Perceived Adequacy Of Social Support Systems Available To Older Adults In Nnewi Town, Anambra State

ABSTRACT

Social support is a valuable resource that comprises of tangible and intangible forms of assistance, welfare services in which older adults receive from various networks to help them in achieving and maintaining a sense of wellbeing and satisfaction in life. The study was on perceived adequacy of social support systems available to older adults in Nnewi town in Anambra State. The questionnaire, in-depth interview, and focus group discussion guides were used as instruments for collection of data from 568 respondents. The quantitative data were analyzed using version 20 of Statistical Package for Social Sciences (SPSS) and frequency distribution tables and percentages were used to present the results. Chi-square (χ²) was used to test the hypotheses; binary logistic regression was used to predict the effect of independent variables on a dependent variable while the qualitative data collected were analyzed in themes as complement to the quantitative data. The findings show that majority of the respondents (89.5%) receive social support from various support networks which include the children, spouse, church, friends, community, government and N.G.Os. However, children and friends (78.6% and 56.7%) respectively are the predominant sources of social support with minimal support from the government (22.5%) and N.G.Os (4.8%). The study also found that of all the support received by older adults, financial support was more available to them and also the only support they receive whenever it is needed. However, FGD and IDI reports noted that the social support received by older adults was not adequate and also not satisfactory. The study found that giving older adults monthly allowance will help to improve on their wellbeing. Four hypotheses were tested and three hypotheses were accepted while one was rejected. The data from the logistic regression analysis indicated that some variables like marital status, number of children, and monthly stipend were significant in predicting whether older adults will receive social support when it is needed or not. The study therefore recommends for formulation of national policy that will address social security and welfare services for the well being of older adults.

 

 

 

TABLE OF CONTENTS

Title Page        —          —          —          —          —          —          —          —          —          —          i

Approval page             —          —          —          —          —          —          —          —          —          ii

Certification page       —          —          —          —          —          —          —          —          —          iii

Dedication      —          —          —          —          —          —          —          —          —          —          iv

Acknowledgement      —          —          —          —          —          —          —          —          —          v

Abstract          —          —          —          —          —          —          —          —          —          —          vii

Table of contents        —          —          —          —          —          —          —          —          —          viii

List of tables   —          —          —          —          —          —          —          —          —          —          x

List of figures             —          —          —          —          —          —          —          —          —          —          xiii

List of Acronyms–     —          —          —          —          —          —          —          —          —          xiv

CHAPTER ONE:     INTRODUCTION– —          —          —          —          —          —          1

• Background to the study        —          —          —          —          —          —          —          1
•      Statement of the problem       —          —          —          —          —          —          —          6
•      Research questions      —          —          —          —          —          —          —          —          9
•      Objectives of the study           —          —          —          —          —          —          —          10

1.5       Significance of the study        —          —          —          —          —          —          —          10

1.6       Operationalization of key concepts    —          —          —          —          —          —          11

CHAPTER TWO:    LITERATURE REVIEW–            —          —          —          —          —          13

• Review of empirical literature–          —          —          —          —          —          —          13

2.1.1    Forms of social support for the older adults–           —          —          —          13

2.1.2    Sources of social support for older adults–   —          —          —          —          15

2.1.3    Factors that determines levels of social support for older adults–    —          17

2.1.4    Importance of social support to older adults–            —          —          —          18

2.2       Review of theoretical literature–        —          —          —          —          —          —          19

2.2.1    The concept of social support–           —          —          —          —          —          19

2.2.2    Types of social support–         —          —          —          —          —          —          20

2.2.3    Social work and older adults’ social support–           —          —          —          23

2.3       Review of relevant theories    —          —          —          —          —          —          —          24

2.4       Theoretical orientation —         —          —          —          —          —          —          —          28

2.5       Study hypotheses–     —          —          —          —          —          —          —          —          29

CHAPTER THREE:                        RESEARCH METHODOLOGY– —          —          —          31

3.1       Research design —       —          —          —          —          —          —          —          —          31

