Refugee and Aging Refugees
Refugee is a term the United Nations High Commissioner for Refugees (UNHCR) uses to designate persons who have been forced to flee their country of origin because of internal conflicts (i.e., civil war) or government persecution (UNHCR 2019). Once designated as a refugee, the United Nations along with participating countries assist individuals and families to resettle in a new country. Refugees differ from asylum seekers or immigrants. Refugees, due to their designation by the United Nations, are persons who have been identified as living in regions known to be under aggression, occupation, foreign domination, or in severe public disorder as to make residing in that region unsafe (UNHCR 2019). They are provided with limited financial assistance, housing, and access to health and social services for their first year of resettlement in the new country.
Aging refugees are persons who may have resettled at a younger age and who are now entering old age. Aging refugees might also be person who arrived as older adults. Either of these groups of aging refugees faces challenges as refugees that other refugees may not. These challenges will be discussed next.
Research studies focused on aging refugees have examined the intersection of the refugee experience and aging. This intersection is compounded by cultural differences between the refugee’s country of origin and the hosting country. These cultural differences shape both the perspectives and understanding of the refugee experience and the experience of aging.
By 2050, 22% of the world population will be 60 years of age or older (WHO 2019). Daily, 44,400 people are forced to leave their homes because of conflict and persecution (UNHCR 2019). As many as 30% of these displaced individuals are older persons (Barbelet 2018). Older refugees are some of the most vulnerable populations (Barbelet 2018). In relocating to refugee camps, resettlement policies, agency and family resources, and personal health of the older person can force some to remain behind. Those who accompany their family to the refugee camps can arrive with long-suffering health conditions depending on the length and extent of unrest prior to their exodus. Depending on the conditions of the camps, they may experience malnutrition and worsening of morbidity (Morris et al. 2009; Taylor et al. 2014).
Refugee Experience Through the Life Course
A life course perspective of a person looks at the age and developmental tasks of an individual from conception until death (Hou 2012; Slade and Borovnik 2018). Life course issues affect the experiences of refugees (Slade and Borovnik 2018). A child who resettles with their parents and siblings has a different experience than the parents, or the grandparents. When examining a person through a life course perspective, the person’s age, developmental stage, and societal/cultural role expectations are considered. Is the person functioning in ways culturally expected for someone that age? What are the assumed needs and challenges for someone at a specific stage of life? In considering older refugees, these questions are important to understand the experiences of refugees who are at a later stage of life.
Older refugees can face unique challenges. On an individual level, older refugees can be challenged by drastic changes in their social role within society and in the family. While in the camps, older persons can also lose social capital. Where once the older member of the family experienced his/her role in the family with purpose, stature, and influence, he/she may feel like a burden or as forgotten (Barbelet 2018; Condon 2003; Burton and Breen 2002). However, older persons can be stabilizing members in the family, providing cultural and lived expertise that can benefit other family members. Prior to the resettlement process, families are interviewed in the refugee camps. Family members are identified. Older refugees are often the grandparents within the family and placed together with their children and grandchildren in the host country. Grandparents can provide caregiving tasks to the youngest family members (Barbelet 2018; NGO Committee on Ageing 2019) and in so doing support the family during resettlement. As new arrivals, refugee families are coping with meeting basic life needs such as housing, work, school for the children, and transportation, learning to adapt their cultural foods to locally accessible foods (Beiser 2009; Colic-Peisker and Tilbury 2003; Lindencrona et al. 2008; Nawyn 2010). Older family members can serve invaluable roles as caregivers, cultural experts for both the younger family members and for agencies providing services to the families.
Many of the services provided families the first year of resettlement are to aid the family in meeting their basic needs, but also to encourage integration into the culture and community of the host country. Language acquisition of the host language is encouraged not just as a means to gain employment or enter mainstream school classrooms, but to also aid persons to interact with others in the community (Connor 2010; Witec 2014). Resettlement agencies might see integration as an indicator of successful resettlement and look for ways of encouraging new arrivals to attend local events, make friendships outside of their cultural community, and adopt local customs (Atwell et al. 2009; Gans 1997; Pyong Gap 2007; Rudmin 2003).
