generations a hidden source of diversity

GenerationsA Hidden Source of Diversity

Kenneth J. Doka, PhDProfessor of Gerontology, The College

of New RochelleSenior Consultant, The Hospice

Foundation of America

Objectives

1. Describe the characteristics of varied generations Formative Experiences Core Values

2. Explore the implications of generational differences Medical Care and End-of-Life Counseling Issues and Concerns Workplace Differences

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Caution!

Generational differences are only one source of diversity

Others include: Ethnicity and Culture Gender Social Class Spirituality/Humanism Geographical


The Nature of Diversity

Remember Sue & Sue’s Asian Proverb – Every person is

Like no other person Like some other

persons Like all other persons

The Value of Cohort Analysis

Understanding Generations


Generations

Each generation is unique – shaped by social, historical and demographic (size, composition) forces

(Strauss and Howe)

Implication

Systems of care need to be reassessed and reinvented as each

new cohort agesNote such reimagining

involves intergenerational

considerations – i.e. Baby Boomers

managing care of GI Generation Parents


Generations

Generations are both interactive and reactive

Each generation not only interacts with others (despite the fact that industrial societies are more age-segmented) but reacts the experiences shaped by preceding generations

Cohort analysis begins with the size and composition

(gender, ethnicity etc.) of a generation

It is more than sheer size

Each generation is shaped by context –

the historical and social experiences


The GI Generation(Born 1901 – 1924)

Childhood – a time of prosperity

Decline in child labor Increase in education Development of mass

adolescent organizations (Boy and Girl Scouts)


GI GenerationFormative Experiences

Experienced Depression and World War II

GI Bill – Housing and Education

Expected and Valued Government Role


GI Generation Formative Experiences

First Aging Generation First generation to

benefit from Medicare, Medicaid, Social Security and Aging Network

GI GenerationValues

Respect Authority (and seek respect)Follow Orders, “Regular Guy”, Team

PlayerAltruistic “Can Do”Rigid Sex Role Definitions

The Silent Generation(Born 1925-1942)

Formative Experiences Sandwiched between GI Generation and Boom – a

“Transitional Generation” Many fought in career, those on the cusp may

have served in Vietnam First American Generation the declined in

numbers Generally Experienced Prosperity and Security Divorce still rare in their childhood Civil Rights Generation

The Silent GenerationValues

“Fitting in” – The Organization ManEmerging Concern with Inner SelfTransitional – Cultural and Gender Roles


The Traditional Generations

Often the GI Generation and the Silent Generation are now grouped together as they now share common experiences of later life, GI Generation rapidly dying off, and many formative experiences were not radically different – intact homes, utilized savings accounts, etc.


The TraditionalistsImplications for Medical Care and End-of-Life

As a group, often accept the fact that life is unfair – hence accepting of fate

Grow up at a time when medical treatments were limited – children died from polio, whooping cough, heart attacks were fatal – hence some may be fatalistic and view medications and hospitals with suspicion

Yet generally adherent – will seek doctors advice for anything health related; rarely will question physicians



African-Americans in these generations experienced harsh discrimination and prejudice – themes that may emerge in life review

Because of the Tuskegee experiments may be distrustful of medical professionals

That distrust as well as spiritual values may leads to a reluctance to consider palliative care

Many persons may have a pride of survivorship


Langston Hughes’ Mother to Son

Well son, I’ll tell you

Life for me ain’t been no crystal stair.

It’s had tacks in it,

and splinters,

And boards torn up

And places with no carpet on the floor

Bare.

But all the time

I’se been a-climbin’ on,

And reachin’ landin’s

And sometimes goin’ in the dark

Where there ain’t been no light.

So boy, don’t you turn back.

Don’t you set down on the steps

“Cause you find it kinda hard.

Don't you fall now –

For I’se still goin, honey,

I’se still climbin

And life for me ain’t been no crystal stair



Often end-of-life preparation meant wills and other estate planning

Now accepting need for healthcare proxies and advance directives – yet ethnic differences exist

With increasing dependence they may have conflicts with baby boom caregivers on “downsizing” as they eschew the wastefulness as their boomer children attempt to toss out “clutter”

May seriously struggle with difficult decisions regarding savings and assets v. eligibility for governmental programs


The TraditionalistsImplications for Counselors

Tend to be quiet about emotions and feelings

Generally resistant to therapy as defined as for persons who were “crazy”

Even resistant to EAP’s since they first experienced such programs as dealing with occupational alcoholism

Though first generation to embrace widow/widower and other grief support groups


The TraditionalistsImplications for Counselors

Often rising rates of alcoholism – these generations tended to exhibit more drinking and alcohol use may increase with retirement

