A COMPARATIVE STUDY OF THE PREVALENCE, PATTERN,

DETERMINANTS AND EFFECTS OF ELDER ABUSE IN AN URBAN

AND A RURAL LOCAL GOVERNMENT AREA OF LAGOS STATE

BY

DR ONIGBOGI MODUPE OLAJUMOKE

A DISSERTATION SUBMITTED TO THE NATIONAL POSTGRADUATE

MEDICAL COLLEGE OF NIGERIA IN PARTIAL FULFILLMENT OF

THE REQUIREMENTS FOR THE AWARD OF THE FELLOWSHIP OF

THE FACULTY OF PUBLIC HEALTH (FMCPH)

NOVEMBER 2015

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DECLARATION

I hereby declare that this dissertation titled “A COMPARATIVE STUDY OF THE

PREVALENCE, PATTERN, DETERMINANTS AND EFFECTS OF ELDER ABUSE IN AN

URBAN AND A RURAL LOCAL GOVERNMENT AREA OF LAGOS STATE is my original and individual work.

It was written under the supervision of Dr.K.A.Odeyemi.

I declare that this work has not been submitted by me anywhere else in part or in full for any other examination.

______

Dr M.O. Onigbogi

Department of Community Health,

Lagos University Teaching Hospital, Lagos

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CERTIFICATION

I hereby certify that this dissertation was written by Dr M.O. Onigbogi under my direct supervision in the Department of Community Health and Primary Care, Lagos University

Teaching Hospital, Idi-Araba, Lagos State.

Supervisor

______

Dr K.A. Odeyemi

Department of Community Health and Primary Care,

Lagos University Teaching Hospital,

Idi-Araba, Lagos.

Head of Department

______

Dr K.A. Odeyemi

Associate Professor and Head of Department, Community Health and Primary Care,

Lagos University Teaching Hospital,

Idi-Araba, Lagos.

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ACKNOWLEDGEMENT

I am most grateful to God Almighty for giving me the strength to complete this project.

I want to appreciate my project supervisor, Dr K.A. Odeyemi who in spite of her busy schedule was patient to read this project work and suggested ways of moving forward.

To my parents, thank you for all your support. To my husband, Olanrewaju who gave words of assurance and hope during the course of doing this work, I appreciate you so much. I also appreciate my lovely children Oluwadarasimi and Ibukunoluwa.

To all the research assistants, CDA chairmen, community leaders and community guides I say a big thank you. I also appreciate the elderly respondents who took their time to answer our questions.

To all our consultants in the Department of Community Health, Lagos University Teaching

Hospital, thank you for taking the time to impart some knowledge.

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TABLE OF CONTENTS

DECLARARTION ii

CERTIFICATION iii

DEDICATION iv

TABLE OF CONTENTS v

LIST OF TABLES ix

LIST OF FIGURES xiii

LIST OF ABBREVIATIONS xiv

SUMMARY xv

CHAPTER ONE 1

INTRODUCTION 1

1.1.Background 1

1.2 Problem statement 4 1.3

Justification 6

1.4 Research hypothesis 9

1.5 Research questions 9

1.6 Aim and objectives 10

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CHAPTER TWO 11

LITERATURE REVIEW 11

2.1 History of Elder Abuse 11

2.2 Prevalence of Elder abuse 12

2.3 Patterns and types of Elder abuse 20

2.4 Theoretical models of Elder abuse 23

2.5 Risk factors for elder abuse 24

2.5. A. Individual level factors 24

2.5. B. Relationship factors 26

2.5. C. Community factors 27

2.5. D. Society factors 28

2.6 Characteristics of perpetrators 29

2.7 Perceptions concerning elder abuse 31

2.8 Consequences of elder abuse 34

2.9 Legislation on welfare of the elderly in Nigeria 36

2.10 Role of extended family support in prevention of elder abuse 37

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CHAPTER THREE 38

METHODOLOGY 38

3.1 Description of study area 38

3.2 Study design 40

3.3 Study population 40

3.4 Inclusion criteria 40

3.5 Exclusion criteria 40

3.6 Sample size estimation 40

3.7 Sampling technique 42

3.8 Data collection tools and technique 44

3.9 Training of research assistants 45

3.10 Qualitative data collection technique 45

3.11 Data analysis 46

3.12 Ethical considerations 49

3.13 Limitations 50

CHAPTER FOUR 51

RESULTS 51

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4.1 Quantitative results 51

4.2 Qualitative results 132

CHAPTER FIVE 143

DISCUSSION 145

5.1 CONCLUSION 157

5.2 RECOMMENDATIONS 158

REFERENCES 159

APPENDICES

Appendix A: Consent form and questionnaire 177

Appendix B: Focus Group Discussion guide 197

Yoruba Questionnaire 200

Appendix C:List of urban and rural LGAs in Lagos State 220

Appendix D: List of wards in Surulere LGA 221

Appendix E: List of wards in Ikorodu LGA 222

Appendix F: Letter to Surulere LGA

Appendix G: Letter to Ikorodu LGA

FGD Pictures

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Appendix H: Ethical approval

LIST OF TABLES

Table 1: Socio-demographic characteristics of respondents in urban and rural areas 51

Table 1b:Socio-demographic characteristics of respondents in urban and rural

LGAs (contd) 52

Table 2: Living arrangements, care provider and home ownership of respondents in

urban and rural LGAs 54

Table 3: Respondents housing and social amenities in urban and rural LGAs 56

Table 4: Ownership of household items by respondents and wealth index by location 58

Table 5: Major source of income and financial support of respondents in both locations 59

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Table 6: Distribution of financial dependants in the past 12 months in both locations 60

Table 7: Health status of respondents in urban and rural areas 62

Table 8: Social habits of respondents in urban and rural locations 64

Table 9: Activities of daily living and physical functionality of the respondents in

both locations 66

Table 10: Respondents’ involvement with social activities in the urban and rural areas 68

Table 11: Perceived social support in urban areas 69

Table 12: Perceived social support in rural areas 70

Table 13: Perceived social support scores of respondents in urban and rural areas 71

Table 14: Prevalence of elder abuse in urban and rural locations 72

Table 15: Types of psychological and physical abuse experienced in the last 12 months 74

Table 16: Types of neglect, financial and sexual abuse in the last 12 months 76

Table 17: Frequency of elder abuse in the last 12 months 78

Table 18: Association between socio-demographic variables and elder abuse in urban and rural location 81

Table 19: Association between health status, social habits and elder abuse 83

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Table 20: Association between living arrangements, social contacts and elder abuse 85

Table 21: Association between respondents’ financial support and elder abuse 87

Table 22: Factors associated with psychological abuse in the urban and rural locations 89

Table 23: Factors associated with financial abuse in urban and rural locations 91

Table 24: Factors associated with physical abuse in both urban and rural locations 93

Table 25: Factors associated with sexual abuse in both locations 95

Table 26: Factors associated with neglect in urban and rural locations 97

Table 27: Relationship between social support scores from family, friends and elder abuse in the urban areas 99

Table 28: Relationship between social support scores from family, friends and elder abuse in the rural areas 101

Table 29: Relationship between social support scores from significant others and elder abuse in urban and rural areas 103

Table 30: Relationship between total social support scores and types of elder abuse

in the urban area 105

Table 31: Relationship between total social support scores and types of elder abuse

in the rural areas. 107

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Table 32: Relationship between perpetrators of psychological and physical abuse and

the abused elders in urban and rural areas 109

Table 33: Relationships between perpetrators of neglect, financial with sexual abuse

and the abused elders 111

Table 34: Characteristics of perpetrators of psychological abuse in urban and rural areas 112

Table 35: Characteristics of perpetrators of physical abuse in urban and rural areas 114

Table 36: Characteristics of perpetrators of financial abuse in urban and rural areas 116

Table 37: Characteristics of perpetrators of sexual abuse in urban and rural areas 118

Table 38: Predictors of elder abuse in the urban location 119

Table 39: Predictors of financial abuse in the urban location 120

Table 40: Predictors of psychological abuse in the rural location 121

Table 41: Predictors of elder abuse in both locations 122

Table 42a: Depression symptoms in urban and rural areas in the last one month 124

Table 42b: Depression symptoms in urban and rural areas in the last one month (contd) 126

Table 43: Depression scores in rural and urban areas 128

Table 44: Association between types of elder abuse and depression in urban and

rural areas 129

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Table 45a: Problems of the elderly in the community 132

Table 45b: Problems of the elderly in the community contd 133

Table 46: Roles of the elderly in the community 135

Table 47a: Perceptions about psychological elder abuse 137

Table 47b: Perceptions about psychological elder abuse 138

Table 48: Perceptions about physical abuse 139

Table 49: Perceptions about financial abuse 140

Table 50: Atypical forms of elder abuse 141

Table 51: Perceived cause of elder abuse 143

Table 52: Consequences of elder abuse 144

LIST OF FIGURES

Figure 1: Interaction among types of elder abuse in the urban location 79

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Figure 2: Interaction among types of elder abuse in the rural location 80

Figure 3: Effects of elder abuse 123

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LIST OF ABBREVIATIONS

AARP- American Association of Retired Persons

ADL- Activities of Daily Living

FGD- Focus Group Discussion

IBM- International Business Machines

INPEA- International Network for Prevention of Elder Abuse

LGA- Local Government Areas

SPSS- Statistical Package for Social Sciences

WHO – World Health Organization

USA- United States of America

UK- United Kingdom

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SUMMARY

Elder abuse is gradually emerging as a significant public health and social problem in developing countries. Changing family and community support structures, economic environments, urbanization and shifts in values and practices are influencing the way elders are treated in the society. The prevalence of elder abuse which occurs in variety of ways in different social contexts may increase with rapidly aging population in many developing countries including

Nigeria. This study was conducted to determine and compare the prevalence, pattern, determinants and effects of elder abuse among the elderly in an urban and a rural Local

Government Area (LGA) of Lagos State.

Using a multistage sampling technique, 500 elderly respondents were selected from Surulere and

Ikorodu LGA. Data was collected through quantitative and qualitative methods. A pretested interviewer- administered questionnaire and FGDs were used to collect information from the respondents. Data was analyzed with IBM SPSS 20 and summarized using frequencies and proportions. Chi-square statistics was used to test for associations between variables and independent t-test was used for comparison of means with p-value assumed to be significant at p≤0.05. Binary logistic regression was used to predict the outcome of dependent variables. The

FGDs were analyzed using framework analysis to derive categories and themes.

The overall prevalence of elder abuse was 22.8% in the last 12 months. The prevalence of elder abuse was higher among the urban (29.6%) than the rural respondents (16%), p<0.001.

Psychological abuse was the most prevalent form of elder abuse and its prevalence was higher

17 among the urban (25.6%) than the rural respondents (8.8%), p<0.001. The other types of elder abuse did not show any statistically significant difference in the urban and rural LGA. The prevalence of financial and physical abuse in this study was 7.0% and 3.4% respectively. Sexual abuse and neglect were the least reported forms of elder abuse.

The predictors of elder abuse among urban respondents include presence of financial dependants

{OR:2.19 (95% CI: 1.21-3.94) and lack of satisfaction with level of involvement in social activities {OR: 2.15 (95% CI: 1.20-3.84)}. Psychological abuse in the rural location was predicted by the lack of financial support {OR: 2.88 (95% CI: 1.04-7.97)}. Financial abuse in the urban areas was best predicted by the presence of financial dependants {OR: 2.86 (95% CI: 1.02-

8.04)}.The respondents who had experienced physical abuse had significantly worse total social support scores (38.75±9.87) in the urban areas compared to those who had not experienced physical abuse (44.64±4.93); p=0.002. Significantly worse total social support scores was also reported for those who had experienced neglect (26.33±12.42) in rural areas compared to those with no experience of neglect (43.53±11.60); p=0.011.

Perception of what constitutes elder abuse in the community includes being ignored, disrespected, being required to pay bills and administrative bottlenecks encountered when trying to collect retirement benefits. Focus group discussants suggested high unemployment rates of the youths, peer pressure and modernization as possible factors responsible for elder abuse.

Most of the victims of elder abuse, 60.8% in urban and 42.5% in rural reported being angry as a result of elder abuse while only the experience of neglect in the urban LGA was associated with depression.

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CONCLUSION: Recommendations include creating social support groups and opportunities for social interaction among elderly peers in the community, establishing welfare programs, improving socio-economic conditions in the community, and improving family and community bonds with the elderly through awareness creation.

KEY WORDS: Elder abuse, mistreatment, community, urban, rural.

CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND

The world is ageing at a faster rate than has ever been known before in history.1 The progress that has been made with public health, medical interventions, improved standards of living and pharmaceuticals are increasing the life expectancy of populations across the globe.2 Worldwide, it is predicted that the number of people aged 60 years and above will double from the current

600 million to 1.2 billion by 2025.2 Although the proportion of older people out of the total population is higher in the developed countries, the percentage increase of the elderly population is much greater in the developing world.3Majority of the one million people reaching the age of

60 years every month are in the developing countries.3 In the next few decades, the numbers of older people in Sub-Saharan Africa will grow exponentially from 43 million in 2010 to 163 million by 2050 with their population rising from 5 to 10 %.4This progression in population ageing presents social, economic and cultural challenges to individuals, families, societies and the global community.5

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The individual process of ageing is multidimensional and involves physical, psychological and social changes.5Ageing increases the incidence and prevalence of disability and sometimes non- communicable diseases thus placing a physical and emotional strain on families and a financial burden on national, individual and health care budgets.2 It is therefore associated with increased dependence on others due to the reduction in physical functioning and frailty that accompanies it.3, 6

Elder abuse is emerging as an important public health and social problem that is usually pervasive and concealed from public knowledge.3 It is an expression of the anomaly of inter- personal violence and like other forms of domestic violence is brought about by a combination of economic, psychological, and social factors as well as physical and mental health conditions of the victim and the perpetrator.3It has been declared by the World Health Organization “as a violation of a person’s fundamental human right to be safe and free from violence”.7

The definition of onset of “old age” has not been accurate varying among different countries.6 In many developed countries the age of 65 years has been recommended for defining older persons as this is usually the age of retirement at which people become qualified for social security allowances.5 However, in most developing countries, this socially constructed idea based on retirement age remains insignificant.7 More concern is attributed to the roles assigned to people in their lifetime.7“Older persons frequently define old age as a stage at which functional, mental and physical capacity is declining and people are more prone to disease or disabilities and so can no longer carry out their work or family roles”. 5, 7 The United Nations defines the elderly as people aged 60 years and above.5

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In most traditional African societies, older persons, in particular males are highly respected and revered.8 The family has been the most natural and helpful social organization for the care and support of the elderly.8-10 The changing social and economic environments have resulted in the elderly no longer being given the respect and honour that tradition and cultural practices uphold.

8,11 Shifts in values and practices have influenced how the elders are viewed and treated in many societies.8, 11Industrialization and urbanization are eroding long standing patterns of interdependence between the generations of a family, often resulting in financial and emotional hardship for the elderly.8, 11, 12-14 These changes, create situations where elder abuse proliferate. 7

Abuse and neglect of older adults is a complex and multifaceted problem and according to the definition adopted by the World Health Organization “Elder Abuse is defined as a single or repeated act or lack of appropriate action occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person.”7Elder abuse can take the form of physical, psychological, sexual or financial abuse and also intentional and unintentional neglect, and can occur in domestic, community or institutional settings.7 It may also include medication abuse, abandonment, scapegoating, and marginalization of older people in institutions or social and economic policies.7

While research into elder abuse first emerged from developed countries where most of the studies have been carried out, evidence from some developing countries have demonstrated that it is a global phenomenon.3 The wide range of prevalence obtained for elder abuse of between 1-

40% is based on different population measures and varying definitions employed in several surveys. 3, 15-20 These figures however under- represent the true estimates because elder abuse is not easily reported by the victims because of shame.3, 21 Elder abuse denotes a breach of human and civil rights, an important cause of injury, ill health, hopelessness and dejection.22, 23 Like

21 other forms of violence, it has adverse effects on the victims, families, communities and health sector.21, 22

In Nigeria, the absence of social security systems, present economic situation and unpleasant government reform programmes has created increased difficulties for Nigerians especially the elderly.24 Elder abuse and neglect has therefore become more visible as a tragic social problem.24

It is bound to occur in situations where the family remains the only source of support for the elderly when sustainable systems and programs which ensure old age security arrangements are not available.25

1.2 PROBLEM STATEMENT

Elder abuse and neglect is gaining increased attention both internationally and precisely in some nations. There is growing concern regarding the global phenomenon of aging both in the developed and the developing nations of the world.9 Future demographic trends suggest that in both developed and developing countries, there will be dramatic increase in the population of the elderly.7 In developing countries, the demographic changes are taking place in circumstances of increasing mobility, changing family structures, rapid urbanization, modernization, industrialization, poverty and a rise in the number of women in the workforce. A combination of these factors have gradually reduced the availability of primary caregivers for the elders and increased the incidents of neglect and elder abuse.7, 26-27

The traditional social values and network of intergenerational exchange in Africa have gradually been drained due to the rapidly changing socioeconomic structures.12, 24Despite the invaluable contribution that the elderly make to their families and communities, they continue to experience deepening poverty, discrimination, violence and abuse and are unable to access

22 entitlements that are theirs by right.28 They also encounter social exclusion due to age discrimination and changing functions and practices within the family.28 This means that many elderly people face a future of neglect and abuse without a social safety net particularly in countries like Nigeria where pension benefits cover only a small segment of the elderly population.12, 24, 29, 30 The issue of elder abuse has not been adequately addressed in Nigeria because it is not yet recognized as an area of concern due to limited awareness on elder abuse.24

The victims continue to suffer in silence and endure the anguish associated with the scourge.24

In many parts of the continent, elders are valued and respected and awareness is just developing that elder abuse does occur. Elder abuse is still proscribed and when it does occur it is regarded as a domestic issue that should be resolved in the home.24, 27 The body of knowledge on ageing and older persons in Africa is not as widely known as in other continents due to lack of access to adequate funding for research and administrative restrictions.8, 12 There is therefore a huge reliance on criminal and social welfare records, journalistic reports, and small scale studies which have indicated that abuse, neglect and financial exploitation of older people are widely prevalent.7, 24

The overwhelming effects of elder abuse for the older person includes worsened quality of life, psychological distress, insecurity and loss of property.31 Studies till now have documented that the victims of elder mistreatment have significantly higher levels of psychological distress, and more negative self-perceptions about themselves than non-victims. Depression, suicidal thoughts and feelings of unhappiness, shame or guilt are common among victims of elder abuse.32, 33 As a result, elder abuse has been found to be associated with increased morbidity and in some cases mortality.31The financial cost of elder abuse is also enormous with costs rising as a result of increased use of medical and emergency services by abused older adults and billions of dollars

23 being spent annually on victims of elder abuse.34, 35 Considering the fact that the incidence of elder abuse is expected to rise with the growth of aging population, an increase in financial cost most likely will occur.35

1.3 JUSTIFICATION

Inter-personal violence has always been classified according to age groups. 26 Despite the fact that much information is available about child abuse and violence against women in the reproductive age group, too little is known about elder abuse especially in developing countries.3,

26 Elderly persons often find themselves in situations that make them less active within the society, with dwindling income and retirement occurring, their presence becomes diminished within the mainstream of society. They may lose mental and physical capabilities, leaving them vulnerable to exploitation.36 In Nigeria, the elderly make up the most vulnerable group after children and they are often marginalized.24 The focus of government policies has not been favorable towards the elderly because they constitute a relatively small part of the population although in terms of absolute numbers they are great.37 The population of the elderly 60 years and above in Nigeria according to the national census of 2006 was 6,987,047 which constitute

4.97% of the population, the largest south of the Sahara.38, 39

In Africa, the extended family has been depended upon to be the mainstay of care and support to the elderly.9, 27 The sustenance of this traditional arrangement for the elderly is currently being

24 threatened by rapidly occurring changes in the social and economic environment.9 Such changes are making smaller family sizes more prominent, increasing the rural-urban migration pattern and the number of females who are working. In summary, these have resulted in disintegration of the traditional way of caring for the elderly.9 The advent of modernization and urbanization has caused marked change in attitudes toward the elderly.2 Urbanization is promoting nucleation of family systems and reducing the care and support for the elderly.40, 41It is also recognized that increasing unemployment rates and poverty has made it increasingly difficult for grown up children to manage their own families as well as their aged parents thus putting the elderly at risk of abuse and neglect.39 With waning support systems, abuse of the elderly, in the form of violence, neglect, abandonment, disrespect, is becoming more prevalent leading to physical injuries and lasting psychological effects.42

Elder abuse can manifest in a variety of social contexts influenced by societal structures and factors such as social class, culture and urbanization which serves to pattern social behavior, perception and attitudes towards the elderly.43 Perception about what is regarded as elder abuse varies among different societies. 43 Location may play a role in the occurrence of elder abuse and this warrants its study in developing countries. In developed countries, the elderly in rural populations who are part of abnormal family relationships are particularly disadvantaged in that they may not be able to gain access to aging meetings and preventive services due to isolation.44

Geographic and social isolation, family obligations and caregiver stress are considered to be leading contributory factors to family violence in this setting.44 The setting in Africa is such that the anonymity and impersonal nature of urban living and the physical and social environment in cities may contribute to the problem of elder abuse.45 In rural settings pattern of abuse may vary as a result of cultural practices.30 Anecdotal evidence suggests that in some areas in rural Africa,

25 elderly women whose relatives meet with some kind of bad luck are blamed as the cause and branded witches resulting in being beaten, banished or killed.30 Urbanization may also influence the perpetration of abuse or violence because of the different characteristics of urban and rural areas in terms of population, family values, social amenities including the exposure to mass media and other forms of technology.46 The characteristics of perpetrators and the pattern of violence may vary in both urban and rural locations.