Integration may not be a reliable indicator of successful resettlement, and this may be especially true in older adults. Whereas new arriving children have school to expose them to the new culture and community, and working adults might have their places of employment, older adults may spend most of their time at home. At home, they might perform household tasks and childcare, not unlike when they were in their homeland. In addition, they may speak their primary language with their immediate family, with extended family via social media, and watch televised programs from their home country (Marlowe 2017). These older persons may not be integrating, but they are showing other indicators of successful resettlement.
As time progresses, the family faces new challenges. Issues concerning integration, assimilation, and belonging become more predominant and are reflected in intergenerational dynamics within the families, and dynamics in communities and, on a larger scale, in society. Do the refugee groups appear to communities and the larger society to be “fitting in,” adopting the cultural attributes of the host country? For older family members, this might be a greater challenge. Older persons appear to be less integrated than other family members. Their roles as caregivers, cooks, and “keepers of the culture” have made learning the dominant language less relevant. As family members get more established in the main culture, the older person’s expertise can feel less valued, and their roles less needed (Downing and Tillery 1992; Dubus 2015, 2018b; Hadziabdic et al. 2010; Hsieh et al. 2010; Moreno et al. 2007; Naffi and Davidson 2016; Schenker et al. 2012; Witec 2014).
Older refugees may feel more isolated as the family appears to be integrating into the host community. Whereas the older family member may have experienced a feeling of belonging within the family in the first few years of resettlement, this may shift. Belonging has historically been used in the context of migration to assess a new arrival’s experiences of “fitting in,” “feeling connected” to the place and people they now share a community with and feeling safe. It has also been used as a component of successful integration. Recent research has explored the use of social media by immigrants and refugees (Dubus 2018b; Young et al. 2006). This research suggests that the concept of belonging has changed because of social media. Older refugees using social media can connect with families around the world through video calls, text messaging, emails, and shared internet repositories of digital artifacts (pictures of children, videos, text posts). Their sense of belonging is not confined to their physical environment. Through social media, it is possible for older members to feel close even if they are in different countries. Connection with other family members outside of the immediate family may lessen older refugees’ feelings of isolation.
For policy makers and social service agencies, new questions arise: If a sense of belonging is no longer tied to one’s geographical location, then how do we measure successful resettlement or integration, especially for older refugees? What then should the goals be for community agencies that work with immigrant groups? How will this affect the dynamics of the community where the refugees reside? What does this global connection mean for immigration policies and services for older refugees?
One indicator of successful recovery after trauma or successful adaptation after significant lost and change is the ability to return to pre-event levels of functioning. This ability is resiliency, a concept used in social sciences to capture those qualities a person has that helps them to “bounce back” after adversity (Greene and Conrad 2012). Stemming from risk assessment theories, social science theories on resiliency contextualize a person’s resilience within risk factors and protective factors. Each of these factors can enhance or burden a person’s resiliency (Greene 2014).
Older adults may arrive with protective factors that aid in resettlement. Older adults have multiple experiences of having “weathered” hard times, loss, and changes in life (Dubus 2018a; Greene and Conrad 2012). Older adults often have a positive coping style for managing stress and a stable image of one’s self (Kuwert et al. 2009; MacLeod et al. 2016; Martin et al. 2015; Smith and Hollinger-Smith 2015). These are characteristics that can strengthen a person’s adaptability. In addition to these characteristics, the social role older persons hold in many families can also be a protective factor. For example, an older woman who resettles with her immediate family may find that transition less disruptive than other family members. While their adult children might be tasked with finding work, and the grandchildren attending local schools, older adults might be tasked with familiar household chores and childcare. Whereas the adult children and grandchildren might find learning the dominant language a necessity to engage with work and school, grandparents may not experience learning the language as needed. Older adults might spend most of their time with their family who are able to interpret for them at the grocery store and bank. All these methods of staying connected to their primary language, culture, and relationships help the older person to re-establish herself/himself with a sense of purpose, role, and self-identity similar to before the life-changing events. These successful and resilient coping skills may be overlooked if assessing the older refugee through behaviors that reflect integration into the new country.