Yet a rising rate of suicide as this group ages – probably a result of untreated depression, alcoholism, status changes, and cascading issues arising from aging and loss


The TraditionalistsWorkplace Implications

Value honesty, loyalty, and hard work – one thing at a time

Detail oriented Communication more formal Works well with hierarchy and

rules – has a sense of organizational history

Historically the last generation where males primarily worked and women stayed home or had part-time or traditionally female careers

Likely in the leadership of the organization


The TraditionalistsAttitudes toward Recreation and

Leisure Often a challenge to redefine themselves distinct from occupational roles

A paradoxical perspective Recreational and leisure a reward

for productivity Yet a reversion to unproductive

periods of life albeit deserved In recreational therapy there is

value of explaining rationale behind activity

Younger traditionalists may see leisure more productively – elderhostel, “grand” travel etc.


The Baby Boom(Born 1943-1960)

Formative Experiences Sheer Size – Now 73

Million Shaped by Watergate,

Vietnam A Generation of

Worsening Trends

(Divorce, Delinquency, etc.)


The Baby Boom and Diversity

The Baby Boom is a diverse generation both ethnically and spiritually

Ethnic diversity and the 1965 Immigration Act

Spiritual Diversity – the growth of non-Western Religions


The Baby Boom and Diversity

The Baby Boom generation experienced the sexual revolution and was active in gay rights movements

This was the first generation to experience gay marriage and same sex partnerships


Boomers Have Changed Every Institution They Have Encountered

Schools and Colleges

The MilitaryMusic and MediaPoliticsThe WorkplaceSociety


Boomer Legacy

Agitated for Civil and Individual Rights

Including strong inter-gender support for Women’s Rights

Created a strong and sustained Environmental Movement

Aging Rights -- The next crusade?


Boomer Values Individualistic Eclectic Spirituality Resource Aware Choice, Creativity and

Control Distrustful of Authority –

including government Trust persons not positions Sense of Entitlement Aging Adverse Strong Emphasis on Health

and Wellness


Boomer Sense of Justice

Boomer’s have a finely tuned sense of “injustice” that can alienate them from businesses that they perceive as greedy or unfair

Example – Stewart Shops and the pricing of The NY Times

Baby Boomers

A 2009 study by Martin, Freedman, Schoeni, and Andreski about Boomers approaching 60 did not find major improvements in health over the past generation despite public health successes and generational emphases

This may reflect greater improvements in diagnosis, subjective expectations of Boomers on how they doing, and other factors such as obesity

The authors note that final conclusions could not be made but “it is perplexing boomers are not doing better”.


Aging Boomers

On Jan. 1, 2011, the first Boomers turned 65 years old

Everyday thereafter 10,000 more will cross that threshold

By 2030 when all Boomers are over 65, 18% of the US population will be 65 or older.


Aging Boomers

Boomers generally consider old age begins at 72

Most feel near a decade younger than their actual age

Implications for marketing and programming


Baby Boom GenerationImplications for Medical Care and End-of-Life

Boomers will expect to be actively involved in determining their medical care

Boomers are heavy consumers of alternative medicines including chiropractors, acupuncture, herbal and natural treatments, vitamins


Boomer Drug Use

Boomers had a high rate of experimentation with recreational drugs

A certain percentage have continued drug use as they age

Health consequences of life-long use are still unclear, and likely vary dependent on the drug of choice

Policy issues?



Boomers value “death with dignity”, as well as effective pain management – they were in the forefront of the hospice movement so that portends well for hospice use

On the other hand, control and options might make hospice more attractive if it offers concurrent care

Katz and Wright (2011) recount a case where a woman opted out of hospice since it did not offer life-extending treatment nor nutritional support – patient wanted to survive till daughter’s wedding



Boomer focus of control may lead to some interesting ethical dilemmas

Some boomers have stated in advance directives that if they do not know enough to eat – do not feed them!


Baby BoomersImplications for Counselors

As a generation, grew up with guidance counselors so not adverse to therapy (mediated by other variables)

Embraced self-help movements – especially as self-help turned from prohibitory to enhancing


Baby Boomers Institutional Care

Boomers value privacy, dignity, and autonomy

Private rooms will be in demand

Cost analysis indicates that such use of space is viable even at Medicare rates in about 7.5 years (Calkins & Cassella, 2007)

In addition, remember the opportunity costs – double rooms are more likely to stay empty


Boomers will demand

Individuality (Matching Environments)

Freedom to choose Continuity in life styles Personal belongings Privacy – including private

rooms Contact with grandchildren

(children-friendly facilities) Internet and technology Safety


Boomer Concerns for Parents

Reshaped Adult Care Market

Emphasizing continuum of care

Assisted Living Amenities for well

older persons such as spas and gyms


Baby BoomersImplications for Funeral Service

Boomers will demand greater options – choice including products, services

Boomers will wish options for creative rituals

Internet savvy – video streaming, Internet Memorials and Sign in’s

Diversity – language cards etc.


