Related topics: •  Seniors and Depression •  Seniors and Friendship

Imagine yourself, at the age of 70, moving to a foreign land -- say, Turkey or China. Not only must you communicate with your local pharmacist in Turkish or Mandarin, but you have to fill out medical forms and read prescriptions written in a strange and unwieldy alphabet. Even accomplishing the simplest tasks can take on Herculean proportions when you're constantly fumbling for words.

This scenario, in reverse, is reality for thousands of foreign-born seniors who have immigrated to the United States. Whether they've come to escape persecution or simply to remain with family, most will grapple with alien concepts of medicine as well as foreign health care and insurance systems. During the next 10 years, as newcomers who arrived in the 1980s and '90s grow older, a quarter of all the foreign-born immigrants and refugees living in the United States will be over the age of 50. For these seniors, acquiring English literacy -- along with the cultural references woven into language -- can mean the difference between getting quality medical care and missing out on important services.

In a spartan adult school in Richmond, California, four elderly Laotian women, bespectacled and in turban headdresses, settle into their seats for their early morning English lesson. "Good morning, class! What day is it?" the teacher calls out. "Good Morning, teacher! It's Monday," sings out one woman, raising her hand. "Today's not Sunday?" jokes the teacher in mock surprise. "Not Sunday, teacher! No school, Sunday!" says another student. The Laotians watch the teacher's face attentively. Finally she smiles, admitting her bluff. Relieved, the class erupts in good-natured laughter.

In nearby Berkeley, where high-tech salaries have resulted in skyrocketing rents, an elderly Chinese couple join a chorus of ESL classmates reading a lesson on the blackboard called "House Problems" -- or how to rent an apartment in the San Francisco Bay Area. The students recite in unison: "If you can read the newspaper in English, it is easier to find an apartment. Then you need to look at the house or apartment. If you like it, you talk to the landlord. You may have to sign a lease and pay more than $500 a month, and you may need to pay more than $1,500 to move in. This can be a problem!"

In English As a Second Language (ESL) programs across the United States, seniors like these are learning the vocabulary that will help them shop, ride the subway, and take a physical examination. Eventually it will help them make sense of their American-born grandchildren as well. ESL classes also provide elderly immigrants with a community outside the home. In the classroom they can make friends, resolve common problems, and become more independent by taking a break from family -- key factors, doctors say, in maintaining emotional health.

Today, most senior ESL students attend "mixed" classes that include both young and older adults, and the majority prefer it that way. "Seniors don't want to be segregated," says Andrea Toth, a specialist on immigrant seniors learning English who works at Mills College in Oakland, California. "And younger adults like having them in the classroom." Friendships that develop in the course of study -- often crossing ethnic and generational barriers -- draw seniors out of isolation, integrating them into multicultural American society. And while younger students are often nervous and competitive, Toth says, seniors tend to contribute a relaxed sense of humor to the classroom.

While evidence shows that seniors are fully capable of absorbing new information, the elderly do face challenges when it comes to learning English. Impaired hearing and sight may interfere with concentration, and short-term memory, so crucial to language acquisition, often diminishes with age. Still, syntax, comprehension, and grammar are not age-affected, and long-term memory and problem solving may actually improve. Another advantage: Elder students tend to be more dedicated and patient. "Seniors are some of the hardest-working students I have," Toth says.

Some of Toth's students, for instance, are refugees from the mountains of Laos and Cambodia who speak a mother tongue with no written alphabet at all. In the ESL classroom they must learn to read and write for the first time. Others, like many of Toth's Chinese elders, must fight to overcome traditional taboos: In their childhood schoolrooms, deference to authority was the norm. The teacher lectured; students spoke only when spoken to -- and never to each other. Decades later, in ESL class, these elders find American "partnering" and story-sharing exercises mortifying. "These exercises defy every aspect of their upbringing. It can take months before they're able to join in," says Toth. Once elderly students become comfortable with a less authoritarian learning environment, however, they find it "liberating," she adds. In ESL classrooms where teachers promote critical thinking, students also learn that in the United States "questioning the experts" -- from news reporters to doctors -- is not only expected but even valued.

