Journal of Gerontology & Geriatric Medicine Category: Medical Type: Research Article
The Social Inclusion of Older People in France: Social Participation, Loneliness and Giving
- Frédéric Balard1*, Alice Miron2, Tatiana Botteau2
- 1 King Departement Of Sociology, Laboratoire Lorrain De Sciences Sociales, Université De Lorraine, France
- 2 Departement Of Sociology, Laboratoire Lorrain De Sciences Sociales, Université De Lorraine, France
*Corresponding Author:Frédéric Balard
King Departement Of Sociology, Laboratoire Lorrain De Sciences Sociales, Université De Lorraine, France
Received Date: Oct 30, 2019 Accepted Date: Nov 18, 2019 Published Date: Nov 26, 2019
This paper analyzes the design and implementation of projects and initiatives targeting older people, and discusses a survey of older people examining feelings of loneliness and/or uselessness. We will begin with a brief overview of theories on successful aging, to show how the question of social exclusion eventually came to the forefront. We will then examine the evolution of this notion in French old-age policies. Finally, we will present the findings of the VIEU1 project, offering avenues of reflection to consider social inclusion from a new perspective.
1VIEU is the acronym of our project. It means « VIeillir et Etre Utile » that could be translate by « Aging and being useful ». This project received the support of the MUTAC Foundation.
FROM THE THEORY OF AGING TO LONELINESS POLICIES
Leading theories on aging
Initially, the disengagement theory unequivocally pointed at the issue of the social exclusion of older people, although the authors claimed that an individual could in some cases contribute to this disengagement process. This theory was subsequently quoted and repeated, which contributed to consolidating its individual, natural and biological arguments . Over the years, the evolution of this concept in publications consolidated its tendency towards ageism .
In contrast with this theory of disengagement, the activity theory - which, according to Havighurst, was essentially supported by those he called “practical workers” - developed and imposed it. It was disseminated by researchers such as Rowe and Khan  who believe that successful aging is «multidimensional, encompassing the avoidance of disease and disability, the maintenance of high physical and cognitive function, and sustained engagement in social and productive activities» (p. 433). Suggesting that successful aging consists in preserving activities and attitudes acquired in the middle age, activity theories promote active and productive aging as a response to social exclusion. As demonstrated by Foster and Walker [6,7], there is a close proximity between the notion of «successful aging», mostly used in the US, and that of «active aging» which is prevalent in Europe.
The laroque report: promoting social inclusion
In the 1970s policies were developed including the increase of the minimum income for older people, financial support against housing exclusion and the development of home care services and information services to break down the isolation of older people. Politically, social exclusion was seen as a process that led to older people’s exclusion from economic growth. The measures built on this perception strove to help older people benefit from a similar lifestyle to middle-aged people. However, the economic slowdown and the growing focus on disability greatly transformed and narrowed down the scope of old-age policies in favor of the integration of older people. In the 1980s and 90s there was an attempt to quantify dependency and produce adapted responses to what appeared both as a medical and an economic issue. In a general policy context of de-centralization, liberalization and underfunding of social services, the fight against social exclusion no longer appeared as a state priority for old-age policies. Social inclusion issues were thus handed over to local authorities and associations. While in the 60s old age was perceived as another period in life, the 90s became more focused on the «fourth age» and on the functional incapacities associated with this period in life.
The construction of older people’s isolation and loneliness as a public concern
Nevertheless, after 2003, these themes were taken on board by civil society and not for profit bodies and associations, who brought isolation and loneliness issues back on the agenda. For example, the Foundation De France (FDF) regularly published surveys on «loneliness in France», including a 2014 study pointing at the «growing isolation of older people». In 2011, the fight against loneliness was declared a national priority. In 2012, the delegate Minister for older people and autonomy initiated a reflection on older people and isolation. About thirty organizations came together to work on this issue. In 2014, the participants formed the association MONALISA (acronym for “National Action against Elder Isolation”). The working group was led by the general delegate of the charity Les Petits Frères des Pauvres. The group published a report  which recommends to “mobilize” with and for older people on different levels: a national commitment articulated in a common charter; local stakeholder collaboration; the promotion of community engagement and solidarity with older people2 . In 2015, the first section of Law n° 2015-1776 on society’s adaptation to tackle aging included an alinea entitle «Maintaining social cohesion and fighting isolation: MONALISA»3.