There is paucity of data regarding elder abuse in Africa.30 Very little is known about relationship factors and how they increase the risk for elder abuse in Africa.30 There exists a huge gap in knowledge on the causes and consequences and also perpetration of elder abuse in Sub-Saharan

Africa.30 Only extreme cases are reported in the newspapers as incidents of a criminal nature.24

Few studies have explored elder abuse and perpetrator characteristics from the perspective of older adults in the communities.26 The data on national prevalence of abuse and perpetration of abuse among the elderly in Nigeria is scanty. Suggestions have however been made to indicate that urbanization may be a risk factor for elder abuse.47

There is a need to identify the prevalence, perpetrator characteristics and determinants of elder abuse in the community. Lagos city is a product of rapid urbanization and is the economic nerve of Nigeria.48 This study will be a comparative study of the prevalence, pattern and risk factors for elder abuse in a rural and an urban Local Government Area of Lagos State. It will help to present baseline data on prevalence and characteristics of elder abuse in Lagos state, examine the attributes of victims and perpetrators and look at the contextual variables related to abuse and neglect. This task is both indicative of the emergence of elder abuse as a public health problem

26 and serves as a channel for achieving increased visibility in order for the issue to be placed on the forefront of social and political agendas. The information generated from this study will be useful in developing policy and appropriate interventions for preventing abuse of the elderly.

1.4 RESEARCH HYPOTHESIS

Null Hypothesis

There is no difference in the prevalence, pattern and determinants of elder abuse in an urban and a rural Local Government Area of Lagos State.

Alternative Hypothesis

There is a difference in the prevalence, pattern and determinants of elder abuse in an urban and a rural Local Government Area of Lagos State.

1.5 RESEARCH QUESTIONS

1. Is there a difference in the prevalence of elder abuse in an urban and a rural Local

Government Area of Lagos State?

2. Is there a difference in the pattern of elder abuse in an urban and a rural Local

Government Area of Lagos State?

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3. Is there a difference in the determinants of elder abuse in an urban and a rural Local

Government Area of Lagos State?

4. Who are the perpetrators of elder abuse in an urban and a rural Local Government Area

of Lagos State?

5. Is there a difference in the perception of elders concerning elder abuse in an urban and a

rural Local Government Area of Lagos State?

6. What are the effects of elder abuse on the victims in an urban and a rural Local

Government Area of Lagos State?

1.6 AIM AND OBJECTIVES

General objective

To determine and compare the prevalence, pattern, determinants and effects of abuse among the elderly in an urban and a rural Local Government Area of Lagos State in order to make recommendations on how it can be prevented.

Specific objectives

1. To determine and compare the prevalence of elder abuse in an urban and a rural Local

Government Area of Lagos State.

2. To determine and compare the pattern of elder abuse in an urban and a rural Local

Government Area of Lagos State.

3. To identify and compare the determinants of elder abuse in an urban and a rural Local

Government Area of Lagos State.

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4. To assess the perception of the elders on elder abuse in an urban and a rural Local

Government Area of Lagos State.

5. To examine the effects of elder abuse in an urban and a rural Local Government Area of

Lagos State.

CHAPTER TWO

LITERATURE REVIEW

2.1 HISTORY OF ELDER ABUSE

Elder abuse is one of the last forms of familial violence to come to public attention. Child abuse and domestic violence were the first to appear in literature and they were initially referred to as baby battering and wife beating respectively. The problem of elder abuse which was originally called “granny battering” later emerged.49 The first wave of research on elder abuse was described in British scientific journals in 1975.49

In the United States of America, these reports were immediately viewed as a socio-political concern and quickly led to legislative action. In the United Kingdom, it took another 15 years for the issue to receive research and political attention. 50Australia, Canada, China, Norway and

Sweden reported research into elder abuse to the United Nations in the 1980s, while Argentina,

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Brazil, Chile, India, Israel, Japan, South Africa, Great Britain and European countries reported research into elder abuse in the 1990s.7 1999 was declared by the United Nations as the

International Year of the Elderly. Issues of physical and emotional abuse against the elderly and street violence against the elderly began to be discussed and addressed in that year as of concern to the world as a whole and not just to developed or developing nations as individuals.26 Elder abuse is now seen as a human rights issue and has shifted away from a needs-based approach to a rights-based approach that recognizes the rights of people to equality of opportunity and treatment in all aspects of life as they grow older.51 The World Elder Abuse Awareness Day which was established by the United Nations in 2006 has been observed annually on the 15th of

June.52

Non Governmental Organizations (NGOs) in Nigeria commemorate the yearly occasion with a view to increase public awareness concerning the subject and provide solutions. The

International Network for the Prevention of Elder Abuse Nigerian Chapter established in 2007 acts in collaboration with other NGOs to discuss issues regarding the plight of the elderly in

Nigeria.53 Several NGOs such as Rosetti Care, Concerned Civil Society Coalition and Dave

Omokaro Foundation have organized annual events to foster solutions concerning elder abuse like encouraging the younger generation to respect the elderly, partnering with the Nigerian

University Commission to mainstream Gerontology as a course in several tertiary institutions in the country and organizing press events to draw attention to the problem of elder abuse.54

2.2 PREVALENCE OF ELDER ABUSE

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Estimates of the prevalence of elder abuse range from 2% to 10% based on various survey methods and case definitions from earlier population based surveys done in developed countries.15, 16, 55, 56 Recent studies conducted in several developed countries have indicated an increase in the prevalence of elder abuse.

One-year prevalence of elder abuse among community dwelling and cognitively intact elderly persons in the United States of America ranged between 7.6% -11.4% in different locations.21, 57,

58 A study conducted in the United States of America yielded a prevalence of 11.4% for elder abuse.57 This study assessed the types and risk factors of elder abuse. It also reported on the characteristics of perpetrators of abuse. The strength of the study includes the methodology that was used to recruit 5,777 elderly respondents. A random digital dialing was used to recruit a nationally representative sample of community dwelling elderly respondents. The weakness of the study was that it left out elders without cell phones and the interviews were conducted using the telephones suggesting that privacy of the individual could not be ascertained. This may affect the disclosure rates for elder abuse. A gap noticed in this study was its failure to assess the effects of elder abuse on the victims. The effects of elder abuse could have been examined by asking related questions on the effects of mistreatment.

Another study conducted in New York reported that 7.6% of 4,156 respondents had experienced elder abuse.21 The strengths of this study include its methodology and the scope covered. This study was carried out in the urban, sub-urban and rural areas of New York. It made use of random digital dialing strategy to create a representative sample of elderly respondents in the

New York State. The study assessed the prevalence, patterns, risk factors and characteristics of

31 perpetrators of elder abuse. The weakness of the study was that it left out elders without cell phones and the interviews were conducted using the telephones suggesting that privacy of the individual could not be objectively ascertained. The gap in this study was that it did not look at the effects of elder abuse which could have been assessed using the questionnaire.

A European survey of 7 countries reported a total prevalence of 22.6% for past year elder abuse.59 The study was conducted in Germany, Greece, Lithuania, Italy, Portugal, Sweden and

Spain with a prevalence of 35.3%, 23.2%, 33.0%, 14.6%, 33.8%, 36.6% and 28.5% respectively for elder abuse. 59 A major strength of this study was it being multi-country and an adequate sample size of 4,467 respondents was used. A standardized instrument was used to assess abuse which could be applied by other researchers. It was conducted in the urban areas of the seven countries making generalizability of findings to rural areas impossible. This study provided information on various aspects of elder abuse, relationship of perpetrators to the abused, the role of social support as a risk factor for mistreatment and the effects of elder abuse but did not describe perpetrators in terms of their socio-demographic and mental health characteristics.59

These characteristics could have been elicited from the respondents using the questionnaire.

The prevalence of elder abuse reported in a community based study in Macedonia was 32.0%.59

This study was community-based and was nationally representative which is a major strength of the study. It made use of a standardized questionnaire and adequate sample size of 960 respondents and the results showed the interaction between the specific subtypes of elder abuse experienced, however the data was not disaggregated into rural or urban categories. This study also assessed the risk factors and effects of elder abuse. A gap observed in this study was its

32 failure to describe the profile of perpetrators of abuse which could have been counted as risk factors. This gap could have been be addressed by asking the respondents to describe the characteristics of the perpetrators.

In the United Kingdom a prevalence of 2.6% was obtained from a sample of 2,100 people for elder abuse.61 The strengths of this study include its national representativeness, the sampling methodology and the scope of the study. The methodology used in the study was a multistage stratified probability sampling design and interviewers were trained for the research. The questionnaire used was a standardized instrument. The study reported on prevalence, risk factors and effects of elder abuse. The study made an attempt to characterize the perpetrators of elder abuse by asking for the age and relationship of perpetrators to the abused. The gap observed in this study include not assessing the relevance of socio-economic status to elder abuse and not determining other processes that may have led to elder abuse such as the use of alcohol and drugs by perpetrators. This could have been assessed by asking the respondents about the perpetrators.

In Ireland, a prevalence of 2.2% was obtained for abuse among 2,100 community-dwelling elderly respondents.62 This study examined the prevalence and risk factors for elder abuse. The strength of this study was making use of older women as interviewers which may have elicited more accurate response from the respondents. It also made use of a multistage cluster sampling methodology in recruiting respondents. This study was comprehensive in that it assessed the prevalence, risk factors and effects of mistreatment. It examined the mental health characteristics

33 of perpetrators of elder abuse and also reported clustering of different types of elder abuse experienced.62

At least 18.4% of 1045 elderly respondents in Israel had experienced elder abuse. 63This study was a community based study that examined the prevalence and risk factors and characteristics of perpetrators of elder abuse.63 The gap observed in this study was that it did not examine the effects of elder abuse on the victims. This study was nationally representative and multistage sampling technique was adopted in recruiting respondents. It was however conducted only in urban areas making generalizability to rural areas impossible.

Community-based studies carried out in Asia have also provided information on the prevalence of elder abuse. A study carried out in rural China in reported that 36.2% of the 2,039 participants had experienced elder abuse.19 The strengths of this study include the sampling methodology and the sample size used considering that it was done in a rural location. This was a cross-sectional descriptive study and cluster sampling was used in selecting the respondents. The interviewers used in this study were Masters in Public Health students. The study provided information about prevalence, risk factors and effects of elder abuse.19 The gap observed in this study however was the fact that the characteristics of perpetrators were not assessed. The questions on perpetrators could have been included in the questionnaire used for the survey.

A study also conducted in China reported a prevalence of 44.4% and 31.2% among rural and urban dwelling populations.64 It was a cross-sectional descriptive study. The weakness of this study was the fact that it was hospital-based, therefore the respondents were more likely to be

34 frailer than the general population and therefore impossible to generalize these findings to urban or rural populations. The strengths of this study include making use of a validated instrument to provide information about the prevalence and factors influencing elder abuse. It examined the effects of elder abuse on the quality of life of respondents but did not assess the characteristics of perpetrators.64

A prevalence of 21.1% was reported for elder abuse in a study conducted among 355 respondents in Hong Kong.17 It was a cross-sectional descriptive study that also assessed the impact of elder abuse on psychosocial functioning. This study however did not examine the effect of risk factors such as social support on the prevalence of elder abuse neither did it elicit information on the characteristics of perpetrators.

A different study of Hong Kong Chinese families reported a prevalence of 27.5% for elder abuse among 276 respondents.65 The strengths of this study was the fact that it was community-based and descriptive. The study was however limited to the urban areas. The study provided information about the prevalence and risk factors for elder abuse. The gaps observed in this study include not assessing the characteristics of perpetrators and the effects of elder abuse. These questions could have been included in the questionnaire used for the survey.

In India, a national prevalence study indicated that more than one-fifths (23%) of the 6,748 adults surveyed had experienced a form of elder abuse with the most common forms being disrespect, verbal abuse and neglect.66 The strengths of this study was its national representativeness, the sampling methodology and the sample size used in the study. This study

35 assessed prevalence of various types of abuse, socio-demographic risk factors and described the relationship of perpetrators to the victims. Social support and health status as risk factors for elder abuse were not assessed in this study. The effects of elder abuse were also not explored in this study.

Another community-based study carried out in urban India reported a prevalence of 14% among

400 respondents for any type of elder abuse.67 The strengths of this study include the sampling methodology and the scope of the study. The study employed a multistage sampling technique and assessed prevalence, risk factors and effects of elder abuse. An attempt was also made to describe the relationship of perpetrators to the victims, although the socio-demographic profiles and mental health of the perpetrators were not explored. The study conducted only in urban areas making generalizability to rural areas impossible.

In Kerala India, almost half (49%) of the 300 elders surveyed had experienced some form of abuse and neglect from their family members while in Kuala Lumpur Malaysia, a prevalence of

9.6% was obtained.68, 69 The studies in Kerala and Kuala Lumpur however did not assess the effects of elder abuse or characteristics of perpetrators.68, 69

Few studies on elder abuse done in Africa indicate that it is an emerging problem. In a study done in rural Egypt, a prevalence of 43.7% was obtained for elder abuse.70One of the strengths of this study was that it made use of an adequate sample size of 1,106 respondents. This study used of validated instruments in assessing elder abuse. The gaps in this study include not assessing the

36 prevalence of sexual abuse, the role of social support in elder abuse and the characteristics of perpetrators.70

In rural Kenya 81.1% of the 366 respondents had experienced elder abuse.43 This was a cross- sectional descriptive study that assessed the prevalence, risk factors and causes of elder abuse. A major strength of the Kenyan study was exploring community attitudes and perception towards elder abuse by using focus group discussions in addition to the quantitative study.43 The gaps observed in this study however were not assessing the role of social support in elder abuse and not exploring the effects of elder abuse. The data gathered was restricted to the rural areas therefore the results cannot be generalized to the urban areas.

In South Africa, 60.3% of the women and 64.3% of the men experienced elder abuse.71 This was a community-based descriptive study conducted in rural and urban areas of South Africa. A multistage sampling technique was used in selecting respondents. This study provided information about the prevalence and predictors of elder abuse but did not assess the role of social support in predicting mistreatment neither did it describe the perpetrators nor effects of elder abuse in this setting.71These gaps could have been addressed by including questions on social support and perpetrator profiles in the questionnaire.

In Ekiti, Nigeria, 58% of 220 elders surveyed had experienced a form of abuse.72 This was a community-based study that assessed the prevalence and perception of elder abuse. This study did not make use of a standardized instrument in eliciting elder abuse. This study did not assess the effects of elder abuse on the victims neither did it elicit how social support contributes to

37 elder abuse nor describe the perpetrators of elder abuse. These gaps could have been addressed by including questions on social support, perpetrator profiles and effects of abuse in the questionnaire used for the survey.

A study conducted among elderly women in rural and urban areas of Oyo state reported a prevalence of 30% for elder abuse.73 This study made use of standard instruments in assessing elder abuse in the community which was a major strength of the survey. A multistage sampling technique was used in selecting respondents. The study however did not ascertain the effects of social support on elder abuse and did not describe the perpetrators of abuse and the causes of elder abuse.73 These gaps could have been addressed by including questions on social support and perpetrator characteristics in the survey instrument.

A study in Enugu, Nigeria examined the prevalence of elder abuse in a cross-sectional study of

294 respondents.74 It was cross-sectional descriptive community-based study. The questionnaire used in this study only assessed the prevalence of physical psychological and financial abuse but did not include questions on neglect and sexual abuse as components of elder abuse. The risk factors and effects of elder abuse were not assessed in this study. The perpetrator characteristics were also not addressed in this survey. These gaps could have been addressed by including questions on neglect, sexual abuse, perpetrator profiles and effects of elder abuse in the survey instrument.

2.3 PATTERNS AND TYPES OF ELDER ABUSE

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Abuse of older persons comprises of various types such as psychological abuse, physical abuse, financial abuse, sexual abuse and neglect. In whatever form the abuse occurs, it will result in suffering and a reduced quality of life for the older person.7 The pattern and impact of elder abuse will depend on its frequency, duration, severity and consequences as well as the cultural context in which it occurred.7A major gap in elder abuse studies is the failure to assess the frequency and severity of the phenomenon. This study seeks to address these gaps in literature.

Psychological Abuse

This is sometimes referred to as verbal or emotional abuse; it involves the intentional infliction of mental anguish or the provocation of fear of violence or isolation in the older person.7

Psychological abuse can take various forms, such as name-calling, humiliation, intimidation or threats of banishment to a nursing home.7 It also includes embarrassment, controlling behavior, such as limiting access to transportation, money, and other resources, social isolation, disregarding or trivializing needs, or damaging or destroying property.75 In the United States of

America the prevalence of psychological abuse ranged from 1.6%-4.6% while in the United kingdom it was 0.4%.21, 57, 58, 61 The European survey reported a prevalence of 19.8% for psychological abuse with a prevalence of 27.1%, 13.2%, 10.4%, 24.6%, 21.9%, 29.7%, and

11.5% in Germany, Greece, Italy, Lithuania, Portugal, Sweden and Spain respectively.60 In

Israel, a prevalence of 14.5% was obtained while 27.3%, 5.1% and 36% was the prevalence of psychological abuse in rural China, Egypt and Kenya respectively.19, 43, 63,70

Physical Abuse

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This is the infliction of pain or injury, physical coercion or drug induced restraint.7 The most common violent acts toward elderly persons include slapping, pushing, hitting, burning, force- feeding, restraint, striking with objects or other show of force.75, 76 Frequent results of such mistreatment are bruises, sprains, abrasions, and occasionally skeletal fractures, burns, and other wounds.74 In the United States of America the prevalence of physical abuse ranged from 1.6%-

2.2% while in the United kingdom it was 0.4%.21, 57, 58, 61 The European survey revealed a prevalence of 3.3% for physical abuse with a prevalence of 3.3%, 3.4%, 1.0%, 3.8%, 2.1%,

4.0%, and 1.4% in Germany, Greece, Italy, Lithuania, Portugal, Sweden and Spain respectively.60 In Israel, a prevalence of 1.6% was obtained while 4.9%, 5.7% and 7% was the prevalence of physical abuse in rural China, Egypt and Kenya respectively.19, 43, 63, 70 In Iran, less than 1% of the 600 elders interviewed had experienced physical violence.77 In Enugu, Nigeria, a prevalence of 7.8% was obtained for physical abuse.74

Financial or Material Abuse

This is the illegal or improper exploitation or use of funds or resources of the older person.7

Financial exploitation of the elderly includes all forms of fraud, taking money under false pretence, forging of any kind of document to dupe the older person, illegal forced taking over of assets and property and the use of funds belonging to the older person to purchase expensive and inappropriate items for either the older person’s use or the use of another person.75 In the United

States of America, the prevalence for financial abuse ranged from 4.2%- 5.2% while that of the

European survey ranged from 1.8% -7.8% with the highest prevalence in Portugal.21,57, 58, 60 In the United Kingdom, the prevalence of financial abuse was 0.7% while in rural China, the prevalence was 2.0%.19, 61 In Israel 6.4% of the elders surveyed had experienced financial abuse

40 while prevalence for financial abuse in Iran was 41%.63, 77 On the African continent, a prevalence of 3.8%, 10% and 41.6% was obtained in Egypt, Kenya and Ado- Ekiti respectively. 43, 70, 72

Sexual Abuse

This includes all non-consensual sexual contact with the older person such as unwanted touching, sexual battery like rape or coerced nudity.7Among all types of abuse, sexual abuse is the most hidden and the least reported. The prevalence of sexual abuse reported for the United

States of America ranged between 0.6%-2.2% while that of United Kingdom was 0.2%. 21, 57, 58

,61 In the European survey of 7 countries, a prevalence of 0.8% was obtained for sexual abuse with a range of 0.3%-1.5% with the highest being in Greece.60 Most of the African studies previously cited did not assess the prevalence of sexual abuse.

Neglect

Neglect refers to the intended or unintended failure of a formal or informal caregiver to fulfill any part of a care-giving obligation. This may or may not involve a conscious and intentional attempt to inflict physical or emotional distress on the older person.7 Examples include failure to provide an older person with the necessities of life such as food, water, clothing, shelter, medical care, hygiene or social stimulation.7, 76 Care giver neglect is regarded by some authors as the most prevalent type of abuse. In Israel and Iran the prevalence of neglect was 26% and 66% respectively.63, 77 The prevalence of neglect reported for the United States of America ranged between 1.8%-5.9% while that of United Kingdom was 1.1%. 21,57,58, 60 In Kenya and Egypt, a prevalence of 47% and 42.4% respectively was obtained for neglect.43, 70 In Akwa Ibom, Nigeria, the prevalence of neglect among pensioners was 46.7% while in Ado- Ekiti, neglect was found to be 60.9%. 72, 78

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2.4 THEORETICAL MODELS OF ELDER ABUSE

Several approaches have been put forward to explain elder abuse.32, 76, 79, 80

Situational theory claims that an overburdened and stressed caregiver creates an environment for abuse.32, 76

Exchange theory addresses reciprocity and dependence between the abused and the perpetrator.

