Perceptions of Quality of Eldercare among the Elderly and their Caregivers in Nigeria Open Access

Fritz, Meredith (2017)

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Background: As the global population ages, sub-Saharan Africa remains one of the youngest regions in the world. Much research on the elderly takes place in countries where the demographic transition has already begun, with little qualitative research on elderly from low- and middle-income countries. Objective: To understand how the perception of quality of eldercare differs among the elderly, their caregivers, and change-makers in Nigeria. In the Nigerian context, health care options for the elderly include private and public health care, native medicines, and care provided by family members. Methods: Interviews and focus group discussions with elderly and caregiver participants were conducted in urban and rural sites in three states during the summer of 2016. Key informant (change-maker) interviews were conducted in each community. Data were analyzed using a thematic analysis approach. Results: Primary health care is perceived as ineffective and inefficient due to high referral rates to higher-level institutions and inadequate staffing and equipment. Secondary- and tertiary-level health care are perceived as inaccessible because of high cost. Universally, private health care is seen as better-quality than public health care. Many elderly participants supplemented or exclusively medicated with native medicines (herbal concoctions and teas). Care provided by families was highly patient-centered, taking into account the elderly person's wants and desires. Despite this, reports of abuse and neglect are pervasive in the data. Discussion: The dominant perception of eldercare in Nigeria is one of 'care reciprocation'. In this system, parents invest in their children and later, children are expected to provide good 'return on investment' by caring for parents in their old age. The breakdown of this system results in neglect and abuse of elderly persons and blame is placed squarely on the youth.

Table of Contents

INTRODUCTION Problem -- 2 Purpose and Research Questions -- 3 Definition of Terms -- 4 Significance -- 5 LITERATURE REVIEW Global Aging -- 6 The Demographic Transition -- 9 Aging in Sub-Saharan Africa -- 10 The Formal Health Care System -- 12 Structure -- 12 Quality of Care -- 13 The Role of Elders -- 14 Health Status of Elderly Nigerians -- 15 The Informal Health Care System -- 17 Role of Children -- 17 Caregiving -- 18 Conceptual Framework -- 19 Conclusion -- 20 METHODS Study Design -- 21 Instruments -- 25 Data Analysis -- 26 WHO Framework -- 27 Limitations -- 30 RESULTS Background Context -- 32 Society's View of Aging and the Elderly -- 32 A Child's Responsibility -- 35 Programs and Policies -- 39 Perceptions of Quality of Care -- 40 Primary Health Care -- 41 Secondary and Tertiary Health Care -- 43 Native Medicines -- 46 Informal Care -- 47 Abandonment of the Elderly -- 50 DISCUSSION The Parent-Child Relationship -- 53 Primary Health Care -- 55 Native Medicines -- 57 Secondary- and Tertiary-level Hospitals -- 59 Informal Care -- 60 Abuse and Neglect -- 61 Limitations -- 63 CONCLUSIONS Recommendations -- 66 Implications -- 67 Final Thoughts -- 69 REFERENCES -- 71

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