Health and Care in Old Age in Africa

Pranitha Maharaj

• Editorial: Routledge
• Año: 2020
• ISBN:
  9780429665240
• Edición: 1
• Categoría: Social Sciences
• Categoría: Global Development Studies

This book explores health and care of the older population in Africa, focusing on policy and programmatic responses, gaps and future challenges related to health and care across the continent.

The first part of the book sets the scene for the volume, profiling the demographic and health situation of the elderly in Africa. It also provides an overview of the various models of care in Africa, looking in particular at the family care model, which constitutes the main source of support for the elderly in Africa. Part 2 provides case studies from across the continent to explore varying forms of elder care as well as the health challenges facing the elderly in the different contexts. The final part considers key aspects related to older person's experience of social pensions, which are widely recognised as a potentially powerful strategy of meeting the needs of older persons..

Identifying lessons regarding African-centric models of care, as well as reflections on the structural and policy challenges that are likely to confront countries across the continent as they strive to meet the specific needs of increasingly ageing populations, this book will be of interest to scholars of health and social care of the elderly.

1 Introduction

Pranitha Maharaj

Introduction

This book explores the connection between health and care in old age in Africa. Population ageing – the process by which older people increasingly constitute a proportionally larger share of the total population – affects virtually every country in the world and is therefore a matter of global concern. Over the past few decades the world’s population has not only increased significantly, it has also become considerably older. A larger number of the population than ever before are now living to 60 years and beyond. From a demographic and public health perspective, the massive increase in the number of people reaching older age is hailed as a success story. The increase in life expectancy is celebrated as a victory for public health interventions, medical advancements and an indication of economic progress.

Population ageing often occurs in conjunction with changes in the health profile of the population. An analysis of the most recent Global Burden of Disease (GBD) study highlights that while life expectancy is 73 years, healthy life expectancy is only 63 years (IHME, 2018). This suggests that, on average, ten years of elderly life are spent in poor health. As people grow older they are more likely to experience a greater morbidity and disease burden. They are more inclined to develop chronic health conditions, such as cardiovascular diseases, chronic respiratory diseases, hypertension and diabetes that are less common in younger ages. As people age, they are also more likely to experience multiple health complications at the same time. Older age is also often characterised by the emergence of several complex health states that tend to occur only much later in life and that do not fall into discrete disease categories (WHO, 2018). Studies also suggest that older people in less developed countries are vulnerable to short-term illnesses due to infections and poor living conditions. These diseases include lower respiratory infections, diarrhoeal diseases and malaria (Streatfield et al., 2014; Troeger et al., 2018). As people live longer, they are also more likely to encounter numerous and various health obstacles that prevent their full participation in society. As a result, the global challenge in health is likely to be enormous.

While there are some indications that the current generation of the older population is much healthier than previous generations of older individuals (Strand et al., 2018), their activities are also likely to be limited by physical or cognitive disabilities which are growing disproportionately because the proportion of the oldest age groups (80 years and over) is rapidly increasing. Some types of disabilities increase with age, such as hearing and visual impairment. Estimates show that just under half of people aged 60 years and over live with disabilities worldwide (WHO, 2011). Ageing is usually accompanied by many degenerative health conditions, one of the most common and feared is the decline of cognitive ability (Langa and Levine, 2014). Cognitive decline or cognitive impairment occurs when a person has trouble remembering, learning and understanding new things alongside poor concentration and decision-making, which affects their everyday life (Tangney et al., 2014; WHO, 2019). Cognitive decline often ranges from mild to severe; with mild usually characterised by slight memory loss or other minor cognition problems, but later becoming more severe and leading to neurodegenerative conditions such Alzheimer’s disease and other forms of dementia, causing loss in the ability to perform daily activities of life (WHO, 2019). The oldest age groups are at greater risk of physical and cognitive disabilities, which is likely to have major adverse effects on their social and physical activities. They are likely to experience disruptions in normal daily functioning, which will probably affect their quality of life. As a result, there is an expanding need among the elderly for assistance. As people live longer there is likely to be a greater utilisation of health services, an increased need for long-term healthcare services as well as more assistance in carrying out the activities of daily living (WHO, 2018).

The elderly do not constitute a homogenous group and there is no typical older person. In many developed countries, the chronological age of 60 or 65 years, roughly equivalent to the age of retirement, is often identified as the onset of old age (WHO, 2015). However, in Africa, there is not much consensus about the age at which a person becomes old. In general, it is important to recognise that in many African countries, people who are younger than 60 may be regarded as old because they have physical characteristics (such as wrinkles, grey hairs) usually associated with people over the age of 60 in other settings. In addition, a person may be considered old because of changes in their health profile. They are more likely to experience health difficulties which affect their functioning and specifically their ability to carry out activities of daily living like bathing, dressing, eating and other independent activities. A person may also be considered old because of their social roles in the family such as a grandparent. Older people are likely to have widely varying abilities; moreover, there is likely to be considerable diversity in the ageing process by gender, class, ethnicity and nationality (Maharaj, 2013).

