Erin G. Roth

Baby Boomers in an Active Adult Retirement Community: Comity Interrupted

PURPOSE OF THE STUDY This article explores a clash between incoming Baby Boomers and older residents in an active adult retirement community (AARC). We examine issues of social identity and attitudes as these groups encounter each other. DESIGN AND METHODS Data are drawn from a multiyear ethnographic study of social relations in senior housing. Research at this site included in-depth, open-ended interviews (47), field notes (25), and participant observation in the field (500 hr). Research team biweekly discussions and Atlas.ti software program facilitated analysis. FINDINGS We begin with a poignant incident that has continued to engender feelings of rejection by elders with each retelling and suggests the power and prevalence of ageism in this AARC. We identify three pervasive themes: (a) social identity and image matter, (b) significant cultural and attitudinal differences exist between Boomers and older residents, and (c) shared age matters less than shared interests. IMPLICATIONS Our data clearly show the operation of ageism in this community and an equating of being old with being sick. The conflict between these two age cohorts suggests that cohort consciousness among Boomers carries elements of age denial, shared by the older old. It also challenges the Third Age concept as a generational phenomenon.

The Dark Side: Stigma in Purpose-Built Senior Environments

This paper focuses on stigma in collective living environments for older adults. We contrast two design profiles, a purpose-built campus which opened in 1997, and an older setting that grew by accretion over decades. The separation by care levels in both sites is reflected in their cultures as residents and staff relate to levels of care through a vocabulary of fear. Residents of the independent living building on the purpose-built campus refer to the assisted living building as “the dark side.” In this setting we observe stigma assigned to a place in the built environment. By contrast, the older setting features a less-structured clustering of independent living and assisted living. We have observed less stigma associated with levels of care in this older building. Grounding our analysis in data drawn from ongoing ethnographic research, we focus on the built environment as it relates to stigma in the social environment.

Diabetes and the Motivated Patient: Understanding Perlocutionary Effect in Health Communication

Abstract Health care providers (HCP) understand the importance of keeping patients motivated but may be unaware how their words may have unintended negative effects upon their patient’s lives. People with diabetes report being told by their HCP that they are “cured” or that they are praised for strides made in weight loss and/or lowered blood glucose, and interpret these messages in unexpected ways. For this paper, we focus upon one case to illustrate the depth and nuance of the patient–provider communication as it emerged within a larger interview-based ethnographic study. Audio-recorded interviews and transcriptions were analyzed discursively. Discourse analysis reveals the ways ideology affects how the patient responds to HCP’s utterances and how this affects diabetes self-care. Findings indicate significant perlocutionary effects upon health outcomes, varying both positively and/or negatively. This study points to the importance of carefully considering the power of words and whenever possible knowing the patient’s ideological orientation to their world. HCPs should be explicit and deliberate with their communication. Sensitization to the various ways patients hear and react to messages in a clinical setting may lead to improved health outcomes, especially for those with chronic health conditions such as diabetes mellitus.

Understanding the Subjective Experience of Medication Adherence for Older Urban African Americans With Type 2 Diabetes and a History of Illicit Drug Addiction.

Objective: African Americans experience high rates of type 2 diabetes mellitus (T2D). Self-management strategies, such as medication adherence, are key to mitigating negative T2D outcomes. This article addresses a gap in the literature by examining the intersections of drug abuse histories and medication adherence among urban, older African Americans with T2D. Method: In-depth interview data were collected as part of a larger ethnographic study examining the subjective experience of T2D among urban older adults. Two representative focal cases were selected and thematic analysis performed to illustrate how former illicit drug addicts perceive prescription medication usage. Results: Narratives reveal that participants are displeased about having to take prescription drugs and are making lifestyle changes to reduce medication usage and maintain sobriety. Discussion: Previous drug abuse not only complicates medication adherence but is also a significant part of how older African Americans who are former drug users frame their understanding of T2D more broadly.

Microaggressions: An Approach to Understanding the Health of Workers in Long-Term Care Settings

To the Editor: In recent news, a nurse filed suit against her employer, an assisted living organization, alleging that the organization “failed to protect her from abusive racism from residents.” Claims of racism in long-term care (LTC) settings have been reported by minority workers for more than two decades. Regrettably, the literature in this area is limited, particularly research addressing the health outcomes of minority staff resulting from negative racial interactions in the workplace. Attesting to the importance of the racial context in LTC, racial and ethnic minorities and immigrants account for more than 50% of the direct care workforce, while the older adults who receive care from these workers are on average 80% white. Notably, immigrant workers may be at increased risk for negative health outcomes, as they report feeling significantly less respected by both residents and residents’ families than workers born in the United States. As such, the perspectives of minority workers regarding issues of respect are especially valuable, both because they are the staff who are most often victimized in this manner, and because improved interactions may increase job retention, satisfaction, and possibly worker health outcomes. The negative physical and mental health implications of racism have been well documented in the literature. Thus, there is good reason to expect that negative racial interactions in LTC settings are additionally problematic in terms of workers’ physical and mental health, and that greater attention is needed to address this critical workforce issue as the health of those who provide care may have implications on the quality of caregiving. The concept of racial microaggressions (RMA) is helpful to frame and guide work in this area. Overtly racist acts have now been replaced by more subtle messages surrounding racial inferiority of minority groups: