ACCESSING TREATMENT BY THE ELDERLY IN NIGERIA – A STUDY IN IGBO-ETITI LOCAL GOVERNMENT AREA

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ABSTRACT
The elderly (60 years +) constitute more than 7% of the world population and in Nigeria constitute about 5.2% of the population based on the 2006 population census. The elders apart from being repositories of our culture and tradition also helps in mediation for peace as well as take care of children orphaned by current ravaging diseases including HIV/AIDS.
The objective of this study is to assess the challenges faced by the elderly in accessing healthcare using a descriptive cross-sectional survey.
Data was collected from 300 respondents of which females (57.7%) outnumbered (t=53.29,df=299,p˂.001) males (42.3%). Only 40.4% of the sample population has recognizable source of income i.e. pension and royalties from farm and business while the remaining 59.6% relies on monetary gift from children and relatives, charity, begging etc. 207 (69.0%)of the respondents (t=21.24,df=298,p˂.001) answered affirmatively to have been sick in the past 6 months while interestingly 145 (48.3%) of the respondents claims to be having chronic diseases other than hypertension, diabetes, arthritis, and stroke (t=32.39, df=294,p˂.001). The ‘chronic illness’ they are suffering as the researcher identified is  psycho-somatic symptoms characterized by tingling and crawling sensations as well as internal heat. 209 (69.7%) of the respondents claims they seek health in places other than hospitals while those that seek health in hospitals are 30.3% of the respondents (t=31.16,df=294,p˂.001). It is worthy of note however, that 76 (25.3%) of the respondents claims patent medicine store as their choice for treatment while 142 (47.3%) claims they rarely go to hospital (t=42.98,df=297,p˂.001).

The irony in the survey which depicts the apathy of the respondents to things involving the government is that irrespective of their proved poverty based on their income, they don’t consider that Cost, Distance to specialized centres, Attitude of health workers etc. impedes their access to healthcare. Equally as a proof of their perfunctoriness, 190 (63.3%) of the respondents answered on the negative on whether  they advocate free/subsidized treatment for the elderly arguing that if they answer on the affirmative it won’t change anything. Apart from the perceived apathy, however, there is every conviction that most of the people issued with the questionnaire are incapable of answering the questions rationally.  

TABLE OF CONTENTS

Title page
Table of contents
List of tables
List of figures
Abstract

CHAPTER ONE
Introduction
Justification
Goal
Specific objectives

CHAPTER TWO: LITERATURE REVIEW
Demographic pattern of the elderly
Morbidity of the elderly
Health seeking behaviour of the elderly
Sources of income of the elderly
Challenges of accessing healthcare

CHAPTER THREE: METHODOLOGY
Study area
Sample size
Study design
Ethical Approval
Data collection
Limitation of study

CHAPTER FOUR: RESULTS
Demographic pattern of the elderly
 Income and its sources
Morbidity of the elderly
Health seeking behaviour
Challenges in accessing treatment from hospitals

CHAPTER FIVE: DISCUSSION

CHAPTER SIX: CONCLUSION AND RECOMMENDATION
REFERENCES

CHAPTER ONE
Introduction
           Aging is a silent process whose consequences are difficult to anticipate. It creeps insidiously on people with some of the elderly finding it difficult to admit the reality of their transition into adulthood. The aging process is brought about by a progressive and universal deterioration in various physiological systems related to mental, physical, behavioural and biomedical domains. These changes are irreversible, independent of pathological conditions and contribute significantly to general loss of function or death.1 The elderly are the old people and are equally referred to as seniors, senior citizens, older adults, or simply elders depending on the culture and the context in which the reference is being made. Traditionally the age of 60 was seen as the beginning of old age. Most developed countries have accepted the chronological age of 65 years as a definition of elderly or older person.2 In Nigeria, the retirement age from the civil service is 60 years for most categories of workers and that accords them the statues senior citizens. Apart from the chronological age, certain physiological changes like greying of hair, wrinkles, and changes in voice as well as adoption of certain role like being a grandparent confers on people the statues of an old person.3
           The elderly are usually chronologically classified into young old (60-74 years), aged (75-79years), and the oldest old at 80 years and above4 or based on their capability to take care of themselves hence the elderly and fit, elderly and infirm, elderly and sick, elderly and psychiatric5 and these gives an indication of the level of care required by the elderly person. The elderly are very important as they are a repository of cultural and traditional values and are indispensable in the peaceful settlement of disputes especially in the cases of land and landed properties like economic trees and land itself. They are equally indispensable especially in the care of orphaned children in HIV ravaged communities where their children had succumbed to the scourge of AIDS as well as in the provision of household income especially in the rural areas where they are custodians of landed properties like economic trees like palm trees, oil-bean trees, bread-fruit trees etc.
           Much of the world is aging rapidly.6 Both the number and proportion of people aged 60 years and older are increasing; although at different rates in different parts of the world. According to the WHO publication, the proportion of people aged 60 years and above is growing faster than any other age group as a result of both longer life expectancy and declining fertility.7 While this can be seen as a success story for public health policies and for socioeconomic development, it also challenges society to adapt; in order to maximize the health and functional capacity of older people as well as their social participation and security.8 The number of older adults has raised more than threefold since 1950; from approximately 130 million to 419 million in 2000, with the elderly share of the population increasing from 4% to 7% during that period. In Africa, the same scenario is being re-enacted as the population is aging rapidly and it is being projected that by 2050, the number of people over 60 years living in Africa will increase from just fewer than 50 million to just fewer than 200 million.10
Various published demographic projections indicate that the number and proportion of elderly persons in Nigeria is on the increase. According to the 1991 population census, the elderly population is 4,598,114 representing about 5.2% of the Nigeria population of 88,992,220 while in 2006 the elderly population is 6,987,047 representing about 4.9% of the overall population of 140,431,790.11 The decrease in the percentage may be attributed to a more proportionate increase in the younger age group within the two periods of enumeration. It is being projected that the population of the elderly in Nigeria will be 15 million in 2025, a rank of 11th in the whole world.12 In some demographic survey, the population of the elderly in Nigeria had remained static at 3.0% to 3.4% from 1950 to 2010 which is an indication of the high mortality rate of this age group occasioned by the lack of comprehensive government policy and implementation of health and social care for the elderly. The aforementioned accounts for the low level of the life expectancy from birth and the characteristic peak of Nigeria’s population pyramid. In principle however, and according to the Demographic Transition Theory, Nigeria should be having a low birth rate and a low death rate hence the population of the elderly in Nigeria should be increasing.

According to the 2006 census, one-third of the elderly population are within the age range of 60 and 65 years while the remaining two-third are of 65 years and above and females accounts for 46% of the overall elderly population. This demography runs counter to the feminization of the old as seen in developed countries though this finding may be attributed to the low statues of women which increases their mortality rates relative to men over the entire life course. The literacy level of the elderly in Nigeria according to the 2006 census is quite alarming with 75% of the elderly being unable to read or write in one of the Nigerian languages and it equally revealed  that males are three times more likely to be literate than females.13 This finding can be attributed to the fact that most of the elderly people enumerated in the 2006 census lived much of their younger lives prior to the period of accelerated socio-economic development in Nigeria which saw a massive investment in education..... 

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