R EVIEW A RTICLE AN INVESTIGATIVE STUDY OF THE EXPERIENCES OF ELDERLY PEOPLE IN A SOUTH AFRICAN BLACK

ABSTRACT: The aim of this study was to investigate the expe- riences which impact on aspects of the lives and sense of well- CHIGALI GM, Dip. PT (Zambia), 1 being of elderly people in a township in in order to BSc Hons. PT (UWC) ; make recommendations for future service delivery. A cross- MARAIS M, Dip PT (UCT), 2 sectional, qualitative survey was carried out in Mfuleni Township, MSc(Physiotherapy) (UWC) , MPOFU RMB, PhD (UWC), a part of the Cape Metropolitan Region in the . 3 Sixteen people of ages ranging from 60-82 years were conve- MSc Rehab. (So’ton UK). MCSP . niently selected from a group of elderly people who meet regularly 1 Livingston General Hospital, Livingstone, Zambia. 2 Lecturer, Department of Physiotherapy, Faculty of at a community centre. Data were collected through focused Community and Health Sciences, University of the group discussions and unstructured interviews. Analysis of data Western Cape. 3 revealed three main categories namely, psychological/ emotional, Professor and Dean Faculty of Community and Health Sciences, University of the Western Cape. socio-economic and health, under which different themes emerged. The experiences of individuals in a given society may vary, but somehow, their basic rights tend to be universal as revealed by the literature. Loneliness and isolation, lack of recreation facilities, loss of dignity and respect, poor health services and lack of shelter are some of the experiences expressed by the elderly people in this sample. These experiences highlight the need for clearly stated policies and commitment by governmental and non-governmental structures, appropriate health service strategies and improved socio-economic standards supported by properly researched data.

KEY WORDS: AGEING, GERONTOLOGY, HEALTHY AGEING, NEEDS OF OLDER PERSONS.

The article was based on research done by Mr. Chigali in partial fulfilment of his B.Sc. (Honours) in Physiotherapy at the University of the Western Cape.

INTRODUCTION the country’s resources by the various Ferreira and Charlton (1992) noted Health professionals such as physiothe- racial groups, classified by the previous that a significant number of the elderly rapists are increasingly being recognized government as “African, Coloured, Indian Africans living in urban areas suffered a as important partners in the delivery of and White”. The “Apartheid” policies greater degree of ill-health and disability services at Primary Health Care level, brought about disparities in education, than other racial groups. Furthermore, which includes community-based rehabi- health care and financial resources with the older persons from rural and urban litation. The traditional role of physio- the first three groups being highly dis- areas had difficulties in accessing health therapists has to change to meet the needs advantaged when compared to their white services due to lack of transport, whereas of the communities in which they work. counterparts. A survey conducted by the former also experienced the lack of One of the requirements for the success Ferreira and Charlton (1992) found that health professionals as a major barrier to of policy implementation and intervention 80% of elderly Africans living in rural accessing health services. by health professionals in communities areas and 50% in urban areas had no Ferreira and Charlton (1992) reported is an understanding of the socioeconomic, formal education and only some had that most of the factors seen as con- political and cultural factors that may access to the means-tested social old age affect the well-being and quality of life pension scheme. Hampson (1996) of communities or individuals. Know- observed that, despite the national state CORRESPONDENCE TO: ledge of such factors should enable the pension scheme, the vast majority of George M. Chigali physiotherapist to adopt a more holistic the rural elderly population still depend Livingston General Hospital approach in community-based service mostly on the family support system, P.O. Box 60091 rendering. whose continued existence is being Livingstone Prior to 1994 South Africans lived threatened by a host of factors, namely Zambia through a system of racial discrimination modernisation, urbanisation and the Tel +260 3 320756 which meant inequality in accessing of HIV/AIDS pandemic. E-mail: [email protected]