•      Area of the study        —          —          —          —          —          —          —          —          31
•      Population of the study —       —          —          —          —          —          —          —          32
•      Sample size     —          —          —          —          —          —          —          —          —          33

3.5       Sampling procedure    —          —          —          —          —          —          —          —          33

3.6       Instruments for data collection           —          —          —          —          —          —          34

•      Administration of Instruments           —          —          —          —          —          —          34
•      Methods of data analysis        —          —          —          —          —          —          —          35

CHAPTER FOUR: RESEARCH FINDINGS                                                                  37

4.1       Introduction    —          —          —          —          —          —          —          —          —          37

4.2       Socio-Demographic characteristics of respondents–  —          —          —          —          37

4.3       Socio-Demographic characteristics of the respondents from In-Depth Interviews

and Focus Group Discussions —         —          —          —          —          —          –           45

4.4       Views of the respondents on availability of social supports —           —          —          49

4.5       Views of the respondents on factors that influences social supports–           —          58

4.6       Cross tabulation of research variables             —          —          —          —          —          72

•      Test of hypotheses —   —          —          —          —          —          —          —          —          94

4.8       Predictors of adequacy of social supports–    —          —          —          —          —          100

4.9       Discussion of findings–          —          —          —          —          —          —          —          105

 

CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS     117

5.1       Summary of findings —          —          —          —          —          —          —          —          117

5.2       Relationship between findings and theoretical orientation–  —          —          —          121

5.3       Implication of the Study —     —          —          —          —          —          —          —          124

5.3.1    Implication for Social policy   —          —          —          —          —          —          124

5.3.2    Implication for Social Work practice in Nigeria         —          —          —          125

5.4       Limitations of the Study —     —          —          —          —          —          —          —          126

5.5       Conclusion      —          —          —          —          —          —          —          —          —          127

5.6       Recommendations      —          —          —          —          —          —          —          —          128

5.7       Areas for further research–     —          —          —          —          —          —          —          129

REFERENCES —     —          —          —          —          —          —          —          —          —          131

APPENDIX I:           Derivation of sample size        —          —          —          —          —          148

APPENDIX II:          Letter to respondents —          —          —          —          —          —          149

APPENDIX III:        In-depth interview schedule – —          —          —          —          —          155

APPENDIX IV:        Focus group discussion guide —          —          —          —          —          156

APPENDIX V:          Focus group discussion guide for caregivers —          —          —          158

 

 

 

 

CHAPTER ONE

INTRODUCTION

1.1       Background to the study

Life is naturally transitional as every individual passes through stages of life. These stages are childhood, adolescence, adulthood, and old age. Each of these stages has peculiar and diverse characteristics. Ogunsakin, Shehu and Dare (2012) posit that period of childhood is more of a time of dependency and assistance to take up some actions especially from the parents or guardians while adulthood is an active period which marks independence. Old age remains the final phase in transition which requires social supports despite the wellbeing of the individual during adulthood. According to Tang (2008) social support is accepted as a valuable resource comprising of tangible and intangible forms of assistance, welfare services that individuals receive from government, community, church, family and friends. In the views of McPherson and Wister (2008) social support serves as a measure to achieve a balanced person-environment fit in later life in which the family remains the most available institution for such provision. Although social support is needed by everybody, it is a must for older adults, as it helps in achieving and maintaining a sense of wellbeing and satisfaction in life (Okoye & Akinyemi, 2009). Similarly, Kahn, Hessling and Russell (2003) posit that social support is an important resource for older adults as common life events may jeopardize the support networks of this age group.

