'Once I Became a Pensioner I Became a Nobody - a Non-Entity': The Story of One Woman's Experience of the Health Care System

By Greaves, Moira; Rogers-Clark, Cath | Contemporary Nurse : a Journal for the Australian Nursing Profession, February 1, 2011 | Go to article overview

'Once I Became a Pensioner I Became a Nobody - a Non-Entity': The Story of One Woman's Experience of the Health Care System


Greaves, Moira, Rogers-Clark, Cath, Contemporary Nurse : a Journal for the Australian Nursing Profession


BACKGROUND

There are numerous definitions and conceptualisations of social isolation with most identifying socially isolated individuals as rarely or never spending time in the company of friends, associates or other people in social groups (Cattan, White, Bond, & Learmouth, 2005; Findlay, 2003). Social isolation has been consistently identified as a significant factor in the development of negative health outcomes (Dugan & Kivett, 1994; Findlay, 2003; Findlay & Cartwright, 2002; Hensher, 2006; Machielse, 2006; Wenger, Davies, Shahtahmasebi, & Scott, 1995) and while a number of issues play a role in the development of social isolation of older people, illness and disability appear to be the most common among risk factors (Grundy, 2006; Murray, 2001; Schröder- Butterfill & Marianti, 2006; Tanner, 2003, 2007).

FRAMING THE CASE STUDY

Social isolation is a significant component of the lives of many older people, particularly those aged 75 years and older who are living independently within the Australian community. While the impact of social isolation is dependent on a diversity of socioeconomic, personally adaptive, cultural and health influences, descriptions of 'isolation' often vary. Several researchers (Copeland, 2002; Greaves & Farbus, 2006; Mann, 2000; Victor, Bowling, Bond, & Scambler, 2003) have postulated that social isolation occurs in the absence of meaningful and sustained relationships with significant others or when a person experiences minimal levels of social participation and perceived inadequate social interactions. Yet others (Cattan et al., 2005; Findlay, 2003) argue that social isolation, particularly of older people, remains a complex phenomenon involving psychosocial, physiological, economic, demographic, cultural and religious or spiritual aspects of a person's life. A review of the related literature revealed substantial consideration of the phenomenon of social isolation and its causative and contributory factors (Cattan et al., 2005; Findlay, 2003; Machielse, 2006; Russell & Schofield, 1999; Victor et al., 2003). These factors included but were not limited to: long term illness, age related disabilities, chronic pain, recent bereavement, geographical isolation, relocation, living alone, decreased social and family networks and financial losses related to retirement and loss of income.

Theoretical perspectives on social isolation in older people have evolved over time (Ebersole, Hess, & Schmidt Luggen, 2003) and include disengagement, activity, continuity and gerotranscendence theories, which were developed in response to varying degrees of withdrawal by older people from mainstream society. Disengagement theory, proposed by Cumming and Henry (1961), argued that withdrawal or 'disengagement' was a natural and unavoidable occurrence of ageing. Latter researchers (Berkman, 1995; Dugan & Kivett, 1994; Payton Fay, 2004) largely debunked this theory asserting that disengagement is often precipitated by life changes that make it difficult for people to remain active within a social context, which often led to social isolation. While Cumming and Henry (1961) proposed disengagement theory, Havighurst (1961) formalised activity theory suggesting that people who maintained participatory activity levels and social networks were less likely to withdraw from social contacts or become lonely. However, critical debate ensued as activity theory did not differentiate between types of activity, assuming that any activity could substitute for significant losses of social involvement. Havighurst subsequently proposed continuity theory in 1968 in response to discussion surrounding activity and disengagement. This theory symbolised a more formal clarification by exemplifying a life course perspective to delineate typical ageing. Atchley (1989) further expanded continuity theory emphasising the significance of personality and highlighting the relationship between past, present and future; and why continuity of ideologies and lifestyles were central to processes for coping with the inevitable changes that ageing brings. …

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