data from Thailand, this discussion of the need for and structure of eldercare will include data from two other countries with arguably different cultures (e.g. dominant religion) and levels of development, and which are at different stages of the demographic transition from a youthful to an ageing nation: Portugal and the United States. (These represent the authors' home nations. We hope, also, that our different backgrounds - sociologist, nurse, medical doctor - will add breadth to our perspective.) Thus the research questions focus on the P-E Model's applicability to rural Thai eldercare in particular and, in general, its application across cultures. Finally, we will discuss the implications of this model for health sciences education, practice, and policy.

Eldercare

The term 'caregiver' refers to anyone who provides assistance to someone else who is, to some degree, incapacitated and needs help (Family Caregiver Alliance 2003). …

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