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Unmet Needs For Care and Support For The
Unmet Needs For Care and Support For The
Abstract
The study is focused on understanding the broad issues of care and support of the
elderly with a view to explaining factors influencing the gaps in their expectations and
experiences. This is an empirical attempt with a view to understanding and under-
scoring the importance and limitation of the domains of support from core family
members (spouses and children) within the available support networks for the elderly.
The study utilized primary dataset including quantitative and qualitative data collected
in Ijesa communities in South-west, Nigeria. The findings showed that children and
spouses ranked highest among sources of support networks rated by the elderly for five
patterns of support identified. Logistic regression results showed that individual
variables including age, education, family of orientation, and living in same town with
children to a large extent determine level of unmet need for support. The study
concluded that personal attributes rather than other social variables are important
determinants of high level of unmet need for elderly.
Introduction
Increasing trend in the population of the aged or elderly has been a big
challenge for many developed countries. Their prevailing high life expectancy
and low total fertility rates, hovering around the replacement level of 2.1, have
given rise to a population structure with a large proportion of the aged relative
to the working population. The steady increase of life expectancy in the
developing countries coupled with gradual decline in fertility implies that the
aging phenomenon deserves more well-structured attention. Currently, the
elderly account for almost 5 percent of over 200 million populations in the sub-
Saharan Africa region; it is projected that the elderly will constitute about 10
percent of the over 600 million population in 2050 in the sub-region (UN,
2002; UN 2012).
Nigeria, with over 170 million population, is a youthful population with a
progressive growth rate of 2.8% and a median age of 17.3 for males and 18.4
for females (NPC, 2008), and about 45% of the country’s total population are
under 15 years of age. This broad description of the country as a youthful
10 The Nigerian Journal of Sociology and Anthropology Vol. 12
Review of Literature
Culture, norms and values are naturally part of normal way of life in traditional
Nigerian societies. Such were passed from one generation to another and were
held in high esteem (Akinyemi, 2009). The issue of support for the elderly is
one of such values. In any traditional African society and in most countries of
the world the family is charged with the responsibility for the provision of
support for the elderly (Chappell, 1985). Such support predominates and it is
provided voluntarily without any remuneration (Kosberg, 1992; Brown, 1999).
The emerging challenges of the elderly population caught most countries in the
African region unawares and exposed their insensitivity to this crucial
demographic issue.
The expectation of the elderly is built in anticipation of adequate support
from the family when “inactivity time comes”. The social and economic needs
of the elderly were therefore expected to be catered for through the extended
family system, which was a three-to-four generation bounded together by
strong kinship ties. Several reasons supported the anticipation of the elderly
and the expected roles of the family towards their support in older ages.
History and generational trend has always been that elderly care is a
responsibility of the family in which he had been part of. Informal sanctions
were sometimes meted out to the “irresponsible family members” who failed in
supporting the elderly (Kosberg, 1992). Traditional religious belief of
ancestral worship largely supported that family members should cater for the
elderly. For instance, in Yorubaland some traditionalists believed that the
spirits of their ancestors are always around them, and that favour or reprisal
from such spirits depends on how well the spirits are pleased. Also, the transfer
of land ownership through inheritance in a predominant agrarian society
contributed to the traditional expectation of old age support.
Infertility and childlessness are also crucial issues in the expectations of the
elderly. However, several living arrangement patterns including foster and
surrogate parentage were aimed at cushioning the effect of childlessness. It is
generally believed that having surviving children at old age is a blessing. The
premise is that informal systems of age integration and support by the family
will continue to play critical roles in the support of the elderly. There are
customs and adage that supported this orientation. The elders provided care to
the children who in turn provided care to them in their old age, hence the
Yoruba adage, “ti okete ba dagba tan, omu omo re ni o ma nmu” (As rodent
aged, it sucks the child’s breast). The more children one has the more chances
of receiving better care when one is no longer able to support oneself. There
was a system that ensured that the needs of individuals were catered for within
the family. Nobody would starve when other members of the family had
plenty. However social and economic changes currently occurring have put
into doubt the continued viability of such traditional arrangements for the
12 The Nigerian Journal of Sociology and Anthropology Vol. 12
elderly. Such changes like increased emphasis on small family units, migration
to urban areas, more working wives, new life styles and changing values all
have effects on the entire society, as well as the youth who are less disposed to
supporting their elderly parents.