Both doctors and teachers agree that learning English is crucial to patients who must learn to navigate a complex health care system. Patients who speak some English do tend to receive better care, says intensive care nurse Alan Fitzpatrick of San Francisco's St. Mary's Hospital. "It's very important for in-patients to be able to describe basic bodily functions and to indicate pain in English to nurses and doctors," he says. Without these prompts, medical staff often have to rely on intuition: is the patient really in pain or just nervous trying to explain herself in a foreign tongue?

In emergency situations such as a heart attack, a few critical words can greatly help staff make a proper diagnosis. "When I have a patient pointing to their heart and I hear the word 'pain' or 'pressure,' I immediately call for an electrocardiogram," Fitzpatrick says. "I'll have the relevant blood enzyme work drawn up and give medication to prevent another attack." He says hospital staff should learn to praise attempts to speak English made by timid patients, who usually know some English but are afraid to make mistakes.

Seniors' ESL studies can also help immigrant parents and grandparents escape the thorny dynamic of "reversing roles" with their English-speaking children. "The children end up in charge of the family," explains one teacher, whether negotiating with landlords, acting as chauffeur, or translating for their elders at the hospital. "Psychologically, it's damaging for the elders to lose their authority. For the children it's an enormous burden."

Despite the benefits to family, grandparents may not always be praised for attending English classes. "Unfortunately, family members often discourage my students," says Eunice Lew, an ESL teacher with a classroom in San Francisco's Chinatown. "They ask, 'Why should you take classes? You don't work. And you have family to talk to.' I try to counter that by reminding my students how important it is for their own well-being." Furthermore, within multigenerational immigrant families, there may be two conflicting linguistic goals: Parents often want their American-born children to learn English at school, and the native language at home by speaking it exclusively with their grandparents. Such arrangements leave elders little opportunity to practice English. For them, ESL classes are a lifeline to the culture and language of their new home.

Crossing borders and vast oceans, immigrant elders often lose more than a homeland. In their traditional communities the aged were often revered and frequently held positions of great esteem: Besides holding influence over extensive social networks of neighbors and kin, elders acted as caretakers of children and as teachers passing on cultural values and traditions.

In the United States, immigrant seniors face the task of rebuilding a life from scratch in a land where such social structures have disappeared. Unable to navigate the daily world of outside activities or speak to their American-born grandchildren, elders suffer a demotion in status and loss of self-esteem that frequently leads to chronic depression. "As reverence for the elderly breaks down," explains northern California psychologist Lotte Marcus, "self-medication such as drinking and smoking increases, further eroding respect within the family."

For elders uprooted from their culture and trying to find a foothold in this country, studying English can be a blessing in disguise. "By learning even a little English, seniors experience positive, progressive change. They have a sense that there can be a better tomorrow," says Dorothy Lemberger, an ESL teacher in Berkeley, California.

Seniors who have come here as refugees, fleeing war and trauma, are among the hardest hit by depression. "For survivors, learning English can be a primary step in a return to mental health," says Meredith Larson, a torture rehabilitation researcher. Seniors, who have lost a whole way of life and often cannot envision starting over, may be hardest hit. Some refugees, holding on to hopes of returning home, resist English at first: For them, learning the language may symbolize accepting a life in exile. Yet learning English is critical to becoming members of the larger society -- and having access to everything from food and shelter to health care and psychiatric help, Larson says. "Translators aren't always available, and trauma survivors may not trust them," she says. "When I ask survivors what services they need, English language learning always tops the list. It's a tool they can use to take control of their environment."

--Diana Reiss-Koncar is a freelance journalist in Berkeley, California, who has written for Hippocrates, Vibe, and many other publications.

References

Last updated November 25, 2008
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