CHANGING PATTERN OF CARE FOR THE ELDERLY AND THE INTERVENTION OF MOONSHINE ELDER CARE CENTRE, BENIN CITY, EDO STATE
CHAPTER ONE
INTRODUCTION
1.1    BACKGROUND TO THE STUDY
It is now commonplace to reflect on the fact that the Nigerian population, like the populations of Western developed countries is aging. Aging will continue because of the extension of life and the reduction of fertility (Troisi 2004). The  ageing  of  world’s  population  is  a  crucial  challenge  for  the  21st  century.  Population ageing affects individuals and nations and due  to  several  factors  which  include  decline  in  fertility,  improvement  in public  health,  increase  in  life  expectancy  and  changes  in pattern of care  among  the  family structures and the decline in community services.
Aging is the accumulation of changes in a person over time. More so, aging is a multidimensional process of physical, psychological and social change. (Bowen and Atwood 2004). Some dimensions of aging grow and expand over time, while others decline. Research shows that even in  late  life,  potentials  exist  for  physical,  mental and  social  growth  and  development  (Papalia, Sterns, Feldman, and Camp, 2002).  According  to  the  Economic  and  Social  Commission for  Asia  and  the  Pacific, the  number  of  older  persons  (people  aged  60  and  over)  in Asia,  as  a  whole,  will more  than  double  from  322  million  in  2000  to  about  705  million  in  2025. Countries  like  Japan  and  Singapore  will  likely  have  the  oldest  population  by  2030.  Decline  in  fertility  was  brought  about  by  more  wide  spread  acceptability  of  family  planning  and changes  in  family  structure while  increase  in  life  expectancy  is  attributed  to  improved  medical care  on  support  of  the  elderly  was  brought  about  by  technological  advancement (ESCAP 2001).             
According  to  a published  U.S  Bureau  Bulletin  of  the  Census  and  Database  on  Ageing  in  1988,  the  world’s  total population  is  growing  at  a  rate  of  1.7  percent  per  year.  The  population  aged  60  years  and  above is  increasing  by  2.2  percent  per  year;  and  the  number  of  persons  aged  65  years  and  over,  is rising  by  2.8  percent  annually.  The  bulletin  shows  further  that  every  month,  the  net  balance  of the  World’s  older  population  (60  years  and  over)  increases  by  1.2  million  persons.  It is expected that this demographic pattern will continue.  Troisi  (2004)  observed  that  already  one  out  of  every ten  persons  is  now  60  years  or  above.  By  2050,  one  out  of  five  will  be  60  years  or  older  and  by 2150,  one  out  of  three  persons  will  be  60  years  or  older  (Troisi  2004:354).
Troisi also observed that  the  older  population  is  ageing,  that  is,  the  oldest  old  (80  years  or  older)  is  the  fastest growing  segment  –  constituting  11  percent  of  the  60  years  or  older  age  group,  is  projected  to grow  to  19  percent  by  2050.  The  number  of  centenarians  is  projected  to  increase  15fold  from approximately  145,000  in  1999  to  2.2  million  by  2050  (Troisi  2004:354).  Even  though population  of  the  elderly  is  increasing  in  all  countries  of  the  world,  up  till  the  early  80‟s,  the demographic  transition  was  mostly  viewed  as  a  phenomenon  of  the  developed  countries  (Sylvia, 2000;  Troisi,  2004).  But  in  fact  as  observed  in  the  literature  the  great  majority  (two-third)  of those  over  60  years  of  age  live  in  the  developing  world  and  that  the  proportion  is increasing steadily  and  will  reach  nearly  three-quarters  by  the  2030‟s  (UNFPA  and  CBGS,  1999  cited  by Sylvia,  2000:9).
In  Nigeria,  the  proportion  of  the  aged  population  has  been  increasing. According to a research by (NPC)  before  Nigeria  gained independence  in  1960,  there  was  a  population  census  conducted  in  1952/53.  Since independence,  the  country  had  only  conducted  three  successful  population  censuses  in  1963, 1991  and  2006.  The  total  number  of  persons  aged  60  years  and  above  in  1952/53  was 2,448,000.  In 1963,  1991  and  2006  population  census  the  total  number  of  persons  aged  60  years and  above  was  3,617,000  and  8,227,782  and  19,580,204 respectively (NPC 2003).  This data shows that the population of the elderly has significantly increased and the  issue  of  changing  family  structure and  care  provision  for  the  elderly  is  one  of  such  values,  which  is  culturally  rooted  and  esteemed but face with challenges in modern time. In  many  traditional  African  societies the  family  is  charged  with the  responsibilities  for  the  provision  of  support  for  the  elderly and such  support is  provided  voluntarily  without  any  remuneration  (Kosberg,  1992;  Brown,  1999).  The population of the elderly in the world is increasing rapidly (United Nations, 2004) and the rate of increase is higher in developing countries including Nigeria.