The Baby BoomRecreation and Leisure

The generation that refused to grow!

Boomers value recreation, activity, and leisure

See it as essential to good physical and mental health

Embrace the premises of recreational and activity therapy (relation of leisure to life satisfaction)

Caveat – Sensitive to activities considered demeaning or attitudes perceived as disrespectful


The Baby BoomRecreation and Leisure

First generation with widespread technological literacy (first generation to fully experience computers as routine in the workplace – yet still digital immigrants

Gender roles not as rigid Boomers have a strong

outdoor emphasis Aquatic programs are valued

– especially for fitness (rather than play)


Baby BoomersWorkplace Implications

The retirement of the Baby Boom Generation will create job shortages in many fields as 73 million boomers will need to be replaced by 49 million in the next generation

Skewing the dependency ratio


Aging BoomersRetirement and Work

70% of Boomers say they plan to work beyond retirement age.

While there are financial reasons for this, Boomers also cite the need for mental and social stimulation, and physical activity

Many Boomers, especially professionals define themselves by their careers

Yet about half do retire at 65 – for reasons of health, age discrimination or a declining economy


Generation X (1961 –1981)Formative Experiences

Strauss & Howe call them “The Thirteenth Generation”

Raised in a time of terrorism, environmental disasters, disease (AIDS)

See Boomers childhood as carefree – more aware of consequences

Boomer parents – friendship valued, high divorce rate

Higher percentage of latch key children

Economically “a depression of the young” as houses seem hard to afford, etc.


Generation XValues

Technologically advanced and aware

Independence and self-reliant Entrepreneurs Savvy consumers and distrustful

of work organization’s commitment

Non-ideological Music and dress as a divider Decline in college graduation

(especially for males) compared to Boomers

Reactive – trying still to see what they believe and where they fit in


Generation X Implications for Medical Care and End-of-Life

With the oldest members approaching 50, just beginning to struggle with an awareness of mortality

Value speed, efficiency and a consultative style in medical providers

More open to non-traditional forms of care

Often seek information from the Internet including costs

Beginning to be parental caregivers More critical of medical care than

Baby Boomers or Generation Y – perhaps reflecting they are relatively new to negotiating the system


Generation X Implications for Counseling

Open to counseling, responsive to coaching, they embrace an expansive and enhancing view of counseling

Often both genders have tried to cultivate support systems based on friendship bonds “urban tribes”

Depression, anxiety, and eating disorders are the major psychological issues that this generation experiences

Substance abuse (outside of smoking) is not major – entered the workforce when drug-testing is common


Generation X Implications for the Workplace

Entrepreneurship valued as is a more equalitarian and horizontal work environment

Prefer flexible options – including flextime, working remotely as an option

Expect voice to be heard, opinions solicited, and disputes conciliated

Want to balance life and work


Generation X Implications for Health Care

Seeking a sense of balance has created generational shifts in medicine

Generation MD’s are more likely to be female, technologically savvy, want stability, and balance

“I am not bothered by older doctors saying ‘we worked harder.’ Instead I pity them for justifying their misery.”


Generation X Recreation and Leisure

Emphasis on balance offers opening to leisure

Often leisure is focused on self-development, inner growth, nurturing relationships, and keeping fit

Because of economic challenges, cost is a factor in the activities chosen


Generation Y “The Millennial Generation” (1982 - 2000)

Formative Experiences Born in a time where there is a

deep interest in youth – education, health, etc.

Late Boomer parents seeking not to repeat mistakes – civic virtues emphasized

Tolerant generation (Diversity emphasized)

Technologically advanced Pragmatic and non-ideological Most “medicated”generation –

now relatively high rates of underage alcohol, illegal drug use and trading of prescription medications


Generation Y Formative Experiences

The first internet generation Digital natives – rather than

digital immigrants Accentuated differences between

“the know” and “know nots” Strong technological connections

to parents – texting etc. Emerging adulthood – a

lengthened period of dependency The “virtual” community – where

things are not always what they seem!