SA JOURNAL OF PHYSIOTHERAPY 2002 VOL 58 NO 3 21 tributing positively to the quality of life of the study were explained to a group ing etc. All interviews were tape-recorded of older South Africans were related to of approximately twenty five elderly and transcribed verbatim and checked basic rights, such as satisfactory health, people who attended the Masiphumle by two translators who were proficient housing, favourable living arrangements, Community Centre. in English and Xhosa. economic security and psychological The criteria for selection were that Six participants were fluent in the well-being, particularly in terms of feel- the participants were English language while the rest spoke ing in control of one’s life and having • currently living in Mfuleni, Xhosa only which is the predominant some degree of independence. • sixty years and over (both female and language in Mfuleni Township. The Housing for Africans living in urban male were accorded the same chance), Xhosa responses were translated into areas is still posing a great challenge. • capable of hearing instructions (with English verbatim. Notes were taken, Most of them cannot afford to purchase or without hearing aids) and describing key phrases of responses and houses of their own due to prohibitive • able to understand the spoken word to some non-verbal cues, which provided costs and thus remain living in multi- carry out the instructions. information about emotions and effects generational houses with little living The participants were randomly associated with certain sensitive issues. space. Mfuleni Township is an example divided into groups of four, irrespective Categories were generated from the of this housing arrangement. This town- of gender. A qualitative cross-sectional data and further refined and validated ship is located in the Region experience survey was carried out. This through constant comparative analysis. of the Cape Metropolitan area in the method, used in sociological research, Data that did not fit any of the categories Western Cape Province. It has a popu- takes a snapshot approach to the social were arranged in new categories. lation of around 20 000 which is contin- world and it can be exploratory, descrip- uously increasing because of a growing tive or explanatory (Neuman, 2000). In RESULTS AND DISCUSSION eruption of informal settlements. Mfuleni this study the researcher collected infor- Of the sixteen participants, nine were is an almost exclusively African commu- mation at one point in time, namely on female while the rest were male. Their nity. Many of the estimated 2 500 elderly the day of the study. mean age was 68.9 years with ages residents of this community are pension- All discussions and interviews took ranging from 60 to 82 years. Only one of ers who have been employed as labourers place at the Masiphumle Community the females and three males had spouses and domestic workers. These elderly Centre in Mfuleni. The participants of while the rest were widowed. people live either with their children, each small group, facilitated by the Three major categories which emerged grandchildren or alone. A number of them researcher and a translator, discussed from the discussions are tabulated in meet at a community centre (Masiphumle their needs freely, using both English and Table1. - Let us rest) which was built and is Xhosa. The responses elicited during the maintained mainly by donor funding. small group discussions were followed 1. PSYCHOLOGICAL /EMOTIONAL For the past ten years this township up with individual interviews to explore This category included themes of lone- has been one of the community-based certain issues that had emerged. Each liness/isolation, sexuality/love/marriage, education centres for students from small group discussion lasted an average lifestyle/ behaviour and respect/dignity. the Faculty of Community and Health of 80 minutes while the individual inter- These are discussed below. Sciences at the University of the Western views lasted five to ten minutes each. Cape. New students from this faculty The subjects responded to a variety of 1.1 Loneliness/isolation are orientated to community life in a issues affecting their lives, namely health, Most of the participants who stayed disadvantaged community such as this, finance, marriage, family support, hous- with their children and grandchildren while senior students are placed here for their clinical practice/community-based Table 1: Summary of categories and themes education (Mpofu 1999). The aim of this study was to inves- CATEGORIES THEMES tigate the experiences of the elderly 1. Psychological/ emotional Loneliness/isolation people who attend the centre in Mfuleni Sexuality/ love/marriage Township with a view to assist the Life-style/ behaviour planners of community-based education Respect and dignity curricula for health sciences students to 2. Socio-economic Recognition/money/status understand and to provide solutions to Pension some of the needs of the elderly people Safety and Security. with whom the students interact. Family and community support

METHODOLOGY 3. Health Mobility On the day of the study a convenient Technical aids sample of sixteen volunteers was Functional activities. recruited. This was done after the details Recreation