Growing research has examined the refugee experience past the first year of arriving, describing it as an experience that spans the life course (Hertz and Marshall 2001; Wong et al. 2011). Becoming old as a refugee describes refugees who have resettled when they were younger, and decades later find themselves entering old age in a country and culture they didn’t anticipate in which to age (Fox 2005; Giles and Reid 2005). There experiences and needs differ from those who arrive as an older person. One of the aspects of arriving old, described above, is the protective factor older persons can have if they are able to maintain their social and familial roles. If they are able to remain embedded within their families in ways that maintain their previous skills, connections, and purpose, then they seem to adapt better. However, if the person arrives at a younger stage of life, s/he may find it challenging to enter a new stage of life within the context of a different culture (Dubus 2010; Cook 2010). When analyzed using a life course perspective, each remarkable life event or stage needs to be understood from both the individual’s view of him/herself within that stage, and societal expectations of that person’s behaviors and needs (Paat 2013).
Refugees can experience each mile stone in life through the cultural expectations of their country of residence, and through the cultural expectations of their country of origin. For persons who resettle from countries similar to their country of origin, the transition to old age can be smoother (Das et al. 2013). Their experiences of aging may match those they had observed when they were younger. Others may treat them as they had anticipated an older adult would be treated. They may focus their attention on tasks that feel congruent with the roles they expected to hold as an older adult.
If, however, they resettle into a culture that is not like the culture of early life, then they may have a more difficult time transitioning to old age (Fryer et al. 2013). Another factor that influences the experiences of old age for refugees is that they did not choose to migrate to another country, nor the specific country of their resettlement. As older persons try to reconcile their expected experience of old age with their current experience, this factor can affect a person’s ability to adapt to a new life stage (Kuwert et al. 2009).
For refugees, there are additional factors that affect how one experiences entering old age. By the very nature of being designated as a refugee by the United Nations, a refugee is most likely to have witnessed and/or experienced severe trauma. This trauma can be from acts of war, conflict, or persecution, but also from severe deprivation of food, shelter, and healthcare (Hudson et al. 2016; Slobodin and de Jong 2015). These traumas can have life-long effects on the physical and mental health of the survivors (Hinton et al. 2013). Refugees entering old age may do so with the burden of chronic diseases and post-traumatic stress disorders (PTSDs) (Wong et al. 2011). Studies have shown a relation between severe childhood trauma and later life occurrence of type 2 diabetes (Wagner et al. 2015). Overall, refugees suffer more chronic diseases and psychological distress than the general population, even decades after resettlement (Kinzie et al. 2008; Wagner et al. 2015).
Moreover, the expectations of old age affect the person’s framing of their current experience (Collings 2001; Fry 1980; Desai and Tye 2009; Becker and Beyene 1999; Dubus 2014; Foucart 2003). For example, in some cultures, old age begins when their own children reach childbearing age. For them, old age begins in their early 40’s at the time when their children are in their early 20’s and preparing to have children. They may expect to stop work and enter their grandparent role. This can be a difficult transition as their children may not share those expectations. The children might not have children in their early 20’s and may not want to live with their parents. For some cultures, this may be the first time in an older person’s life that they are facing the possibility of living without family members. Exacerbating this life stage are the expectations that society has for persons in their early 40’s. While the person may feel unable to work at her/his previous levels of functioning, in the United States, one’s early 40’s does not qualify a worker for social security retirement benefits (Dubus 2014). This can create a dual-life stage experience. A person’s subjective experience might be of entering old age, while the society’s expectations might be of the person entering middle adulthood. These two stages have different cultural, social role, and developmental task differences (Foucart 2003).
