SOCIO-CULTURAL DETERMINANTS OF SUCCESSFUL AGEING AMONG OLDER ADULTS
ABSTRACT
The ageing process that takes place in older adulthood can either be usual or successful. Determinants of success in ageing are perceived from both objective and subjective perspectives. The objective of this research was to study the socio-cultural determinants of successful ageing in Ebonyi State, Nigeria. The design for the study was a cross-sectional survey with a sample size of 1105 drawn from a target population of 121, 651. The sampling methods involved multistage cluster sampling, stratification, systematic and availability sampling techniques while questionnaire and focus group discussions were the major instruments for data collection. Data collected were presented in tables and figures while univariate, bivariate and multivariate analyses were employed in the analysis. The hypotheses were tested using Chi-square, whereas logistic regression models were employed in predicting the influence of some variables on successful ageing. The results show that socio-cultural factors that determine successful ageing in Ebonyi include health, being physically active, having close personal relations, being socially active, financial security, meeting rites of passage, and having and seeing children progress. In conclusion, it is recommended that free medical service, financial assistance, indigenized old people’s homes, housing programmes, and specialized transportation services, and advocacy, be given the older adults in order to assist them in age successfully.
TABLE OF CONTENTS
Title Page i
Approval ii
Certification iii
Dedication iv
Acknowledgements v
Abstract ix
Table of Contents x
List of Tables xii
List of Figures xiv
CHAPTER ONE: INTRODUCTION 1
1 Background to the Study 1
2 Statement of the Problem 4
3 Research Questions 7
4 Objectives of the Study 8
5 Significance of the Study 8
6 Operationalization of Concepts 10
CHAPTER TWO 12
2.1 Review of Theoretical Literature 12
2.1.1 The Concept of Ageing 12
2.1.2 Concept of Successful Ageing 16
2.2 Review of Empirical Literature 20
2.2.1 Concept of Successful Ageing 20
2.2.2 Factors that Influence Successful Ageing 25
2.2.3 Influence of Religion on Successful Ageing 28
2.2.2 Other Socio-cultural Determinants of Successful Ageing 30
2.3 Social Work with Older Adults 47
2.4 Review of Related Theories and Model 49
2.5 Theoretical Framework 55
2.6 Study Hypotheses 60
CHAPTER THREE: RESEARCH METHODOLOGY 61
3.1 Research Design 61
3.2 Study Area 61
1.3 Study Population 63
3.5 Sampling Procedure 64
3.6 Instruments for Data Collection 65
3.7 Method of Data Collection 67
3.8 Method of Data Analysis 68
CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS 70
4.1 Introduction 70
4.2 Socio-demographic Characteristics of Respondents 71
4.3 The Concept of Successful Ageing 81
4.4 Perception of Successful Ageing 98
4.5 Life Goals 97
4.6 Rating of Importance of Factors of Successful Ageing 125
4.7 Effect of Past Lifestyle and Adjustment to Age-related Losses 142
4.8 Test of Hypotheses 152
4.9 Predictors of Influence of Some Socio-demographic Characteristics on Successful Ageing 157
4.10 Discussion 160
CHAPTER FIVE: SUMMARY, CONLUSION AND RECOMMENDATIONS 170
5.1 Summary 170
5.2 Recommendations 173
5.3 Relationship between Findings and Theoretical Framework 175
5.4 Contribution of Research to Knowledge 176
5.5 Implication of Findings to Policy 177
5.6 Implications of Findings for Social Work Practice 179
5.7 Limitations of the Study 180
5.8 Conclusion 181
5.9 Area for Further Study 182
REFERENCES 183
APPENDIX I 201
APPENDIX II 207
APPENDIX III 212
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
The substantial increase in life expectancy at birth achieved over the previous century combined with medical advances, escalating health and social costs, and higher expectation for older age, have led to international interest in how people age successfully. Debates continue as to what constitutes successful ageing. An appropriate answer is needed for this question as gerontologists of the new millennium are increasingly focusing on how to promote successful ageing or how older adults can retain the ability to function in their environments as they age (Rowe & Khan, 1998; United Nations (UN), 2015; Vaughan, Leng, Lamonte, Tindle, Cochrane & Schumaker, 2016). Promoting successful ageing is important as the world continues to experience enormous growth in the population over 60, the age category referred to as the aged or older adults. Although the industrialized nations of the world have higher percentages of people over 60, almost two-thirds of the world's older adults now live in the developing world (Lindsey & Beach, 2004). Even in the poorest regions of Asia, Africa, Latin America, and the Caribbean, where life expectancy is much lower than global average, the elderly population is growing at an outstanding rate, at a faster rate than in the developed world (Kinsella & Velkott, 2001; Macionis, 2010; UN, 2015).