22 SA JOURNAL OF PHYSIOTHERAPY 2002 VOL 58 NO 3 complained of being lonely most of the family system which the elderly of for a woman to fulfil all those roles. time. They explained that during the day today lived through has a serious nega- We are old. We cannot remarry”. their children were at work and when tive impact on them. They are no longer The widowers, however, expressed they came back from work they were holding positions of prominence in some desire to remarry, but complained either too tired to socialise with them or societal structures as they are no longer of not finding the right partners as one they went out for leisure. This dilemma the folklore tellers, neither are they con- said: “When we try to remarry it is dif- is explained by the following quotation: sidered as repositories of wisdom. The ficult to find the right woman, as most “I stay with my son who is not married elderly at the centre confirmed this as women want only to get married for the and the nature of his work requires him they said that their children were no sake of money”. to be out of town most of the time. I am longer available as most of them go Those who were married said that life left in the house, sometimes for a day out for leisure and come back home only goes on as usual. All the groups, however, or more depending on which town he to find the elderly already in bed. agreed that marriage provides better has gone to work and I cannot even Abongomera (1994) put it simply that companionship as long as the spouses prepare meals for myself. I depend on the youngsters of today prefer to turn to continue to love and care for each other. meals from the Centre”. schools, newspapers, radio, and other The issue of sexuality and marriage Those who are widowed miss the media to acquire modern technical is a challenging one. Ebersole and Heiss companionship they had with their late knowledge. Deprived of a social role, (1990) defined sexuality as quality of spouses, as when their partners were the elderly lose the meaningful routines the person, energy-force that is expressed alive it was easy for them to engage in and stimulation that keep them active in every aspect of the person’s being. discussions of interest and of relevance and in good health (Apt, 1995). In this The World Health Organisation (WHO) to both. They mentioned that the spouses study the elderly at the centre in Mfuleni defines it as integration of the somatic, show love and they care for each other stressed social isolation which is cha- physical, emotional, intellectual and and provide good interaction, as one racterised by not feeling integrated or social aspects of sexual being, in ways participant said: included in supportive networks. Dugan that are positively enriching and that “I really miss my husband; we used to and Kivett (1994) identified factors that enhances personality, communication and talk about a lot of issues and laugh. It is contribute to social isolation. These love. The participants pointed out that difficult to talk with children because they include instability of residence, infre- they could best share their experiences, are rarely at home and in addition do not quent contact with friends and children, emotions and cultural values that relate enjoy the topics that we old people like”. lack of participation in social groups and to their generation with their own The participants at the centre in decline in sensory acuity and health. spouses. They viewed changing cultural Mfuleni Township complained of lone- values, lack of space and responsibilities liness as well as social and emotional 1.2 Sexuality /love/marriage as a serious dilemma. The fast changing isolation, factors which are supported by The widows felt that it was difficult for culture due to development leads to a the literature (Peplau and Perlman 1992; them to have sexual partners because widening intergenerational gap, parti- Dugan and Kivett 1994). Some studies they lived with their children and grand- cularly in places where this development reveal interplay of factors as causative children, with one mentioning: “We are is not matched with the resources. It factors of loneliness while Dugan and supposed to be good role models to our brings conflict of interest in all aspects Kivett (1994) showed that changes in children and grandchildren. It becomes of living. Sadly, the new lifestyles and loneliness were related to transitional difficult to advise them if we do not act values that come with development may life events like changes in marital status, as good examples to them”. cause the generation of people aged 60 usually through loss of a spouse and They said that marriage was entan- years and over to be devalued (Alvarez health. Furthermore, Dugan and Kivett gling, as one of them explained: 1989) as they are forced to depend on (1994) recognised the seriousness of “Marrying again means you as a woman their children on a number of issues. loneliness and isolation in association moving into another home and if you As also confirmed by this study, the with other debilitating conditions such have children they have to follow you to loss of spouse was the single most impor- as depression, grief and anxiety. Thiberg the new home and this could create a lot tant factor contributing to loneliness in (1989) viewed loneliness and isolation of problems. Traditionally a woman is later life (Berg et al 1981; Kivett and as threats to health, while Weiss (1973) supposed to be maintained by her hus- Scott 1979). Revenson (1986) observed identified two dimensions of loneliness, band. This means that relatives of your greater loneliness among those elderly namely social and emotional isolation. new husband will have to depend on that never married, or became separated, Weiss (1973) stated that social isolation you for all domestic chores. Secondly divorced or widowed than married elderly results from being or feeling detached the children become aliens in your new persons. Social isolation in elderly peo- from a social network or community, home and thirdly most of the men will ple is also associated with increased whereas emotional isolation stems from ask you to change your name and this tiredness, visits to health providers, drug loss or absence of an attachment figure. presents further problems, for instance, prescriptions, and physical and psycho- One could argue that the threat to the you have to assume a new identity. Old logical symptoms (Svanborg and Selker continued existence of the extended as we are, it becomes very demanding 1993).