Although some of the variations in older people’s health are genetic, much is attributable to the influence of physical and social environments including homes, neighbourhoods and communities, as well as individual characteristics such as their sex, ethnicity or socio-economic status (Ferraro, Kemp and Williams, 2017). The environment has a powerful influence on the development and maintenance of healthy behaviours (Mitchell and Popham, 2008). Lifestyle and particularly maintaining healthy behaviours such as following a balanced, nutritious diet, engaging in regular physical activity and refraining from tobacco use are important in reducing the risk of non-communicable diseases and contributing to greater physical and mental wellbeing (Fox and Pacus, 2018; WHO, 2018). According to WHO (2018), “supportive environments enable people to do what is important to them, despite losses in capacity”. The presence of safe and easily accessible buildings and transport facilities are examples of supportive environments.

In line with the 2030 Agenda for Sustainable Development, which seeks to realise the human rights of all, nations should take a holistic life course approach to ageing. It is important to integrate ageing issues into programmes and policies to achieve the Sustainable Development Goals (SDGs). A primary goal of the SDGs is to “leave no one behind”. The goal recognises the importance of ensuring healthy lives and the promotion of wellbeing for all, including older women and men, for sustainable development.

This book argues that the ageing of the population has far-reaching implications, not only for the elderly but also the larger society. People are not only living longer, but many are also living longer in poor health and, as a result, they may require greater health assistance and, sometimes, even long-term care. In Africa, the ageing of the population is occurring in the context of a range of challenges including high levels of poverty, political instability and conflict, shifting household structures, a large disease burden, weak and non-functioning health institutions and political mismanagement on a massive scale. This book attempts to fill the gaps that exist by exploring the health and care of older men and women in Africa. It is intended for a range of audiences including sociologists, demographers, economists, health promotion professionals and activists. The intention is to target both academics and practitioners, including policy-makers and advocacy groups working to bring attention to the health and care of the older population in Africa.

The introductory chapter is organised as follows. First, the chapter provides a brief overview of trends in population ageing in Africa. Second, it looks at the options for the care of the growing older population in Africa. Finally, it ends briefly by describing the chapters and closes with some reflections for future work on this area.

Population ageing in Africa

Over the past few decades, there has been unprecedented growth of the global population, increasing from 2.5 billion in 1950 to 7 billion in 2011, and is currently close to 8 billion. Most of the increase has been occurring in developing regions, and in particular in Asia and Africa. Over the past several decades, fertility levels have been declining in almost all regions of the world, but at a much slower pace in Africa. Not surprisingly, the population of Africa is projected to increase dramatically over the next few years and the United Nations (2019) estimates suggest that population is likely to reach 2 billion by 2038. Not only is the population expected to increase rapidly over the next few decades, but according to the United Nations (2019), in Africa the growth is likely to be most pronounced among the older population.

During the next five decades, the number of persons in the world aged 60 years or older is expected to almost triple, increasing from 382 million people in 1980 to 962 million in 2017 (United Nations, 2017). By 2030, older persons are projected to account for one in six people globally (United Nations, 2015). Although population ageing is more apparent in developed regions, it is increasingly gaining prominence in less developed regions. Two-thirds of the world’s older persons live in the developing regions, where their numbers are growing faster than in the developed regions. In 2050, it is expected that nearly eight in ten of the world’s older persons will be living in the developing regions (United Nations, 2017). Although currently the percentage of older persons is much higher in the developed regions, the number of older persons is increasing more rapidly in the less developed regions over a shorter time period. By the year 2025, projections suggest that 75% of this population will be living in developing countries including Africa. While Africa is a relatively youthful continent, a number of African countries have large numbers of older people. In 2015, the older population constituted more than one million in 11 African countries, including 5.6 million in Nigeria, 4.6 million in Egypt and 3.1 million in South Africa (He, Goodkind and Kowal, 2016).

In Africa, over the next 20 years the population of older people will more than double in many countries. Interestingly, the number of the oldest of old people is also increasing rapidly with projections indicating that the number of people aged 80 or over worldwide will grow more than threefold between 2017 and 2050, rising from 137 million to 425 million and reaching almost 910 million by 2100 (United Nations, 2017). The increase in the number of older people is likely to have major consequences for the continent as a whole, as well as for individual countries. Older people in developing countries are more likely to be affected by diseases than in the developed world. For instance, two-thirds of people living with Type 2 diabetes live in the developing world, and older people in developing countries lose five times as many years from chronic lung disease and twice as many from stroke as in developed countries (UNFPA, 2012).