 Currently, Nigeria has the highest number of the elderly people in Africa estimated to be about 5.6% of the Nigeria population (NPC, 2008). With this increase in the growth of the aging population, the number of people that will need health care will undoubtedly increase. (Donatelle 2011) posited that in most curricula  for  health  professionals,  little  or  nothing  is  indicated  about  the  care  of  the  elderly showing absolute neglect in this area (Mclafferly and Morrison 2004) stated also that most health workers  have  very  poor  knowledge  of  mental  health  conditions  which  are  common  with  the elderly  and  as  such  health  workers  come  to  service  with  deep  seated,  negative,  diluted  and superstitious belief about caring for the elderly.  This lack of adequate knowledge and negative attitude towards the care of the elderly may result in serious problems in our society in the near future.
The nuclear institution formed  the  bulwark  of  informal  social  welfare support  to  elders  in  Africa  (Apt  and  Katila,  1994  in  Ghana;  Adamchak  1991,  in  Zimbabwe  and TogonuBickersteth,  1987a,  b  1988,  1989  in  Nigeria).   Unfortunately,  with  the  SubSaharan  African  societies  coming  under  various  cultural  influences and  high  death  tolls  of  the  youth  by  HIV/AIDS,  the  traditional  institution  that  supported  elderly care  is  highly  threatened.  The  extended  kinship  support  is  gradually  declining  under  the pressure  of  modernity.  Economic  woes  and  recession,  coupled  with  governments‟  insensitivity in  the  region,  also  compounded  the  problems  of  the  elderly  as  they  have  been  largely  neglected in  various  issues  that  affect  them. Most  African  countries  are inadequately  prepared  for  the  emerging  challenges  of  the  growing  elderly  population  (United Nations,  1994). The extended families institution has generally become less effective in the support of the care for the elderly.  To  make  things  worse  in  this  part  of  the  continent, concurrently  with  the  rising  proportion  of  the  elderly,  is  the  weakening  of  the  traditional  safety nets (Ojewale 2013).
A major  challenge  in  the  face  of  rising  proportion  of  the  elderly population,  is the physiological and psychological care of the elderly, This  research  is  therefore an  attempt  to  understand the changing pattern of care for the  elderly  in  Nigeria. The family cannot  adequately  meet  the  needs  of  the  old  persons in Nigeria, and the diminishing  economic  power  has  hindered  the  willing  family  member’s  capability to provide care.  Priorities  are  given  to  the  needs  of  the  members  of  the  nuclear  family  –  spouse  and children  –  at  the  expense  of  older  family  members:  parents  or  grandparent, care provided by the family has gradually decreased.  But  with  changing  social  and  economic configurations,  older  persons  are  most  of  the  time  left  in  the  care  of  strangers  i.e.  people  who are  not  properly  trained  to  be  caregivers,  many  of  them  uneducated,  young  and  frustrated (Oyetunde and Ojewale 2013).
This has led to the changing pattern of care and the social work intervention and services in modern society, this research work is to explore the social work intervention and the introduction of moonshine elder care Centre as a platform to bridge the gap of care for the elderly in Benin City, Edo State.
1.2 STATEMENT OF THE PROBLEM
       The need for Geriatric institutions is more than ever more urgent now in Nigeria because of the increasing number of aged people. It was estimated that by 2015, there will be 64.6 million aged in the world; this figure was expected to rise to 103 million in 2030 and by 2050, we should have over 205 million aged people (Mudiare, 2013). With increasing numbers of older people, especially in Africa, unfortunately the increase  is  taking place in a situation where  the  society is least prepared for challenges that  older  people  are experiencing at present  as  the  demand  to  meet  their  needs grows.  The  range  of  problems  that  older  people  in  Africa  are  facing  is  constantly increasing as societies are locked up in conflicts, experience huge economic problems, natural  disasters,  diseases  and  deterioration  in  family  relationships.   