Methods
The study was conducted in Osun State in South-western Nigeria. Osun State
was created out of the old Oyo State in 1991 and the state has 30 local
government areas (LGAs). The total population of the state was 3,423,535 in
the 2006 population census. The state comprises various ethnicities including
the Ijesa, Ife, Oyo, and Igbomina. This study however covered only the
predominantly Ijesa communities which consist of six local government areas
(LGAs), namely Ilesa West, Ilesa East, Oriade, Atakumosa East, Atakumosa
West and Obokun LGAs, with a combined population size of over 700,000. Of
the six LGAs in Ijesa, Ilesa East and West are urban (municipal) LGAs,
Atakunmosa East and West are semi-urban while Oriade and Obokun comprise
of predominantly rural settlements. Three out of the six LGAs were selected
such that each strata - urban, rural, and semi-urban was represented in the study
sample. These are Ilesa East, Atakunmosa West and Oriade LGAs.
Enumeration Area maps (EAs) used in the 2006 national population census
were obtained for the three LGAs and the EAs were randomly selected from
each LGA. A complete listing of the households in each EA provided the
sampling frame for the identification and selection of eligible respondents. The
criterion for inclusion in the sample was the presence of an elderly person aged
60 years or more. The study sample included a total of 456 elderly men and
491 elderly women. Information was collected through the administration of
questionnaires, using face-to-face interviews, on selected respondents.
Qualitative data was collected through in-depth interviews and focus group
discussions.
Variable Measurement
Guided by literature, the study identified five main support domains as critical
for old age support. These include financial care, routine daily care, personal
visitation, improved social status, and medical care. Financial expectations
relate to issues that directly bother on money. These include things that they
needed money for. Daily care covered issues that they do daily, like feeding,
clothing etc. Visitation is on personal visitation made to the elderly; this
excludes phone calls and electronic mails. Improved status relates to social
status like owning personal houses, chieftaincy titles, etc. While medical care
covers all that relates to health care of the elderly. Also, extensive review of
literatures in Africa and beyond identified ten sources of people or groups of
people that provide the elderly with care and support.
Respondents were asked on a Likert scale (1-5) to score expected level of
care and the actual level of care received from children on items on each of the
five patterns of support. Weights were assigned to each of the items for each of
Unmet Needs for Elderly in Nigeria
the pattern of support (the weights attached to the categories were as thus; 1 for
low, 2 for below average, 3 for average, 4 for high and 5 for very high). These
were cumulated for all the items for each pattern of support identified. Those
below the mid-values (median) were regarded as low, while points above the
mid-values were regarded as high. So, we have low, middle and high values.
Unmet need for care and support is a concept in gerontology studies which has
been extensively used in many publications (Krause and Markides, 1990;
Krause 1995; Allen & Mor, 1997; Lévesque et al., 2004; LaPlante et al., 2004;
and Akinyemi 2009;). The proportion of those with computed values of unmet
need above the median scores was assigned as high unmet need.
The dependent variable was measured as the proportion of respondents
with high unmet needs for each of the five patterns of support. Studies have
suggested gender dimension to levels of unmet needs for support in old age, so
we included sex as one of the independent variables. Other covariates used
were age group, education, religion, marital status, family type, residence,
household headship, wealth index, children ever born (CEB), child/children
living in the same town, child/children abroad (as a proxy for empowerment).