It suggests that abuse can occur within a framework of tactics and responses in family life.32, 58

Intra-Individual dynamics (psychopathology) theory claims a correlation between a mentally or emotionally disturbed abuser and abused. 32, 76

Intergenerational transmission theory or social learning theory states that an adult’s behavior relates to learned behavior as a child, thus reverting to the same pattern in adulthood. 76,

80

Feminist theory is based on domestic violence models, highlighting the imbalance of power within relationships and how men use violence as a way to demonstrate power.76

Political and economic theories have criticized the emphasis on individualistic theories claiming that structural forces and marginalization of elders within society have created conditions that lead to conflict and violence.76

Ecological model In response to the inadequacy of any single model and in order to accommodate the multiplicity and complexity of factors associated with elder abuse, researchers have considered the ecological model.80 This model explores the interactions between individual and contextual factors. It considers violence as a result of the complex interplay between the

42 person’s individual characteristics, close interpersonal relationships, characteristics of the community in which the person lives or works and societal factors such as policies and social norms.76, 80, 81

2.5 RISK FACTORS FOR ELDER ABUSE (THE ECOLOGICAL MODEL)

2.5. A. Individual level factors

Gender

Gender has been proffered by some researchers as a risk factor in elder abuse.7 Women have the advantage of longevity and they are more likely than men to experience elder abuse and discrimination in access to basic services such as education, health care and social security resulting in a cumulative status of ill-health which due to women’s second class status is often neglected or ignored. 23Some studies indicate that more victims are women as opposed to men. 61,

62, 67, 68, 76, 82 Older women were found to be more at risk of emotional, physical and sexual abuse in studies conducted in the United States of America and Canada.57, 83 Female widows are more likely to be victims of abuse.7

However, a study carried out in seven European countries showed that more men than women were victims of psychological, physical and financial abuse while more women experienced sexual abuse.60

Age

Ageing may be a risk factor for abuse due to the increased dependence on others, social isolation and frailty that accompanies it.7 The risk of maltreatment appears to increase with age.

43

A study in Kerala India showed that as age increases, the chances of abuse also increase, while in

Ireland, the prevalence of maltreatment among people older than 70 years was twice that among people aged 65- 69 years.62, 68 However, a study found younger age to be associated with elder emotional and physical abuse while another study linked it with emotional and financial abuse.57,

58

Dependence or Disability

Elder abuse rates may increase with higher levels of functional or health dependence, disability.84, 85 In Spain, the rate of abuse was four times among older people with higher levels of dependence.85 In addition, a study of the risk factors for elder maltreatment by caregivers in

Chinese families in Hong Kong showed that overall, verbal and physical abuse were predicted by participant’s dependence on the caregiver.65 Worsening health and dependence on someone to carry out activities of daily living have also been reported as risk factors for suspected abuse.86

Recent research found functional impairment as a risk factor for emotional and financial abuse while another study found poor self-reported health status to predispose to neglect and financial abuse.57, 58 A study in Ireland also found impaired physical health to be associated with higher risk of maltreatment.62 Also, older people with cognitive impairment such as Alzheimer’s disease and other forms of dementia experience a higher prevalence of maltreatment than the general population.87

2.5. B. Relationship factors

Living arrangements or shared accommodation

44

Living arrangements such as overcrowding and lack of privacy has been has been associated with elder abuse. Interacting regularly or sharing living accommodation with a perpetrator may increase the opportunity for violent encounters.7, 15, 88 Some studies in developed countries show that living alone reduces the risk of elder abuse whereas living with a family member is a risk factor for becoming a victim of abuse.15, 88 However, the risk of mental and financial abuse may increase when people live alone. A study in the United Kingdom showed that people living alone were more likely to report that they had experienced financial abuse in the past year than the participants who were living with other people.61 In contrast, a study done in urban India found that the elderly living alone reported experiencing more abuse and neglect than those staying with children or families.67

Financial dependence of the perpetrator

Many cases of elder abuse occur because the perpetrators are usually financially dependent on the elders for their accommodation, maintenance, transport and other costs.84, 89 This may be an important factor in our setting due to high unemployment rates of the youths.

2.5. C. Community factors

Social isolation

Social isolation is also a risk factor for elder abuse globally.7, 55 Isolation of older people can be both a cause and a consequence of abuse.85A lot of older people are isolated because of physical and mental diseases. The loss of friends and family members also reduces the opportunities for

45 social interaction.7 Elderly persons who are isolated from friends and family are also vulnerable to elder abuse because the behaviour remains concealed from public knowledge.

Lack of social support

The social networks of the elderly characterized by assistance from friends, family, neighbours and other community members constitute the sources of social support for the elderly and this may be an indication of well being in the elderly.90 Elderly people with low levels of community support were more prone to abuse compared to those with high levels of community support in

Ireland and India .62, 63Studies in China found that greater social support lowers the risk of elder abuse.91, 92 Most studies in Africa did not assess the role of social support in relation to elder abuse.

2.5. D. Societal factors

Socioeconomic status and poverty

Economic and social policies that contribute to sustenance of high levels of economic and social disparities within societies may add to the tensions that arise between groups. A great number of elderly people live on low incomes, increasing their dependence on others.7 A few studies have examined socioeconomic status as risk factors for elder abuse. In Turkey, a study found that the risk of elder abuse increased by more than twice if the educational level was primary school or lower versus secondary school or higher.93 In Israel and Pittsburgh, a higher educational level was a protective factor for verbal abuse.63, 94 A study among Latinos found a contrasting result in which higher educational levels predisposed them more to abuse.95 In India, two different studies

46 showed that economically dependent elderly were more vulnerable to verbal abuse and neglect than those who were not economically dependent and those who had eight or more years of education was protective of elder abuse.68, 96 A recent study in Bangladesh showed that 62% of elders from poor households had experienced elder abuse compared to 6% of elders from rich households.97 Similarly, low income and racial minority status were risk factors for neglect.68, 76

When governments also marginalize the elders by not making adequate investments for them leaves them vulnerable to exploitation.7

Cultural norms

Ageism which is a reflection of negative attitudes and stereotypes towards older people dehumanize them in various ways.7Widespread ageism across all sectors of society including the health care sector has been recognized as an important factor in the identification, management, and prevention of elder abuse.7

In Sub Saharan Africa, societal and community factors which contribute to elder abuse include the systems of patrilineal and matrilineal inheritance and land rights which affects the distribution of power.26, 98Accusations of the practice of witchcraft have driven many older women from their homes and their communities.7 Also, the disintegration between generations of a family, caused by rural-urban migration and the increasing coverage of people enrolling in formal education and changing roles women play in society have contributed to elder abuse. 26In addition, the processes of modernization are eroding the traditional welfare system in Africa such as the extended family structure. 11The indicators of modernization are urbanization and social isolation which are risk factors for elder abuse.47, 99Some studies found rural living to be

47 associated with increased risk of emotional abuse and elder abuse while urban living was associated with increased risk of physical or sexual abuse.83, 96, 100

2.6. CHARACTERISTICS OF PERPETRATORS

The dependency and the vulnerability of the elderly are the main factors that are capitalized upon by the perpetrators of elder abuse.100 The primary caregiver may perpetrate abuse because care giving may be seen as stress producing particularly if the elderly is dependent upon this person.100 If the perpetrator is not the caregiver, the dependency of an older adult on others for help may create a ready atmosphere or situation to persons who seek to exploit dependence. The elderly may also be neglected simply because the perpetrator is not experienced in care giving.7,26, 100

Perpetrators come from different backgrounds as well as the same backgrounds as the abused.

Also, gender differences may exist in the form and perpetrator of elder abuse. Studies done in the

United Kingdom and Ireland have indicated that perpetrators of elder abuse are more likely to be men than women especially for sexual abuse, severe physical abuse and homicide.62, 101, 102 More than half (51%) of the perpetrators of elder abuse were the spouses and 49% was by other family members in the United Kingdom.101 The perpetrators of abuse may have mental health problems such as depression, previous history of violent behavior and substance misuse especially alcohol abuse.102 In a study conducted in seven European countries, the partners or spouses were the most common perpetrators of psychological and physical abuse while most sexual abuse was committed by friends or acquaintances. Financial abuse in this study was mostly inflicted by other people such as care givers who are not family or friends.60

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A study carried out in Macedonia reported that in most cases, the elderly were psychologically abused by sons (29.5%), spouses (25.5%) and daughters-in-law (22.6%). Partners or spouses were most frequently the perpetrators of physical abuse (30.9%) followed by the daughters-in- law (23.6%). Financial abuse was most frequently perpetrated by sons in 40.8% of cases and daughters in law in 18.3% of cases while sexual abuse was mostly perpetrated by spouses in

76.9% of cases and male acquaintances in 23.1% of cases. The elderly respondents in Macedonia were neglected most commonly by their daughters-in-law. Neglect was most frequently committed by females in the Macedonian study.103 In Ireland and Israel adult children were most frequently identified as perpetrators of elder abuse and were usually unemployed and substance abusers. 62, 63

In the United States of America, about 57% of the perpetrators of elder abuse were partners or spouses and half of them were using drugs or alcohol at the time of abuse. About 30% of the perpetrators had a history of mental illness and more than one third of them were unemployed as well as had legal problems.104, 105Some caregivers who drink alcohol excessively may neglect their responsibilities to older people who depend on them.106 Another study that reviewed literature on elder financial abuse in the United States of America reported that 60% of the perpetrators were males aged between 30 and 59 years old. Most perpetrators of financial abuse were strangers (51%) followed by family and friends at 34%.107

In Japan, women are usually responsible for caring for the elderly and they make up the larger proportion of perpetrators. It is extremely rare for a person other than the family member to be

49 the abuser in Japan.108 A study conducted in India showed that sons were the primary perpetrators in 56% of cases compared to daughters –in law in 23% of cases.66

Previous studies in Africa have not described characteristics of perpetrators in terms of age, sex, substance use and mental health. This study seeks to fill these gaps in knowledge.

2.7. PERCEPTIONS CONCERNING ELDER ABUSE

Perceptions about what constitutes elder abuse varies across different cultures and nationalites.

Focus group discussions conducted in five developing countries and three developed countries generated older people’s views about what is termed abuse of the elderly.26The developing countries were Argentina, Brazil, India, Kenya and Lebanon while the developed countries were

Canada, Austria and Sweden.26

In developing countries, the government was blamed for the mistreatment the elderly experienced in their homes, in public, and in health care institutions. 26 This was referred to as societal abuse which was said to be the root cause of most of the other types of abuse experienced at personal levels.26 In Kenya, abadonment was the most common issue metioned about elder abuse in both healthcare settings and in other social contexts.26 This was a common trend in both rural and urban areas.109 Also featured as elder abuse in Kenya was the fact that the older person or the family had to pay for health care services.109

In India, the elderly considered negligence as a form of abuse, while emotional abuse, verbal abuse, economic abuse, lack of respect towards the elders, and physical abuse embodies elder

50 abuse.26, 64, 110 Legal abuse was also mentioned in Lebanon and India. The elderly Indians felt that their daughters in law could easily file a complaint of being abused by them to the police and the reported elderly could be arrested.26 The elderly Lebanese felt legal abuse occurred because there were no laws to protect the rights of the older adults. 26

In Brazil, from the older person’s view, elder abuse was any deviation from the expectation of how they were to be treated in the family and public by virtue of their age.111 Most of the respondents perceived abuse to be any violation of the rights of the individual and the most frequently mentioned types of abuse were psychological in nature.111A few elderly persons spoke about physical forms of abuse though uncommon.111Also, the pattern of elder abuse was presented as seasonal. It was linked with long weekends, and holiday seasons in which elders were put in hospitals if their family members had a place to go to spend the holidays.26,111

Societal abuse in terms of discrimination based on age as well as difficulties in accessing health and social services and inadequate pensions were among the frequently perceived forms of abuse in Argentina. 112 Disrespect was featured as elder abuse in all the developed and developing countries surveyed.26 Literature from parts of Africa also indicate that marginalization, disrespect, more violent forms of abuse such as accusations of witchcraft and seizing of assets are perceived and regarded as elder abuse.113

In Canada, loss of freeedom of choice , as well as loss of control over their lives and being forced to do things against their free will constituted elder abuse. 26The study in Sweden revealed that elder abuse though considered a taboo was unacceptable. Loss of respect for the elderly and cut back in health care benefits were commonly accepted to be precursors of elder abuse.114

51

Several types of abuse were discussed, including psychological and physical abuse as well as neglect , ageism, and crimes against elderly people.114In Austria, the most common perception of elder abuse was failure of the elderly persons to be treated as regular citizens with rights.115 They felt ignored by both the government and other social security agencies and were of the opinion that they were maltreated while trying to access social services.115 Confining an adult with disability to institutions for long term care was also frequently mentioned as a form of elder abuse and it was perceived as psychological punishment.115

The elderly in Ireland viewed psychological abuse as the most damaging form of elder abuse and it was the main determinant of the impact of abuse on the older person.116Apart from the individual types of elder abuse experienced, the elders also mentioned abuse at the societal levels citing that disrespect was common in the society due to lack of adequate funding committed to the training of health workers and school children on respectful behaviour towards the elderly.116

2.8. CONSEQUENCES OF ELDER ABUSE

The consequences of elder abuse can be serious and can have negative effects on older people.

Abuse in old age has profound effects on the physical, psychological, social, security and financial wellbeing of the individual. 31Physical and mental capacity as well as social positions are grossly affected by incidents of elder abuse and neglect. It may also increase the severity of existing health conditions that has already affected the elderly person’s well-being and can render disease and prevention promotion activities ineffective.31 Researchers advocate that more

52 research is needed to better understand the relationship between elder abuse and a range of health outcomes.117

Physical consequences

The elderly may be unable to defend themselves because they usually have less phsical strength.

Studies have shown that older persons subjected to abuse are more prone to having physical injuries.31, 32 Injuries may result in deleterious and life altering situations such as hip fractures, chronic pain, need for supports, disability and a move to assisted living or ultimately premature death.31, 118 Neglect has been associated with increased incidence of malnutrition, dehydration, hypothermia, hyperthermia, pressure sores, which further complicates the health isssues of the elderly.31

Psychological consequences

Few studies have reported that a high proportion of abused elderly people suffer from depressive symptoms and psychological distress.119-121These include feelings of guilt, shame, lonelinesss, loss of self esteem, embarassment, fear, anxiety reactions, helplessness, insecurity, and post traumatic stress syndrome.112, 122 A study in the United States of America found that victims of elder abuse had a higher likelihood of reporting emotional symptoms and functional impairments.122 Victims of elder abuse have also been reported to deny they are being mistreated, minimize the abuse or excuse the abuser, thus enhancing the risk for perpetration of the abuse.114

Financial consequences

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Financial abuse may result in loss of property, inability to pay bills, lowered standard of living and poverty. 123 There are tangible and intangible social and financial implications associated with elder abuse such as costs to healthcare and community services as well as justice systems and the older victims themselves.35, 122

Social consequences

Abuse and neglect of older adults has significant impact on the individual, family and society because it affects social functioning. The compromise in health may necessitiate increased help from family and community services.124 It may result in having fewer contacts with family members, violent actions and withdrawal from social circles.32

2.9. LEGISLATION ON THE WELFARE OF THE ELDERLY IN NIGERIA

Nigeria’s interest in ageing as a social problem began with the first World Assembly on Ageing in Vienna in 1982, but Nigeria only showed serious commitment in 1999 when the report of the

4th Global conference of the International Federation of Ageing in Montreal, Canada was submitted to the Federal Executive Council by the delegates who represented the country.39 The fall out of the Montreal meeting was for each country to recognize that population ageing was occurring with its attendant problems and there was a need to develop strategies for solving the social and economic challenges faced by the older persons with the hope of improving their dignity and quality of life.125 Subsequently, the Federal Executive Council decided to set up an

54

Inter-ministerial Committee to fashion out a National Plan of Action on Active Ageing for

Nigeria. A broad action plan was developed but this was not implemented due to lack of funds.126

In Nigeria, the elderly has not been a priority of successive governments though the 6th Senate passed; A “Bill for an Act to establish a National Centre for Elderly Persons for General Purpose of Providing Welfare and Recreational Facilities For the Elderly and the Designing of

Developmental Programmes and Activities for the Advancement of Elderly persons in Nigeria”.

This bill was passed on July 14, 2009.39 This bill is yet to be implemented.39“The main cause of

Nigeria’s failure to act on ageing is due to lack of comprehensive evidence on the magnitude, nature, implications and challenges of the population ageing that would convince policy makers”.126 Nigeria is ranked 86th position out of 96 countries according to a report published on the United Nations International Day of old persons.127 Only Ekiti and Osun States which are located in Southwestern parts of Nigeria provide social pensions for people older than 65 years.127 Lagos State’s commitment to the health and well being of the elderly only includes providing them with free health care services at the government hospitals.128

2.10. ROLE OF THE EXTENDED FAMILY SUPPORT IN PREVENTION OF ELDER

ABUSE

The care and support of the elderly in Nigeria has traditionally been provided by the family members, especially the wives, sons, daughters, sons-in-law and daughters-in-law. This care giving was not only influenced by emotional ties emerging from blood or marital relationships but also by the requirements of traditional values, norms and behaviours of various ethnic groups

55 in Nigeria.129,130 The care of the elders therefore had a moral and spiritual connotation to it.

Traditionally, the elderly did not know poverty because the extended family system was in existence where children, parents and grandparents lived together to provide social support and material benefits to one another.129, 130Hence, it can be extrapolated that elder abuse was not common place in traditional Africa due to this traditional form of care.

The extended family is however dwindling as a culture resulting decreasing social networks as urbanizationand migration take young members of the family away. Social changes are also affecting the position of the elderly in the society and leading to a reduction in their social status and influence in the community.131 All these factors may lead to increase in prevalence of elder abuse in the community.

CHAPTER THREE

METHODOLOGY

3.1 DESCRIPTION OF STUDY AREA

The study was conducted in Lagos State. The state was created on May 27, 1967 and is located in South Western Nigeria on the narrow coastal flood plain of Bight of Benin. It lies approximately on longitude 20 42oE and 30 22oE respectively and latitudes 60 22oN and 60 521 N.

Lagos State is bounded to the North and East by Ogun State of Nigeria, to the West by the

Republic of Benin, and to the South by the Atlantic Ocean. It remains the most populous state in

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Nigeria but also the smallest in the Federal Republic of Nigeria in terms of land space. It occupies an area of 358,862 hectares or 3,577sq.km. Lagos is a metropolitan city made up of 5 administrative divisions, namely Lagos, Ikeja, Ikorodu, Epe and Badagry. These are further divided into 20 Local Government Areas, 4 of which are rural and 16 designated as urban. This stratification is based on the availability of social amenities and infrastructure such as pipe borne water, electricity and good road networks.132, 133 The state has an institutional facility for the care of the elderly and offers free medical treatment for the elderly accessing the government health care facilities.128

The state is the commercial and industrial hub of Nigeria and enjoys a concentration of about

70% of commercial and business activities in the country with over 2000 manufacturing industries and 200 financial institutions.132 Lagos State has a total population of 9,113,605 according to the 2006 census which represents over 6.4% of the national population of 140 million.38However, the current estimates of the population by the Lagos State Government puts it at 21million.132 The population of older persons aged 60 years and over in Lagos State is 331,

071 for both sexes representing a proportion of 3.63% of the total population of the state.132

3.1 Surulere Local Government Area

Surulere Local Government Area is one of the 16 urban Local Government Areas in Lagos

State.It is located at 623N and 325E. Its distance from Central Lagos is about 8km. With an area of about 27sq km, the area is bounded to the North by Mushin LGA, tothe West by Ojo LGA and to the East by Mainland LGA.123 It is a thickly populated area with a population of 962,833 people and is divided into 23 wards.38 The total population of the elderly in Surulere Local

Government Area is 21,761 including 10,616 men and 11,145 women.38Surulere LGA is a well planned area with modern industrial estates at Iponri, Iganmu, and Coker areas and comprises of

57 the proper “Eko” people, migrants from other parts of Nigeria like Ibo people of the East,

Yoruba of the West, Hausa people of the North and Ilaje and Urhobo of the Mid Western parts of

Nigeria.132 There are eight primary health centers in Surulere LGA. There are no designated health facilities or day care facilities for the welfare of the elderly.

3.1 Ikorodu Local Government Area

Ikorodu LGA is one of the four rural Local Government Areas in Lagos state. It occupies an area of 161,954 square kilometers and is the second largest LGA in the state. It lies about 36 kilometers North east of the City of Lagos. It has boundaries with Kosofe LGA to the West, Epe

LGA to the East, and the Lagos Lagoon to the South. The inhabitants of Ikorodu are mostly

Ijebus a Yoruba sub-group. The occupations of the people include farming, hunting and fishing.

132 It has 30 wards and a total population of 527,917 according to the 2006 National Population

Census.38The total population of the elderly in Ikorodu LGA is 17,526 including 9,418 females and 8,108 males.38 There are 19 Primary Health Centers and two Secondary Health Facilities in

Ikorodu LGA. There are no designated health facilities or day care facilities for the welfare of the elderly.