SA JOURNAL OF PHYSIOTHERAPY 2002 VOL 58 NO 3 23 1.3 Life-styles/ behaviour / how to spend my money no matter how was not difficult for them to get the Respect and dignity little it may be”. pensions as the offices of the Social The elderly people complained of the Some of them said that they made Welfare were situated about three hun- different life-styles of the young gene- wills in which their children will mostly dred metres away from the Centre. One ration compared to theirs, as one said: be the beneficiaries of their estate. of them said: “The pension is not enough. “We never used to smoke and drink They (Government) should increase it by the way our children and grandchildren 2.3 Family/community support about 20-30%. Sometimes the churches do. It was rare to see a young woman Most of the participants acknowledged require us to contribute as much as we smoke and drink, but nowadays things the support they got from their children can, but we find ourselves without money have changed. Children have the freedom and immediate members of the family to contribute”. to do what they want”. like brothers and sisters and sometimes Most of the participants blamed the from the grandchildren. This support was 3. HEALTH intergenerational gap in culture and the mainly in the form of domestic chores, Most of the participants said that they new legislation, such as the Human financial, material and transport, as one were in good health despite having Rights Charter for giving the young said: “They do provide me with financial chronic medical disorders, such as people excessive rights, thus resulting in support. It is usually not enough but at hypertension, arthritis, neurological dis- the elderly losing their respect and dig- least it is there. Sometimes it is difficult orders and visual defects. The major nity. One participant commented: “Each to get all you want at once because they difficulty, which was highlighted, was child wants to live the way they want. have to manage their lives as well”. accessibility to health facilities. Transport If you try and intervene by suggesting Some community members also help was cited as one of the problems leading that this is not the way we should live the elderly in the form of transport and to difficulties in accessing health care and treat each other, the children either visits in times of illness, as one said: facilities. Mfuleni has one Community ignore you or they tell you to mind your “When you have not been seen for a day Health Centre which does not handle own business. You cannot beat them or so some members of the community serious cases, although referral systems because they will report you to Social come to check on you and if you are very exist between the clinic and the nearest Welfare for child abuse. Further, the pro- ill they do arrange transport to take you government hospitals, such as Tygerberg blem is compounded by our dependency to the hospital”. Hospital which is 30 kilometres away on the children both financially and Wilkin (1987) offers a useful defini- from Mfuleni. materially. Our children do not respect tion of dependency as, “a state in which Participants cited overcrowding at us as it used to be in the olden days. Those an individual is reliant upon others for hospitals and lack of drugs as difficulties olden days are gone for good”. assistance in meeting recognised needs”. they encounter when seeking health Clearly this is the prevailing situation in services. They complained of standing 2. SOCIO-ECONOMIC Mfuleni where the elderly who partici- in long queues in government hospitals This category contained the themes of pated in this study were dependent on where they are exempt from paying recognition/money/status, pension, safety their children or grandchildren. Even medical fees, as one said: “We have to and security as discussed below. those who were married and staying queue for a long time to see a doctor and alone were dependent on financial and sometimes medicine is not available”. 2.1 Recognition/Money/Status. material support from their children or A few had medical aid schemes which The elderly people in this study com- grandchildren, because they no longer helped them to access private hospitals plained that life was difficult without had a source of income of their own. which, they said, were better organised enough money. They thought that the The participants complained of poor in terms of provision of medical services. situation could be helped if they could housing, pointing out that the houses help themselves, as one said: “Our sta- they lived in were small and that they 3.1 Functional Activities tus in this society could be maintained find themselves sharing a room with All the participants mentioned that they if we had better houses and property so their grandchildren and sometimes the did not experience any difficulties in that the children could visit us instead of children, as one said: “We stay in small activities of daily living such as bathing, us being dependent on them”. houses and some of us share one room eating, dressing, walking and use of the with our children and grandchildren. toilet. They noticed, however, that they 2.2 Safety and security/ Dependency I suggest that the Centre could build were slow in some of these activities. Most of the participants said that they houses for us elderly so that we can rent Over half of the participants expressed take most of the major decisions con- them”. having difficulties in doing one or two cerning them though they sometimes of their chores. Shopping was cited as consult their family in order to have 2.4 Pension the most cumbersome as the following different opinions on the matter. Some The participants who receive pensions quotations illustrated: “We send the kids also said that they do control and direct from the National Pension Scheme said to buy for us”, and “I go on my own to how they feel their money should be that R 475.00 per month was inadequate buy whatever I want. When I used to send spent, as one said: “I make decisions on to meet their requirements. However, it the kids they used to cheat on change”.

