|
DISCUSSION
The purpose of this study was to explore the level of social isolation and
depression among the Cambodian elderly in Long Beach, California. This study sought
to examine in-depth interviews with fifteen Cambodian elderly by using the Geriatric
Depression Scale and the Social Isolation Interview guide. The information acquired for
this study was analyzed by the qualitative method approach. The Geriatric Depression
Scale was further explored in terms of the respondents’ indirect statements and responses
to each question. Similarly, the social isolation interview guide was analyzed as well in
terms of their statements, feelings, and other various issues encompassing their lives in
the United States.
Summary of Findings
According to the Geriatric Depression Scale (GDS), the results show various
levels of depression among the Cambodian elderly. One (6.7%) participant was
categorized as normal, six (40%) ranked mildly depressed, and eight (53.3%) ranked very
depressed. Since about half of the participants ranked very depressed, it supports the
findings of other researchers (Meinhardt, et al., 1984 & Carlson & Rosser-Hogan, 1993)
concerning depression among the Cambodian refugees. As found in those studies,
Cambodian refugees are the most depressed group among Southeast Asian refugees.
However, the respondents’ comments in the interview give a very different picture or
viewpoint.
It is worthy to note that the GDS may not accurately reflect the level of depression
among the Cambodian elderly due to cultural differences in defining concepts such as
feelings of helplessness, hopelessness, and relative affluence (whether or not most people
are better off than they). The existence of these feelings is regarded as normal or
acceptable due to cultural norms and old age. For example, all participants responded
“Yes” to feelings of helplessness; thirteen participants (86.7%) responded “Yes” to
feelings of hopelessness; and, fourteen (93.3%) responded “Yes” to feelings that others
are better off than they. Responding “Yes” to these questions generally indicate
depression. However, contrary to the above questions, fourteen (93.3%) respondents
reported “Yes” to being satisfied with their life and twelve (80%) reported “Yes” to
feeling wonderful to be alive.
The point of the example is to show the respondents’ inconsistency of feelings
when responding to the above mentioned questions. It does not truly reflect respondents’
“very depressed” status according to the GDS, most reported feelings of positive life
satisfaction and felt that it is wonderful to be alive at the same time most reported feelings
of hopelessness, worthlessness, and that others are better off than they. This
inconsistency may be due to cultural norms and decorum when respondents are asked
these feelings. For example, to some respondents, reporting “No” to feelings that others
are better than they would indicate poor individual character of arrogance and egoism.
Additionally, the participants’ statements to each GDS items reflected their
feelings of depression as related to the inability to freely roam the community, medical
problems, and family disruption. Family disruptions such as divorce, domestic violence,
and criminal activities among their children appear to be the primary source of depression
among the Cambodian elderly. An additional source of depression is the inability of their
children to maintain cultural parental obligations for them. Family disruption among the
Cambodian elderly supports the findings of Zhang and colleagues (1997). The finding
suggests that “stressful family situation” is one of the primary risk factors for depression
among the Chinese elderly. Zhang further suggested that the Chinese elderly expect
cultural values of loyalty, piety, benevolence, and righteousness from their children.
Disruption of such values also leads to stressful family situation.
Social isolation among the Cambodian elderly appears to have no significance
in terms of their relationship with their spouse and children. Many reported to have
supportive friends and children who they rely on for transportation and sources of
network to the community. Many are dependent on their children for in-home supportive
services such as food, medical care, and the maintenance of government assistance
(SSI/SSA). Boredom and the inability to independently travel are among the general
complaints among most participants, especially for male participants.
There were no significant hardships in terms of financial problems. Many
participants stated that they were grateful for government assistance. Their lives are
basically what they should be at their age. Traveling some would be nice, being around
others to socialize or to talk/teach about their culture would be nice. Overall, this group
of respondents was not depressed in the way most would have assumed. On the contrary,
this group reflected a strong level of resilience in terms of coping with lives regardless of
lack of acculturation and a having a traumatic war past. The findings in no way suggest
that this population is entirely independent and do not need further assistance. They still
need assistance, for instance, with translation when responding to the social services
department or transportation. The needs of this population should be determined by
asking them what they consider to be their needs, rather than through mere observation or
supposition.
Limitations
This study is based on a qualitative research method and the limitations to the
study may be due to the researcher’s bias of selective data interpretation that will only
support the researcher’s theoretical conclusion. The researcher may also be inclined to
interpret the data through his or her own introspection, thoughts, and feelings.
Additionally, the method of “snowball” sampling may create inadequate representation of
the target population and may result in a bias method of data collection procedures.
Other biases affecting the study’s data and interpretation include the limitations of
external and internal validity, which the outcome of the study has no inference for
causality and generalizability; the sample size does not accurately reflect the Cambodian
elderly population in Long Beach. One of the limitations of qualitative research is its lack
of precise descriptive statements about the target population.
Implications for Future Research
Further research is needed in order to shed light upon this under-represented
population. There is also a need for better understanding of their perceptions and feelings
in terms of health status, acculturation and quality of life.
Furthermore, there is a need to develop quantitative instruments or scales that are
sensitive to Cambodian cultural norms. For example, the Geriatric Depression Scale does
not accurately capture the population’s sense of depression. The meaning of
“hopelessness” or “worthiness” may not reflect depression among the Cambodian elderly.
In order to capture the population’s sense of depression, it is best to participate/interact
the respondents in the study rather than measuring the feelings with a
westernized/eurocentric depression scale. For example, ask them what truly makes them
depressed.
Further research studies could also address the cultural awareness and issues
among medical and mental health providers serving the Cambodian elderly. As health
care professionals, it is essential to understand this population in terms of their traumatic
past and current living situation. An in-depth understanding of this population will help
to better serve their needs and to address their problems more effectively.
Implications for Social Work Practice
Social workers working with the Cambodian elderly should be aware of their
cultural norms, traumatic past, living situations, and their own perceptions of what they
need and how they define what their problem is. Additionally, social workers should be
aware of the germane problems the Cambodian elderly face. These problems are
identified as maintaining government assistance (SSI/SSA), obtaining U.S. citizenship,
and future nursing home placements.
Many Cambodian elderly subsist on Social Security income and are generally
appreciative of government benefits. This subsistence is an important asset to them in
terms of their livelihood and independence. They may rely on family members or pay
others to file for government benefits for them or to respond to the social services
department in order to maintain government assistance. The elderly who had to rely on
others for these services may be required to pay exorbitant fees for processing services.
Another problem many Cambodian elderly face is acquiring U.S. citizenship
status. This is important for them because they may desire to return to Cambodia in order
to visit family members or relatives who were separated from them during the war or to
participate in burial ceremonies for their son, daughter, or other relatives. This area of
concern relates to the government’s one-month limitation policy for those who are
receiving SSI/SSA. This policy restricts their visit in Cambodia and profoundly deters
their need to visit family members there or practice cultural traditions.
A future problem for the Cambodian elderly is the need for culturally sensitive
nursing home placements. There will be a time when family members cannot carry the
hardships of caring for their elders and may eventually place them in nursing home
facilities designed for the mainstream population. This is a tremendous hardship for the
Cambodian elderly due to language barrier, conflicting traditional values, and mainstream
dietary practice. There is a need for a nursing home that is culturally competent and
flexible to meet the needs of the elderly who ultimately face drastic changes from
traditional settings to mainstream environment.
NEXT CHAPTER - REFERENCES
RETURN TO TABLE OF CONTENT
|