3.2 STUDY DESIGN

The study was a comparative cross sectional study of the prevalence, pattern, determinants and effects of elder abuse in an urban and a rural Local Government Area in Lagos State.

3.3 STUDY POPULATION

The study population consisted of males and females aged 60 years and above.

3.4 INCLUSION CRITERIA

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Adults aged 60 years and above at the time of study and those who permanently resided in the selected LGA were eligible for the study.

3.5 EXCLUSION CRITERIA

Elderly persons who could not provide information by themselves due to dumbness, deafness or psychiatric illness, unconsciousness or any other communication problems and elderly visitors to the Local Government Areas were excluded from the study.

3.6 SAMPLE SIZE ESTIMATION

The sample size was determined using the formula for comparing two proportions.

2 134 n/group = (u+v) [P1(100-P1) + P2(100-P2)]

2 (P1-P2)

Where n = Minimum sample size for each group u = Standard normal deviate corresponding to the probability of type 1 error (α) at 5%

= 1.96 v = Standard normal deviate corresponding to the probability of making type II error (β) of

20% power at 80% = 0.84

P1 = the prevalence of elder abuse among rural dwelling adults in South Africa

= 65.1%71

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P2 = the prevalence of elder abuse among urban dwelling adults in South Africa

= 52.2%71

(P1 – P2) = minimum difference in prevalence of elder abuse between the rural and urban dwellers. n =(1.96+0.84)2[65.1(100- 65.1) +52.2( 100 -52.2)]

(65.1- 52.2)2

Minimum sample size per group = 225

To compensate for incompletely filled questionnaires, 10% would be added = 23 n= 225+23= 248

Minimum sample size per group = 248

The minimum sample size per group is 248 approximated to 250.

3.7 SAMPLING TECHNIQUE

A multistage sampling technique was used for the study.

Stage 1: Selection of Local Government

Two local government areas, one urban (Surulere) and one rural (Ikorodu) were selected by simple random sampling through balloting from a stratified list of 16 urban and 4 rural LGAs in

Lagos State.

Stage 2: Selection of wards

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Four wards were selected from each of the two Local Government Areas by simple random sampling through balloting, making a total of eight wards. The wards selected in Surulere LGA were Agunbiade, NuruOniwo, Gbaja Obele Odan and Shitta Bankolemo while those of Ikorodu

LGA were Ibeshe, Majidun, Tonabu and Atere.

Stage 3: Selection of streets

In each of the selected ward, streets were selected by simple random sampling from the list of streets obtained from the local government secretariat. An equally proportionate number of respondents were interviewed in each ward.

Agunbiade ward- A total of 9 streets were selected by simple random sampling through balloting from a total of 34 to achieve a sample size of 62 respondents in this ward.

Nuru Oniwo ward- A total of 10 streets were selected from a list of 58 streets by simple random sampling through balloting to achieve a sample size of 63 respondents in this ward.

Gbaja Obele Odan ward- A total of 13 streets were selected from a list of 56 streets by simple random sampling through balloting to achieve a sample size of 63 respondents in this ward.

Shitta ward- A total of 6 streets were selected by simple random sampling through balloting to achieve a sample size of 62 respondents from a list of 19 streets.

Ibeshe ward- A total of 15 streets were selected through balloting from a list of 30 streets to achieve a sample size of 62 in this ward.

Majidun ward- A total of 16 streets were selected from a list of 36 streets through balloting to achieve a sample size of 63 respondents in this ward.

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Tonabu ward- A total of 18 streets were selected out of 30 by simple random sampling through balloting to achieve a sample size of 62 respondents in this ward.

Atere ward- A total of 14 streets were selected out of 41 through balloting to achieve a sample size of 63 respondents in this ward.

Stage 4: Selection of houses

The first house in each street was selected by simple random sampling method through balloting and subsequent houses were selected consecutively until the sample size required was achieved.

Stage 5: Selection of households

In each house, a household with eligible respondents was selected by balloting for houses with more than one household. If more than one elderly person was present in a household, the respondent was selected through simple random sampling by balloting. If a selected house had no eligible respondent, then the next house was used.

3.8 DATA COLLECTION TOOLS AND TECHNIQUES

Data was collected using both qualitative and quantitative methods. For the quantitative aspect, an interviewer- administered questionnaire adapted from a questionnaire on elderly abuse and neglect by the WHO and that used for the abuse of the elderly study in Europe was used to obtain information from the respondents.3, 135 The questionnaire consisted of seven sections labeled 1-7. Section 1 consisted of questions on socio-demographic details; the respondent’s age at last birthday, sex, religion, marital status, education status, and occupation. Section 2 consisted of questions on the living arrangements of the respondents such as the number of living children, number of persons living in the respondent’s household, whom the respondent lives with, house

62 ownership, possession of household items and the monthly income of the respondents. Section 3 consisted of questions assessing the medical and social history of the respondents such as health status, present medical illness, medication use, compliance with medication, alcohol consumption and cigarette smoking history. Section 4 consisted of questions on activity of daily living which was used to assess dependence and functionality. Section 5 consisted of questions on the prevalence and pattern of elder abuse including the types of elder abuse, frequency of occurrence and the perpetrator characteristics. The various types of elder abuse such as psychological, physical, financial, sexual abuse and neglect were assessed with 35 questions.

Section 6 assessed the factors associated with elder abuse by asking questions about social support, financial dependence of the respondents, and financial dependence of the perpetrator.

The seventh section assessed the effects of elder abuse on the victims, which consisted of questions on how the elders felt about abuse, injuries experienced by the elders and whether the respondents had any symptoms of depression using the Geriatric Depression Scale.

The questionnaire was pretested in Mushin LGA and Badagry LGA among 10respondents each in both locations and it was corrected to suit the socio cultural environment. The questionnaire was administered in the two predominant languages in the state, Yoruba and English. It was translated to Yoruba and back translated into English to ensure original meanings were retained before translation by an expert in linguistics.

3.9 TRAINING OF RESEARCH ASSISTANTS

Five research assistants were trained for two days on the proper administration of the questionnaire. An understanding of the survey procedure, methodology, coordination of the

63 project, logistics and standardization of the process were emphasized during the training. The research assistants had a minimum qualification of Ordinary National Diploma and were able to speak English and Yoruba language fluently. The research assistants and the researcher collected data with the use of the questionnaire. Data was collected over a 4 month period, between

August and November 2014. The completed questionnaires were reviewed by the researcher and research assistants and errors and wrong entries were corrected before leaving each venue.

Completed questionnaires were stored in locked up folders to further ensure confidentiality.

3.10 QUALITATIVE METHOD OF DATA COLLECTION

Four Focus Group Discussions (FGDs) were carried out for qualitative data collection after the quantitative data collection. The tool was adopted from the one used in a WHO study.26Two

FGDs, one elderly male group and one elderly female group each were carried out in both the rural and urban areas. The purpose of the Focus Group Discussions was to assess the perceptions of the elders concerning elder abuse in their communities. The participants of the Focus Group

Discussions were purposively recruited through the Community Development Association members. The participants who comprised of elderly persons who were aged 60years and over were invited to the venue of the FGDs. The urban FGD was held in an enclosed location within the community while the location for the rural FGD was at the residence of the chairman of

Community Development Association of Imota. The urban FGDs comprised of a group of 10 elderly women and another group of 9 elderly men. The rural FGDs comprised of 10 elderly women and 8 elderly men each. Their ages ranged from 62 to 98 years. Each FGD was made up of the participants, a moderator and a recorder. The discussions were taped on a recorder. Each

64 session lasted an average of 1hour. The discussants were entertained after each FGD session and were given transport fares to venue and back to their homes.

3.11 DATA ANALYSIS

The questionnaires were collated and entered into IBM Statistical Package for the Social

Sciences statistics version 20(SPSS Inc., Chicago,USA) spreadsheet. Data was cleaned and analyzed using the same software and winpepi. Data was presented using frequency tables, charts and Venn diagram. Data was summarized with percentages and proportions and Pearson chi-square was used to test for associations between variables and Fischer’s exact was used wherever the cell content was less than 5. The independent t-test was used to test for difference between means. Values of p≤0.05 were considered as statistically significant. Binary logistic regression was used to predict the outcome of the dependent variable. The independent variables that were fed into the regression models were those factors found to be statistically significant in bivariate analysis. The predictor variables were entered into the logistic regression model as a single block to control for possible confounders between the predictor variables. The magnitude and direction of the relationship between the variables were expressed as odd’s ratios.

Questions on the various types of abuse experienced within 12 months preceding the study was analyzed. A positive response to any of the questions in the various categories was assumed to be a positive experience of abuse. The frequency of elder abuse was measured by reporting the highest frequency for each category of abuse and multiple abuses was said to occur if the respondents had experienced any combination of at least two or more types of abuse.

65

Socio-economic status was assessed by constructing wealth index tertiles using the Principal

Component Analysis. The following variables were included in the calculation of the wealth index; ownership of household items included in question 18, monthly income, ownership of a house, type of house, source of water, type of fuel used for cooking and were entered into the

PCA and a factor was derived which accounted for 33.0% of the observed variance. Some variables were deleted from the analysis matrix to improve the fit. Ownership of house, type of housing, monthly income, source of domestic water, mobile phones were subsequently removed from the model which improved the variance to 42%. Tertiles were constructed and categorized into highest tertiles, middle tertiles and lowest tertiles.

The Katz index of Independence in the Activities of Daily Living commonly referred to as the

Katz ADL was used to assess physical functioning which is also part of the WHO questionnaire.

The index ranked adequacy of performance in six functions: eating, dressing, toileting, bathing, transferring (getting up from a sitting position), walking and feeding. A score of 1 was assigned to respondents for independence in any of these activities and 0 for any level of dependence in any of the activities. A score of 6 indicates full function, 3-5 indicates moderate impairment and

2 or less indicates severe functional impairment.136

A modified form of the Multidimensional Scale of Perceived Social Support (MPSS) which comprised of 12 items rated on a 5-point Likert scale with response format ranging from

1=strongly disagree to 5= strongly agree was used to assess perceived social support from family, friends and significant others. It consists of 12 questions which can be divided into 3 sub- scales: support from family, significant other and friends. Each sub-scale was calculated when all related 4 items were answered. The possible range of each subtotal score ranged from 4-20. The possible range of total score (sum of all 12 responses) was 12-60. A high score signifies

66 increased level of perceived social support. Mean scores were generated for each sub-scale and total mean scores were also calculated and the difference in mean scores between abused and non abused elders were tested using the T-test. The total MSPSS has been reported to have high internal consistency with Cronbach’s alpha 0.86.137, 138

The Geriatric Depression Scale 15 (GDS 15) was used to measure depression. Each question had a yes or no answer. A score of 1 point was assigned to each question. A yes answer to questions

“2, 3, 4, 6, 8, 9, 10, 12, 14, 15” and a no answer to questions “1, 5, 7, 11 and13” indicates depression. Scores for depression can range from 0-15. A score of 5 -10 points is suggestive of mild depression and > 10 points severe depression.139

Focus Group Discussions (FGDs) were analyzed using Framework Analysis method. Transcripts were first read for a general overview, and comprehension. This stage was followed by familiarization with the data, achieved by listening to tapes, reading the transcripts and observational notes taken during the interview. The next stage involved identifying a thematic framework –themes were developed from the research questions and narratives of research participants. Descriptive statements were formed and an analysis was carried out on the data.

This was followed by indexing, highlighting and sorting out quotes and making comparisons both within and between cases. Quotes were then lifted from their original context and re- arranged under the newly –developed thematic content and finally interpreted.

3.12 ETHICAL CONSIDERATIONS

The approval to conduct this study was obtained from the Health Research and Ethics Committee of Lagos University Teaching Hospital before commencement of the study. Permission was also

67 obtained from the secretariat of Surulere and Ikorodu Local Government Area. Permission was also sought from the leaders of the Community Development Association of Surulere wards and

Ikorodu wards. A written informed consent was obtained from each of the respondents before the interviews were conducted by signature or by thumb printing on each questionnaire. All the interviews were conducted privately and confidentiality was maintained throughout the study.

Names and addresses were not included in the data collection instrument. Respondents had the choice to decline or withdraw from the study at any time without any consequences.

The elders that were found to be suffering from abuse and neglect were linked up with social workers from a Non Governmental Organization, “Initiative for Better Public Health” who sent provisions to the elders that required assistance.

3.13 LIMITATIONS

The ages of few of the respondents were not known and estimates were made by relating historical events to the birth period of the respondents. Some of the respondents could not recall some of the socio-demographic details of the perpetrators of abuse.

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CHAPTER FOUR

RESULTS

The survey sample comprised 500 respondents with half 250(50.0%) residing in the urban and the other half 250(50.0%) in the rural areas.

Table 1a: Socio-demographic characteristics of respondents in urban and rural LGAs

Variable Urban Rural Total χ2 Df P-value

n=250(%) n=250(%) n=500(%)

Age (years)

60 – 69 148(59.2) 133(53.2) 281(56.2) 3.53 3 0.316

70 – 79 65(26.0) 73(29.2) 138(27.6)

69

80 – 89 32(12.8) 33(13.2) 65(13.0)

>90 5(2.0) 11(4.4) 16(3.2)

Mean age±SD 69.7±8.2years 70.2±9.1years 69.9±8.7years t=0.69 0.489

Sex

Male 100(40.0) 79(31.6) 179(35.8) 3.94 1 0.062

Female 150(60.0) 171(68.4) 321(64.2)

Marital Status

Single 3(1.2) 7(2.8) 10(2.0) 6.44 3 0.096*

Married 141(56.4) 117(46.8) 258(51.6)

Separated 13(5.2) 21(8.4) 34(6.8)

Widowed 93(37.2) 105(42.0) 198(39.6)

*Fischer’s exact

Table 1b: Socio-demographic characteristics of respondents in urban and rural LGAs (continued)

Variable Urban Rural Total χ2 Df P-value

n=250(%) n=250(%) n=500(%)

Religion

Christianity 153(61.2) 134(53.6) 287(57.4) 15.53 2 <0.001**

Islam 96(38.4) 99(39.6) 195(39.0)

Traditional 1(0.4) 17(6.8) 18(3.6)

Ethnicity

Yoruba 179(71.6) 218(87.2) 397(79.4) 22.58 2 <0.001**

Igbo 45(18.0) 13(5.2) 58(11.6)

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Others 26(10.4) 19(7.6) 45(9.0)

Occupation

Unskilled 94(37.6) 120(48.0) 214(42.8) 23.32 3 <0.001**

Semi-skilled 20(8.0) 42(16.8) 62(12.4)

Skilled 8(3.2) 10(4.0) 18(3.6)

Retired 128(51.2) 78(31.2) 206(41.2)

Level of Education

No formal education 45(18.0) 129(51.6) 174(34.8) 93.86 3 <0.001**

Primary 67(26.8) 78(31.2) 145(29.0)

Secondary 67(26.8) 28(11.2) 95(19.0)

Tertiary 71(28.4) 15(6.0) 86(17.2)

**p≤0.05 Others: Hausa, Ibibio, AkwaIbom

Females constituted the majority of respondents in both urban 150(60.0%) and rural 171(68.4%) areas. Most of the respondents in both locations were married, 141(56.4%) in the urban location and 117(46.8%) in the rural area. There was no statistically significant difference in age, sex and marital status distributions of the respondents in the two locations. There was a statistically significant difference in the ethnic composition of both groups with the rural location having more respondents from the Yoruba tribe 218(87.2%) than the urban area 179(71.6%) while respondents of the Igbo tribe were more in the urban 45(18.0%) than the rural areas 13(5.2%).

The main religion in both areas was Christianity with 153(61.2%) in urban and 134(53.6%) in the rural location. A higher proportion of respondents in the urban area were retired 128(51.2%) compared to the rural respondents 78(31.2%) while more of the rural respondents were unskilled workers 120(48.0%) compared to the urban respondents 94(37.6%). A higher proportion of rural respondents had no formal education 129(51.6%) compared to the urban respondents 45(18.0%)

71 while more of the urban respondents had tertiary education 71(28.4%) compared to the rural respondents 15(6.0%). The differences in occupational status and educational status were statistically significant.

Table 2: Living arrangements, care provider and home ownership of respondents in urban and rural areas

Variable Urban Rural Total χ2 df P-value

n=250(%) n=250(%) n=500(%)

No of living children

0-4 93(37.2) 105(42.0) 198(39.6) 1.20 1 0.314

≥5 157(62.8) 145(58.0) 302(60.4)

Living Arrangement

Alone 8(3.2) 39(15.6) 47(9.4) 22.57 1 <0.001**

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Other family members 242(96.8) 211(84.4) 453(90.6)

Main Care Provider

Spouse 39(15.6) 25(10.0) 64(12.8) 37.01 3 <0.001**

Self 62(24.8) 128(51.2) 190(38.0)

Children 142(56.8) 92(36.8) 234(46.8)

Relatives 7(2.8) 5(2.0) 12(2.4)

Ownership of home

Owned by me 111(44.4) 85(34.0) 196(39.2) 15.46 2 <0.001**

Rented 131(52.4) 136(54.4) 267(53.4)

Owned by children 8(3.2) 29(11.6) 37(7.4)

**P≤0.05

A higher proportion of the urban respondents had 5 or more children 157(62.8) compared to their rural counterparts 145(58.0) although the difference in the number of children that they had was not statistically significant. More of the rural dwellers 39(15.6%) compared to the urban dwellers

8(3.2%) lived alone and this difference was statistically significant. A higher proportion of urban respondents 142(56.8%) mentioned their children as their main care provider compared to their rural counterparts 92(36.8%) while more rural respondents 128(51.2%) took care of themselves solely compared to the urban dwellers 62(24.8%). The difference in care giving was statistically significant. More of the urban dwellers 111(44.4%) owned their homes compared to the rural dwellers 85(34.0%) and similar proportions in both locations rented their homes. The difference in home ownership was statistically significant.

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Table 3: Respondents housing and basic amenities in urban and rural LGAs

Variable Urban Rural Total χ2 Df P-value n=250(%) n=250(%) n=500(%) Type of Housing One bedroom 75(30.0) 91(36.4) 165(33.0) 144.99 4 <0.001* Flat in blocks 123(49.2) 23(9.2) 146(29.2) Duplex 25(10.0) 18(7.2) 43(8.6) Bungalow 27(10.8) 100(40.0) 127(25.4) Huts 0(0.0) 18(7.2) 18(3.6) Source of water Pipe borne water 93(37.2) 98(38.2) 191(38.2) 21.263 3 <0.001*

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Bore hole 109(43.6) 69(27.6) 178(35.6) Well 48(19.2) 78(31.2) 98(19.6) Lake, pond/stream 0(0.0) 5(2.0) 5(1.0) Type of toilet Water closet 248(99.0) 92(36.8) 340(68.0) 224.05 3 <0.001* Pit latrine 1(0.4) 144(57.6) 143(29.0) Public toilet 1(0.4) 8(3.2) 9(1.8) No facility /bush 0(0.0) 6(2.4) 6(1.2) Fuel for cooking Electric / gas 51(20.4) 16(6.4) 67(13.4) 79.17 2 <0.001* Kerosene 198(79.2) 172(68.8) 370(74.0) Charcoal / Firewood 1(0.4) 62(24.8) 63(12.6) Electricity supply Yes 250(100.0) 233(93.2) 483(96.6) 17.60 1 <0.001* No 0(0.0 17(6.8) 17(3.4) * Fischer’s exact

Most of the urban respondents 123(49.2%) lived in flats in block of flats compared to the rural elderly 23(9.2%) while most of the rural dwellers 100(40.0%) lived in bungalows compared to the urban dwellers 27(10.8%). There was a statistically significant difference in the type of housing in the both locations. The source of water for majority of the respondents in the urban location was borehole 109(43.6%) compared to majority of rural respondents 98(38.2%) who got their water supply from pipe borne water. The majority of urban respondents used water closet 248(99.0%) compared to rural respondents who mostly used pit latrine 144(57.6%). Although a greater proportion of urban dwellers 198(79.2%) used kerosene for cooking compared to the rural respondents 172(68.8%), more rural respondents 62(24.8%) used firewood/ charcoal compared to the urban respondents 1(0.4%). There was a statistically significant difference in the source of

75 water supply, type of toilet used and type of fuel used for cooking and availability of electricity in both locations.

Table 4: Ownership of household items by respondents and wealth index by location

Variable Urban Rural Total χ2 Df P-value

n=250(%) n=250(%) n=500(%)

Household items

Radio 235(94.0) 163(65.2) 398(79.6) 63.49 1 <0.001**

Television 240(96.0) 148(59.2) 388(77.6) 97.39 1 <0.001**

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Mobile Phone 205(82.0) 171(68.4) 376(75.2) 12.40 1 0.001**

Refrigerator 174(69.6) 72(28.8) 246(49.2) 83.25 1 <0.001**

Generator set 168(67.2) 69(27.6) 237(47.4) 78.26 1 <0.001**

Air conditioner 69(27.6) 32(12.8) 101(20.2) 16.99 1 <0.001**

Electric iron 233(93.2) 113(45.2) 346(69.2) 135.13 1 <0.001**

Fan 248(99.2) 189(75.6) 437(87.4) 63.22 1 <0.001*

Wealth index

Lower tertile 5(2.0) 110(44.0) 115(23.0) 146.02 2 <0.001**

Middle tertile 63(25.2) 70(28.0) 133(26.6)

High tertile 182(72.8) 70(28.0) 252(50.4)

**P<0.05

There was a statistically significant difference in possession of all household items with urban respondents having more appliances than the rural respondents. There was a statistically significant difference in the wealth index of the respondents in the urban and rural locations. A higher proportion of the urban dwellers 182(72.8%) belonged to the higher tertile compared to the rural dwellers 116(44.0%) who were mostly in the lower tertile.