24 SA JOURNAL OF PHYSIOTHERAPY 2002 VOL 58 NO 3 3.2 Mobility and technical aids The impression was that they rarely function, family and community support Masiphumle Centre has an administra- visit each other outside the Centre due and recreation. tive vehicle which is used to provide to the distance between their living quar- Physiotherapists are not traditionally some elderly with transport to and from ters. Their outcry was the lack of ade- involved in addressing the issues relating the Centre. The majority of the partici- quate facilities in Mfuleni for the elderly to some of the needs and experiences pants said that they were able to walk to have fun. While they appreciated the of the elderly highlighted in this study. for over a hundred metres without seri- literacy classes, they still felt that they However, physiotherapists could use ous problems, though slowly. One said: should be involved in a lot more recrea- their skills in promoting physical activity “Though I do not go very far I am able tional activities than provided at their and delaying the onset of disablement in to walk around the house and visit my centre. Recreational activities are said the elderly. Furthermore, physiothera- neighbours. I do not walk very fast but to be important for the elderly people in pists could facilitate the participation of at least I am able to walk on my own helping them to ‘enjoy’ life and endure this sector of the community as integral and do what I want in the house without morbidity (Borgono 1989). It is well members of society. Health professionals overburdening my children”. documented in the literature that healthy and students in the different health-related Another area of concern arises from ageing could be influenced by a lot of professions could assist in raising aware- the non-availability of technical aids factors such as interacting with others, ness among the youth about the elderly and other assistive devises such as spec- participating in a lot of developmental as a potential resource. Students placed tacles and hearing aids. Three of the tasks and feeling of worth that one is here for fieldwork should be made aware sixteen participants had walking aids part of a developing society (Alvarez of these needs in order to plan and which they obtained through the assis- 1995; Ebersole and Hess 1990; Svanborg implement appropriate interventions in tance of the Centre. Assistive devices and Selker 1993). The elderly can influ- collaboration with the different sectors were not obtainable anywhere in Mfuleni. ence and direct certain decision-making of the community. Those elderly persons who had specta- processes and hence be involved in the The research could have benefited cles said that the nearest place where problem-solving process. from a longitudinal study including more they could obtain spectacles, although Although the elderly people in elderly participants from this township, expensive, was from Bellville which is Mfuleni said that they could carry out as opposed to a cross-sectional one, so about 20 kilometres away. They sug- basic activities of daily living this did as to observe the variations of expe- gested the establishment of mobile ser- not mean that they could carry out tasks riences over a period of time. A longi- vices which could provide technical aids. such as shopping, use of transport and tudinal study would entail periodical In a study by Ferreira and Charlton the ability to manage finances. Finlay group discussions and interviews to (1992), health was ranked first as a (1993) stated that the quality of life in see if the results are consistent over a factor affecting the quality of life of many elderly people depend upon being period of time. More research is neces- the elderly people in South Africa. The mobile to pursue a variety of indoor and sary in this area so as to gather more WHO defines health as “a state of outdoor activities. information to provide the necessary complete physical, mental and social insight into the experiences of elderly wellbeing and not merely the absence of CONCLUSION AND RECOMMENDATIONS people in a township like Mfuleni. disease”. It further states explicitly that The findings of this study are similar to These experiences highlight the need the enjoyment of the highest attainable those of other studies (Berg et al 1981; for a human rights approach with clearly standard of health is one of the funda- Borgono 1989; Dugan and Kivett 1994; stated policies and commitment, appro- mental rights for all. Ferreira and Charlton 1995; Hampson priate health service strategies, and 1996). The economic situation of these improved socio-economic standards 3.3 Recreation elderly is closely related to the changes supported by properly researched data. When the community centre was esta- taking place in the social conditions of blished, the participants expected to be society. The pension which some of them involved in activities which would reduce receive is not adequate to meet most of REFERENCES their boredom. 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