According to McPherson and Wister (2008) social support involves an integrated continuum of care and support which enables older adults to age gracefully as their strength, mobility, cognitive functioning, and health decline. To them, these supports include informal assistance like shopping, daily monitoring, scrubbing, cooking, bathing, banking, and transportation. Other forms of social support also involve help (financial, material, and emotional) received from family members, friends, relatives, neighbours and the like (Leutar, Štambuk & Rusac, 2007). In the view of Oladeji (2011) family members (primarily a spouse or adult children), friends, or communities provide up to 80 to 90% of these support for older adults. Social support also include formal care by government through pension scheme, paid employees who visit or live in the family home to help with meals, bathing, therapy, and mobility (McPherson & Wister, 2008). It also entails different forms of financial help or in kind from state and other institutions (Kokorić, Berc & Rusac, 2010).

It is generally believed that social supports from family, friends, community, and government will go a long way in reducing the large number of frail older adults (Cranswick, 2003). Studies have shown that availability of social support can minimize the problems affecting the emotional, physical, social, economic, and psychological wellbeing of older adults. In the views of Holt-Lunstad, Smith and Layton (2010) older adults with adequate social support have greater opportunities to survive from diseases such as cancer, cardiovascular disease, inflammation and less effective immune system functioning. Social support also helps to cushion the effects of other diseases like functional disability and pains associated with arthritis (Evers, Kraaimaat, Geenen, Jacobs & Bijlsma, 2003).  Supporting this view, Taylor (2011) noted that social support helps older adults reduce psychological distress such as anxiety or depression in stressful time. Furthermore, Dong, Beck and Simon (2010) and Fiori, Antonucci and Cortina (2006) believe that higher level of social support can modify and reduce depression in old age, increases mental health, and acts as coping resources in older age. It has also been reported that older adults with low social support are faced with mental disorder, depression, anxiety than older adults with high social support (Barrera, 1986; Cohen & Wills, 1985). Examples of mental disorder that may be associated with low social support include post traumatic stress disorder (PTDS) (Brewin, Andrews & Valentine, 2000), panic disorder (Huang, Yen & Lung, 2010), social phobia (Torgrud, Walker, Murray, Cox, Chartier & Kjernisted, 2004), and major depressive disorder (Lakey & Cronin, 2008).

Several factors have been put forward by scholars as having influence on social support. According to Mirowsky and Ross (2003) higher educational attainment increases a person’s likelihood of having close friends on whom to rely upon and of experiencing greater family stability, including a stable and supportive marriage. Formal educational settings may also encourage the development of friendships and interpersonal skills; people with more education and related social advantages may also have more time and resources to maintain relationships and support friends emotionally and financially (Cutler & Lleras-Muney, 2008; Mirowsky & Ross, 2003).  On the other hand, there is general perception that social support is higher among persons with higher socio-economic and employment status (Gallie & Paugam, 2000). Henly, Danziger and Offer (2003) found that most economically needy families are those with most limited access to social support. Reduced social networks and social support are more frequent among older people with low socio-economic position (Weyers et al, 2008).

Literature has suggested that an absence of informal support can have a serious impact on health and quality of life of low-income elderly women living alone, and this may also lead to premature institutionalization (Ryser & Halseth, 2011). Also Paskulin and Vianna (2007) report that gender differences have been found to influence the degree of social support across the ageing process. According to them, women have larger and more varied social networks with more friends and more social support than men. In the views of Sharir, Tanasescu, Turbow and Maman (2007) females are more likely to receive social support from friends and significant others, than males do. Moreover, females tend to have larger social contacts as compared to males because they seek emotional support in their relationship, while the males only receive social support from their spouses and colleagues (Kendler, Myers & Prescott, 2005).

Researchers have found that there are cultural differences in seeking, providing, and accepting social support across the globe (Sasaki & Kim, 2008; Hashimoto, Imada & Kitayama, 2007; Kim, Sherman, Ko & Taylor, 2006; Taylor, Sherman, Kim, Jarcho, Takagi & Dunagan, 2004). For instance, Taylor et al (2004) report that Europeans and Americans seek, accept, and use social support more to enable them cope with stressful situations than the Asians. Reasons for these cultural differences are found in the beliefs that the need to ask for support is less likely because people anticipate that their needs are to be provided by others before it is explicitly sought. Secondly, some cultures believe that personal problems should be solved independently because each person should be responsible for his or her own problems. Also, there is a growing concern about the potentially negative consequences following support seeking, such as criticism from people (Kim, Sherman, Ko & Taylor, 2006).