Table 5: Major source of income and financial support of respondents in both locations

Variable Urban Rural Total χ2 Df P-value Freq(%) Freq(%) Freq(%)

Major source of income Personal 104(41.6) 147(58.8) 251(50.2) 14.83 3 0.001* Spouse 16(6.4) 12(4.8) 28(5.6)

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Children 126(50.4) 88(35.2) 214(42.8) Others 4(1.6) 3(1.2) 7(1.4) Total 250(50.0) 250(50.0) 500(100.0) Source of personal income Pension 37(35.6) 15(10.2) 52(20.7) 43.48 2 <0.001** Salary 25(24.0) 13(8.8) 38(15.1) Trading 42(40.4) 119(81.0) 161(64.1) Total 104(41.4) 147(58.6) 251(100.0) Financial situation Self sufficient 34(13.6) 24(9.6) 58(11.6) 7.60 3 0.023** Partly self sufficient 155(62.0) 138(55.2) 293(58.6) Total dependence 61(24.4) 88(35.2) 149(29.8) Total 250(50.0) 250(50.0) 500(100.0) Having financial support Present 231(92.4) 183(73.2) 414(82.8) 32.36 1 <0.001** Absent 19(7.6) 67(26.8) 86(17.2) Total 250(50.0) 250(50.0) 500(100.0) Main source of financial support Spouse 26(11.3) 19(10.4) 45(10.9) 5.45 3 0.141* Children 200(86.6) 153(83.6) 353(85.3) Relatives 3(1.3) 3(1.6) 6(1.4) Others 2(0.9) 8(4.4) 10(2.4) Total 231(55.8) 183(44.2) 414(100.0) *Fisher’s exact **P<0.05

The children were the major source of income for the urban respondents 126(50.4%) compared to the rural respondents whose major source of income was from their personal earnings

147(58.8%). More of the rural respondents 88(59.1%) were totally financially dependent on others compared to the urban respondents 61(40.9%) and this difference was statistically significant. A greater proportion of rural respondents 67(26.8%) did not have any form of financial support compared to the urban respondents 19(7.6%).There was a statistically

78 significant difference in the major source of income and availability of financial support in both locations. The children were the major source of financial support in the urban 200(86.6%) and rural 153(83.6%) locations.

Table 6: Distribution of financial dependants in the past 12 months in both locations

Variable Urban Rural Total χ2 Df P-value Freq.(%) Freq.(%) Freq.(%) Presence of financial dependants Yes 100(40.0) 111(44.4) 211(42.2) 0.99 1 0.365

79

No 150(60.0) 139(55.6) 289(57.8) Total 250(50.0) 250(50.0) 500(100.0) Financial dependants Spouse 6(6.0) 8(7.2) 14(6.6) 21.07 4 <0.001* Children 63(63.0) 75(67.6) 138(65.4) Grandchildren 14(14.0) 27(24.3) 41(19.4) Niece/nephew 5(5.0) 1(0.9) 6(2.8) Others 12(12.0) 0(0.0) 12(5.7) Total 100(47.4) 111(52.6) 211(100) Degree of dependence Total 21(21.0) 76(68.5) 97(46.0) 52.92 2 <0.001* Partial 67(67.0) 34(30.6) 101(47.9) Episodically 12(12.0) 1(0.9) 13(6.2) Total 100(47.4) 111(52.6) 211(100) Problems with financial dependants Yes 15(15.0) 17(15.3) 32(15.2) 0.004 1 0.949 No 85(85.0) 94(84.7) 179(84.8) Total 100(47.4) 111(52.6) 211(100) *Fischer’s exact

Similar proportions of urban 100(40.0%) and rural 111(44.4%) respondents had financial dependants and this did not show any statistically significant difference. The children were the most common dependants in the urban 63(63.0%) and rural (67.6%) areas, however the rural respondents 27(24.3%) had a higher proportion of dependants being the grandchildren compared to their urban counterparts 14(14.0%) and this difference was statistically significant. A greater proportion of dependants in rural areas 76(68.5%) were totally dependent on the respondents compared to those of the urban areas 21(21.0%) and this showed a statistically significant difference.

80

Table 7: Health status of respondents in urban and rural areas

Variable Urban Rural Total χ2 df p-value Freq.(%) Freq.(%) Freq.(%) Presence of health problems Yes 178(71.2) 191(76.4) 369(73.8) 1.75 1 0.186 No 72(28.8) 59(53.6) 131(26.2)

81

Total 250(50.0) 250(50.0) 500(100.0) Types of Health problem Cardiovascular 76(42.7) 35(18.3) 111(30.2) 26.02 1 <0.001* CNS 13(7.3) 29(15.2) 42(11.4) 5.67 1 0.021** GIT 4(2.2) 18(9.4) 22(5.7) 8.46 1 0.004** Endocrine 20(11.2) 18(9.4) 38(10.3) 0.33 1 0.610 Eye 50(28.1)) 75(39.3) 125(33.9) 5.14 1 0.028** Genitourinary 9(5.1) 6(3.1) 15(4.1) 0.87 1 0.433 Respiratory 22(12.4) 25(13.1) 47(12.7) 0.044 1 0.877 Musculoskeletal 68(38.2) 155(80.7) 22(60.2) 69.76 1 <0.001** Fever 12(6.9) 10(5.3) 22(6.0) 0.39 1 0.661 Total 178(71.2)*** 191(76.4)*** 369(73.8)*** Self rated health Excellent 25(10.0) 34(13.6) 59(11.8) 57.074 4 <0.001** Very Good 54(21.6) 37(14.8) 91(18.2) Good 106(42.4) 54(21.6) 160(32.0) Fair 65(26.0) 95(38.0) 160(32.0) Poor 0(0.0) 30(12.0) 30(60.0) Total 250(50.0) 250(50.0) 500(100.0)

***Multiple response**p≤0.05

CNS: Central Nervous System GIT: Gastrointestinal System Fever: malaria

The difference in existing health problems in both locations was not statistically significant.

More urban respondents 76(42.7%) had cardiovascular related health problems compared to rural respondents 35(18.3%). A higher proportion of rural respondents 29(15.2%) had central nervous system related health problems compared to urban respondents 13(7.3%). A higher proportion of rural respondents 18(9.4%) had gastrointestinal system related health problems compared to urban respondents 4(2.2%). More urban respondents 20(11.2%) had endocrine related health

82 problems than rural respondents 18(9.4%) while more rural dwellers 75(39.3%) had eye related problems compared to urban dwellers 50(28.1%). The differences in prevalence of cardiovascular, central nervous system and eye related health problems were statistically significant. The differences in genitourinary and respiratory health related problems were not statistically significant. A greater proportion of rural respondents 155(80.7%) had musculoskeletal problems 68(38.2%) compared to urban respondents and this difference was statistically significant.

A greater proportion of the urban respondents indicated that their health status was good

106(42.4%) compared to the rural respondents 54(21.6%) while more of the rural respondents

30(12.0%) were of poor health status compared to the urban respondents who did not report poor health 0(0.0%). The difference in self rated health status was statistically significant.

Table 8: Social habits of respondents in urban and rural locations

Variable Urban Rural Total χ2 Df P-value Freq.(%) Freq.(%) Freq.(%) Currently takes alcohol Yes 58(23.2) 88(35.2) 146(29.2) 8.71 1 0.004** No 192(76.8) 162(64.8) 354(70.8)

83

Total 250(50.0) 250(50.0) 500(100.0) Frequency of alcohol intake Rarely 23(39.7) 31(35.2) 54(37.0) 14.37 2 0.001** Occasionally 21(36.2) 12(13.6) 33(22.6) Regularly 14(24.2) 45(51.1) 59(40.4) Total 58(39.7) 88(60.3) 146(100.0) Presently smoking cigarettes Yes 19(7.6) 16(6.4) 35(7.0) 0.28 1 0.726 No 231(92.4) 234(93.6) 465(93.0) Total 250(50.0) 250(50.0) 500(100.0) Frequency of smoking Rarely 1(5.3) 4(25.0) 5(14.3) 5.74 2 0.075* Occasionally 4(21.1) 0(0.0) 4(11.4) Regularly 14(73.7) 12(75.0) 26(74.3) Total 19(54.3) 16(45.7) 35(100.0) *Fisher’s exact **P≤0.05

A larger proportion of the urban dwelling elderly 192(76.8%) did not consume alcohol compared to the rural elderly respondents 162(64.8%) while more of the rural respondents 45(51.1%) compared to urban respondents 14(24.2%) regularly consumed alcohol. The differences in alcohol consumption and the frequency of alcohol intake in both locations were statistically significant. The difference in cigarette smoking and the frequency of smoking in both locations was not statistically significant.

Variable Urban Rural Total χ2 Df p-value (ADL)

n=250(%) n=250(%) 500(%) Bathing Require no assistance 243(97.2) 213(85.2) 456(91.2) 22.43 1 <0.001**

84

With some assistance 7(2.5) 37(14.8) 44(8.8) Dressing Require no assistance 243(97.2) 238(95.2) 481(96.2) 1.37 1 0.242 With some assistance 7(2.8) 12(4.8) 19(3.8) Toileting Require no assistance 243(97.2) 244(97.6) 487(97.4) 0.08 1 0.779 With some assistance 7(2.8) 6(2.4) 13(2.6) Eating Require no assistance 247(96.8) 248(99.2) 495(99.0) 0.202 1 0.653 With some assistance 3(1.2) 2(0.8) 5(1.0) Walking Require no assistance 237(94.8) 231(92.4) 468(93.6) 1.202 1 0.361 With some assistance 13(5.2) 19(7.6) 32(6.4) Getting up from a sitting position Require no assistance 218(87.2) 223(89.2) 441(88.2) 0.480 1 0.580 With some assistance 32(12.8) 27(10.0) 59(11.8) ADL score (functionality) Require no assistance 216(88.4) 200(80.0) 416(83.4) 3.686 2 0.175 Moderately needs help 25(10.0) 36(14.4) 61(12.2) Severe disability 9(3.6) 14(5.6) 23(4.6) Table 9: Activities of daily living and functionality scores of the respondents in both locations

**P≤0.05 ADL: Activities of Daily Living

A higher proportion of respondents in the rural areas 37(14.8%) compared to urban 7(2.5%) elderly needed assistance with bathing and this difference was statistically significant. The differences in the need for assistance with dressing, toileting, eating, walking and getting up from a sitting position of respondents in both locations were not statistically significant.

85

Overall, more of the rural respondents 14(5.6%) compared to their urban counterparts 9(3.6%) had severe disability indicating they required total assistance with activities of daily living but this difference was not statistically significant.

Table 10: Respondents’ involvement with social activities in the urban and rural areas

Variable Urban Rural Total χ2 Df P-value Freq.(%) Freq.(%) Freq.(%) Involvement in social activities Yes 221(88.4) 199(79.6) 420(84.0) 7.202 1 0.010**

86

No 29(11.6) 51(20.4) 80(16.0) Total 250(50.0) 250(50.0) 500(100.0) Satisfaction with social activities Yes 163(65.2) 139(55.6) 302(60.4) 4.82 1 0.035** No 87(34.8) 111(44.4) 198(39.8) Total 250(50.0) 250(50.0) 500(100.0) Reasons for non satisfaction Health problems 56(64.4) 60(54.1) 116(58.6) 4.59 3 0.205 Activities not available 7(8.0) 19(17.1) 26(13.1) Too expensive 8(9.2) 14(12.6) 22(11.1) Age 16(18.3) 18(16.2) 34(17.1) Total 87(43.9) 111(56.1) 198(100.0) Contact with children Yes 246(98.4) 216(86.4) 462(92.4) 25.63 1 <0.001** No 4(1.6) 34(13.6) 38(7.6) Total 250(50.0) 250(50.0) 500(100.0) **P<0.05 A higher proportion of the respondents in the urban 221(88.4%) compared to those in the rural areas 199(79.6%) were involved in social activities and the difference was statistically significant. A higher proportion of respondents in the rural areas 111(44.4%) expressed dissatisfaction with their level of involvement in social activities compared to the urban respondents 87(34.8%) and this difference was statistically significant. Also a higher proportion of the rural respondents 34(13.6%) did not have frequent contacts with their children compared to the urban respondents 4(1.6%) and the difference was statistically significant.

Table 11: Perceived social support in urban areas

Statement Strongly Disagree Indifferent Agree Strongly Total disagree agree Special person around 0(0.0) 3(1.2) 42(16.8) 147(58.8) 58(23.2) 250(100.0)

87

Special person I can 1(0.4) 2(0.8) 30(12.0) 152(60.8) 65(26.0) 250(100.0) share my joys Family tries to help 3(1.2) 18(7.2) 45(18.0) 151(60.4) 33(13.2) 250(100.0)

Emotional help from 1(0.4) 4(1.6) 35(14.0) 168(67.2) 42(16.8) 250(100.0) family Special person who 4(1.6) 1(0.4) 29(11.6) 139(55.6) 77(30.8) 250(100.0) comforts me Friends try to help me 6(2.4) 38(15.2) 113(45.2) 84(33.6) 9(3.6) 250(100.0)

Depend on friends 8(3.2) 69(27.6) 81(32.4) 84(33.6) 8(3.2) 250(100.0)

Share problems with 0(0.0) 12(4.8) 46(18.4) 153(61.2) 39(15.6) 250(100.0) family Friends with whom I 6(2.4) 44(17.6) 96(38.4) 84(33.6) 20(8.0) 250(100.0) can share my joys Person caring about my 0(0.0) 5(2.0) 27(10.8) 159(63.6) 59(23.6) 250(100.0) feelings Family helps make 2(0.8) 8(3.2) 33(13.2) 161(64.4) 46(18.4) 250(100.0) decisions Share problems with 10(4.0) 78(31.2) 88(35.2) 65(26.0) 9(3.6) 250(100.0) my friends

Most people 161(64.4%) in the urban area agreed that their family was willing to help them make decisions while they 78(31.2%) mostly disagreed that they could talk about their problems with their friends.

Table 12: Perceived social support in rural areas

Statement Strongly Disagree Indifferent Agree Strongly Total disagree agree

88

Special person around 13(5.2) 9(3.6) 20(8.0) 140(56.0) 68(27.2) 250(100.0)

Special person I can share 8(3.2) 13(5.2) 31(12.4) 125(50.0) 73(29.2) 250(100.0) my joys Family tries to help 19(7.6) 49(19.6) 36(14.4) 77(30.8) 69(27.6) 250(100.0)

Emotional help from 16(6.4) 29(11.6) 36(14.4) 113(45.2) 56(22.4) 250(100.0) family Special person who 8(3.2) 8(3.2) 25(10.0) 141(56.4) 68(27.2) 250(100.0) comforts me Friends try to help me 31(12.4) 72(28.8) 28(11.2) 71(28.4) 48(19.2) 250(100.0)

Depend on friends 41(16.4) 69(27.4) 24(9.6) 69(27.6) 47(18.8) 250(100.0)

Share problems with 15(6.0) 34(13.6) 29(11.6) 101(40.4) 71(28.4) 250(100.0) family Friends with whom I can 30(12.0) 37(14.8) 20(8.0) 111(44.4) 52(20.8) 250(100.0) share my joys Person caring about my 14(15.6) 4(1.6) 20(8.0) 147(58.8) 65(26.0) 250(100.0) feelings Family helps make 37(14.8) 32(12.8) 27(10.8) 86(34.4) 68(27.2) 250(100.0) decisions Share problems with 35(14.0) 35(14.0) 26(10.4) 99(39.6) 55(22.0) 250(100.0) friends Most people 147(58.8%) in the rural areas agreed that there was a person that cared about their feelings while they 72(28.8%) mostly disagreed with the statement that their friends really tried to help them.

Table 13: Perceived social support scores of respondents in urban and rural areas

89

Variable Urban Rural T-test P-value

n=250(100%) n=250(100%)

Mean±SD Mean±SD

Total social support scores 44.45±5.23 43.33±11.73 1.384 0.167

Support from family 15.60±2.16 14.34±4.53 3.947 <0.001*

Support from friends 12.48±2.88 13.06±4.96 1.611 0.108

Support from others 16.38±2.23 15.92±3.30 1.810 0.071

*P<0.05 The mean score of perceived social support from family was better in the urban 15.60±2.16 than the rural location 14.34±4.53 and this difference was statistically significant while no difference was observed in the mean scores of perceived total social support, support from friends and support from significant others in both locations.

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Table 14: Prevalence of elder abuse in urban and rural locations

Variable Urban Rural Total χ2 Df P-value Freq.(%) Freq.(%) Freq.(%) Psychological Yes 64(25.6) 22(8.8) 86(17.2) 24.772 1 <0.001* No 186(74.4) 228(91.2) 44(82.8) Total 250(100.0) 250(100.0) 500(100.0) Physical abuse Yes 8(3.2) 9(3.6) 17(3.4) 0.031 1 1.000 No 242(96.8) 241(96.4) 483(96.6) Total 250(100.0) 250(100.0) 500(100.0) Financial abuse Yes 18(7.2) 17(6.8) 35(7.0) 0.031 1 0.861 No 232(92.8) 233(93.2) 465(93.0) Total 250(100.0) 250(100.0) 500(100.0) Sexual abuse Yes 6(2.4) 6(2.4) 12(2.4) 0.000 1 1.000 No 244(97.6) 244(97.6) 488(97.6) Total 250(100.0) 250(100.0) 500(100.0) Neglect Yes 3(1.2) 3(1.2) 6(1.2) 0.000 1 1.000* No 247(98.8) 247(98.8) 494(98.8) Total 250(100.0) 250(100.0) 500(100.0) Elder abuse Yes 74(29.6) 40(16.0) 114(22.8) 13.135 1 <0.001** No 176(70.4) 210(84.0) 386(77.2) Total 250(100.0) 250(100.0) 500(100.0) * Fischer’s exact **P<0.05

91

A higher proportion of the urban respondents 64(25.6%) had experienced psychological abuse compared to the rural respondents 22(8.8%). The difference in the experience of psychological abuse was statistically significant. Almost equal proportions of respondents in the rural 9(3.6%) and urban area 8(3.2%) had experienced physical abuse. Similar proportions of respondents had also experienced financial abuse in the urban 18(7.2%) and rural 17(6.8%) areas and this was same with the experience of sexual abuse by urban 6(2.4%) and rural 6(2.4%) respondents. Also the experience of neglect was the same in both locations 3(1.2%). There was no statistically significant difference in the experience of physical, financial, sexual abuse and neglect in both locations. A prevalence of 114(22.8%) was obtained for elder abuse in this study. A greater proportion of respondents in the urban area 74(29.6%) had experienced elder abuse compared to the respondent in the rural area 40(16.0%).The experience of elder abuse in totality was statistically significantly different in the rural and urban locations.

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Table 15: Types of psychological and physical abuse experienced in the last 12 months

Variable Urban Rural Total χ2 Df P-value Freq.(%) Freq.(%) Freq.(%) Psychological abuse 64(25.6)*** 22(8.8)*** 86(17.2)*** Insulted 33(51.6) 15(68.2) 48(55.8) 7.47 1 0.005** Belittled 13(20.3) 7(31.8) 20(23.2) 1.88 1 0.253 Ignored 14(21.9) 4(18.1) 18(20.9) 5.76 1 0.028** Threatened to harm 3(4.7) 7(31.8) 10(11.6) 1.63 1 0.339* Prevented from 4(6.3) 1(4.5) 5(5.8) 1.82 1 0.372* seeing other people Shouted at 46(71.9) 11(50.0) 57(66.3) 24.26 1 0.000** Did something to spite 8(12.5) 3(13.6) 11(12.8) 2.32 1 0.221* you Threatened to hit 3(4.7) 7(31.8) 10(11.6) 1.63 1 0.339* Blamed you for 4(6.3) 2(9.0) 6(6.9) 0.68 1 0.686* misfortunes Prevented from social 2(3.1) 1(4.5) 3(3.5) 0.56 1 1.000* activities Physical abuse 8(3.2)*** 9(3.6)*** 17(3.4)*** Slapped 4(50.0) 2(22.2) 6(35.3) 0.68 1 0.686* Pushed 6(75.0) 3(33.3) 9(52.9) 1.02 1 0.504* Burned 0(0.0) 1(11.1) 1(5.8) 0.32 1 1.000* Threw something at 2(25.0) 3(33.3) 5(29.4) 0.20 1 1.000* you Twisted your hair 1(12.5) 1(11.1) 2(11.8) 0.03 1 1.000* Used a weapon 0(0.0) 1(11.1) 1(5.8) 1.01 1 1.000* Punched 2(25.0) 2(22.2) 4(23.5) 0.00 1 1.000* Beaten up 1(12.5) 1(11.1) 2(11.8) 0.00 1 1.000* Locked in room 2(25.0) 0(0.0) 2(11.8) 2.01 1 0.499*

***multiple response *Fisher’s exact **P<0.05

93

The most frequent type of psychological abuse experienced was being shouted at in the urban location 46(71.9%) while the most frequent in the rural area was being insulted 15(68.2%). A higher proportion of urban respondents reported being shouted at 46(71.9%) compared to the rural respondents 11(50.0%). There was a statistically significant difference in experience of insults and being shouted at in the urban and rural areas. Being pushed was more common in urban areas 6(75.0%) compared to the rural areas 3(33.3%). The difference in experience of various forms of physical elder abuse in urban and rural locations was not statistically significant.