This ageing development is recent. About 2000 years ago, the average life expectancy of a Roman was twenty-two years. In fact for the most of human history, the average life expectancy at birth was less than twenty years, with most people failing to survive the first few years of life (Lindsey & Beach, 2004). The average baby born into the world today can expect to live to be sixty-five, although there is enormous variation depending on where the baby is born - from an 83 years average life expectancy in Japan, 81 years in France, 78 years in the United States of America, to 52 years in Nigeria, and 51 years in Angola (World Health Organization, 2015). More and more people in the industrial societies are leading longer, healthier and more productive lives than ever before. In Africa, in 2015, there were about 64.5 million Africans aged 60 years or older. In Western Africa those aged 60 years or over were about 16.1 million, while in Nigeria those aged 60 or over were about 8.2 million. These figures are much higher in the industrial world. For example, in 2015 there were 44.8 million Japanese aged 60 years or over, 28.7 million Germans aged 60 years or over, and 96.9 million Americans aged 60 years or over.
These changes are due to many factors. Modern agriculture, sanitation systems, epidemic control, and medicine have all contributed to decline in mortality throughout the world. All these factors are added to the current demographic trend of increased life span and decreased birth rate. Owing to all these, population ageing is occurring worldwide. In their publications on levels and trends in population ageing, World Population Prospects: the 2015 Revision, the United Nations Population Division (2015) notes that the number of older persons—those aged 60 years or over—has increased substantially in recent years in most countries and regions, and that growth is projected to accelerate in the coming decades: Between 2015 and 2030, the number of people in the world aged 60 years or over is projected to grow by 56 per cent, from 901 million to 1.4 billion, and by 2050, the global population of older persons is projected to more than double its size in 2015, reaching nearly 2.1 billion. Globally, the number of people aged 80 years or over, ‘the old old’ (oldest-old) persons, is growing even faster than the number of older persons overall. Projections indicate that in 2050 the oldest-old will number 434 million, having more than tripled in number since 2015, when there were 125 million people over age 80. Over the next 15 years, the number of older persons is expected to grow fastest in Latin America and the Caribbean with a projected 71 per cent increase in the population aged 60 years or over, followed by Asia (66 per cent), Africa (64 percent), Oceania (47 per cent), Northern America (41 per cent) and Europe (23 percent) (United Nations Population Division, 2015).
In Nigeria there has also been manifest increase in the population aged 60 and above: In 1991, the population aged 60 and above was 4,598,114. Of this number 906,675 were aged 80 and above (NPC, 1991). In 2006 the number aged 60 and above rose to 6,987,047, out of which 1,475,278 were aged 80 and above (NPC, 2006). According to Mirkin and Weinberger (2000), and Zhao (2015), there can be little doubt that changes in age distribution have complex social and economic implications at the societal and individual levels.
As the age of the elderly increases, so do their problems become more manifest (Moody, 2009; WHO, 2015). Although there is very obvious diversity among the elderly, they experience some peculiar problems all over the world. These problems are most obvious in developing countries where communities are bereft of infrastructure and social amenities. How one is able to take proactive measures against these problems determines the wellbeing of the older adults which affects their continued contribution to national progress. This wellbeing is what has attracted the catchword, ‘successful ageing’ into gerontological literature. However, what people perceive as successful ageing has been a subject of varied interpretations.
Knowing the socio-cultural determinants of successful ageing is important to geriatrists, social gerontologists and social workers to enable them play a role in preventive activities that promote successful ageing. Rowe and Kahn (1998), Fiocco and Yaffe (2010), World Health Organization (2014, 2015) are of the opinion that gerontologists of the new millennium will increasingly focus on how to promote successful ageing, or how adults can retain the ability to function in their environment as they age. For gerontologists to be successful in this mission of helping people to age successfully, they have to appreciate the socio-cultural determinants of successful ageing in the society. Rowe and Kahn (1998), basing on the findings of a study conducted by Mac-Arthur Foundation on successful ageing, concluded that three key features characterize successful ageing. The features include: avoiding disease and disability; continuing engagement with life, including both social relationships and productive activity; and maintaining mental and physical functioning. These are really important features that characterize successful ageing. However, many other categories of people have a different perception of successful ageing. For example, in a gender based study of successful ageing, women were found to see active sexual life as an important feature of successful ageing (Woloski-Wruble, Olie, Leefma & Helnikie, 2010). People from different societies see successful ageing from different perspectives. For example, a study of native elders in Bristol Bay shows that place of residence also influences perception of successful ageing. The above instances show that socio-cultural variables influence the perception of successful ageing.
