|What future for Africa's senior citizens? Photo courtesy|
An exceptionally friendly and likeable father of two in his mid-forties started rehashing the same story with divergent variations to his long-time friends who have heard the story countless times. Next, he stopped to help a total stranger at a mall and began to entertain him with the same story about his adolescence through young adulthood in a small town in Nigeria. About two years later, he suddenly stopped his car at the shoulder of the road, having lost his sense of direction. He just sat in the car waiting for help and making no attempt to get it. Without his mobile phone with him, it took his family a frustrating four hours to locate him. Oftentimes, he would walk out of the house, leave the doors open and wander the neighborhood until a neighbor’s kid would walk him home. His condition worsened over the next couple of years.
Imagine how frustrating and exhausting it was for his wife and two adult children to take care of their loved one at home. The emotions, pains, anxiety, uncertainty and confusion associated with caring for a loved one at home cannot be measured, including the loss of time by family caregivers who are actively employed. The unpredictability of what would happen next to the patient is another uncertainty. Would it be incontinence, walking out of the front door after mid-night and wandering the neighborhood, or having another bout of restless night? Despite all these tolls on family members, the guilt trips, lack of understanding of the disease and in this case the African culture’s insistence on at-home care of aged parents made this family dispel an alternative care setting other than their home.
Now in his mid-fifties, he is a resident of a nursing home just a few miles from his family home. Even after his initial admission into this nursing home, he continued to tell his old story. Through his casual conversations, most nurses in the facility knew the names of members of his family as well as his friends. Over time, his sense of memory and the frequency of his speech started to diminish. Now, he no longer recognizes members of his family nor his friends, and the only two words he utters are hello and bye. Sadly, the master communicator has lost his true voice and touch! He was the leader of his high school debating team and the senior prefect of the school during his senior year.
Although still frustrated about the deteriorations in his state of health, family members express a big sigh of relief as they are encouraged by improvements in the care he now receives in a nursing-home setting. They notice every little thing and simple changes such as his clean shave, nice haircut, well-manicured nails, robust and healthy look. They regret waiting so long to have him in a nursing home, especially after he was diagnosed with onset of dementia by his family doctor.
Dementia refers to a group of symptoms and conditions caused by disorders that affect the brain. The results are a loss of or decline in brain functions such as memory, thinking, reasoning and so on. Alzheimer’s disease is the most common cause of dementia; and it accounts for about two-thirds of all cases of dementia. Vascular dementia is the second most common cause of cause of dementia. It is caused by impaired blood flow to the brain due to either a narrowing or complete blockage of blood vessels in the brain; and since brain cells are deprived of the oxygen and nutrients which they need to function well, a person suffering from vascular dementia often experiences several mini strokes over a period of time. However, Parkinson’s disease is a neurological condition which affects the movement of its sufferer through tremors, rigidity and other problems with balance and motor skills. Other causes of dementia include Huntington’s and Pick’s diseases; and head trauma.
Taking care of a spouse or a parent with Alzheimer’s disease, vascular dementia, Parkinson’s, Huntington’s or Pick’s disease at home can be very stressful for family caregivers; hence, the undeniable need to look for alternative care settings that specialize in taking care of patients and the elderly with such conditions.
To initiate such a transition, family members and caregivers need to search for a nursing home with a riveted focus on provision of quality health and custodial care services to its residents and investment in the right mix of health care professionals with the know-how, expertise, compassion and professionalism required to properly care for such patients. The represented professionals on its staff include gerontologists, geriatric physicians and psychiatrists, nurses, social workers, dieticians, social activity directors and aides.
In most African countries, there is an upcoming wind of change which will alter, for good, the landscape of eldercare. However, there seems to be little or no hard statistics to support this idea. Notwithstanding the lack of supportive data, the following observations and trends are leading indicators and likely agents of change in eldercare: an increasing population of aged, disabled, mentally and cognitively impaired senior citizens; and a declining number of family caregivers to our elderly population.
In addition but on a positive note, there is an increasing population of actively engaged elderly persons who are delaying full retirement in exchange for an extended working lifetime. As a group, these elderly individuals, typically urbane, having accepted their company’s early retirement incentive packages, continuing to just enjoy what they do best, or starting to run their own or partners’ exciting business ventures with rewards of rather luxurious lifestyles and escapes to great vacation spots for relaxation, feel that they are too young to fully retire. Also represented but on a negative note in this group are looters of their nation’s central bank, treasury, oil, gas and solid mineral resources whose unconscionable behaviours and greed continue to leave the rest of their citizenry in abject poverty.
All together, these trends are about to power an upcoming wind of change that will steer the national discourse of most African nations in the direction of the need for alternative long-term care settings for their elderly population other than their homes, the homes of their adult children or close relatives as our traditional African customs and practices have inculcated in our mindsets. The same trends will ultimately increase the demand for high-quality long-term eldercare settings, starting first in our major cities and towns. Regrettably on the supply side, there are just a few alternative eldercare centers that can boast of delivering high-quality long-term eldercare.