94

Table 16: Types of neglect, financial and sexual abuse in the last 12 months

Variable Urban Rural Total χ2 Df P-value Freq.(%) Freq.(%) Freq.(%) Financial abuse 18(7.2)*** 17(6.8)*** 35(7.0)*** Made you give your 4(22.2) 7(41.2) 11(31.4) 0.84 1 0.544* money Used fraud for your 4(22.2) 7(41.2) 11(31.4) 0.84 1 0.544* money Stole your property 15(83.3) 9(52.9) 24(68.6) 1.58 1 0.295 Forced to sign 0(0.0) 1(5.9) 1(2.9) 1.02 1 1.000* Pretended to obtain 2(11.1) 3(17.6) 5(14.3) 0.20 1 1.000* goods Sexual abuse 6(2.4)*** 6(2.4)*** 12(2.4)*** Sexual touch 5(83.3) 1(16.7) 6(50.0) 2.69 1 0.216* Tried sexual intercourse 2(33.3) 5(83.3) 7(58.3) 1.30 1 0.253* Sexual intercourse 0(0.0) 1(16.7) 1(8.3) 1.02 1 1.000* Neglect*** 3(1.2)*** 3(1.2)*** 6(1.2)*** Denied food 3(100.0) 3(100.0) 6(100.0) 0.00 1 1.000* Denied clothing 1(33.3) 1(33.3) 2(33.3) 0.00 1 1.000* Denied medical care 1(33.3) 1(33.3) 2(33.3) 0.00 1 1.000 *

*Fischer’s exact ***Multiple response

The most frequent type of financial abuse experienced by elders in the rural 9(52.9) and urban area 15(83.3) was having their money or properties stolen. There was no statistically significant difference in the forms of financial abuse experienced in the rural and urban area. The most common type of sexual abuse experienced in the urban 5(83.3) area was being touched against their will while the most common type in the rural area was trying to have sexual intercourse against their will 5(83.3) There was no statistically significant difference in the form of sexual

95 abuse experienced in both locations. Similar proportions experienced being denied food in both rural 3(100.0) and urban locations 3(100.0). There was no statistically significant difference in the types of neglect experienced in both locations.

96

Table 17: Frequency of elder abuse in the last 12 months

Variable Urban Rural Total χ2 Df P-value Freq.(%) Freq.(%) Freq.(%) Psychological abuse 4.39 2 0.094 Only once 24(37.5) 10(45.5) 34(39.5) Few times 38(59.4) 9(40.9) 47(54.7) Always 2(3.1) 3(13.6) 5(5.8) Total 64(74.4) 22(25.6) 86(100.0) Physical abuse 3.04 2 0.316 Only once 5(62.5) 6(66.7) 11(64.7) Few times 3(37.5) 1(11.1) 4(23.5) Always 0(0.0) 2(22.2) 2(11.8) Total 8(47.1) 9(52.9) 17(100.0) Financial abuse 0.59 2 0.790 Only once 8(44.4) 6(35.3) 14(40.0) Few times 9(50.0) 9(52.9) 18(51.4) Always 1(5.6) 2(11.8) 3(8.6) Total 18(51.4) 17(48.6) 35(100.0) Sexual abuse Only once 3(50.0) 3(50.0) 6(50.0) 0.00 1 1.000 Few times 3(50.0) 3(50.0) 6(50.0) Total 6(50.0) 6(50.0) 12(100.0) Neglect Only once 1(33.7) 0(0.0) 1(16.7) 1.20 1 1.000 Few times 2(66.7) 3(100.0) 5(83.3) Total 3(50.0) 3(50.0) 6(100.0)

There was no statistically significant difference in the frequency of various types of elder abuse in the urban and rural locations.

97

This is a venn diagram showing raw figures of the interactions about how various types of elder abuse occurred among victims in urban areas. Of the 74 people who experienced elder abuse, 44 of them experienced psychological abuse alone, 2 people experienced sexual abuse alone and 6 people singly experienced financial abuse. Four elders (4) experienced physical and psychological abuse, 11 elders experienced financial and psychological abuse, one elder experienced neglect and psychological abuse and one person experienced sexual and psychological abuse.

A single form of abuse was reported by 52(20.8%) and multiple types by 22(8.8%) of the urban respondents. Psychological abuse 44(17.6%) frequently occurred alone in the urban location.

Financial, sexual and physical abuse with neglect frequently occurred in combination with psychological abuse. Physical abuse and neglect did not occur alone in the urban location.

98

NONE

210

This is a venn diagram showing raw figures of the interactions about how various types of elder abuse occurred among victims in rural LGA. Of the 40 people who experienced elder abuse in the rural locations, 9 people experienced psychological abuse alone, 12 people experienced financial abuse alone and 3 elders experienced sexual abuse alone. Of these 40 elders, 6 people experienced physical abuse and psychological abuse at the same time, four people experienced both financial and psychological abuse, one person experienced sexual and psychological abuse and one person experienced both neglect and psychological abuse.

A single form of abuse was reported by 24(9.6%) and multiple types by 16(6.4%) of the rural respondents. Financial abuse 12(4.8%) commonly occurred alone in the rural location. Physical abuse financial abuse with neglect occurred in combination with psychological abuse. Physical abuse and neglect did not occur alone in the rural location.

99

Table 18: Association between socio-demographic variables and elder abuse in urban and rural location

Variable Elder abuse Elder abuse (Urban) (Rural) Yes No Total Yes No Total n=74 n=176 n=250 n=40 n=210 n=250 (29.6) (70.4) (100.0) (16.0) (84.0) (100.0) Age 60 – 69 43(29.1) 105(70.9) 148(100) 18(13.5) 115(86.5) 133(100) 70 – 79 22(33.8) 43(66.2) 65(100.0) 15(20.5) 58(79.5) 73(100.0) >80 9(24.3) 28(75.7) 37(100.0) 7(15.9) 37(84.1) 44(100.0) χ2=1.08 df=2 p=0.593 χ2=1.73 df=2 p=0.452 Sex Male 35(35.0) 65(65.0) 100(100) 15(19.0) 64(81.0) 79(100.0) Female 39(26.0) 111(74.0) 150(100) 25(14.6) 146(85.4) 171(100) χ2=2.33 df=1 p=0.157 χ2=0.77 df=1 p=0.458 Marital Status Single 0(0.0) 3(100) 3(100.0) 2(28.6) 5(71.4) 7(100.0) Married 38(27.0) 103(73.0) 141(100) 16(13.7) 101(86.3) 117(100) Separated 6(46.2) 7(53.8) 13(100.0) 7(33.3) 14(66.7) 21(100.0) Widowed 30(32.3) 63(67.7) 93(100) 15(14.3) 90(85.7) 105(100) χ2=3.32 df=3 p=0.311* χ2=6.07 df=3 p=0.092* Employment status Employed 35(28.7) 87(71.3) 122(100) 30(17.4) 142(82.6) 172(100) Unemployed 39(30.5) 89(69.7) 128(100) 10(12.8) 68(87.2) 78(100.0) χ2=0.09 df=1 p=0.783 χ2=0.85 df=1 p=0.356 Level of education None 12(26.7) 33(73.3) 45(100.0) 16(12.4) 113(87.6) 129(100) Primary 21(31.3) 46(69.7) 67(100.0) 11(14.1) 67(85.9) 78(100.0) Secondary 20(29.9) 47(70.1) 67(100.0) 11(39.3) 17(60.7) 28(100.0) Tertiary 21(29.6) 50(70.4) 71(100.0) 2(13.3) 13(86.7) 15(100.0) χ2=0.29 df=3 p=0.965 χ2=10.58 df=3 p=0.011** *Fisher’s exact **p<0.05

100

In the urban area, a higher proportion of respondents in the 70-79 age group 22(33.8%) had experienced elder abuse compared to those in the 60-69 age group, 43(29.1%) although the association of age with elder abuse was not statistically significant. A higher proportion of males

35(35.0%) had experienced elder abuse compared to the females 39(26.0%) although the association was not statistically significant in the urban location. A higher proportion of respondents who were widowed 30(32.3%) had experienced elder abuse compared to those who were married 38(27.0%) but the association of marital status with elder abuse was not statistically significant. Also, a slightly higher proportion of unemployed respondents in the urban location 39(30.5%) had experienced elder abuse compared to the employed elderly

35(28.7%) although the difference was not statistically significant. A higher proportion of the respondents with primary education 21(31.3%) had experienced elder abuse compared with those with no formal education 12(26.7%) although the difference was not statistically significant in the urban location.

In the rural location,, a higher proportion of respondents in the 70-79 age group 15(20.5%) had experienced elder abuse compared to those in the 60-69 age group, 18(13.5%) although the association was not statistically significant. A higher proportion of males 15(19.0%) had experienced elder abuse compared to the females 25(14.6%) although the association was not statistically significant in the rural area. A higher proportion of employed respondents in the rural location 30(17.4%) had experienced elder abuse compared to the unemployed elderly

10(12.8%) although the difference was also not statistically significant. In the rural location, a higher proportion 11(39.3%) of respondents with secondary education had experienced elder abuse compared to those with no formal education 16(12.4%) and this association was statistically significant.

101

Table 19: Association between health status, social habits and elder abuse

Variable Elder abuse Elder abuse (Urban) (Rural) Yes No Total Yes No Total n=74 n=176 n=250 n=40 n=210 n=250 (29.6) (70.4) (100.0) (16.0) (84.0) (100.0) Existing health problems Yes 55(30.9) 123(60.3) 178(100.0) 31(16.2) 160(83.8) 191(100) No 19(26.4) 53(73.6) 72(100.0) 9(15.3) 50(84.7) 59(100) χ2=0.50 df=1 p=0.542 χ2=0.03 df=1 p=1.000 Health status Good 55(29.7) 130(70.3) 185(100.0) 17(13.6) 108(86.4) 125(100) Fair/poor 19(29.2) 46(70.8) 65(100.0) 23(18.4) 102(81.6 125(100) χ2=0.01 df=1 p=0.939 χ2=1.07 df=1 p=0.389 Functional impairment Full function 65(30.1) 151(69.9) 216(100.0) 30(15.0) 170(85.0) 200(100.0) Moderate 5(20.0) 20(80.0) 25(100.0) 8(22.2) 28(77.8) 36(100.0) impairment Severe 4(44.4) 5(55.6) 9(100.0) 2(14.3) 12(85.7) 14(100.0) impairment χ2=2.11 df=2 p=0.336* χ2=1.34 df=2 p=0.493* Alcohol intake Yes 23(39.7) 35(60.3) 58(100.0) 17(19.3) 71(80.7) 88(100.0) No 51(26.6) 141(73.4) 192(100.0) 23(14.2) 139(85.8) 162(100.0) χ2=3.66 df=1 p=0.071 χ2=1.11 df=1 p=0.366 Cigarette smoking Yes 9(47.4) 10(52.6) 19(100.0) 4(25.0) 12(75.0) 16(100.0) No 65(28.1) 166(71.9) 231(100.0) 36(15.4) 198(84.6) 234(100.0) χ2=3.12 df=1 p=0.114 χ2=1.03 df=1 p=0.480* *Fisher’s exact

102

A higher proportion of respondents who had health problems 55(30.9%) had experienced elder abuse compared to those without health problems 19(26.4%) in the urban location but the association between existing health problems and elder abuse was not statistically significant.

Similar proportions of those who reported they had good 55(29.7%) and poor 19(29.2%) health status had experienced elder abuse in the urban location. A higher proportion of those who had severe impairment 4(44.4%) had experienced elder abuse compared to those who had full function 65(30.1%) in the urban location. A higher proportion of respondents who currently took alcohol 23(39.7%) had experienced elder abuse compared to those who did not consume alcohol

51(26.6%) in the urban location. A higher proportion of those who smoked cigarettes 9(47.4%) had experienced elder abuse compared to those who did not smoke 65(28.1%) in the urban location.

In the rural location, a slightly higher proportion of those who had health problems 31(16.2%) had experienced elder abuse compared to the respondents who did not have health problems

9(15.3%). A higher proportion of respondents who reported they had poor health status

23(18.4%) had experienced elder abuse compared to those who had a good health status

17(13.6%). A higher proportion of respondents who had moderate impairment 8(22.2%) had experienced elder abuse compared to those who had full function 30(15.0%) in the rural location.

A higher proportion of respondents who currently took alcohol 17(19.3%) had experienced elder abuse compared to those who did not consume alcohol 23(14.2%) in the rural location. A higher proportion of those who smoked cigarettes 4(25.0%) had experienced elder abuse compared to those who did not smoke 36(15.4%) in the rural location. In both urban and rural areas, there was no significant association between the presence of existing health problems, health status, functionality, alcohol intake, cigarette smoking and the experience of elder abuse.

103

Table 20: Association between living arrangements, social contacts and elder abuse

Variable Elder abuse Elder abuse (Urban) (Rural) Yes No Total Yes No Total n=74 n=176 n=250 n=40 n=210 n=250 (29.6) (70.4) (100.0) (16.0) (84.0) (100.0) Living arrangement Alone 0(0.0) 8(100.0) 8(100) 4(10.3) 35(16.7) 39(100.0) Others 74(30.6) 168(69.4) 242(100) 36(17.1) 175(82.9) 211(100.0) χ2=3.48 df=1 p=0.067* χ2=1.13* df=1 p=0.350* Living children ≤ 4 25(26.9) 68(73.1) 93(100.0) 16(15.2) 89(84.8) 105(100.0) ≥ 5 49(31.2) 108(68.8) 157(100) 24(16.6) 121(83.4) 145(100.0) χ2=0.53 df=1 p=0.479 χ2=0.08 df=1 p=0.862 Contact with children Yes 71(28.9) 175(71.1) 246(100) 31(14.4) 185(85.6) 216(100.0) No 3(75.0) 1(25.0) 4(100) 9(26.5) 25(73.5) 34(100.0) χ2=4.02 df=1 p=0.079* χ2=3.21 df=1 p=0.081 Satisfaction with social activities Yes 41(25.2) 122(74.8) 163(100) 23(16.5) 116(83.5) 139(100.0) No 33(37.9) 54(62.1) 87(100) 17(15.3) 94(84.7) 111(100.0) χ2=4.44 df=1 p=.042** χ2=0.07 df=1 p=0.863 *Fischer’s exact **P<0.05

In the urban location, a significant proportion of respondents who lived with others 74(30.6%) had experienced elder abuse and none of the elders who lived alone experienced such. The association between living arrangement and elder abuse was not statistically significant. A higher proportion of respondents who had 5 or more children 49(31.2%) had experienced elder abuse compared to those with fewer children 25(26.9%) but their association was not statistically significant. A higher proportion of respondents who reported not having frequent contact with their children 3(75.0%) had experienced abuse compared to those who frequently saw their

104 children 71(28.9%) although the association was not statistically significant. A higher proportion of respondents who were not satisfied with their involvement in social activities 33(37.9%) had experienced abuse compared to those who expressed satisfaction 41(25.2%). There was a statistically significant association between satisfaction with involvement in social activities and the experience of elder abuse in the urban location.

In the rural location, a higher proportion of respondents who lived with others 36(17.1%) had experienced abuse compared to those who lived alone 4(10.3%) although the association between living arrangement and elder abuse was not statistically significant. A slightly higher proportion of respondents who had 5 or more children 24((16.6%) had experienced elder abuse compared to those with fewer children 16(15.2%) but their association was not statistically significant. A higher proportion of respondents who reported not having frequent contact with their children 9(26.5%) had experienced abuse compared to those who frequently saw their children 31(14.4%) although the association was not statistically significant. A slightly higher proportion of respondents who were satisfied with their involvement in social activities

23(16.5%) had experienced abuse compared to those who did not express satisfaction 17(15.3%) but the association was not statistically significant in the rural location.

105

Table 21: Association between respondents’ financial support and elder abuse

Variable Elder abuse Elder abuse (Urban) (Rural) Yes No Total Yes No Total n=74 n=176 n=250 n=40 n=210 n=250 (29.6) (70.4) (100.0) (16.0) (84.0) (100.0) Financial situation Self sufficient 12(35.3) 22(64.7) 34(100.0) 5(20.8) 19(79.2)) 24(100.0) Partly self 41(26.5) 114(73.5) 155(100.0) 20(14.5) 118(85.5) 138(100.0) sufficient Total dependence 21(34.4) 40(65.6) 61(100.0) 17(17.0) 73(83.0) 81(100.0) χ2=1.95 df=2 P=0.347 χ2=0.72 df=2 P=0.687 Financial Support Present 66(28.6) 165(71.4) 231(100.0) 26(14.2) 157(85.8) 183(100.0) Absent 8(42.1) 11(57.9) 19(100.0) 14(20.9) 53(79.1) 67(100.0) χ2=1.54 df=1 P=0.214 χ2=1.63 df=1 P=0.242 Financial Dependants Present 37(37.0) 63(63.0) 100(100.0) 21(18.9) 90(81.1) 111(100.0) Absent 37(24.7) 113(75.3) 150(100.0) 19(13.7) 120(86.3) 139(100.0) χ2=4.38 df=1 P=0.047** χ2=1.27 df=1 P=0.299 Wealth tertiles High tertile 54(29.7) 128(72.5) 182(100.0) 12(17.1) 58(82.9) 70(100.0) Low tertile 1(20.0) 4(80.0) 5(100.0) 16(14.5) 54(85.5) 70(100.0) Middle tertile 19(30.2) 44(69.8)) 63(100.0) 12(17.1) 58(82.9) 110(100.0) χ2=0.23 df=2 P=0.891* χ2=0.31 df=2 P=0.838 *Fisher’s exact **P<0.05 In the urban location, a slightly higher proportion of respondents who were self sufficient

12(35.3%) had experienced elder abuse compared to those who were totally dependent on others financially 21(34.4%) and the association was not statistically significant. A higher proportion of respondent who did not have financial support 8(42.1%) had experienced elder abuse compared to those who had some form of financial support 66(28.6%) in the urban location although the association was not statistically significant. Almost similar proportions of respondents in the

106 high tertile 54(29.7%) and middle tertile 19( 30.2%) socioeconomic groups had experienced elder abuse therefore the association was not statistically significant. A higher proportion of respondents who still had financial dependants 37(37.0%) were more likely to have experienced elder abuse compared to those who did not have financial dependants 37(24.7%) and this association was statistically significant.

In the rural location, a slightly higher proportion of respondents who were self sufficient

5(20.8%) had experienced elder abuse compared to those who were totally dependent on others financially 17(17.0%) and the association was not statistically significant. A higher proportion of respondents who did not have financial support 14(20.9%) had experienced elder abuse compared to those who had some form of financial support 26(14.2%) in the urban location although the association was not statistically significant. A higher proportion of respondents who still had financial dependants 21(18.9%) were more likely to have experienced elder abuse compared to those who did not have financial dependants 19(24.7%) but this association was not statistically significant. Similar proportions of rural respondents in the high tertile 12(17.1%) and middle tertile 17(17.1%) socioeconomic groups had experienced elder abuse therefore the association was not statistically significant.

107

Table 22: Factors associated with psychological abuse in the urban and rural locations

Variable Psychological abuse Psychological abuse (Urban) (Rural) Yes (%) No (%) Total (%) Yes (%) No (%) Total (%) 64(25.6) 186(74.4) 250(100.0) 22(8.8) 228(91.2) 250(100.0) Age 60 – 69 37(25.0) 111(75.0) 148(100.0) 9(6.8) 124(93.2) 133(100.0) 70 – 79 19(29.2) 46(70.8) 65(100.0) 9(12.3) 64(87.7) 73(100.0) >80 8(21.6) 29(88.4) 37(100.0) 4(9.1) 40(90.9) 44(100.0) χ2 = 0.79 df= 2 p=0.690 χ2 = 1.82 df = 2 p=0.388* Sex Male 27(27.0) 73(73.0) 100(100.0) 8(10.4) 71(89.9) 79(100.0) Female 37(24.7) 113(75.3) 150(100.0) 14(8.2) 157(91.8) 171(100.0) χ2= 0.17 df = 1 p=0.768 χ2 = 0.25 df = 1 p=0.635 Satisfaction with social activities Yes 35(21.5) 128(78.5) 163(100.0) 14(10.1) 125(89.9) 139(100.0) No 29(33.3) 58(66.7) 87(100.0) 8(7.2) 103(92.8) 111(100.0) χ2= 4.19 df = 1 p=0.041** χ2= 0.63 df = 1 p=0.504 Contact with children Yes 62(25.2) 184(74.8) 246(100.0) 15(6.9) 201(93.1) 216(100.0) No 2(50.0) 2(50.0) 4(100.0) 7(20.6) 27(79.4) 34(100.0) χ2= 1.27 df = 1 p=0.271* χ2= 6.81 df = 1 p=0.017** Financial Support Yes 56(24.2) 175(75.8) 231(100.0) 12(6.6) 171(93.4) 183(100.0) No 8(42.1) 11(57.9) 19(100.0) 10(14.9) 57(85.1) 67(100.0) χ2 = 2.94 df = 1 p=0.102 χ2= 4.28 df = 1 p=0.046** *Fischer’s exact **p≤0.05

In the urban location, a higher proportion of respondents aged between 70 and 79 years

19(29.2%) had experienced psychological abuse compared to those older than 80 years 8(21.6%) and those aged between 60 and 69 years 37(25.0%) and the association was not statistically

108 significant. A slightly higher proportion of urban males 27(27.0%) had experienced psychological abuse compared to the females 37(24.7%) but the association between sex and psychological abuse was not statistically significant. A higher proportion of urban respondents who did not have frequent contact with their children 2(50.0%) had experienced psychological abuse compared to those who frequently saw their children 62(25.2%) although this association was not statistically significant. A higher proportion of urban respondents who did not have financial support 8(42.1%) had experienced psychological abuse compared to those who had some form of financial support 56(24.2%) in the urban location although the association was not statistically significant. A higher proportion of urban respondents who were not satisfied with their frequency of involvement in social activities 29(33.3%)compared to those who expressed satisfaction 35(21.5%) had experienced psychological abuse and this association was statistically significant.

