Abstract
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
About this Master's Thesis
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