Findings
Basic Socio-Demographics
Table 2 gives the description of the background of the respondents. In all, 947
respondents were surveyed (456 males and 491 females). More than 50 percent
across both sexes were aged 70 years and above with slightly more than one
out of every five as an octogenarian for both sexes. About 70 percent of males
and almost 96 percent of females had no formal education or a maximum of
primary school education. Also, the result shows that males were substantially
more educated than females as almost 30 percent of males, compared with only
3 percent of females completed secondary school or had tertiary education.
More than 3 out of every 5 respondents (about 60%) were in monogamous
family type. About 68 percent of males compared with 27 percent of females
were currently married while 25 percent of males were widowers compared to
58 percent of females who were widows. About 42 percent of men compared
with 54 percent of women were engaged in paid activities within the last 12
months preceding the survey. Trading and farming activities were the major
occupations reported in the study area.
14 The Nigerian Journal of Sociology and Anthropology Vol. 12
Patterns of Support
Five patterns of support are of interest in this study. Table 3 presents the
distribution of the elderly by those who ranked their expectations and
experiences on a Likert scale. These were scored over the ten main sources
from which support were expected. As shown in table 3, the distribution of the
respondents across the levels of expectation and experience showed that for
financial support, 61 percent of the males had high level of expectation while
58 percent had high-level of experience. Among females, 39 percent had high
level of expectation and 38 percent had high level of experience of financial
support.
Unmet Needs for Elderly in Nigeria
From the FGDs, views expressed by the elderly discussants and the adults who
participated in the in-depth interviews suggested that men in these
communities had more expectations than women. The views expressed showed
that men expected support for various things from personal needs to improved
status. Women on the other hand are more likely to require limited support in
buying clothing items for ceremonies, feeding, and general upkeep.
Some of the male discussants in Ilesa mentioned that they will need support to
give their parents befitting burial ceremony. Of a particular reference was the
case of an educated retired male discussant of 71 years old in Ilesa. He
expressed his views as follows:
It is important that my children support me with money so that I
can give a befitting burial ceremony to my late parents. Also, I
wish to be buried in my own house which I should occupy before
16 The Nigerian Journal of Sociology and Anthropology Vol. 12
Among female discussants, these views which were also corroborated. Most of
the women discussants that expressed their expectation have limited requests,
particularly from their children. A 61-year-old widow from Osu expressed
herself thus:
My expectation is that my children will be sending foodstuffs to
me regularly and enough money to eat. Every other thing outside
this will be additional.
This view received the applause of the people and many of the discussants
echoed a popular Yoruba adage:“ti ounje ba ti kuro ninu ise, abuse buse”,
which literarily translates, “food is the most important issue for a poor person”.
Beside this, clothing items and money for petty trading were widely reported
among women.
In-depth interview conducted with the working adults also confirmed that
elderly fathers expected more from their children than mothers. In the views of
some of the participants, the frequency of requests from mothers may be higher
than that of the fathers but the extent of expectation from fathers are usually
greater than that of mothers. One of in-depth interview participant, a 42-year-
old Banker in Ilesa reported that:
My mother will like to request for the same things over and over
again from me. In most cases, it is money to buy clothes, shoes,
bags etc. She asks for this almost every festive periods, such as
Easter, Christmas or celebration times. My father’s request is
most of the times once in a year but they are heavy demands. For
instance, money to roof a house, money for a building project,
money promised his society in church or town, car, money for a
big ceremony like burial etc.
are 66 years old and above are less likely (0.6), compared with those below this
age group, to report high unmet need for financial support from children.
Those with high levels of education are more than twice (2.4) more likely than
those with low education to report high unmet need of financial support from
children. The elderly who, or whose spouses, are heads of households are
thrice more likely than those headed by a child or family member to report
high unmet need for financial support from their children. Those residing in
personal houses, those of rich wealth index and those whose family of
orientation are monogamous are less likely than the reference category to have
high unmet need for financial status from children. Those with at least a child
living within the same town are twice more likely than those without a child in
the same town to report high unmet need for financial support from their
children.