In as much as these harrowing experiences, frustrating structural strains, the  elderly  are  faced  with  the  challenges  of  deteriorating  health  conditions,  poor nutrition, poor housing, poor hygiene, lack of healthcare, elder abuse, social security, isolation,  boredom,  and  dependence.  At varying international fora, much concern has been expressed about the elderly, with profound suggestions made towards improving their conditions.  These fora include  the  United  Nations‟  First  World Assembly  on  Ageing,  in  Vienna  in  1982  (United  Nations,  1982  cited  in  NPC,  2003); International  Conference  on  Population  and  Development,  1994,  and,  Madrid International Plan on Ageing, 2002 (NPC, 2003).
Given the economic difficulties in families, unemployment, urbanization and poverty, it is increasing difficult for grown up children to manage their own families of procreation as well as their aged parents thus putting the elderly at risk of abuse and neglect whether or not they live alone. Researchers continue to come up with different findings about the changing patterns of the care for the elderly especially in developed economies. Can the findings of those studies be replicated in emerging economies like Nigeria? In Nigeria, little or no empirical studies have been done to establish the changing pattern of care for the elderly and the intervention (Mudiare, 2013).  
1.3 OBJECTIVES OF THE STUDY
The broad objective of this study is to examine the changing patterns of the care for the elderly and social work intervention.  
 The specific objectives are:
1. To examine the challenges encountered by the elderly in our society.
2. To examine the level of professional intervention by social workers and its contribution to care for the elderly.
3. To examine the role of social workers in elderly care centers.  
4. To determine the importance of legislative enactment on policy for the Geriatric institutions.
1.4 RESEARCH QUESTIONS
In line with the objectives of the study, the following research questions are raised:
1. What are the problems encountered by the aged in the society?
2. To what extent does moonshine elderly care center cater for the aged or elderly in our society?
3. To what extent will government social security and social protection benefit the elderly?
1.5 SIGNIFICANCE OF THE STUDY
Having increased number of ageing population is an indicator of high survival rate occasioned by good health system and condition of living. At the family level, it is a pride in some communities in Nigeria to have their parents or relations ageing who are elders because of their roles in recounting past stories, customs, tradition and care for the children. On the other hand, they come to become liabilities to the families when they pose health problems requiring fund for treatment or constitute total economic burden on family and children.
At the community or family level, elderly persons become liabilities when they are not contributing to the economy and much money has to be set aside for their health provision and other services. As a result of the poverty in the family level and government’s non provision for the ageing, a significant number engaged in alms and begging and other undignified practices to earn living.  Older people constitute a part of society’s structure which has a role to play and has some needs that must be met. However, if those needs are not met such as engaging  in  activities,  shelter,  food,  clothing,  financial,  isolation,  health,  sex,  safety, love,  affection,  belongingness,  respect,  welfare,  retirement,  etc.,  they  can  constitute  a problem to the society and thereby, affect other parts of the social structure. The most likely result is that, older people may depend on other parts of the structure for survival and create problems for the society, especially the family and the government. These practices were considered in the past as a taboo.
    The study therefore scrutinize the role of extended family in the care if the aged living in the respondents‟ area with a view to knowing the level of care and support available for them. The findings of this study provided information on the level of awareness of elderly, the introduction of elder care institution and services. It further provided information for care and support, types of occupation engaged in their challenges and means of addressing them. In addition, it provided useful basis upon which further studies can be made.
The  result  will  help  to  provide  basic  information  for  designing  structures  and programmes  for  the  care  of  the  elderly  in  the  community.  It will also provide evidence based information on graceful ageing. It will serve as a reference material to other researchers in the field of community health practice. Findings  of  the  study  will  help  in  showing  the  level  of  knowledge and  attitude  of  the care providers towards the care of the elderly and will help improve the decision making. The result will also help in building up knowledge base on the care of the elderly patients. Improving data base  on  elderly  health  nutrition  and  standard  of  living  which  will  help  for  further  research, advocacy, policy dialogue and programming.
1.6 AREA OF STUDY
Moonshine eldercare Centre facility, which is located in Benin City, Edo State Nigeria. Between 1st and 2nd Ugbor, 12 Ezezobo longe street, GRA, Oka, Benin City.
1.7 DEFINITIONS OF CONCEPTS
Pattern:Type of care given to the elderly
Modernization:Refers to a model of a progressive transition from a pre-modern or traditional to a modern society or way of doing things.
Care:The provision of what is necessary for the health, welfare, maintenance and protection of the elderly.
Aged:Individuals from 60years and above
Extended family:A family which can be extended beyond the nuclear family, it include the grandparents and other relatives.
Nuclear family: A couple and their dependents children, regarded as a basic social unit.