Refugees are not a homogeneous group that can easily be characterized (UNHCR 2019; Guterres and Spiegel 2012). This can make developing culturally effective health and social service interventions and services challenging. Social workers, medical professionals, and professionals from education, housing, employment, among others, will be the ones expected to meet the needs of this ever-changing population. There are many variables that make a single approach ineffective for this population, in particular for older refugees. The agencies that provide for refugees are often under-resourced, thereby limiting the available services and resources. What then can agencies be expected to provide that will be helpful to older refugees?
Research indicates that cultural expectations of old age play a significant role in the needs and expectations of older refugees Additionally, younger family members who may feel removed from the culture of older persons may misunderstand the needs and experiences of the older person. And, similarly, the cultural expectations of aging that the service providers hold also affect the support and understanding older persons receive.
The life course perspective examines different periods of one’s life as developmental stages. It is a theory that can help health and behavioral health providers and policy makers to better meet the needs of age-specific populations by understanding the bio-psycho-social needs at various stages. For example, older persons’ quality of life can be an indicator to the effectiveness of certain early life interventions and factors. Regarding refugees, a success of a resettlement program may not be fully assessed after the first year of settlement. A successful resettlement program might be best assessed 20 years after resettlement, when those arriving in early adulthood are preparing to be grandparents. How does the older person feel about entering old age in this country? Do the soon-to-be parents feel prepared to parent? Will the newborns have access to quality healthcare, and will they feel welcomed into this world? In this view, successful resettlement services provide the foundation for successful development at each life stage.
Future Directions of Research
Future directions of research on aging refugees continues to examine older persons who are designated as refugees and most often resettle with, or to, their family members. Global economic disparities have increased the number of economic migrants, people feeling pushed to leave their country of origin to seek work in other countries. Climate changes have forced others to resettle to sustainable regions, abandoning draught, flood, and fire-ravaged areas. The definition of refugees is expanding among social scientist. A constant in this changing definition will be the concept that refugees are those who are forced from their country of origin. Future research could focus on culturally effective resettlement programs that pay attention to the needs and experiences of older forced migrants. Data on older refugees need to be accurate, current, and detailed to reflect the issues and needs of this population (Barbelet 2018; Sheppard and Polack 2018). This is imperative and is in line with the 17 Sustainable Development Goals adopted by the United Nations as part of the Agenda 2030 (United Nations 2019). Goal 3 of the agenda is to ensure healthy lives and promote well-being for all at all ages. In particular, the eighth task focuses on universal health coverage. This task cannot be successfully achieved for older refugees unless extensive research is conducted. Studies need to better understand the ages, gender, issues, needs, resources, and challenges for older refugees (Barbelet 2018; Sheppard and Polack 2018). Research can expand on the transnational experience of aging. Research could perform longitudinal studies tracking young refugee families through the next few decades, noticing their needs and experiences throughout the life course. Studies could examine refugee program interventions and services targeted to specific age groups to assess their human life course development usefulness and effectiveness. More needs to be understood about the role older persons have in families that have been forced to resettle. What role does the older person have in keeping alive the culture of the country of origin? How does the older person within the family contribute to or hinder the family’s ability to successfully resettle? Are services or interventions needed to help older persons resettle successfully? As research grows, so too will our definition of successful resettlement. As this definition changes, so too will the research questions change.
Aging refugees was divided into two reference groups: those who, as older persons, have been resettled into a new country and those who resettled when a young adult and aged into an older person. Refugee populations are considered separately from other immigration populations because of their United Nations designation and accompanying resettlement support, and because they have often experienced severe trauma. For service providers and policy makers, these distinctions are important as they point to different considerations when delivering services.
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