It is obvious that gerontologists are increasingly focusing on how to help the elderly age successfully. For geriatrists and social gerontologists to effectively provide services and contribute to making policies that really enhance the wellbeing of older adults and enable them age successfully, it is pertinent that they appreciate the socio-cultural variables that influence what their potential and existing clients perceive as successful ageing. In this project therefore, we have set out to find out what the older adults in Ebonyi State perceive as successful ageing, and to determine how they rate the importance of the features of successful ageing.
1.2 Statement of the Problem
Globally, the number of older persons is growing faster than the numbers of people in any other age category. As a result, the share of older persons in the total population is increasing virtually everywhere. While population ageing is a global phenomenon, the ageing process is more advanced in some regions than in others, having begun more than a century ago in countries that developed earlier, and getting underway only recently in many countries where the development process has occurred later, including the decline of fertility. In 2015, one in eight people worldwide was aged 60 years or over. By 2030, older persons are projected to account for one in six people globally. By the middle of the twenty-first century, one in every five people will be aged 60 years or over. By 2030, older persons will outnumber children aged 0-9 years (1.4 billion versus 1.3 billion); by 2050, there will be more people aged 60 years or over than adolescents and youth aged 10-24 years (2.1 billion versus 2.0 billion) (United Nations Population Division, 2015).
The pace of world population ageing is accelerating. Projections indicate that the proportion aged 60 years or over globally will increase more than 4 percentage points over the next 15 years, from 12.3 per cent in 2015 to 16.5 per cent in 2030, compared to the 2.3 percentage point increase in the share of older persons that occurred between 2000 and 2015. By 2030, older persons are expected to account for more than 25 per cent of the populations in Europe and in Northern America, 20 per cent in Oceania, 17 percent in Asia and in Latin America and the Caribbean, and 6 per cent in Africa. In 2050, 44 per cent of the world’s population will live in relatively aged countries, with at least 20 per cent of the population aged 60 years or over, and one in four people will live in a country where more than 30 per cent of people are above age 60. The pace of population ageing in many developing countries today is substantially faster than occurred in developed countries in the past. Consequently, today’s developing countries must adapt much more quickly to ageing populations and often at much lower levels of national income compared to the experience of countries that developed much earlier . These figures are a demographic success, but also an economic gloom if they do not age successfully because according to Mirkin and Weinberger (2000), there can be little doubt that changes in age distribution have complex social and economic implications at the societal and individual levels.
The goal of gerontology, whether social or medical, is to help people age successfully, or maintain well being in old age. The concept of wellness has been associated with successful ageing and is often confused with the notion of health (Atchley, 1999). According to Atchley (1999), wellness represents balance among the environment, emotional, spiritual, social, physical and cultural aspects of the individual's life. Health is a part of wellness. New definitions of successful ageing continue to be developed as research and practice with the older adult population progress. Gerontologists continue to debate the factors which lead to ageing well. Many concepts have been studied over the half of the twentieth century. Early research on ageing reflected the concern with adapting to the physical, psychological, and social losses of ageing.
It has been suggested that the ageing process that takes place when a person reaches adulthood can be described as either usual (normal) or successful (Rowe & Kahn, 1997). Rowe and Kahn made this distinction between ‘usual’ and ‘successful’ ageing within the normal ageing population rather than making comparisons with those who have disease such as dementia. According to Knight and Ricchadelli (2003) ‘usual’ describes the normal declines in ageing, including physical, social and cognitive declines. On the other hand, ‘successful’ is defined as having minimal or no physiological or cognitive loss and being actively engaged in life. The term successful ageing has been widely used in literature, sometimes with no specific definition offered and often the meaning is implied. Some of the meanings emerging from literature include positive functioning, physiological well-being, physical and mental health, cognitive growth potential, high quality of life, high life satisfaction, adaptation to life changes and social integration (Abraham & Hansen, 1995; Baltes and Baltes, 1990; Erber, 2005; Meek & Murrell, 2001; Ouwehand, deRidera & Sensing, 2007; Stem & Carstensen, 2000; Sullivan & Fisher, 1994; Woods, Rillamas-Sun, Cochrane, La Croix, Seaman, Tindle … Wallace, 2016; Yoon, 1996).