Generation Y A “wanted” generation as

abortion is legal and parenthood valued as a choice

A “nurtured” generation – social promotion, self-esteem valued, trophies for participation

Scholars feel that their high and perhaps unrealistic expectations may be dashed as they enter a highly competitive world in adulthood


Generation YValues

Accept diversity including more accepting of LBGT

Self expression valued more than self control

Adapt easily to change and technology

Respect must be earned – not based on age, authority, or title


Generation YImplications for Medical Care and End-of-Life

Little experience for most with anything but routine medical care

Most have yet top experience serious illness or the deaths of parents

Any experiences with death likely to traumatic

Questionable as to whether media has desensitized persons to death (Kastenbaum)


Generation YImplications for Counselors

In a generation used to transparency on the web, confidentiality will have to be carefully explained

Expect that you, as counselor, will be googled

Develop a policy, in the consent form, on social networking sites – “to friend or not to friend”

Multitasking is common in this generation – consent forms may need to address use of cell phones, texting (both in general and in session) etc.


Generation YImplications for the Workplace

Natives too to the information age

Very open and sharing Not hierarchical – so will often

skip chain of command Will often, for example, share

salary information with friends to assess their own salaries

Expect quick and positive feedback

Will avoid or leave positions that limit access to the Internet


Generation Y (Millennials) Workplace Attitudes

Want to be treated as special Often remain close to parents – may

even bring them to interviews Need structure and desire feedback May be dependent Team and collaboration oriented

rather than competitive Desire long-term careers with few

risks and with benefits Likely to remain loyal to supportive

companies

Howe, 2010


Generation Z(2001- ?)

New generation emerging Most technologically connected

– many have TV’s, DVD’s in rooms, cell phones likely as they age

Will likely be technologically connected, multi-taskers

Heavily influenced by Disney images – Hanna Montana, The Suite Life etc.

Possible the “New Silent Generation”


Generation Z

Cyber community and cyber interaction


Generations at WorkA Summation

Silent Generation – Value loyalty and discipline, respect authority and hierarchy

Boomers entered work force at a competitive time – self-motivated, often hard workers

Generation X – entrepreneurship valued, prefer a more flexible and horizontal structure. Strong sense that disputes should be conciliated

Generation Y – First digital natives, individualistic, value autonomy, horizontal structures. Little loyalty or expectation of life-long employment. Often loyalty is more based on personal relationships


Generational DifferencesCareer Goals

Silent Generation – Build a legacy

Boomers – Build a stellar career (Competitive)

Generation X –Build a portable career – showing many areas of competence and achievement


Generational DifferencesRetirement

Silent Generation – Retirement as a reward

Boomers – Retirement as an opportunity for retooling, possible second career


Generational DifferencesChanging Jobs

Silent Generation – Shows disloyalty

Boomers – Puts you behind in your career

Generation X & Y – A necessary move to keep current and advancing (the moving shark analogy)


Some Programs Can Transcend Cohorts

Life Review and Reminiscence Programs

Intergenerational Programs

Even here, themes and activities must be cohort-sensitive


The Value of Reminiscence

Enhances mood Establishes time and role

parity Bolsters self-esteem Establishes a continuity of

identity As therapeutic tool Part of later life development Creates and bolsters

community


Danger of Life Review

Can resurface earlier losses and traumas

Life ReviewDifferences with Reminiscence

Reminiscence focuses on positive memories and experiences

Personal history – including positive and negative experiences

Careful observation by therapistAttribution of meaning


Life Review

May Not be Useful with Highly Narcissistic Troubled Life Alienated

Relationships Persons Unable or

Unwilling to Reflect


Life ReviewProblematic Populations

Drawing life’s lessons

What lessons would I like to pass on to others?


Techniques for Life Review and Reminiscence

Photographs and memorabilia

Music and film Creative expressions Genealogies and

genograms Reunions Pilgrimages


Use all senses

Sound Sight Touch and texture Taste Smell and aromas


Ethical Wills: A Tool for Legacies, Remembrances and Inter-

Generational Dialog“Legal wills bequeath

valuables, ethical wills bequeath values.” (Baines, 2002)


Age LinesA Life Review Technique

Chart significant points in one’s life

Identify the challenges faced along the way

Discuss strategies used to overcome these challenges


Intergenerational Programs

Can involve older persons assisting younger, younger assisting older, or mutually beneficial programs – perhaps joint service to the community

Intergenerational programs can offer new stimulations, friendships, experiences, decrease isolation and loneliness, and raise self-esteem


Re-Packaging Programs

Other programs may still be used but will have to repackaged to meet generational interests

The value of Bingo – hand/eye coordination, stimulation etc.

Selling wellness Offering choices


Everything Old Is New Again

Truth of Cohort Analysis – We constantly reinvent systems of care and modify counseling approaches with each new generation

generations a hidden source of diversity

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