In the rural location, a higher proportion of respondents aged between 70 and 79 years 9(12.3%) had experienced psychological abuse compared to those older than 80 years 4(9.1%) and those aged between 60 and 69 years 9(6.8%) and the association was not statistically significant. A slightly higher proportion of urban males 8(10.4%) had experienced psychological abuse compared to the females 14(8.2%) but the association between sex and psychological abuse was not statistically significant. A higher proportion of the rural respondents who had no regular contact with their children 7(20.6%) had experienced psychological abuse compared to those who had regular contact 15(6.9%) and this was significantly associated with the experience of psychological elder abuse. Also a higher proportion of respondents without financial support

10(14.9%) had experienced psychological abuse compared to those with financial support

12(6.6%) and this association was statistically significant.

109

Table 23: Factors associated with financial abuse in urban and rural locations

Variable Financial abuse Financial abuse (Urban) (Rural) Yes(%) No (%) Total(%) Yes(%) No(%) Total (%) 18(7.2) 232(92.8) 250(100) 17(6.8) 233(93.2) 250(100) Age 60 – 69 9(6.1) 139(93.9) 148(100.0) 8(6.0) 125(94.0) 133(100.0) 70 – 79 8(12.3) 57(87.7) 65(100.0) 6(8.2) 67(91.8) 73(100.0) ≥80 1(2.7) 36(97.3) 37(100.0) 3(6.1) 41(93.9) 44(100.0) χ2 = 3.94 df = 2 p=0.190* χ2= 0.36 df = 2 p= 0.839* Sex Male 12(12.0) 88(88.0) 100(100) 9(11.4) 70(88.6) 79(100.0) Female 6(4.0) 144(96.0) 150(100) 8(4.7) 163(95.3) 171(100.0) χ2= 5.75 df = 1 p=0.023** χ2 = 3.84 df = 1 p=0.061 Health status Good 14(7.6) 171(92.4) 185(100) 3(2.4) 122(97.6) 125(100.0) Fair/poor 4(11.2) 61(93.8) 65(100.0) 14(11.2) 111(88.8) 125(100.0) χ2= 0.14 df = 1 p=0.789 χ2 = 7.64 df = 1 p=0.010* Alcohol intake Yes 9(15.5) 49(84.5) 58(100.0) 7(8.0) 81(92.0) 88(100.0) No 9(4.7) 183(95.3) 192(100) 10(6.2) 152(93.8) 162(100.0) χ2=7.82 df = 3 p=0.009** χ2=0.29 df = 1 p=0.606 Financial dependants Yes 12(12.0) 88(88.0) 100(100) 9(8.1) 102(91.9) 111(100.0) No 6(4.0) 144(96.0) 150(100) 8(5.8) 131(94.2) 139(100.0) χ2= 5.75 df = 1 p=0.023* χ2= 0.54 df = 1 p=0.614 *Fischer’s exact **P<0.05

In the urban location, a higher proportion of respondents aged between 70 and 79 years

12(12.3%) had experienced financial abuse compared to those older than 80 years 1(2.7%) and those aged between 60 and 69 years 9(6.1%) and the association was not statistically significant.

110

A higher proportion of urban male respondents 12(12.0%) had experienced financial abuse compared to the females 6(4.0%). The association between sex and financial abuse in the urban location was statistically significant. Also, a higher proportion of the respondents who took alcohol 9(15.5%) reported financial abuse compared to respondents who did not consume alcohol 9(4.7%).There was a statistically significant association between alcohol intake and the experience of financial abuse. A higher proportion of urban respondents with poor health status

4(7.6%) had experienced financial abuse compared to those with good health status 14(11.2%) and the association between health status and financial abuse was not statistically significant.

In the rural location, a higher proportion of respondents aged between 70 and 79 years 6(8.2%) had experienced financial abuse compared to those older than 80 years 3(6.1%) and those aged between 60 and 69 years 8(6.0%) and the association was not statistically significant. A higher proportion of rural male 9(11.4%) respondents had experienced financial abuse compared with their female counterparts 8(4.7%) although the association between sex and financial abuse was not statistically significant. More of the rural respondents who reported a poor health status

14(11.2%) had experienced financial abuse compared to those who reported good health status

3(2.4%). The association between health status and financial abuse was statistically significant in the rural location.

111

Table 24: Factors associated with physical abuse in both urban and rural locations

Variable Physical abuse Physical abuse (Urban) (Rural) Yes % No % Total % Yes % No % Total % 8(3.2) 242(96.8) 250(100.0) 9(3.6) 241(96.4) 250(100) Age 60 – 69 4(2.7) 144(97.3) 148(100.0) 4(3.0) 129(97.0) 133(100.0) 70 – 79 2(3.1) 63(96.9) 65(100.0) 5(6.8) 68(93.2) 73(100.0) >80 2(5.4) 35(94.6) 37(100.0) 0(0.0) 44(100.0) 44(100.0) χ2= 0.70 df = 2 p=0.608* χ2 = 3.99 df = 2 p=0.176* Sex Male 3(3.0) 97(97.0) 100(100.0) 2(2.5) 77(97.5) 79(100.0) Female 5(3.3) 145(96.7) 150(100.0) 7(4.1) 164(95.9) 171(100.0) χ2= 0.02 df = 1 p=0.883* χ2= 0.38 df = 1 p=0.723* Marital status Married 3(2.1) 138(97.9) 141(100.0) 3(2.6) 114(97.4) 117(100.0) Unmarried 5(4.6) 104(95.4) 109(100.0) 6(4.5) 127(95.5) 133(100.0) χ2= 1.20 df = 1 p=0.301* χ2= 0.68 df = 1 p=0.508* Level of education None/Primary 1(0.9) 111(97.8) 112(100.0) 6(4.5) 127(95.5) 133(100.0) Sec/tertiary 7(5.1) 131(94.9) 138(100.0) 3(2.6) 114(97.4) 117(100.0) χ2= 1.20 df = 1 p=0.078* χ2 =0.68 df = 1 p=0.508* Satisfaction with social activities Yes 5(3.1) 158(96.9) 163(100.0) 5(3.6) 134(96.4) 139(100.0) No 3(3.4) 84(96.6) 87(100.0) 4(3.6) 107(96.4) 111(100.0) χ2= 0.03 df = 1 p=0.871* χ2= 0.03 df = 1 p=0.959* *Fischer’s exact

In the urban location, a higher proportion of respondents older than 80years 2(5.4%) had experienced physical abuse compared to those aged between 70 and 79 years 2(3.1%) and those aged between 60 and 69 years 4(2.7%) and the association between age and physical abuse was

112 not statistically significant. Almost similar proportion of urban male 3(3.0%) and female respondents 5(3.3%) had experienced physical abuse. A slightly higher proportion of unmarried urban respondents 5(4.6%) compared to married respondents 3(2.1%) had experienced physical abuse. A higher proportion of respondents with secondary or tertiary education 7(5.1%) was physically abused compared to those with lower educational achievements 1(0.9%).

In the rural location, a higher proportion of respondents aged between 70 and 79 years 5(6.8%) had experienced physical abuse compared to those aged between 60 and 69 years 4(3.0%) and the association was not statistically significant. A higher proportion of rural female 7(4.1%) respondents had experienced physical abuse compared to the male respondents 2(2.5%) although the association between sex and physical abuse was not statistically significant. A slightly higher proportion of unmarried rural respondents 6(4.5%) compared to married respondents 3(2.6%) were physical abused. A higher proportion of rural respondents with no education or primary education 6(4.5%) were physically abused compared to those with secondary or tertiary education 3(2.6%).

Age, sex, marital status, level of education and satisfaction with involvement in social activities were not significantly associated with physical abuse in both locations.

113

Table 25: Factors associated with sexual abuse in both locations

Variable Sexual abuse Sexual abuse (Urban) (Rural) Yes % No % Total % Yes % No % Total % 6(2.4) 244(97.6) 250(100) 6(2.4) 244(97.6) 250(100) Age 60 – 69 6(4.1) 142(95.9) 148(100.0) 5(3.8) 128(96.2) 133(100.0) ≥70 0(0.0) 102(100) 102(100.0) 1(1.4) 116(98.6) 117(100.0) χ2 = 4.24 df = 1 p=0.084* χ2=2.24 df = 1 P=0.139* Sex Male 2(2.0) 98(98.0) 100(100.0) 0(0.0) 78(100.0) 78(100.0) Female 4(2.7) 146(97.3) 150(100.0) 6(3.5) 166(96.5) 172(100.0) χ2= 0.11 df = 1 p=0.736* χ2 = 2.79 df = 1 p=0.181 Marital status Married 3(2.1) 138(97.9) 141(100.0) 1(0.9) 116(99.1) 117(100.0) Unmarried 3(2.8) 106(97.2) 109((100) 5(3.8) 128(96.2) 133(100.0) χ2 = 0.10 df =1 p=0.749* χ2= 2.24 df = 1 p=0.219 Occupation Employed 5(4.1) 117(95.9) 122(100.0) 5(2.9) 167(97.1) 172(100.0) Unemployed 1(0.8) 127(99.2) 128(100.0) 1(1.3) 77(98.1) 78(100.0) χ2= 2.93 df = 1 p=0.113* χ2= 0.61 df = 1 p=0.669 Level of education None/ 2(1.8) 110(98.2) 112(100.0) 2(1.0) 205(99.0) 207(100.0) Primary Secondary 4(2.9) 134(97.1) 138(100.0) 4(9.3) 39(90.7) 43(100) /tertiary χ2 = 0.33 df = 1 p=0.694 χ2= 10.56 df = 1 p=0.009** **P≤0.05

A few of the urban respondents aged between 60 and 69 years 6(4.1%) had experienced sexual abuse while none older than 70 years were sexually abused. A slightly higher proportion of urban female respondents 4(2.7%) were sexually abused compared to the males 2(2.0%). A slightly

114 higher proportion of unmarried urban respondents 3(2.8%) compared to married respondents

3(2.1%) had experienced sexual abuse. A higher proportion of urban respondents who were employed 5(4.1%) were sexually abused compared to one person who was unemployed 1(0.8%).

A higher proportion of respondents with secondary or tertiary education 4(2.9%) were sexually abused compared to those with lower educational achievements 2(1.8%). In the urban location there was no statistically significant association between age, sex, marital status, occupation, level of education and the experience of sexual abuse.

In the rural location, a higher proportion of respondents aged between 60 and 69 years 5(6.8%) had experienced sexual abuse compared to those aged 70years and greater 1(1.4%) and the association between age and sexual abuse was not statistically significant. Few rural females

6(3.5%) were sexually abused and none of the males reported sexual abuse. A higher proportion of unmarried rural respondents 5(3.8%) compared to married respondents 1(0.9%) reported sexual abuse. A higher proportion of rural respondents who were employed 5(2.9%) were sexually abused compared to one person who was unemployed 1(1.3%). In the rural location there was no statistically significant association between age, sex, marital status, occupation and the experience of sexual abuse. A significantly higher proportion of those with secondary school education or higher 4(9.3%) were more likely to have experienced sexual abuse compared to those with none or primary education 2(1.0%) in the rural location.

115

Table 26: Factors associated with neglect in urban and rural locations

Variable Neglect Neglect (Urban) (Rural) Yes % No % Total % Yes % No % Total % 3(1.2) 247(98.8) 250(100) 3(1.2) 247(98.8) 250(100) Age 60 – 69 0(0.0) 148(100.0) 148(100) 1(0.8) 132(99.2) 133(100) 70 – 79 1(1.5) 64(98.5) 65(100.0) 1(1.4) 72(98.6) 73(100.0) ≥80 2(5.4) 35(94.6) 37(100.0) 1(3.0) 43(97.0) 44(100.0) χ2= 8.80 df = 2 p=0.037** χ2 = 0.67 df = 2 p=0.751*

Sex Male 2(2.0) 98(98.0) 100(100.0) 2(2.5) 77(97.5) 79(100.0) Female 1(0.7) 149(99.3) 150(100.0) 1(0.6) 170(99.4) 171(100) χ2= 0.90 df = 1 p=0.566* χ2 = 1.73 df = 1 p=0.235 Marital status Married 0(0.0) 141(100.0) 141(100.0) 0(0.0) 117(100.0) 117(100) Unmarried 3(2.8) 106(97.2) 109(100.0) 3(2.3) 130(97.7)) 133(100) χ2 =3.93 df = 1 p=0.082* χ2 = 2.67 df =1 p=0.250* Health status Good 0(0.0) 185(100.0) 185(100.0) 1(0.8) 124(99.2) 125(100) Fair/poor 3(4.6) 62(95.4) 65(100.0) 2(1.6) 123(98.4) 125(100) χ2=8.64 df = 1 p=0.017* χ2=0.34 df = 1 p=0.561* Functionality status Full function 0(0.0) 216(100.0) 216(100.0) 2(1.0) 198(99.0) 200(100) Impaired 3(8.8) 31(91.2) 34(100.0) 1(2.0) 49(98.0) 50(100.0) χ2=19.29 df = 1 p=<0.001** χ2 = 0.34 df = 1 p=0.490* Satisfaction with social activities Yes 0(0.0) 163(100.0) 163(100.0) 1(0.7) 138(99.3) 139(100) No 3(3.4) 84(96.6) 87(100.0) 2(1.8) 109(98.2) 111(100) χ2= 5.69 df = 1 p=0.041** χ2= 0.61 df = 1 p=0.586* Contact with children Yes 0(0.0) 246(100.0) 246(100.0) 1(0.5) 215(99.5) 216(100) No 3(75.0) 1(25.0) 4(100.0) 2(5.9) 32(94.1) 34(100.0) χ2= 186.74 df = 1 p=<0.001* χ2= 7.23 df = 1 p=0.049* **P<0.05 *Fischer’s exact

116

In the urban area, a higher proportion of respondents with age greater than 80years 2(5.4%) had experienced neglect compared to those in the 60-69 age group (0.0%) and this association was statistically significant while in the rural location, age was not significantly associated with neglect. A higher proportion of males in both urban and rural locations 2(2.0%) , 2(2.5%) respectively were neglected compared to females 1(0.7%) and 1(0.6%) respectively although the association between sex and neglect was not statistically significant in both areas. There was a significant association between functionality and the experience of neglect in the urban location with people who were fully functional 216 (100.0%) not experiencing any form of neglect compared to those who were impaired 31(91.2%). The association between satisfaction with involvement in social activities and respondents’ experience of neglect was statistically significant with those not satisfied with their level of involvement in social activities experiencing more neglect 3(3.4%) compared to those engaged social activities 0(0.0%) in the urban area.

In both rural and urban areas respondents who did not have regular contact with their children

3(75.0%) and 1(25.0%) were more likely to have experienced neglect when compared with those who had contacts with their children regularly 0(0.0%) and 1(0.5%) respectively.

117

Table 27: Relationship between social support scores from family, friends and elder abuse in the urban areas

Abuse Social support from family Social support from friends Type n(%) Mean±SD T test p-value Mean±SD T test p-value Psychological Yes 64(25.6) 15.39±2.63 -0.88 0.380 12.00±3.19 -1.55 0.122 No 186(74.4) 15.67±1.98 12.65±2.76 Physical Yes 8(3.2) 14.38±3.82 -1.63 0.105 9.75±2.71 -2.76 0.006** No 242(96.8) 15.64±2.09 12.57±2.85 Financial Yes 18(7.2) 15.33±1.78 -0.53 0.594 12.78±3.04 0.46 0.650 No 232(92.8) 15.62±2.19 12.46±2.87 Sexual Yes 6(2.4) 16.00±0.63 0.46 0.644 14.17±2.86 1.46 0.147 No 244(97.6) 15.59±2.19 12.44±2.87 Neglect Yes 3(1.2) 15.67±0.58 0.51 0.072 8.33±0.58 -2.54 0.012** No 247(98.8) 15.60±2.18 12.53±2.86 Elder abuse Yes 74(29.6) 15.47±2.46 0.58 0.561 12.04±3.09 -1.16 0.118 No 176(70.4) 15.65±2.03 12.66±2.77 **P≤0.05

The respondents who reported psychological, physical, financial or elder abuse had worse social support scores from family compared to those who had not experienced such but the differences were not statistically significant. In the urban location, the respondents who had not experienced physical abuse 12.57±2.85 reported better social support scores from friends compared to those who had experienced physical abuse 9.75±2.71 and this difference was statistically significant.

118

Likewise, the respondents who had not experienced neglect 12.53±2.86 reported better social support scores from friends compared to those who had experienced neglect 8.33±2.86. The difference in social support scores from friends was statistically significant. The urban respondents who reported psychological abuse and elder abuse had worse scores than those who did not report such experience but the differences were not statistically significant.

119

Table 28: Relationship between social support scores from family, friends and elder abuse in the rural areas

Abuse Social support from family Social support from friends Type n(%) Mean±SD T test P-value Mean±SD T test P-value Psychological Yes 22(8.8) 14.09±5.08 -0.27 0.784 12.59±6.11 -0.47 0.640

No 228(91.2) 14.37±4.48 13.11±4.85

Physical Yes 9(3.6) 13.22±6.72 -0.76 0.450 11.89±7.18 -0.72 0.470

No 241(96.4) 14.39±4.44 13.11±4.87

Financial Yes 17(6.8) 12.35±4.05 -1.89 0.060 12.29±4.43 -0.66 0.508

No 233(93.2) 14.49±4.53 13.12±4.99

Sexual Yes 6(2.4) 17.50±1.76 1.74 0.084 16.67±2.50 1.81 0.071

No 244(97.6) 14.27±4.55 12.98±4.97

Neglect Yes 3(1.2) 7.67±3.51 -2.60 0.010* 8.00±6.08 -1.79 0.075

No 247(98.8) 14.43±4.48 13.13±4.93 Elder abuse Yes 40(16.0) 13.70±4.82 -0.88 0.327 12.65±5.52 -0.58 0.565

No 210(84.0) 14.47±4.47 13.14±4.85

*P<0.05

120

The rural respondents who reported psychological, physical, financial or elder abuse had worse social support scores from family compared to those who had not experienced such but the differences were not statistically significant. In the rural location, the respondents who had not experienced neglect reported better social support scores from family 14.43±4.48 compared to those who had experienced neglect 7.67±3.51 and this difference was statistically significant.

The respondents in the rural areas who reported they had experienced psychological, physical, financial, elder abuse and neglect had worse social support scores compared to those who had no experience of these forms of violence although the differences observed were not statistically significant.

121

Table 29: Relationship between social support scores from significant others and elder abuse in urban and rural areas

Variables Social support scores from significant others

Abuse Type Urban Rural n(%) Mean±SD t test p-value n(%) Mean±SD t test p-value

Psychological Yes 64(25.6) 16.59±2.32 0.91 0.365 22(8.8) 15.63±4.07 -0.42 0.674 No 186(74.4) 16.30±2.19 228(91.2) 15.95±3.23 Physical Yes 8(3.2) 14.63±3.58 -2.28 0.023 9(3.6) 14.22±5.54 -1.58 0.117 ** No 242(96.8) 16.43±2.16 241(96.4) 15.98±3.19 Financial Yes 18(7.2) 16.61±1.69 0.46 0.643 17(6.8) 15.06±2.79 -1.11 0.266 No 232(92.8) 16.36±2.23 233(93.2) 15.98±3.33 Sexual Yes 6(2.4) 17.83±1.72 1.63 0.105 6(2.4) 16.83±1.60 0.685 0.494 No 244(97.6) 16.34±2.23 244(97.6) 15.89±3.33 Neglect Yes 3(1.2) 15.33±1.15 -0.82 0.416 3(1.2) 10.66±6.50 -2.81 0.005** No 247(98.8) 16.38±2.23 244(98.8) 15.98±3.22 Elder abuse Yes 74(29.6) 16.55±2.52 0.82 0.413 40(16.0) 15.47±3.54 -0.93 0.354 No 176(70.4) 16.30±2.22 210(84.0) 16.00±3.26

**P<0.05

The urban respondents who reported the experience of psychological, financial, sexual and elder abuse had better social support scores from significant others compared to those without these experiences but the differences were not statistically significant. In the urban LGA, the

122 respondents who had experienced physical abuse reported significantly worse social support scores (14.63±3.58) from significant others compared to those who had not experienced physical abuse (16.43±2.16).