Examining the correlates of respondents to high unmet need for financial
support from their spouses, seven categorical predictor variables were seen to
be of statistical significance (p<=0.05). These variables include marital status,
family type, household headship, status of housing accommodation, and wealth
index. The odds showed that those who are widowed were less likely to have
high unmet need for financial support compared with those unmarried. Those
in polygamous families were twice more likely than those in monogamous
families to report high unmet need for finance. Those in rented apartments
were less likely, compared with other categories, to have high unmet need for
financial support from spouse. Those who are of rich wealth index were less
likely to have high unmet need for financial support from spouse compared
with other categories. There was no difference in levels of unmet need for
financial support from spouse between those of poor wealth index and those of
average wealth index.
Three categorical variables were consistently significant in predicting high
unmet need from children and spouse. Those who are household heads were
thrice more likely and those headed by spouse more than twice likely,
compared with that headed by a child to have high unmet financial need from
the two sources. This pattern is similar in both models. Those residing in
personal houses were less likely to report high unmet need from children but
twice more likely to report high unmet financial need from spouse. In model 2
for children, age of the respondent, household headship (self), wealth status
(average), family of orientation type, and presence of a child in the same town
with the elderly were significant for high unmet need for daily care. Those in
the 66 years and above were less likely (0.6) to report high unmet need than
those 65 years or less. The possible explanation here is that those in the age
group 65 years or less are likely to be economically active and therefore be
able to support themselves. Those who are heads of households were three
times more likely than those in children-headed households to have high unmet
for daily care from children. This is possible in the sense that those living with
the children are likely to have almost all their needs supported by the children.
Those in average wealth index category were less likely than the poor to report
Unmet Needs for Elderly in Nigeria
high unmet need for daily care from children. Those in monogamous families
and those with a child within the same town were less likely than the reference
category to report high unmet need for daily care.
In model 2, the significant variables were marital status, family of
orientation, children ever born and presence of a child within the same town.
The odds for the significant variables showed that those married and widowed
were less likely, compared with those unmarried, to report high unmet need for
daily care. Also, those born into monogamous family and those with three or
more children were more likely than the reference categories to report high
unmet need for daily care. Those with a child living within the same town had
lower odds of reporting high unmet need for daily care. Although the odds vary
and showed inverse odd relationship, there was a consistency in the level of
significance of unmet need for daily care from children and spouse by family
of orientation type and presence of a child living in the same town.
The odds of high unmet need for personal visitations from children were
presented in model 3. Eight categorical variables were significant in predicting
this. The odds showed that men are twice more likely than women to report
high unmet need for personal visitation from children. Those who are widowed
are three times more likely than those unmarried to report high unmet need for
personal visitation. Those who are married were also almost twice more likely
than the reference category to report this but the distribution was not
statistically significant. Pensioners were eight times more likely than those
self-employed to report high unmet need for personal visitation. Those who are
household heads were twice more likely than those headed by a child to report
high unmet needs for visitation. Those born into monogamous families were
twice more likely than those born to polygamous families to report this. Those
with three children or more were less likely than those with two or less, and
those with a child living in the same town were less likely than the reference
categories to report high unmet need for personal visit from children.
Model 4 presents the distribution of the odds to high unmet need for
improved status. The significant odds for predicting high unmet need for
improved status from children showed that eleven variables were significant.
These include; age, education, marital status, family type, residence, household
headship, wealth index, type of family of orientation, children ever born,
presence of a child living within the same town, and a child abroad. The odds
of the significant variables showed that those aged 66 years and over were
twice more likely than those younger, and those with high education were more
than twice more likely than the reference categories to report high unmet need
for improved status.