METHODOLOGY, THE VIEU PROJECT
Social inclusion promoters and stakeholders
Think tanks promoting the inclusion of older people
We carried out a thematic analysis of the contents of both associations’ websites. We also conducted an in-depth interview with the President of REIACTIS and the Vice-President of Old up. We used semi structured interview guides to shed light the conception of social inclusion and to precise the actions in progress. The interview guide included three main sections: presentation of the informants and his/her professional and associative trajectory, their point of view of social inclusion and the way how they contribute to it, and the past, future and action in progress of their association.
Surveying older people about their everyday lives and feelings of loneliness
The interview guide targeted the expression social isolation and loneliness to distinguish the two notions through the experience of the informant. The framework for the analysis was built using the informants own words in an open-coding model. The words of informants were interpreted in context, taking into account the interaction with the researcher, the life story elements known.
Promoting activities in the local community
This call for projects, as well as the interview with the head of the program, reflects a certain perception of social integration. It expresses an ambition to move away from the paternalistic bias of projects supporting older people, which had been the object of much criticism in the 1990s. Individuals must take an active part in their aging, in their health and in their local community. These elements are articulated through the notion of citizenship, which denotes that individuals are encouraged to take part in the life of the community. The social integration of older people is understood on a local scale - the local territory, the city, the neighborhood - and local stakeholders are tasked with building projects that can achieve this. Active and productive participation in the community is seen as a key factor of integration for older people.
The phrasing of this call for projects associates aging well with local community engagement. Out of 30 responses to the call, 24 were submitted by associations, 2 by public health bodies, 2 by supported housing facilities, 1 by a nursing home and 1 by a municipality. As expected, most proposals replicated the call for projects’ words and spirit in their stated objectives and descriptions. A performing arts charity explained that the objective of their work was to “break down the isolation of older people and support them to become active members of society”. The project targets nursing home residents, with an artistic performance on the theme of the aging body. Being an active member of society is understood as one’s ability to get their voices heard and convey a message that can create more encounters and sharing. The word “active” is closely associated with the notion of social and local inclusion. Artistic creation contributes to giving older people a more active and productive image and creates community cohesion.
Most projects articulate usefulness and social integration with the continuation of working life. For these associations, usefulness refers to the fact for a person to have a place in society, for instance by «re-asserting the value of economic interaction with the rest of society and the ‘active’ population» to quote one of the projects. The FDF, along with the associations that respond to its call for projects, sees local community involvement as a means of creating bonds between people and as a protection against loneliness and isolation. Exclusion is tackled through the promotion of citizen involvement with the support of civil society organizations.
Promoting citizenship and empowerment
It is considered that society provides opportunities for older people’s integration, and that such opportunities should be grabbed: this is considered as the main channel of social participation. The president of REIACTIS supports “an approach that starts from an individual’s capacities and resources, which form part of a life project”, and defines empowerment as an individual’s control over their own life and environment. Although it criticizes the utilitarian and functionalist bias in the notion of “usefulness” when applied to older people, REIACTIS nevertheless purports to “identify ways in which people can be supported to continue to actively participate in community projects”. It promotes “opportunities to wake up to the world through conferences and training courses”.
Preserving a place in society
This social role involves making a distinction between «meaning» and «leisure». Old people’s activities should not just be designed to help them fight boredom or fill their schedules. In short, they should be different from activities in senior citizens’ clubs or nursing homes, whose sole objective is to keep participants busy. On the contrary, the association’s activities aim to fight the loss of meaning. According to the vice president of Old up, the feeling of uselessness begins when older people feel like they do not have a meaningful place in society. The aim is therefore to “preserve the right for people to exist with their own opinions”.
Loneliness and isolation: a lack of clearly defined terms
Visiting older people
According to the vice-president of Old up, this kind of “charitable” interaction contributes to patronizing people rather than helping get out of isolation. This type of action can indeed strip its beneficiaries of their individuality and even stigmatize them. Because there is no reciprocity in the relation, individuals are deprived from the possibility to exist through sharing, which can increase their feelings of loneliness and uselessness.
