Case Studies on Elderly and Institutionalization in the Southern region of Kerala

Abstract

Aging is a period of decline and social attitude towards old age affects the aged population. The practice of institutionalizing the elderly is a broad spreading concept in the modern world, and the old age homes and hospices are growing day by day. The current study aims at exploring the life experiences of the elderly on account of the transition happening due to institutionalization. The current study followed the multiple case study design. The objectives of the study are 1) to understand the social conditions that propel the elderly to choose institutional care, 2) to assess changing the attitude of the elderly towards the society and 3) to determine the coping mechanisms by the elderly in institutions, towards effective adjustment. Samples were selected from the old age homes who were above the age of 65 and institutionalized for at least ten years. Four case studies focused on the current objectives, and semi-structured interview guide was used. The study found that there was some level of psychosocial issues among the elderly and need psychosocial interventions and specialized care for the elderly in the primary, secondary and tertiary levels.

Full text

Journal of Social Work Education and Practice 3(3) 54-58 www.jswep.in
ISSN: 2456-2068 1st July 2018!
Case Studies on Elderly and Institutionalization in the
Southern region of Kerala
Sharon Fernandez1, Lithin Zacharias2, Harikrishnan U.3!
ABSTRACT:! Aging is a period of decline and social attitude towards old age affects the aged
population. The practice of institutionalizing the elderly is a broad spreading concept in the modern
world, and the old age homes and hospices are growing day by day. The current study aims at
exploring the life experiences of the elderly on account of the transition happening due to
institutionalization. The current study followed the multiple case study design. The objectives of
the study are 1) to understand the social conditions that propel the elderly to choose institutional
care, 2) to assess changing the attitude of the elderly towards the society and 3) to determine the
coping mechanisms by the elderly in institutions, towards effective adjustment. Samples were
selected from the old age homes who were above the age of 65 and institutionalized for at least
ten years. Four case studies focused on the current objectives, and semi-structured interview
guide was used. The study found that there was some level of psychosocial issues among the
elderly and need psychosocial interventions and specialized care for the elderly in the primary,
secondary and tertiary levels.
Keywords: Aging, Institutionalization, Psychosocial Issues, Kerala!
!
©2017 This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this license,
visit http://creativecommons.org/licenses/by/4.0/.
!
1. INTRODUCTION
According to population census 2011, there are nearly 104 million elderly persons in India; 53
million females & 51 million males and 13% people are above 60 years old in the state of Kerala.
Traditionally, the age of 60 was generally seen as the beginning of old age. Most developed
countries of the world have accepted the chronological age of 65 years as a definition of 'elderly' or
senior citizen ‘or older person”. Signs of new dilemmas are evident in the State of Kerala, having
one of the lowest population growth rates in India, that is, the fertility and mortality rates have
fallen to very low level, and an average Keralite would live beyond 70 years. All this is leading to a
situation making Kerala a State with a speedily aging population that is, to a grey state concept.
The break-up of the joint family into a nuclear family made it incapable to accommodate the old
due to the pressures created by the demands of a modern urban and industrialized lifestyle.
Studies reported that elderly also undergone marginalization, alienation, social insecurity, limited
social interaction, limited earning possibilities, multiple medical complications, emotional isolation,
limited awareness regarding their legal rights, and natural reluctance to seek justice are their
other issues (Rajasi et al., 2016). The current study aims at exploring the life experiences of the
elderly on account of the transition happening due to institutionalization.
1
Social Worker, Canada
2
State Project Coordinator for Disaster and Climate Change, Department of Psychiatric Social Work, NIMHANS,
Bengalore
3
Fellowship in Psychosocial Support Disaster Management, Department of Psychiatric Social Work, NIMHANS,
Bangalore

