1. Generations A Hidden Source of Diversity1
Generations A Hidden Source of Diversity
Kenneth J. Doka, PhD
Professor of Gerontology, The College of New Rochelle
Senior Consultant, The Hospice Foundation of America

2. Objectives Describe the characteristics of varied generations
Formative Experiences
Core Values
Explore the implications of generational differences
Medical Care and End-of-Life
Counseling Issues and Concerns
Workplace Differences

3. Caution! Generational differences are only one source of diversity
Others include:
Ethnicity and Culture
Gender
Social Class
Spirituality/Humanism
Geographical

4. The Nature of Diversity4
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

5. The Value of Cohort Analysis5
The Value of Cohort Analysis
Understanding Generations

6. 6
Generations
Each generation is unique – shaped by social, historical and demographic (size, composition) forces
(Strauss and Howe)

7. 7
Implication
Systems of care need to be reassessed and reinvented as each new cohort ages
Note such reimagining involves intergenerational considerations – i.e. Baby Boomers managing care of GI Generation Parents

8. 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

9. 9
Cohort analysis begins with the size and composition (gender, ethnicity etc.) of a generation

10. It is more than sheer size
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It is more than sheer size
Each generation is shaped by context – the historical and social experiences

11. The GI Generation (Born 1901 – 1924)
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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)

12. GI Generation Formative Experiences
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GI Generation Formative Experiences
Experienced Depression and World War II
GI Bill – Housing and Education
Expected and Valued Government Role

13. GI Generation Formative Experiences
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GI Generation Formative Experiences
First Aging Generation
First generation to benefit from Medicare, Medicaid, Social Security and Aging Network

14. GI Generation Values Respect Authority (and seek respect)
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GI Generation Values
Respect Authority (and seek respect)
Follow Orders, “Regular Guy”, Team Player
Altruistic
“Can Do”
Rigid Sex Role Definitions

15. The Silent Generation (Born 1925-1942) Formative Experiences
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The Silent Generation (Born ) 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

16. The Silent Generation Values
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The Silent Generation Values
“Fitting in” – The Organization Man
Emerging Concern with Inner Self
Transitional – Cultural and Gender Roles

17. 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.

18. The Traditionalists Implications for Medical Care and End-of-Life
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The Traditionalists Implications 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

19. The Traditionalists Implications for Medical Care and End-of-Life
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

20. 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

21. The Traditionalists Implications for Medical Care and End-of-Life
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

22. The Traditionalists Implications 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

23. The Traditionalists Implications 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

24. The Traditionalists Workplace 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

25. The Traditionalists Attitudes toward Recreation and Leisure
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The Traditionalists Attitudes 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.

26. The Baby Boom (Born 1943-1960) Formative Experiences
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The Baby Boom (Born ) Formative Experiences
Sheer Size – Now 73 Million
Shaped by Watergate, Vietnam
A Generation of Worsening Trends
(Divorce, Delinquency, etc.)

27. 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

28. 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

29. Boomers Have Changed Every Institution They Have Encountered
Schools and Colleges
The Military
Music and Media
Politics
The Workplace
Society

30. 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?

31. Boomer Values 3131 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

32. Boomer Sense of Justice
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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

33. 3333
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”.

34. 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.

35. 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

36. Baby Boom Generation Implications for Medical Care and End-of-Life
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Baby Boom Generation Implications 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

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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?

38. Baby Boom Generation Implications for Medical Care and End-of-Life
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

39. Baby Boom Generation Implications for Medical Care and End-of-Life
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!

40. Baby Boomers Implications 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

41. Baby Boomers Institutional Care
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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

42. Boomers will demand 4242 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

43. Boomer Concerns for Parents
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Boomer Concerns for Parents
Reshaped Adult Care Market
Emphasizing continuum of care
Assisted Living
Amenities for well older persons such as spas and gyms

44. Baby Boomers Implications for Funeral Service
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Baby Boomers Implications 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.

45. The Baby Boom Recreation and Leisure
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The Baby Boom Recreation 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

46. The Baby Boom Recreation and Leisure
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The Baby Boom Recreation 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)

47. Baby Boomers Workplace 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

48. Aging Boomers Retirement 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

49. Generation X (1961 –1981) Formative Experiences
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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.

50. Generation X Values 5050 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

51. 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

52. 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

53. 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

54. 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.”

55. 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

56. 5656
Generation Y “The Millennial Generation” ( ) 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

57. Generation Y Formative Experiences
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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!

58. 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

59. Generation Y Values 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

60. Generation Y Implications 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)

61. Generation Y Implications 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.

62. Generation Y Implications for the Workplace
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Generation Y Implications 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

63. Generation Y (Millennials) Workplace Attitudes
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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

64. Generation Z (2001- ?) 6464 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”

65. 6565
Generation Z
Cyber community and cyber interaction

66. Generations at Work A Summation
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Generations at Work A 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

67. Generational Differences Career Goals
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Generational Differences Career 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

68. Generational Differences Retirement
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Generational Differences Retirement
Silent Generation – Retirement as a reward
Boomers – Retirement as an opportunity for retooling, possible second career

69. Generational Differences Changing Jobs
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Generational Differences Changing 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)

70. Some Programs Can Transcend Cohorts
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Some Programs Can Transcend Cohorts
Life Review and Reminiscence Programs
Intergenerational Programs
Even here, themes and activities must be cohort-sensitive

71. The Value of Reminiscence
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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

72. 7272
Danger of Life Review
Can resurface earlier losses and traumas

73. Life Review Differences with Reminiscence
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Life Review Differences with Reminiscence
Reminiscence focuses on positive memories and experiences
Personal history – including positive and negative experiences
Careful observation by therapist
Attribution of meaning

74. Life Review May Not be Useful with Highly Narcissistic Troubled Life
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Life Review
May Not be Useful with
Highly Narcissistic
Troubled Life
Alienated Relationships
Persons Unable or Unwilling to Reflect

75. Life Review Problematic Populations
Drawing life’s lessons
What lessons would I like to pass on to others?

76. Techniques for Life Review and Reminiscence
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Techniques for Life Review and Reminiscence
Photographs and memorabilia
Music and film
Creative expressions
Genealogies and genograms
Reunions
Pilgrimages

77. Use all senses Sound Sight Touch and texture Taste Smell and aromas
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Use all senses
Sound
Sight
Touch and texture
Taste
Smell and aromas

78. 7878
Ethical Wills: A Tool for Legacies, Remembrances and Inter-Generational Dialog
“Legal wills bequeath valuables, ethical wills bequeath values.” (Baines, 2002)

79. Age Lines A Life Review Technique
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Age Lines A Life Review Technique
Chart significant points in one’s life
Identify the challenges faced along the way
Discuss strategies used to overcome these challenges

80. Intergenerational Programs
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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

81. Re-Packaging Programs
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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

82. Everything Old Is New Again
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Everything Old Is New Again
Truth of Cohort Analysis – We constantly reinvent systems of care and modify counseling approaches with each new generation