The world is ageing and Malta is no exception. Old age brings with it several challenges, including an increase in chronic diseases and disability. Consequently, the need for informal/unpaid care work amplifies significantly.
Nonetheless, we must not fail to appreciate that old persons* are a heterogenous population in which many individuals continue to age actively and contribute to society and not all are mere recipients of care.
A case in point is the large and significant yet inconspicuous group of old persons, including spouses, partners and siblings, who, despite facing their own health challenges, are primary care providers to their loved ones. Their contributions, together with that of adult children and non-kin caregivers such as friends and neighbours, are imperative in ensuring that institutionalisation is indeed a last resort.
In the Western context, especially in Southern European countries, a sense of duty for care provision falls substantially on women, with the widely held view of a devoted daughter or a fostering wife as the main carer, while men are often referred to as ancillary collaborators or secondary carers as their principal liability rests on breadwinning. Housekeeping and emotional work remain marginal to prescriptive constructions of masculinities. However, in contrast to other stages in the life course, in old age, the gender distribution of carers changes as the ratio of men to women carers increases.
In view of shifting contemporary trends in family structures and living arrangements, alongside the wish to age-in-place, the projected reduction in life expectancy gap between men and women, and a gender disability gap echoing women’s experience of greater morbidity, it is anticipated that more old men will become the primary carers of their spouse or partner in the foreseeable future.
Like other European countries, the number of persons experiencing functional decline due to dementia and/or chronic illnesses in Malta is predicted to increase, especially among women, suggesting that, even locally, there is an expected rise in the number of men − particularly old men − taking on the role of primary carers of their spouse.
Yet, while this area of research is growing internationally, informal carers, especially locally, continue to be misrecognised as a homogenous cohort, with men carers, especially old men, remaining an invisible group. Consequently, their support needs are neglected.
It has been documented that, with limited informal care work experience in former years, old men are many times unaccustomed to the skills needed for delivering care.
Old men are many times unaccustomed to the skills needed for delivering care
Ageing men’s engagement in care work is often founded on the view that various men bring in their work and managerial skills into the realm of care work which, in turn, enables them to disengage the emotive from the practical facets of care.
Such abilities help them to deal with the possible negative connotations of the loss of manhood by defining their care responsibilities via managerial, instrumental and practical expressions. Through different strategies, old men strive to uphold continuousness in their rapport with their spouse/partner along with forming and changing roles so to deal with life transformations.
Applying force, concentrating on tasks, barricading emotions, curtailing disruption, diverting attention and self-medicating were some of the strategies adopted by American old husband carers to negotiate issues arising during spousal care work. Literature shows that when men engage in care work, they habitually accentuate the organisational and practical aspects of their role as they feel under pressure to do so in a manner that does not contest their masculinity.
Men’s professional or managerial model shields them from unwarranted anguish and carer burnout. Such an approach also equips them with feelings of self-control and confidence and gives them the capability to decide whether to make use of respite care without remorse and guilt.
Another study held in the US revealed how old men felt that their work as carers went mostly unnoticed and unappreciated and that even close relatives did not understand their complex narrative. For these men, the shift from the public sphere to the invisible realm of care work conveyed a profound cognitive and psychological change since care work was completely opposite to the market-economy work whereby they produced tangible work. Indeed, when old men carers found previous management and organisational skills handy in their efforts to manage spousal care, this made them feel more in control of the situation and invoked positive feelings.
Other researchers found that, due to prevailing masculine norms, old men carers were often unwilling to request or consent to assistance as they longed to preserve control over the situation. In another study, old men echoed a variety of health issues that they themselves were suffering from, thus making their life as carers more difficult and perplexing. However, although men carers may suffer in relation to care work, it was noted how they can still find a space for masculinity and individual control in their carer role. Their suffering can be facilitated by conserving personal identity and marital status, in addition to finding scope in their everyday experiences as affectionate husbands.
In light of the above, the local experience of this phenomenon is currently being investigated through a study at the University of Malta, which aims to explore the lived experiences of old men spousal carers and to understand how old men carers negotiate their role within the feminised context of care. This study is being sponsored by the Endeavour Scholarship Scheme.
It is augured that findings from this study will shed light on whether the local Maltese-cum-Mediterranean context resonates with continental and European contexts.
Roberta Sultana is an occupational therapist and a PhD student with the Department of Gerontology and Dementia Studies within the Faculty for Social Well-being at the University of Malta. She is a member of the Maltese Association of Gerontology and Geriatrics.
*Note: While many researchers advocate the use of the term ‘older adult’ on the basis that referring to someone as ‘old’ propagates stereotypes, this article follows the consensus in critical gerontology that the term ‘old’ is used in a positive and neutral way similar to how other terms for other age groups are used.