Journal of Social Work Education and Practice (07/2018) 3(3) 54-58 ISSN: 2456-2068
Sharon Fernandez, Lithin Zacharias, Harikrishnan U. Case Studies on Elderly and Institutionalization
in the Southern region of Kerala 55!
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2. Methodology
The current study adopted a multiple case study design. The elderly population who were above
the age of 65 and institutionalized for more than ten years were included in the study. Data were
collected through in-depth interviews from the institutionalized elderly from old age homes at
Kollam & Pathanamthitta districts of Kerala. Socio-demographic details including gender, age,
education, religion, previous occupation, critical issues among the participants were collected, and
in-depth interview focused on social conditions of elderly, changing attitudes towards old age
population, coping mechanism among elderly were interpreted in the results. Four different cases
have been listed out based on the objectives in the results. Permission was obtained to carry out
the study from the institutions, and those who accepted the consents were recruited for the study.
3. Results
Table 1: Socio demographic details of participants
Table 2: The key issues identified in the cases
Case no
Gender
Age
Education
Religion
Earlier Occupation
Case 1
Male
71
8th Standard
Christianity
Construction Labourer
Case 2
Male
75
3rd Standard
Hinduism
Agricultural laborer
Case 3
Female
76
10th Standard
Christianity
Homemaker
Case 4
Female
72
5th Standard
Hinduism
Tailoring
Case 1
• Physically and verbally abused by the family.
• He spends most of his earning on liquor.
• Joined voluntarily in the institution with the support of a religious priest.
Case 2
• Physical and verbal abuse after his disease from the family.
• He had a paralytic stroke and needed physical care and support for day-
to-day functions.
• Friend guided him to the institution.
Case 3
• Physical and verbal abuse from daughter in law.
• Family members brought her to the old age home.
Case 4
• Abuse from the daughter in law.
• Forced to move into an old age home.

Journal of Social Work Education and Practice (07/2018) 3(3) 54-58 ISSN: 2456-2068
Sharon Fernandez, Lithin Zacharias, Harikrishnan U. Case Studies on Elderly and Institutionalization
in the Southern region of Kerala 56!
!
Some of the statements from the participants (Case 1 to 4) while interviewing are given below:
• Case - 1 described that “I am asking pardon from God to forgive me for bringing up two
sons who have turned this way. Rest of my life will be a prayer for my sons. I love them,
even though they have abused me. I strongly resist giving them the share of money which
is remaining with me. It’s not because I do not love them, its due to my love for him. I do
not want to spoil them again”.
• Case - 2 pointed out that “There is no respect and love for the elderly from the children.
We are used by our children and thrown out after extracting all the love and good health
spent on them until this time. The younger generation has become arrogant, and they
possess very poor value system. During our period we had strong respect, love, and care
towards the elderly. Our young generation started decomposing”.
• Case - 3 mentioned that "The old age home is a great blessing for people like me. I
interact with all the inmates, and we try to help each other. We are also busy in prayer,
watching TV, occasionally visiting churches. This keeps us going".
• Case – 4 said that "I do not like to live in the old age home, but I have no other
alternative. I am unable to sleep at night; I often feel tearful when I think of the things
happened in my life. I am taken care well by the people here, but it often pains when I
think what my children have done. I pray hard when I am unable to control my feelings. I
feel that my God is listening to my every word and so I feel relieved”.
Objective 1: To understand the social conditions that propel the elderly to choose institutional
care.
• The major reason given for being in an institution was destitution where an individual lacks
all other support systems.
• Poverty is the common denominator for all the older persons who now occupy the same
class position even if they used to be highly regarded during their prime years.
• Lack of education and unattractive employment such as farm working were deemed to be
bad beginning points in life that predisposed one towards institutionalization. One
respondent statement was – "lack of education is what made us really foolish."
Objective 2: To assess changing attitude of the elderly towards the society.
• The person's bad experience from his children made him feel sorry about the whole youth
population.
• The elderly are less concerned by the younger generation. There is no respect and love for
the elderly from the children.
• The past family system with the present one opined that the new generation has a very
poor value system which has less concern about elderly.
Objective 3: To determine the coping mechanisms by the elderly in institutions, towards effective
adjustment.
• Adaptive coping strategies used were observed to be acceptance, hope, change in
perception, re-definition of self, avoidance attitude, dropping of responsibilities, prayer,
less fear for life & death.