In Africa, older people constitute an ever-increasing share of the population. However, there is a great deal of variation in population ageing in Africa by region. The vast majority of the older populations is concentrated in the most populated regions of the continent, namely Northern, Eastern and Western Africa. However, the elderly constitute a major share of the total population of less populated regions of the continent, namely Northern and Southern Africa. While developed countries have had long periods of time to adjust to this change in the age structure of the population, developing countries are forced to adapt to a rapidly ageing population more quickly with a wider population base (United Nations, 2012).

In response to the trends in population ageing, national governments in Africa have made some progress in recent years in addressing the plight of older people. A small but growing number of countries have adopted a range of legal frameworks to protect the rights of older people. At a regional level, in 2016, the African Union adopted a Protocol on the Rights of Older Persons in Africa which aims at promoting and protecting the rights of the elderly and guaranteeing their full contribution and participation in society. However, despite the progress that has been achieved, the ageing population in Africa continues to be largely side-lined in broader efforts to achieve economic and social development. Africa has a population of 1.2 billion, with almost 60% below the age of 25 years (Kweitsu, 2017). Despite the obvious importance of investing in the youth in African economies, it is short-sighted to ignore the plight of the elderly. Some argue that much of the neglect, thus far, reflects prevalent ageist stereotypes of the elderly as uniformly “unproductive” and an economic burden. Others argue that it is largely a result of the recognition that older adults currently constitute a minor share of the total population of the continent. But it is undeniable that the current situation is likely to change rapidly and older people are like to form an increasingly larger share of the population in Africa with some estimates projecting that almost 10% of the population will be 60 or older (United Nations, 2019). Many African countries are also likely to confront increasing population ageing in the context of higher levels of poverty.

Africa is one of the least developed and by far the poorest continent in the world. Over the past two decades the number of people living in extreme poverty in sub-Saharan Africa increased from an estimated 278 million in 1990 to 413 million in 2015 (World Bank, 2018). As people age, their capacity to work and earn an income diminishes which increases their risk of becoming poor. The inability to work has led many older persons to rely on their pension for their survival. However, in many countries, pension funds are either not in place or are insufficient for the elderly to provide for their needs; hence, older persons are more likely to live in poverty than younger age groups (United Nations, 2017). According to recent data, just under 17% of people of pensionable age in sub-Saharan Africa receive any form of pension, meaning that an overwhelming majority of older persons have to rely on their own labour earnings or savings, assistance from relatives or charity for support (United Nations, 2016). There are also cases where older persons are receiving a pension, however, they are also likely to live in poverty because the pension is the only and main source of income for the entire household. In Africa, poverty is widespread, and often the older women constitute the poorest of the poor. Households headed by older women are more likely to experience higher levels of poverty than households headed by older men (United Nations, 2017). The poverty of older people often limits their access to health and care services.

In Africa, women constitute a significant proportion of the older population and the female population size increases with age. As of 2015, there were 84 men per 100 women aged 60 years and older, and 71 men per 100 women aged 80 years and older (United Nations, 2015). The proportion of men in the older population is projected to decline substantially with advancing age. Because their life expectancy is considerably higher than men, women comprise a significant majority of the older population. Projections suggest that the older population will remain predominantly female despite gains in old age survival among men (United Nations, 2017). Women are less likely than men to be in a marital union at later ages (United Nations, 2012). This is mostly because women tend to outlive their spouses because, on average, women are more likely to live longer but often are much younger than their husbands.

In many parts of the region, older people are mostly concentrated in rural areas (UNECE, 2017). In fact, in many rural areas, the elderly constitute the majority of the population as younger adults leave rural areas in search of bigger and better opportunities in the cities and some older urban migrants return to the rural communitie...

Índice

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Table of Contents
• List of figures
• List of tables
• List of contributors
• Acknowledgements
• List of abbreviations
• 1 Introduction
• 2 Ageing in Africa: patterns and trends
• 3 Long-term care for the elderly in sub-Saharan Africa: an analysis of existing models
• 4 Family and kin care of elders in sub-Saharan Africa
• 5 Access to health and healthcare among older persons in Uganda
• 6 Family care in poor urban settings: perspectives and experiences of elderly care recipients in Accra, Ghana
• 7 “Growing old is not fun”: experiences of ageing in rural Zimbabwe
• 8 Crying out for assistance: the elderly in the Democratic Republic of Congo
• 9 Social pensions and health and wellbeing: a focus on South Africa
• Index