Those married and those widowed were thrice more likely, compared with
the unmarried, to have high unmet need for improved status. Those in
polygamous family and those household headed by the elderly were twice
more likely than the reference categories to report this. Those in urban areas,
those of average or rich wealth index, those born into monogamous families,
and those with a child abroad had very low likelihood compared with the
20 The Nigerian Journal of Sociology and Anthropology Vol. 12
reference category to report high unmet need for improved status from
children. It is of interest that those with six or more children and those with a
child living in the same town are twice more likely than the reference
categories to report high unmet need for improved status.
Model 5 which examineed the predictor variables for high unmet need for
medical care from spouse showed that only five variables were significant.
These variables include; education, marital status, type of family, household
headship and presence of a child within the same town. The odds of these
significant variables showed that those of high education, those in polygamous
families, and those in self-headed households were twice or more likely,
compared with the reference categories, to report high unmet need for medical
care support. Those who are widowed or with a child living within the same
town were less likely compared with the reference category to report high
unmet need for medical care from spouse. Comparing the two models for
predicting unmet need from children and spouse, only two of the variables
showed a consistent pattern in both significance and odds. Those with high
education were twice more likely than those with low education to report high
unmet need for medical support from both children and spouse. Also, those in
polygamous families were twice more likely to report high level of unmet need
for this form of support from the children and spouse.
Table 6: Logistic Regression Model Predicting High Unmet Need from Children and Spouses
Children Spouse
Model1 Model2 Model3 Model4 Model5 Model1 Model2 Model3 Model4 Model5
Sex:
Male .98 1.44 2.26** 0.97 1.29 1.03 0.83 1.23 2.05** 0.62
Female RC RC RC RC RC RC RC RC RC RC
Age:
60-65 years RC RC RC RC RC RC RC RC RC RC
66-years and above 0.64** 0.63** 0.94 1.72** 1.32 0.70 1.53 1.38 0.85 0.86
Education:
None/low RC RC RC RC RC RC RC RC RC RC
High 2.49** 1.33 0.79 2.33** 1.83** 1.71 0.99 0.96 1.82** 2.16**
Religion:
Christians 1.01 1.11 0.81 1.20 1.03 1.10 1.81 0.85 0.53 1.05
Non-Christians RC RC RC RC RC RC RC RC RC RC
Marital Status:
Unmarried RC RC RC RC RC RC RC RC RC RC
Married 1.89 1.79 1.98 2.85** 0.97 1.13 0.47** 0.40** 1.21 1.46
Widow/widowed 0.85 1.89 3.19** 3.49** 0.90 0.48** 0.14** 0.14** 0.61 0.43**
Family Type:
Monogamous RC RC RC RC RC RC RC RC RC RC
Polygamous 0.84 1.19 1.25 1.58** 1.64** 1.88** 1.08 1.72** 1.08 2.05**
Work type:
Self employed/farming RC RC RC RC RC RC RC RC RC RC
Government 1.34 1.45 1.60 1.90 2.55 1.03 2.31 1.36 0.83 1.07
Private 1.25 0.50 1.33 0.82 1.73 0.73 0.88 0.83 0.73 0.47
Pensioners 1.53 0.84 7.74** 0.82 3.19 1.11 1.05 4.63 1.25 1.28
Residence:
Urban 0.70 0.73 0.70 0.39** 1.26 1.53 1.55 0.99 0.75 1.59
Rural RC RC RC RC RC RC RC RC RC RC
Household headship:
Self 3.12** 3.04** 2.10** 2.48** 1.78 3.03** 1.77 1.46 1.61 2.37**
10 The Nigerian Journal of Sociology and Anthropology Vol. 12
Spouse 2.28** 1.59 1.34 1.84 1.48 2.28 1.07 2.44 0.47 0.74
Children/family/Others RC RC RC RC RC RC RC RC RC RC
Residential Status:
Rented RC RC RC RC RC RC RC RC RC RC
Personal 0.50** 0.85 1.20 0.97 0.61 1.82** 1.25 1.30 1.11 0.93
Inherited/family house 1.00 1.03 1.04 1.19 1.08 2.97** 1.10 1.60 0.88 1.17