In Africa, Messkoub (2008) has opined that family is the most prominent source of social support for the older adults than elsewhere in the developing world. According to him, the social support systems in Africa are basically on broader familial links than elsewhere. The World Bank (1994) also noted the continued existence of kin, community and tribal support in Africa. However, support from government for the older adult is still minimal. International Social Security Association [ISSA] (2005) reports that pension schemes in most African countries are earnings related and cover formal sector employees who are predominantly urban based. They also posit that Botswana remains the only country with a universal pension scheme, while South Africa operates a means tested scheme. In Kenya, although the government claims to be committed to the welfare activities for older adults with evidence from the various policy documents in which the specific provisions for the needs of the older adults has been made, the family and community support are still the most common (Wabala, 2014).

In Nigeria, social support is solely the responsibility of the family especially the wives, sons, daughters, sons-in-law, and daughters-in-law with little or no assistance from the government (Ogwumike & Aboderin, 2007; Sijuwade, 2008). The supports from family are most often influenced by traditional values, norms, and behaviour which are socially initiated and not as a result of the emotional tie that consist of blood or marital relationship (Okoye, 2012). According to Okunola (2002) and Ajomale (2007) most Nigerian families take care of their older adults by seeing to their needs because the social security policies for older adults in Nigeria are just on paper while the Contributory Pension Scheme covers few older adults and designed mainly for those who had worked in the formal sector.

The needs of older adults can be complex that trained professionals like social workers may be needed to ensure that full, appropriate, and co-ordinated assistance and care are provided (McPherson & Wister, 2008). Social workers are professionals that are well equipped with the skills required to enhance the well being of individuals in the society (National Association of Social Work [NASW], 1994). One of the functions of social work is to carry out social assessments that involve identifying practical and emotional needs and appropriate support for older adults with their wide range of experience and knowledge (Irish Association of Social Workers’ [IASW], 2011). Social workers work directly with older adults and their families to deal with the factors that create or exacerbate their well being. Social support from family, friends, and community resources can maximize the older adult’s ability to adapt and cope, enhance self-esteem and self control, reduce hospital admission and readmission rates, and promote recovery (Mojoyinola & Ayangunna, 2012). They also noted that social workers evaluate the competence of caregivers, their willingness to provide care, and their acceptability of the older adults. Social workers also help to diffuse the sense of crisis for family members by assisting in health care planning and by ensuring that the older adult is included in decision making as well as integrating older adults in the mainstream of the community (International Federation of Social Workers [IFSW], 2007).

Numerous studies have been done on social support in Nigeria. These include studies by Dimkpa (2011) on social support systems of HIV/AIDS rural women; Karick, Dagona, Abangom and Onuchi (2013) on depression, social support among catholic religious in Nigeria; and Okoye (2005) on the erosion of traditional social support available to the elderly. Other studies include that of Okumagba (2011) on family support for the elderly in Delta State of Nigeria; Oladeji (2011) and Sijuwade (2008) on elderly care by family members. However, none of these has addressed the perceived adequacy of social support systems available to older adults. This study therefore hopes to examine the perceived adequacy of social support systems available to older adults in Nnewi town of Anambra State.

 

1.2       Statement of the problem

Social support plays a pivotal role in one’s ability to make healthier choices in life especially in old age (John Hopkins University, 2014). Meaningful support systems and social relationships to a large extent are associated with a sense of security and opportunities for companionship and intimacy which are prerequisite for the well being of older adults (Fajemilehin, 2009; Giang & Dfau, 2009). However, population of older adults has drastically increased in the past decade as a result of improvement in living conditions and better health care (Kinsella & Phillips, 2005). Available data show that the population of Nigerian older adults 60 years and above was 8.8 million in 2012 and will be 28 million in 2050 (United Nations, 2012). On the other hand, poverty is rife in the country and older adults may be more at risk since they are no longer in the economically active phase of life and there is no national social security to provide economic buffer in old age (Gureje, Kola, Afolabi & Oladapo, 2008).