Journal of Social Work Education and Practice (07/2018) 3(3) 54-58 ISSN: 2456-2068
Sharon Fernandez, Lithin Zacharias, Harikrishnan U. Case Studies on Elderly and Institutionalization
in the Southern region of Kerala 57!
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• Participant word - I know that I have to die in this old age home.” It’s a way of coping
through accepting the fact and managing with her situation.”
• Statement from one participant - I know that I have to die in this old age home.” It’s a
way of coping through accepting the fact and managing with her situation.”
• Participant statement - "I am waiting to go near my Mother and rest on her lap when I
leave this world full of cruelty."
4. Discussion
The practice of institutionalizing the elderly is a broad spreading concept in the modern world, and
the number of old age homes are growing day by day. The factors which propel elderly to choose
or accept institutionalization needs to be studied in-depth, so that one may be able to provide
effective psychosocial interventions. A study on abuse against elderly in India revealed that 11%
of 60+-year-olds had experienced at least one type of elderly abuse (Physical 5.3%, Verbal
10.2%, Economic 5.4%, Disrespect 6%, Neglect 5.2%). The most common perpetrator was the
son, who is reported to be responsible for the abuse among 41% of male victims and 43% of
female victims (Skirbekk & James, 2014). This speaks about the need for addressing the
psychosocial issues at the earliest in order to minimize the psychological distress.
The decline in different psychological and social functions is common in old age which makes them
prone to vulnerabilities especially among the elderly living in institutionalized care.
Institutionalization was often met with feelings ranging from bitterness, anger, betrayal, shame,
uselessness, powerlessness to impotence. Results of the study of elderly living in old age home
and within family set-up in Jammu revealed that elderly feel that younger generation has an
attitude which is not supportive towards the oldage population (Dubey, Bhasin, Gupta, & Sharma,
2011). Even though the elderly are able to get relieved from emotional issues by being more
spiritual, that seems to favor the withdrawal of an older adult to him/herself than interacting with
others. In the current study also concluded that the participants have some kind of psychological
distress at institutions. It’s because of the abuse form the loved one or from the family members.
5. Conclusion
Every human being passes through the different phases of life. Old age is said to be the final
phase of life one has to reach. It is otherwise known as the second childhood. This indicates the
care and affection that this population needs. The concept of nuclear family has made the
dependent elderly population more vulnerable to illness. The concept has also increased the
institutionalized homes in the country. This study on institutionalized elderly have brought out the
factors which propel the elderly to choose institutional care, the changing attitude of elderly
towards family, spirituality, modernity, the challenges faced by them under institutional care,
coping mechanisms. Possible psychosocial measures can be adapted to bring out positive changes
in the life and status of institutionalized elderly. Multi-disciplinary teamwork will help to reduce the
bio-psychosocial issues of elderly and give proper awareness to the family to handle the issues.

Journal of Social Work Education and Practice (07/2018) 3(3) 54-58 ISSN: 2456-2068
Sharon Fernandez, Lithin Zacharias, Harikrishnan U. Case Studies on Elderly and Institutionalization
in the Southern region of Kerala 58!
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How$to$cite$this$article:$
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APA:!
Fernandez,!S.,!Zacharias,!L.,!&!U,!H.!(2018,!July).!Case!Studies!on!Elderly!and!Institutionalization!in!
the!Southern!region!of!Kerala.!(A.!Paul,!Ed.)!Journal$of$Social$Work$Education$and$Practice,$
III(3),!54-58.!
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MLA:!
Fernandez,!Sharon,!Lithin!Zacharias!and!Harikrishnan!U.!"Case!Studies!on!Elderly!and!
Institutionalization!in!the!Southern!region!of!Kerala."!Journal$of$Social$Work$Education$and$
Practice!III.3!(2018):!54-58.!
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Chicago:!
Fernandez,!Sharon,!Lithin!Zacharias,!and!Harikrishnan!U.!2018.!"Case!Studies!on!Elderly!and!
Institutionalization!in!the!Southern!region!of!Kerala."!Edited!by!Arun!Paul.!Journal$of$Social$
Work$Education$and$Practice!III!(3):!54-58.!