Child’s house 1.25 2.03 0.57 0.91 1.5 4.42** 1.24 5.10** 2.15 3.07
Wealth index:
Poor RC RC RC RC RC RC RC RC RC RC
Average 0.72 0.28** 0.93 0.35** 0.48** 1.00 0.74 0.37** 0.51** 0.85
Rich 0.33** 0.53 1.25 0.39** 0.65 0.26** 0.70 0.68 0.48 0.70
Family of orientation:
Polygamy RC RC RC RC RC RC RC RC RC RC
Monogamy 0.57** 0.48** 1.82** 0.55** 0.61 1.02 2.03** 1.22 0.88 1.43
Parental Status:
Both parent alive RC RC RC RC RC RC RC RC RC RC
Only father alive 0.34 1.01 0.35 2.40 3.19 2.57 0.52 0.38 2.29 2.75
Only mother alive 0.44 1.99 1.43 1.36 0.75 4.04 0.68 0.24 0.75 0.79
None alive 0.38 1.69 1.55 4.54 1.90 2.49 0.41 0.12 1.40 1.97
Children ever born (CEB)
2 or less RC RC RC RC RC RC RC RC RC RC
3-5 children 0.69 0.78 0.44** 0.76 0.54** 1.24 1.93** 1.28 0.83 1.09
6 or more children 0.72 0.84 0.66** 1.79** 0.92 1.83 1.12 1.19 1.74** 1.27
No child lives in same town RC RC RC RC RC RC RC RC RC RC
Child lives in same town 1.96** 0.65** 0.49** 2.04** 0.90 0.61 0.59** 0.47** 1.56** 0.60**
No children abroad RC RC RC RC RC RC RC RC RC RC
At least a child abroad 0.71 1.32 1.54 0.44** 0.57 0.52 0.58 0.60 0.47** 0.47
Discussion and Conclusion
A very important issue on the support of the elderly emanating from this
analysis relates to the extent the immediate family is responsible for care
of the elderly in Nigeria. Literature, especially on Africa and with
particular reference to sub-Saharan states, is of the notion that the bulk
of support of the elderly rests on the children. Theories on the cultural
root of high fertility sustenance in sub-Saharan countries are premised
on the demand for children as derived demand for old age support. As
reiterated by other evidence (Akinyemi, 2009; Togonu-Bickersteth and
Akinyemi, 2014), relying on unfounded assumptions in the care and
support for the elderly in Nigeria portends serious damaging
consequences. Besides, the lack of policy and programme for the
growing elderly population can only aggravate their poor conditions.
Developing a policy also requires a holistic approach in which cutting-
edge evidence as well as inputs from all stakeholders are well integrated
and translated. Also, there is the need for cultural understanding of the
dynamics of the elderly and their social orientations in order to make
such policy valuable and functional.
The support and care of the elderly traverse financial issues and
involve other important considerations. There is the need to recognize
and develop social responses to address some of these issues. For
instance, the advent of mobile telephone can be explored in improving
the health care of the elderly as well as social communication.
Government in recent time introduced mobile phones that were
configured to meet the needs of farmers for effective communication.
This can be extended to the elderly particularly those in the rural areas in
addressing their immediate needs. Community extension workers in
rural areas can be further trained in providing basic care for the frail
elderly population. The paper concluded that the laxity in developing
appropriate social network of care for the elderly portends serious
consequences for the teeming elderly population in the country. There is
the need for timely active policy development and action in this regard.
References
Akinyemi A. I. (2006) Patterns and dynamics of care and support networks for
the elderly in South-western Nigeria. Unpublished Ph.D. Thesis held by
the department of Demography and Social Statistics, Obafemi Awolowo
University, Ile Ife, Nigeria.
Akinyemi A.I. (2009) Old age as a factor influencing high demand for children
among the Ijesas of South-Western Nigeria: Does number of children
10 The Nigerian Journal of Sociology and Anthropology Vol. 12