Research shows that social support has positive effects on the lives of older adults for a variety of reasons, ranging from satisfaction with life to an enhanced well-being (Gow, Pattie, Whiteman, Whalley & Deary, 2007). Therefore, inadequate social support is associated not only with lower general health and wellbeing, but also with higher levels of emotional distress, more illness and higher mortality rates (World Health Organization [WHO], 2002). According to Caetano, Silver and Vettore (2013) and White, Philogene, Fine and Sinha (2009) inadequate social support affects the physical and mental health of older adults, it decreases the use of health services, poor functional capacity, more somatic health problems and unhealthy behaviours and greater risk of developing cardiovascular disease. This can increase the risk of morbidity, sleep problems, functional decline, and mortality (Costa, Ceolim & Neri, 2011). Bath and Deeg (2005) have also reported higher number of deaths among people with less social support than among those with high social support, networks of relationships and emotional support, while Melchiorre et al (2013) reported that older adults who are restricted to social support are most likely to exhibit signs of depression and somatic complaints.

Social support has been reported by scholars as a key component of successful ageing. According to Gow et al (2007) insufficient or absence of social support is associated with poor cognitive abilities, lower life satisfaction, and higher levels of loneliness. Loneliness according to Rokach, Orzeck and Neto (2004) is a significant factor that can harm one’s mental capacity and life satisfaction and contributes to an older adult’s ability to live at home. Loneliness is related to nega­tive physical health outcomes in older adults, including higher systolic blood pressure, elevated hormone levels, less restorative sleep that affects alertness and mood improvement and per­formance (Hawkley & Cacioppo, 2007).

Dodson (2009) states that individuals with poor social support are susceptible to making negative life choices. For example, Johnson (2008) studied information from women over the age of 77 concerning the impact of social support on the decision to stop driving due to safety reasons. At the conclusion of the study, 52% of the participants upheld their resolution not to drive while 48% did not. Overall, the two groups of women reported very different thoughts about feeling valued and supported. The first group expressed feeling loved and supported by family and friends whereas the second group reported feelings of loneliness and fear of survival. The research suggested that social support networks can positively affect an older adult’s adaptation to their community, and healthy networks contribute to one’s well-being and sense of independence.

Low level of social support may also be crucial risk factors for elder mistreatment (Melchiorre et al. 2013). To them, older adult’s economic dependency adds to the burden and stress experienced by support system especially the family caregivers which also play a role in elder abuse. Low support system may represent a crucial dimension of social insecurity and vulnerability affecting older adults. This may be in the form of isolation which appears to be a risk factor for all forms of elder mistreatment. According to Acierno et al (2010) there are consistent correlations between different types of elder mistreatment and low social support. Findings by Melchiorre et al. (2013) reported that having been exposed to psychological abuse was independently associated with decreased social support. Therefore, if older adults are exposed to high level of social support, it may represent one potential protective factor for elder mistreatment (Dong & Simon, 2008).

There have been studies on social support system in Nigeria by Ogunsakin, Shehu and Dare (2012) in Ilorin, Kwara, Opayemi (2011) in Ogun, Onyishi, Okongwu, and Ugwu (2012) in southeast Nigeria, and Osamor (2015) in Ibadan. However, none have focused on the perceived adequacy of social support systems available to older adults. Therefore, this underscores the importance of this study. The present study is designed to examine the perceived adequacy of social support systems available to older adults in Nnewi.