Giving a comprehensive description of what successful ageing is has preoccupied researchers for many years with the difficulty associated with defining and consequently measuring the construct identified some decades ago (Cumming & Henry, 1961; Havighurst, 1961; Williams & Loeb, !968). Many of the difficulties in definition and measurement include taking into account individual differences in the measurement of criteria of successful ageing; deciding whether the criteria are best measured objectively or subjectively (Knight & Ricciadelli, 2007); and addressing the issue that some aspects of ageing have been also conceptualized as indicators of successful ageing. Many of these difficulties still persist in much of the recent literature (Bee, 1996; Cho, Martin & Poon 2014, Hostein & Minkler, 2003; Ibrahim, 2010; Iwamasa & Iwasaki, 2011; Kok, Aartsen, Deeg, & Martin, 2015; Ouwehand et al, 2007; Torres, 1999). For this difficulty to be properly tackled there is a need also to ensure we are not simply saying that successful ageing is not what the culture and politics of the time are expecting from our older adult population. There is also need to be wary of seeing successful ageing in terms of others' expectations that are likely to represent different criteria.
The difficulty in consensus definition and problem in criteria determination appear intractable. Several researchers including Baltes & Baltes (1990), Gingold (1999), Kok, Aartsen, Deeg, & Martin, (2015), Powell (1992), Rowe and Kahn (1997), Bowling and Dieppe (2005), and McClintock, Dale, Laumann and Waite (2016) have, therefore, concluded that one must take a multicriteria approach to measure successful ageing, to incorporate the different criteria that exist. They also suggest that this approach should include a number of subjective and objective criteria. This has not been reflected well in literature to date, nor has the importance of the criteria for successful ageing to older adults been empirically established. If gerontologists do not know what their potential and existing clients do perceive as determinants of successful ageing, they will lack the focus that should guide them to effectively help people age successfully. This research has, therefore, the problem of finding out the socio-cultural determinants of successful ageing among older adults in Nigeria.
A reasonable quantity of literature exist in Nigeria in the areas of wellness of the elderly, elder abuse, disability in old age, ageing in Nigeria, and social support for the elderly (Adebawole, Atte & Ayeni, 2012; Ajomale, 2007; Eneh, 2008; Gureje, Kola,Afolabi & Oladapo, 2008; Gureje, Kola, Afolabi & Olley, 2008; Imo, 2015; Okoye, 2012). However, not much has been done in the area of what older adults in Nigeria perceive as successful ageing. Such gap in knowledge is a problem as nations must adapt the demographic changes in order to avert the problem of over dependence on the productive age. Yet, not much has been done in the area of ascertaining the socio-cultural determinants of successful ageing among older adults in Nigeria. There lies a gap in existing literature and body of gerontological knowledge.
1.3 Research Questions
The following research questions are posed to guide the research:
1. What are the socio-cultural determinants of successful ageing?
2. How do older adults in Ebonyi State rate the importance of subjective features of successful ageing?
3. What age do older adults in Ebonyi State believe is the best age in the ageing process, and why?
4. How do the older adults feel about their present age?
5. How do older adults rate the importance for criteria of successful ageing that emerge from literature?
6. Does people's perception of the determinants of successful ageing change as they advance in years?
7. What are the factors that hinder successful ageing in Ebony State
8. How can older adults be assisted to age successfully?
1.4 Objectives of the Study
The general objective of the research is to investigate the socio-cultural determinants of successful ageing among older adults in Ebonyi State of Nigeria. The following are the specific objectives which give the reader a more precise understanding of the objectives:
1. To ascertain the socio-cultural determinants of successful ageing in Ebonyi State.
2. To understand how older adults in Ebonyi State rate the importance of subjective features of successful ageing?
3. To know the age older adults in Ebonyi State believe is the best age in the ageing process, and why.
4. To know how older adults feel about their present age.
5. To gauge how the older adults rate the importance for criteria of successful ageing that emerge from literature.
6. To find out whether people's perception of successful ageing change as they advance in age,
7. To establish the factors that hinder successful ageing in Ebonyi State, and
8. To suggest ways older adults can be assisted to age successfully.
1.5 Significance of the Study
The study of the socio-cultural determinants of successful ageing among older adults in Ebonyi State will have relevance to readers in many ways. It has both practical and theoretical significance. Practically, the findings of this study will endue people with knowledge of what constitute successful ageing. This is helpful since social support networks for older adults in traditional societies are mainly informal – spouse, children, relations, friends, and religious organizations. They should appreciate the meaning of successful ageing and be guided in their support for the aged.
