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FACES OF
OPPRESSION

Exploitation

Marginalization

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marginalization.jpg

Powerlessness

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Violence

Physical Abuse

Chinese elders face these four forms of oppression as described by Iris Young (1990).

Exploitation

  • Caregiver neglect is the highest reported form of abuse, with the second most common reported form of elder abuse in China being financial exploitation (Chang & Dong, 2014). 

    • Caregivers may misuse an individual’s money with or without their knowledge. Elders may not be aware of financial exploitation. 

  • Financial exploitation of elders in China includes the illegal use of an individual's money, property or assets, as well as lack of required financial support (Wu et al., 2012).

    • Caregivers may coerce elders into making financial decisions that benefit the caregiver more than them.

    • Caregivers may misuse the elders funds required for healthcare. 

  • Despite mandatory retirement, elderly adults who work in labor intensive jobs are at higher risk for financial exploitation (Wu et al., 2012). 

    • Elderly individuals who are neglected may feel a sense of required financial self-dependency and financial reliance on working. 

Impact on occupational performance

  • Health Maintenance

    • Elders may be forced to make healthcare decisions that are detrimental or lower quality based on costs.

    • Caregivers may make or attempt to make cost-based decisions that lower quality of life.

  • Social Participation

    • Family relationships are strained by accusations or reports of financial exploitation.

    • Limited access to one’s finances may result in withdrawal from friends, family, or community activities. 

  • IADLS

    • Elders who do not have access to their own financial assets cannot choose their daily or long term budgeting.

  • Work participation

    • Elders may be pressured or forced to work in jobs that are labor intensive and harmful in order to meet financial needs.

Marginalization

  • Marginalization in this context refers to older people in China who are being cared for in the home and are excluded from activities that they want and need to do as a result of circumstances out of their control (Young, 1990).  

  • A majority of their children are moving to urban areas where they can get better paying jobs. There have been negative consequences on the Chinese elderly due to this urban migration. 

    • Some individuals need to move with their children if they require more care due to illness or frailty. These sudden changes in living environment and lifestyle become major stressful life events, greatly challenging them both physically and psychologically (Wu et al., 2016). This move is often a major disruption in their daily lives as their social connections are severed, routines are disturbed, and their dependency on their children is increased. Older people can experience symptoms including anxiety, fear, depression, and insecurity, which are manifested in disturbances such as deep sadness, insomnia, and weight changes (He et al., 2020). 

    • Others choose or need to stay behind regardless of the amount of care they need. This is sometimes a result of their children not having the resources, such as time, space, ability, or funds to care for them properly; other times, their isolation is self-inflicted, a consequence of them not wanting to be a burden to their children. This unfortunately leads to neglect of many older persons in China and a high incidence of depression in this population (Zhang et al., 2020).

  • In China, there is a perception that individuals with illness or disability are unable to fulfill their social roles as respectable individuals. They are deeply stigmatized for having disease or disability because of the “loss of self” and are often seen as not having the mental or physical capacity to survive as independent agents (Zhang, 2020).

  • Some groups of individuals in China in the past were denied opportunities for formal education due to their oppressed social status, especially women and individuals with disabilities (Liu & Carpenter, 2005). 

Impact on occupational performance

  • Social participation

    • Some older adults receiving care in the home are socially isolated and have few opportunities to meet people, whereas others lack sufficient resources and skills to build and maintain meaningful social connections, both of which contribute to feelings of isolation.

    • Displaced older individuals in China can experience symptoms including anxiety, depression, and insecurity (He et al., 2020). These conditions and feelings prevent older adults from seeking new social experiences.

    • Low socioeconomic status due to mandatory retirement precludes individuals from participating in social activities requiring funding (Spasojevic et al., 2006).

  • Social and emotional health promotion and maintenance

    • For the elderly receiving care from their family members, it is often difficult for them to express their needs effectively as they are accustomed to being the caregivers and a challenge to develop a new self-identity, especially if they are experiencing disease or illness (Chen & Levkoff, 2017).

  • Communication with the healthcare system

    • Low literacy is common among the Chinese elderly who tend to experience more chronic illnesses (Lam et al., 2004). Low literacy may be an important barrier to receiving adequate health care because patients may not be able to understand appointment slips, medicine labels, directions for self-care, informed consent forms, and health education material. 

    • Low social status contributes to individuals inadequately advocating for their health (Burch & Rembis, 2014; Liu & Carpenter, 2005).

Powerlessness

  • Powerlessness occurs for the elderly in China being cared for by their family as they are unable to have any control over their circumstances (Young, 1990). 

  • Older individuals in China are reliant on the government and their family members to make decisions that affect their lives. 

    • China has a forced retirement at age 55 for women and age 60 for men. Older adults are no longer allowed in the workforce after this time even if they wanted to continue working or needed to work for financial reasons.

    • Due to the implementation of the One Child Policy in China and an aging population there are less individuals in the workforce. China is gradually going to make older individuals work longer to help fill this gap, so individuals who have been looking forward to the retirement age may have to continue working in order to comply with the system and for proper compensation for their livelihood. 

    • With less people in the workforce and China’s modernization and industrialization it has created a busy, competitive lifestyle for adults making it difficult to give proper care and attention to the elderly living in the home (Li et al., 2017). 

  • Older people in China, particularly in rural areas or those who are uneducated and have low income lack resources within the healthcare system that are available to them. Migrants from rural to urban areas experience health inequalities due to social stigmas (Fan et al., 2019).

  • “The lost generation” refers to the older adults in China who do not have any or enough family to care for them due to the One Child Policy. One child bears the responsibility to care for 4 grandparents or aging parents and in-laws (4:2:1).

Impact on occupational performance

  • Social participation

    •  In recent years, the elderly in China are often alienated and lonely due to the lack of family support. 

    • In rural areas of China, older adults are left behind as their adult children seek job opportunities in the urban setting.

    • Older adults may feel forced to migrate from the rural to urban setting to be cared for by their family but many find it to be a difficult and lonely transition (Fan et al., 2019). 

    • Some are left at the mercy of their busy adult children’s schedules and are unable to participate in meaningful social activities. 

  • Health management

    • There are health disparities among older adults in China, especially for individuals who have a low socioeconomic status.

  • Communication with the health care system

    • Many older adults may feel powerless in the medical decisions that are being made by family members due to finance or convenience factors. It is also difficult for individuals who move from a rural area to urban areas where they may speak a different language and are unable to communicate and advocate for their health needs.

Violence

  • Although the number of abuse cases are not completely accurate due to under reporting, 4.9% of China's elderly population reported being physically abused. Compared to 1.4% of the elderly population in the US (Burnes et al., 2016).

  • Long term physical abuse significantly increases health issues, such as chronic pain, mental health concerns, and poor physical health (Rutgers University, 2019).

Impact on occupational performance

  • Social participation

    • In an effort to keep family harmony, many elderly individuals do not tell others about abuse taking place. Due to this, physical signs of abuse happening causes the elderly to avoid social activities 

  • Bathing, Grooming, Personal Hygiene

    • These tasks become difficult for elderly individuals that have been physically abused, as some physical abuse can lead to muscle weakening and broken bones.

    • These tasks may begin to be avoided as the abuse may have previously taken place or is currently taking place during one of these intimate times. 

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