1.3       Research questions

The study will address the following research questions:

1. What are the available social supports for older adults in Nnewi?
2. To what extent does level of education of older adults affect their views on the adequacy of social support they receive in Nnewi?
3. How does gender affect view on the adequacy of social support received by older adults in Nnewi?
4. To what extent does level of income affect view on the adequacy of social support received by older adults in Nnewi?
5. What is the relationship between availability of social support and feeling of wellbeing of older adults in Nnewi?
6. To what extent does state of health of older adults affect their views on the adequacy of social support they received in Nnewi?
7. How does experience of elder maltreatment affect views of older adults on the adequacy of social support they receive in Nnewi?
8. How can social support systems for older adults in Nnewi be improved?
9. What are the implications of the findings for social work practice in Nigeria?

1.4       Objectives of the study 

The general objective of the study is to examine the perceived adequacy of social support systems available to older adults in Nnewi. While the specific objectives are as follows:

1. To find out the available social supports for older adults in Nnewi
2. To ascertain the extent to which level of education of the older adults affect their views on the adequacy of social support they received in Nnewi.
3. To find out how gender affect views on the adequacy of social support received by older adults in Nnewi.
4. To investigate the extent in which level of income affect views on the adequacy of social support received by older adults in Nnewi.
5. To ascertain the relationship between availability of social support and well-being of older adults in Nnewi.
6. To ascertain how the feeling of state of health of the older adults affects their views on the adequacy of social support they receive in Nnewi.
7. To examine how the experience of elder maltreatment affect the views of older adults on the adequacy of social support they received in Nnewi.
8. To find out how social support systems for older adults in Nnewi can be improved.
9. To ascertain the implications of the findings for social work practice in Nigeria.

1.5       Significance of the study

The usefulness of the study lies in the fact that it discusses the role of social support to the well-being of older adults when ageing sets in. Theoretically, the findings of this study will aid the understanding of social support and the need for its provision especially to the older adults. The study will also broaden the knowledge of social workers especially in the area of social gerontology on the importance of provision of social support to older adults. It will as well serve as a guide and referencepoint for students or researchers investigating related topics.

Practically, the findings from the study will help to draw the attention of the Nigerian government at all levels on the need to formulate and implement social security policies and programmes that will address the support and well being of older adults. The findings of the study will provide data that will help the government of Anambra State to consolidate or improve on the already existing financial support programme for older adults in the state. The result of the findings also will stimulate social workers to advocate for the inclusion of older adults in government welfare policies.

1.6       Operationalization of key concepts

Adequate social support: In the present study, this refers to having sufficient emotional, informational, and concrete assistance or support by older adults. This will be measured on ordinal scale.

Elder maltreatment: It refers to any act by omission or commission taken by people in Nnewi against an older adult which may inflict harm or injury.

Experience of elder mistreatment: In the study, it refers to having encountered any unpleasant situation or treated in an unpleasant way which may have led to harm or injury. This will be measured on ordinal scale.

Gender:This refers to the socially constructed characteristics of women and men such as norms, role and relationship between groups of women and men (WHO, 2016). In this study, gender refers to being male or female.

Health challenge: It refers to the presence of illness in general body condition of older adults.

High income:This refers to as earning reasonable amount of money by older adults like ₦50,000 and above per month.

Higher educational background: In this context, refers to as education acquired after secondary school, usually carried out at a university. In the study, it will be measured on ordinal scale.

Life satisfaction: This refers to the measure and evaluation of older adult’s feelings about their well-being which can be assessed in terms of mood, relationship with relatives and significant others.

Loneliness: It refers to a complex and usually unpleasant emotional response of older adults to isolation or lack of companionship, lack of connectedness and relationship with other people.

Low income: This refers to earning relatively small amount of money by older adults like ₦1,000-₦40,000 per month.

Lower educational background:In this study, refers to as having no formal education by older adults as well as maximum qualification of SSCE certificates and its equivalent. This will be measured on ordinal scale.

Older adult:This refers to an individual who is 60 years and above.

Perception:This refers to the way people view things, events and situation around them (Ezumah, 2003). In this context, it refers to the opinions, feelings and views of older adults.

State of health: It refers to general body condition of older adults as regards to presence or absence of sickness.

Well being: This refers to the general condition of an older adult be it social, economic, psychological, spiritual or medical state.

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