The study will guide gerontological social workers in Nigeria to provide services that will help the ageing population to age successfully. Thus, as the life span increases, the health span should increase proportionately.
Another practical significance of this study is that it will help ailing aged people re-evaluate positively their disabilities and cognitive frailties. It will help them to understand the need to demonstrate considerable strengths, adaptabilities and resilience and still be perceived by themselves and others as ageing successfully. As they go through the pages of this report they will understand that many factors constitute successful ageing and so may find the need not to be dismayed by their problems.
Practically, too, policy makers in Nigeria and Ebonyi State in particular will find the report of this study relevant. They will be guided by the findings and recommendations of this report in making policies that actually address the presenting and real problems of the aged. This actually is the core objective of contemporary gerontology - to help people age successfully.
Information gathered from this study may help us and other researcher design treatments, interventions, and educational tools to help people maintain well-being, including physical, emotional, cognitive, functioning well being as they grow older. This can enhance people's quality of life and enable them continue to contribute to national progress
Information from the findings of this research will also be very relevant to such agencies as National Orientation Agency, Attitudinal Change, etc. This is because from the research it shall be known whether people have wrong perception of the determinants of ‘successful ageing.’ Such knowledge will guide the agency in its orientation and reorientation activities on appropriate thinking.
Theoretically, report from the research will enrich of gerontological literature. Very little has been done in the area of what Nigerians/Ebonyians perceive as the socio-cultural determinants of successful ageing. Findings from this work will add much to existing gerontological literature, especially, in the area of subjective aspects of wellness.
This work will also be theoretically significant in adding to theories of ageing. Theories exist that try to explain the process of ageing and relationship between the elderly and the society. This particular work will contribute to theories in the aspect of the socio-cultural determinants of successful ageing.
Finally, the findings contained in the report of this study will contribute much to knowledge. It will add much to gerontology. Readers will gain insight into the varying (if any) perceptions of older adults of the socio-cultural determinants of successful ageing. Such knowledge will be beneficial to the Nigerian society.
1.6 Operationalization of Concepts
Activity: Continued role performance and involvement in life.
Ageing: It is a process of growing old or maturing. It is the biological, psychological and social changes that manifest as one grows older.
Life expectancy: Life expectancy is the average number of years that individuals in a particular birth cohort can be expected to live.
Middle old: The older adult population aged between 70 and 79 years.
Objective Successful Ageing: Assessment of successful ageing based on set criteria (physical health, financial security, social engagement, etc) and not based on one’s own sensations or emotions.
Older Adults: Those whose age falls at the upper end of the age continuum. We, here, use chronology to determine the age of people. Older adults are those aged 60 years and above.
Old old: The old old are the category of older adults aged 80 years and above. They are also referred to as oldest old.
Optimization: In gerontology, optimization is a strategy of focusing on behaviours that maximize quality and quantity of life.
Perception: An idea, a belief or an image one has as a result of how one sees or understands something. At the level of perception, what we see in the world can be quite different from person to person (Larsen & Buss, 2002). Here it means what older adults understand as successful ageing.
Physically active: This means continued productive role performance in old age.
Resilience: The ability to recover form and position; ability to withstand shock, suffering, disappointment etc. Resilience in old age is the ability to survive and overcome numerous major stressors, including disease, disability, and a range of other major age-related losses.
Selection: This is a strategy of concentrating efforts on domains in which effective functioning is most likely to remain high as one is ageing.
Socially active: To be socially active means being engaged in activities in which people interact.
Socio-cultural: The part played by social interaction and cultural practices in determining successful ageing. For example the part played by having close persnal relations, being active in engagements and involvements and also being active in the people’s way of life including religious activities, meeting rites of passage.
Subjective successful ageing: Perception of successful ageing based on the individual‘s personal evaluation and not based on set objective criteria.
Successful ageing: a personal evaluation of wellness in old age based on subjective criteria and basic objective elements appropriate for human dignity and respect.
Wellness: It is a state of well-being. Wellness represents a balance among the environmental, emotional, spiritual, social, physical, and cultural aspects of the individual's life.
Young old: The elderly population aged between 60 and 69 years.
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