So, what are the reasons or explanations for these trends?
First, improvement in medical science, diagnoses, treatment techniques and prevention methods; advancements in gerontology and geriatrics; as well as an increase in educated and health-and-fitness conscious elderly population all contribute to the increase in life expectancy of our elderly population. More of our senior citizens in the 50 to 60 age group are surviving beyond ages 70, 80 and 90. With good dietary habits and daily health-and-fitness regimens, some are likely to become centenarians.
According to the Association of Gerontology in Higher Education, Gerontology is the study of the aging processes and individuals as they transition from middle age to end-of-life, including the physical, mental and social changes in older people as they age, the investigation of the changes in society resulting from our aging population, and the application of this body of knowledge to policies and programs. The same organization defines Geriatrics as the study of health and diseases of the aged and the comprehensive health care of older persons and well-being of their informal caregiver. Geriatrics covers both the physical health (geriatric medicine) and mental health (geriatric psychiatry) care of the elderly.
Second, as we age, there is an increasing likelihood of physical, mental and cognitive disabilities. Our bones and joints are no longer as strong as they used to be. Our vision and hearing capabilities start declining. Even a subset of the elderly population will become pre-disposed to degenerative brain diseases such as dementia. For these reasons, as we get older the onsets of physical, mental and cognitive disabilities begin.
Third, increasing work and home demands for female family caregivers, a group that elderly parents mostly depend on for custodial care at home, are also driving the change or rethink about alternative care settings for their elderly parents. As a group, they are beginning to look for alternative settings for taking care of their elderly parents or professionally trained skilled nurses and home health aides who can take care of their aging parents at home.
Increasingly, female family caregivers are shedding their guilt-trips and relinquishing their part-time or after-working-hours assignments as caregivers in favor of pursuing and developing their professional careers. They are also frowning on the idea of employing house helps to take care of custodial needs of their aging parents because a great majority of house helps lack the compassion and professional training required for providing special custodial services to the elderly. Due to the frailty of some elderly parents, great care must be employed to assist them with activities of daily living, such as eating, bathing, toileting, hygiene, walking and moving around. Oftentimes, family caregivers arrive home from work to discover that their house has an awful smell or stench of feces right from the entrance; and their aged parents are still drenched in fecal matter. The alternatives that will allay their concerns and make these women happier include scenarios that offer outright or partial transfer of the risk of eldercare to a third party at a cost. They are willing to exercise any of the following options: hire a highly trained home health aide to work four to eight hour a day at the parent’s house; drop off a parent daily at a clean, quality alternative setting with highly trained custodial aides; or have a parent with physical, mental or cognitive disability stay for a protracted duration in a good nursing home.
Fourth, changes in family status of our elderly population, such as death of a spouse, divorce, remarriage, death of a family caregiver the elderly parent depended on, are also driving the shift in eldercare setting. If financially able to absorb the additional expenses, some elderly individuals would rather seek alternative settings for eldercare where there is no worry about falling in the bathtub with nobody around to come to their aid, cooking alone, eating alone, getting sick with nobody around to take care of them, or doing laundry alone.
Residents of nursing homes still enjoy their different hobbies, including gardening, travelling, knitting, hiking, canoeing and kayaking, dancing, teaching dance lessons, bird-watching, walking, exercising, nature-walk, sports, reading, and writing. Some residents still drive their own cars. For other residents, the homes do arrange transportation for them to run regular errands such as going to their local banks; visiting their families and friends; helping to pick up a sick grandchild from school; and going to the airport, bus or train station to continue a trip or tour. In fact, activities abound at good nursing homes. The social activity director of a nursing home, or a group of elderly residents, can organize trips to shopping malls, beaches on nice sunny days, the zoo, interesting historical sites and towns, library, movie theaters, music concerts, and operas; or events such as Christmas parties, variety shows, outdoor theaters, nights at the casino, bingo and disco nights. Also residents fall in love. Overall, exciting activities do not stop at old age and in a nursing home.
All together, these trends will power a wind of change in most African nations in favor of alternative long-term care settings for the elderly population other than their homes, the homes of their adult children or close relatives. The new paradigm will also satisfy the African culture’s insistence on at-home care of elderly parents through engagement of professionally trained home health aides and skilled nurses at their homes, particularly in cases where the elderly parent needs no special medical attention. This is the next big bang in business opportunities that Africa anticipates. The irresistible question is how prepared and ready are governments, NGOs and business entrepreneurs to capitalize on the inevitable change in eldercare in Africa?
By Femi O. Odulana
The author is Fellow of the Conference of Consulting Actuaries (FCA) and author of Pension Reforms in Nigeria: A Guide to the Implementation and Operation of Pension Reform Act 2004.