Sharing and exchange
Learning to talk with older people?
This work raises a key issue: should people be trained to talk to older people? Is there not a form of ageism in thinking that these people are so different that we need to learn a specific language to communicate with them? The vice-president of Old up supports this view: “Old people are dead wood, they’re seen as a burden in today’s society, we don’t know what to do with them, and there is no longer a place for them. It’s a bit like talking to inmates; we don’t really know how to address them because they are not really human beings anymore [...]. We don’t know how to talk anymore, we don’t know what to say to them and how to say it, and what are we supposed to say to them anyway? [...] are we trying to turn them into respectable people like you?” Considering that a training program is needed to talk with older people contributes to keeping them at a distance from the rest of society and “ostracizing” them. In addition, activities aimed at tackling loneliness lead to the institutionalization of social bonds, which are potentially disconnected from regular social life. In attempting to respond to the objective situation of social isolation, we forget to consider older people’s subjective experience of loneliness.
Diverse forms of loneliness
It appears that the intensity of this feeling varies over time . Loneliness is felt more acutely during the festive period and holidays, because people feel excluded from the sharing and celebrations. Mrs. Louise says: “We used to have friends and eat together every Saturday for instance, but that is all gone now...” In everyday life, loneliness can be felt more acutely at certain times of the day, during meals when that moment used to be shared with relatives, or in the evening when the night falls and the outside noises go quiet. Mrs. Simone lost her appetite because she feels “too lonely”, while another interviewee (widowed, 74 years old) explains: “It gets the hardest at night when I’m in bed... There is too much silence, not a sound, silence makes me anxious, and that’s the hardest part, being alone at night. When I’m in bed, not hearing a sound.”
Older people face loneliness without asking for any help and do not necessarily express the need to receive a visit from a stranger. They often use the television, and even more often their memories. Mrs. Raymonde: “Well I watch television and I doze off [...] and sometimes I tell stories to myself. All of a sudden, a memory comes back [...]. And I talk to myself. I often talk to myself [...]. And I remember anecdotes...”
Loneliness requires a reorganization of a person’s way of life (Campéon, op. cit.). They may abandon some of their everyday habits: cooking, knitting, looking after them... In the absence of any human contact, such activities may feel pointless and energy-intensive. People who live alone can also sometimes neglect collective activities that lose their meaning when they are not shared. This leads to a form of withdrawal within one’s home. It appears that to tackle loneliness, someone’s presence is not sufficient. This presence needs to be significant. According to the vice-president of Old up, this requires moving beyond co-presence, to build a relation. This is only possible if visitors also consider themselves to be on the receiving end, and that the older person is in a position to give. She explains: “I believe that in order to help someone out of their loneliness, there should be a reciprocity of giving, that is if you want to help a neighbor out of their loneliness you should go ring at their door, tell them you’re making a cake and you forgot to buy some butter. Place them in a situation where they’re the one giving you something, and not the other way around.”
DISCUSSION: RETHINKING SOCIAL INCLUSION
TRUST AND ENGAGEMENT
RECIPROCAL GIVING AS A RESPONSE TO FEELINGS OF USELESSNESS
SOCIAL PARTICIPATION AND THE FIGHT AGAINST ISOLATION: FOR WHOM?
Our research shows that there are different ways of experiencing old age. Rather than social participation, some may choose to preserve activities that are meaningful to them and allow them to preserve the continuity of their personality, or to enjoy moments of solitude to cultivate their memories. To fight against the social exclusion of older people, we should question the way that certain programs targeting older people can themselves breed exclusion, because they convey perceptions of aging that are prescriptive instead of adapting to the reality of old age. Social cohesion can only be meaningful if it rests upon a balanced relation based on reciprocity. The feeling of usefulness reaches beyond citizenship and community participation.
5FORLISA : Formation pour le lien social des aînés. That is the name of the training program dedicated to the volunteers and the professionals who work with older people.
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Citation:Balard F, Miron A, Botteau T (2019) The Social Inclusion of Older People in France: Social Participation, Loneliness and Giving. J Gerontol Geriatr Med 5: 040.
Copyright: © 2019 Frédéric Balard, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.