The rural respondents who did not report any experience of psychological, physical, financial and elder abuse had better social support scores from other people compared to those who had these experiences but the differences were not statistically significant. In the rural LGA, the respondents who had experienced neglect reported significantly worse social support scores

(10.66±6.50) from significant others compared to those who had not experienced neglect

(15.98±3.22) .

123

Table 30: Relationship between total social support scores and types of elder abuse in the urban area

Variable Total social support scores Abuse type n(%) Mean±SD t-test P-value Psychological Yes 64(25.6) 44.98±5.72 0.83 0.408 No 186(74.4) 44.61±5.05 Physical Yes 8(3.2) 38.75±9.87 -3.19 0.002** No 242(96.8) 44.64±4.93 Financial Yes 18(7.2) 44.72±4.91 0.23 0.820 No 232(92.8) 44.43±5.26 Sexual Yes 6(2.4) 48.00±4.15 1.69 0.092 No 244(97.6) 44.66±5.23 Neglect Yes 3(1.2) 39.33±2.08 -1.71 0.088 No 247(98.8) 44.51±5.22 Elder abuse Yes 74(29.6) 44.07±2.52 -0.57 0.452 No 176(70.4) 44.61±5.10 ** P<0.05

The urban respondents who reported psychological, financial and sexual abuse had better total social support scores compared to those who had not experienced these incidents although the differences were not statistically significant. In contrast, the respondents who had experienced neglect 39.33±2.08 had worse total social support scores compared to those who did not report neglect 44.51±5.22 but the difference was not statistically significant. The total social support score was better for the elders who had not experienced physical abuse 44.64± 4.93 compared to

124 those who had experienced the incident 38.75±9.87.The difference in the mean total social support scores in the urban location was statistically significant.

125

Table 31: Relationship between total social support scores and types of elder abuse in the rural areas.

Variable Total social support scores

Abuse type n(%) Mean±SD t-test P-value Psychological Yes 22(8.8) 42.32±14.16 -0.42 0.673 No 228(91.2) 43.43±11.50 Physical Yes 9(3.6) 39.33±18.37 -1.04 0.299 No 241(96.4) 43.48±11.44 Financial Yes 17(6.8) 39.71±10.01 -1.32 0.188 No 233(93.2) 43.59±11.23 Sexual Yes 6(2.4) 51.0±5.37 1.63 0.105 No 244(97.6) 43.14±11.79 Neglect Yes 3(1.2) 26.33±12.42 -2.52 0.011** No 247(98.8) 43.53±11.60 Elder abuse Yes 40(16.0) 41.83±12.78 0.88 0.378 No 210(84.0) 43.61±11.53 **P<0.05 The rural respondents who reported psychological, physical and financial abuse had worse total social support scores compared to those who did not report these incidents but the differences were not statistically significant. Better scores were obtained in the domain of total support for respondents who did not report neglect 43.53±11.60 compared to those who reported neglect

126

26.33±12.42 in the rural location. The difference in scores obtained in the domain total social support for neglect was statistically significant.

127

Table 32: Relationship between perpetrators of psychological, physical abuse and the abused elders in urban and rural areas

Variable Urban Rural Total χ2 Df p-value

(Perpetrators) Freq.(%) Freq.(%) Freq.(%)

Psychological abuse

Spouse 4(6.3) 1(4.5) 5(5.8) 8.15 4 0.086

Children/grandchildren 22(34.4) 4(18.2) 26(30.2)

Son/daughter in law 6 (9.4) 0(0.0) 6(6.9)

Relatives 12(18.8) 3(13.6) 15(17.4)

Neighbours/caregiver/friends 20(31.3) 14(59.1) 34(39.5)

Total 64(74.4) 22(25.6) 86(100.0)

Physical abuse

Spouse 2(25.0) 0(0.0) 2(11.7) 8.80 3 0.044*

Child/grandchild/relatives 0(0.0) 4(44.5) 4(23.5)

Neighbours/friends/others 4(50.0) 5(55.5) 9(52.9)

Paid caregiver 2(25.0) 0(0.0) 2(11.7)

Total 8(47.1) 9(52.9) 17(100.0)

*Fisher’s exact

Most perpetrators of psychological abuse in urban areas were the children 22(34.4%) while most

perpetrators in the rural location were neighbours 13(59.1%).The difference in perpetration of

psychological abuse in both locations was not statistically significant. Most perpetrators of

physical abuse in the urban and rural areas were neighbors 4(50.0%) and 5(55.5%) respectively

but children were more likely perpetrators in the rural location 4(44.5%) compared to the urban

128

0(0.0).The difference in perpetration of physical abuse in both locations was statistically significant.

129

Table 33: Relationships between perpetrators of neglect, financial with sexual abuse and the abused elders

Variable Urban Rural Total χ2 Df p-value (Perpetrators) Freq.(%) Freq.(%) Freq.(%) Financial abuse Child/grandchild 12(66.7) 6(35.3) 18(51.4) 8.62 3 0.035* Son-in -law 2(11.1) 0(0.0) 2(5.7) Relatives 3(16.7) 4(23.5) 7(20.0) Neighbours/others 1(5.5) 7(41.2) 8(22.8) Total 18(51.4) 17(48.6) 35(100.0) Sexual abuse Relatives 1(16.7) 0(0.0) 1(14.3) 1.87 2 0.393 Neighbours 3(50.0) 2(33.3) 5(41.7) Friends/others 2(33.3) 4(66.7) 6(50.0) Total 6(50.0) 6(50.0) 12(100.0) Neglect Spouse/relative/child 0(0.0) 3(100.0) 3(50.0) 6 1 0.100* Paid caregiver 3(100.0) 0(0.0) 3(50.0) Total 3(50.0) 3(50.0) 6(100.0) *Fischer’s exact

Majority of perpetrators of financial abuse in urban areas were the children 12(66.7%) compared to the neighbours 7(41.2%) in the rural location. This difference was statistically significant.

Most perpetrators of sexual abuse in the urban areas were the neighbours 3(50.0%) compared to the friends 4(66.7%) in the rural location. All the perpetrators of neglect in the urban areas

3(100.0%) were the paid caregivers in contrast to the rural areas where the perpetrators were the spouse, relatives or the children 3(100.0%). There was no significant difference in who perpetrated neglect and sexual abuse in both locations.

130

Table 34: Characteristics of perpetrators of psychological abuse in urban and rural areas

Psychological abuse Variable Urban Rural Total χ2 df p-value n=64(74.4) n=22(25.6) 86(100%) Sex Male 25(29.1) 11(50.0) 36(41.9) Female 39(60.9) 11(50.0) 50(58.1) 0.80 1 0.371 Employment status Employed 42(65.6) 8(36.4) 50(58.1) 8.43 2 0.014* Unemployed 21(32.8) 10(45.5) 31(36.0) Don’t know 1(1.6) 4(18.1) 5(5.9) Alcohol use Yes 29(45.3) 5(22.7) 34(39.5) 7.57 2 0.023* No 34(53.1) 14(63.6) 48(55.8) Don’t know 1(1.6) 3(13.6) 4(4.7) Smoking Yes 15(23.4) 3(13.6) 18(20.9) 5.89 2 0.052 No 48(75.0) 16(72.7) 64(74.4) Don’t know 1(1.6) 3(13.6) 4(4.7) Drug use Yes 7(10.9) 3(13.6) 10(11.6) 1.41 2 0.494 No 53(82.8) 16(72.7) 69(80.2) Don’t know 4(6.30) 3(13.6) 7(8.1) *Fischer’s exact

Most of the perpetrators of psychological abuse in the urban location are females 39(60.9%) while males 11(50.0%) and females 11(50.0%) equally perpetrate psychological abuse in the rural areas. There was no statistically significant difference between sex and perpetration of psychological abuse in both locations. Majority of the perpetrators of psychological abuse were

131 employed in the urban location 42(65.6%) compared to the perpetrators in the rural location who were reported to be unemployed 10(45.5%). This difference in employment status was statistically significant. A higher proportion of perpetrators in the rural location 14(63.6%) did not use alcohol compared with those in the urban location 34(53.1%) and this difference was statistically significant. Most perpetrators of psychological abuse did not smoke in the urban

48(75.0%) and rural 16(72.7%) locations. Majority of perpetrators did not use drugs in the urban

53(82.8%) and rural 16(72.7%) areas. There was no statistically significant association between the use of drugs and smoking of cigarettes and the perpetration of psychological abuse.

132

Table 35: Characteristics of perpetrators of physical abuse in urban and rural areas

Physical abuse Variable Urban Rural Total χ2 Df p-value n=8(47.1) n=9(52.9) n=17(100.0)

Sex Male 5(62.5) 7(77.8) 12(70.6) 0.48 1 0.491* Female 3(37.5) 2(22.2) 5(29.4) Employment status Employed 5(62.5) 4(44.4) 9(52.9) 0.08 1 0.771* Unemployed 3(37.5) 5(55.6) 8(47.1) Alcohol use Yes 5(62.5) 5(55.6) 10(58.8) 0.08 1 0.771* No 3(37.5) 4(44.4) 7(41.2) Smoking Yes 4(50.0) 2(22.2) 6(35.3) 1.43 1 0.232* No 4(50.0) 7(77.8) 11(64.7) Drug use Yes 0(0.0) 2(22.2) 2(11.8) 4.03 2 0.133* No 6(75.0) 7(77.8) 13(76.5) Don’t know 2(25.0) 0(0.0) 2(11.8) *Fischer’s exact

Majority of perpetrators of physical abuse in urban 5(62.5%) and rural 7(77.8%) areas were males and there was no statistically significant association between sex and physical abuse. Most perpetrators of physical abuse were employed 5(62.5%) in the urban and unemployed 5(55.6%) in the rural areas but working status of perpetrators was not significantly different in both locations. Most perpetrators of physical abuse in urban 5(62.5%) and rural 5(55.6%) locations consumed alcohol. Most perpetrators of physical abuse did not smoke in the rural areas

133

7(77.8%) and there was no difference in smoking status in the urban areas 4(50.0%).Most perpetrators of physical abuse did not use drugs in the urban 6(75.0%) and rural 7(77.8%) locations. There was no significant difference in the association between perpetrators of physical abuse and alcohol consumption, drug use or smoking status in both locations.

134

Table 36: Characteristics of perpetrators of financial abuse in urban and rural areas

Financial abuse Variable Urban Rural Total χ2 Df p-value n=18(51.4) n=17(48.6) 35(100.0) Sex Male 17(94.4) 12(70.6) 29(82.9) 3.50 1 0.061* Female 1(5.6) 5(29.4) 6(17.1) Employment status Employed 3(16.7) 7(41.2) 10(28.5) 7.49 2 0.024* Unemployed 15(83.3) 7(41.2) 22(62.9) Don’t know 0(0.0) 3(17.6) 3(8.6) Alcohol use Yes 10(55.5) 7(41.2) 17(48.6) 2.51 2 0.286* No 8(45.5) 8(47.1) 16(45.7) Don’t know 0(0.0) 2(11.8) 2(5.7) Smoking Yes 7(38.8)) 4(23.5) 11(31.4) 2.76 2 0.252* No 11(61.1) 11(64.7) 22(62.9) Don’t know 0(0.0) 2(11.8) 2(5.7) Drug use Yes 5(27.8) 3(17.6) 8(22.8) 2.51 2 0.284* No 13(72.2) 12(70.6) 25(71.4) Don’t know 0(0.0) 2(11.8) 2(5.7) *Fischer’s exact

Majority of the perpetrators of financial abuse were males in both urban 17(94.4%) and rural 12

(70.6%) locations and the difference was not statistically significant. A higher proportion of perpetrators of financial abuse were unemployed 15(83.3%) in the urban location compared to those in the rural location 7(41.2%) and this difference was statistically significant. Most of the

135 perpetrators of financial abuse consumed alcohol in the urban areas 10(55.5%) compared to the majority in the rural location 8(47.1%) who did not take alcohol and this difference was not statistically significant. Most perpetrators of financial abuse did not smoke cigarettes in both urban 11(61.1%) and rural 11(64.7%) locations and also did not abuse substances in both locations 13(72.2%), 12(70.6%).

136

Table 37: Characteristics of perpetrators of sexual abuse in urban and rural areas

Sexual abuse Variable Urban Rural Total χ2 Df P-value n=6(50.0) n=6(50.0) n=12(100) Sex Male 4(66.7) 6(100.0) 10(83.3) 2.40 1 0.121* Female 2(33.3) 0(0.0) 2(16.7) Employment status Employed 5(83.3) 3(50.0) 8(66.7) 2.50 2 0.287* Unemployed 1(16.7) 1(16.7) 2(16.7) Don’t know 0(0.0) 2(33.3) 2(16.7) Alcohol use Yes 6(100.0) 3(50.0) 9(75.0) 4.00 2 0.135* No 0(0.0) 1(16.6) 1(8.3) Don’t know 0(0.0) 2(33.3) 2(16.7)

*Fischer’s exact

Most perpetrators of sexual abuse were males in both urban 4(66.7%) and rural 6(100.0%) locations. Majority of perpetrators of sexual abuse were employed in both urban 5(83.3%) and rural areas 3(50.0%). All perpetrators of sexual abuse consumed alcohol in the urban location

6(100.0%) while half of the perpetrators used alcohol in the rural location 3(50.0%).

There was no statistically significant difference in the perpetrators of sexual abuse sex, employment status and alcohol consumption in both locations.

137

Table 38: Predictors of elder abuse in the urban location

Variable Elder abuse (Urban) Odds 95%CI p-value ratio Yes (%) No (%) 74(29.6) 176(70.4) Satisfaction with social activities No 33(37.9) 54(62.1) 2.15 1.20-3.84 0.010* Yes 41(25.2) 122(74.8) 1 Financial dependants Present 37(37.0) 63(63.0) 2.19 Absent 37(24.7) 113(75.3) 1 1.21-3.94 0.009*

Respondents who expressed dissatisfaction with their level of involvement in social activities were twice as likely to experience elder abuse compared with those who were satisfied {OR:

2.15 (95% CI: 1.20-3.84)}. Respondents who had financial dependants were also twice as likely to experience elder abuse compared to those who did not have financial dependants {OR:2.19

(95% CI: 1.21-3.94)}.

138

Table 39: Predictors of financial abuse in the urban location

Variable Financial abuse (Urban) Odds Confidence p-value ratio Interval Yes (%) No(%) (95%) 18(7.2) 232(92.8) Sex Male 12(12.0) 88(88.0) 2.04 0.63-6.66 0.162 Female 6(4.0) 144(96.0) 1 Alcohol intake Yes 9(15.5) 49(84.5) 2.25 0.72-7.08 0.240 No 9(4.7) 183(95.3) 1 Financial dependants Present 12(12.0) 88(88.0) 2.86 1.02-8.04 0.046* Absent 6(4.0) 144(96.0) 1 *p≤0.05

Urban respondents who still had financial dependants were about 3 times{OR:2.86 (95% CI:

1.02-8.04)} as likely to have experienced financial abuse compared to those who had no financial dependants.

139

Table 40: Predictors of psychological abuse in the rural location

Variable Psychological abuse Odds Confidence p-value (Rural) ratio Interval Yes (%) No (%) (95%) 22(8.8) 228(91.2) Financial support Absent 10(14.9) 57(85.1) 2.88 1.04-7.97 0.042*

Present 12(6.6) 171(93.4) 1

Contact with children No 7(20.6) 27(79.4) 2.05 0.81-5.18 0.129

Yes 15(6.9) 201(93.1) 1

*P<0.05

Respondents who did not have any form of financial support were almost 3 times likely {OR:

2.88 (95% CI: 1.04-7.97)} to have experienced psychological abuse in the rural areas compared to those who had financial support.

140

Table 41: Predictors of elder abuse in both locations

Variable Elder abuse

(Rural and urban)

Yes (%) No (%) Adjusted p-value

114(22.8) 386(77.2) OR 95%(CI)

LGA

Urban 74(29.6) 176(70.4) 2.03 1.25-3.28 0.004*

Rural 40(16.0) 210(84.0) 1

Education

None 28(16.1) 146(83.9) 0.82 0.42-1.64 0.580

Primary 32(22.1) 113(77.9) 0.99 0.52-1.88 0.974

Secondary 31(32.6) 64(67.4) 1.42 0.74-2.72 0.293

Tertiary 23(26.7) 63(73.3) 1

Financial dependants

Present 58(27.5) 153(72.5) 1.57 1.12-2.42 0.042*

Absent 56(19.4) 233(80.6) 1

*p≤0.05

For the total population in this study, respondents who lived in the urban area were 2 times more likely to have experienced elder abuse compared to the rural respondents {OR: 2.03 (95% CI:

1.25-3.28)}. Respondents who still had financial dependants were also almost twice as likely to have experienced elder abuse {OR: 1.57 (95% CI: 1.12- 2.42)} compared to those who did not have financial dependants.

141

70.0%

60.80% 60.0%

50.0% 47.30% P e 42.5% r 40.0% c e n 30.0% Urban t 30.0% a Rural g 22.5% e 20.0% 17.5% 14.90% 15.0% 13.50%

10.0% 8.10% 6.70% 5.0%

0.0% Cut off from Anger Frightened Upset Ashamed Depressed family Feelings after occurrence of elder abuse

Figure 3: Effects of Elder abuse

In the both locations,, majority of the abused elders reported anger as a result of elder abuse

60.8% for urban and 42.5% for rural. More of the victims of abuse in the rural areas, 30.0% reported feelings of depression compared to the urban respondents 13.5% while a slightly higher proportion of urban victims, 6.7% compared with their rural counterparts, 5.0% felt cut off from family.

142

Table 42a: Depression symptoms in urban and rural areas in the last one month (1)

(Geriatric depression scale)

Variable Urban Rural Total χ2 df P-value Freq.(%) Freq.(%) Freq.(%) 250(50.0) 250(50.0) 500(100.0) Satisfaction with life Yes 235(94.2) 155(62.0) 390(78.0) 74.592 1 <0.001** No 15(6.0) 95(38.0) 110(22.0) Dropped activities of interests Yes 157(62.8) 135(54.0) 292(58.4) 3.984 1 0.057 No 93(37.2) 115(46.0) 208(41.6) Life is empty Yes 5(2.0) 20(8.0) 25(5.0) 9.474 1 0.003** No 245(98.0) 230(92.0) 475(95.0) Often got bored Yes 69(27.6) 117(46.8) 186(37.2) 18.725 1 <0.001** No 181(72.4) 133(53.2) 314(62.8) In good spirits most of the time Yes 192(76.8) 160(64.0) 352(70.4) 9.828 1 0.002** No 58(23.2) 90(36.0) 148(29.6) Afraid something bad will happen Yes 29(11.6) 14(5.6) 43(8.6) 5.725 1 0.025** No 221(88.4) 236(94.4) 457(91.4) Feel happy most of the time Yes 210(84.0) 151(60.4) 361(72.2) 34.686 1 <0.001** No 40(16.0) 99(39.6) 139(27.8) **P≤0.05

143

A higher proportion of respondents in the rural area 95(38.0%) expressed dissatisfaction with life compared to those in the urban areas 15(6.0%) and this difference was statistically significant.

Most respondents in the urban 157(62.8%) and rural locations 135(54.0%) reported that they had dropped their activities of interest. Majority of the respondents in the urban 245(98.0%) and rural areas 230(92.0%) did not view their lives as empty. A higher proportion of the respondents in the urban 181(72.4%) compared to those in the rural areas 133(53.2%) reported that they often did not get bored and this difference was statistically significant. A higher proportion of urban respondents 192(76.8%) reported they were in good spirits most of the time compared to their rural counterparts 160(64.0%) and this difference was statistically significant.

A higher proportion of respondents in the rural areas 236(94.4%) compared to their urban counterparts 221(88.4%) did not report fear of something bad happening and the difference was statistically significant. A higher proportion of the respondents in the urban 210(84.0%) compared to those in the rural areas 151(60.4%) reported that they were happy most of the time and this difference was statistically significant.

144

Table 42b: Depression symptoms in urban and rural areas in the last one month (contd)

Variable Urban Rural Total χ2 Df P-value Freq.(%) Freq.(%) Freq.(%) 250(50.0) 250(50.0) 500(100.0) Often feel helpless Yes 29(11.6) 43(17.2) 72(14.4) 3.180 1 0.097 No 221(88.4) 207(82.8) 428(85.6) Prefers to stay at home Yes 100(40.0) 139(55.6) 239(47.8) 12.192 1 0.001** No 150(60.0) 111(44.4) 261(52.2) Problems with memory Yes 42(16.8) 113(45.2) 155(31.0) 47.134 1 <0.001** No 208(83.2) 137(54.8) 345(69.0) Wonderful to be alive Yes 242(96.8) 232(92.8) 474(94.8) 4.057 1 0.068 No 8(3.2) 18(7.2) 26(5.2) Feeling worthless Yes 17(6.8) 20(8.0) 37(7.4) 0.263 1 0.733 No 233(93.2) 230(92.0) 463(92.6) Feeling full of energy Yes 180(72.0) 143(57.2) 323(64.6) 11.973 1 0.001** No 70(28.0) 107(42.8) 177(35.4) Situation is hopeless Yes 8(3.2) 10(4.0) 18(3.6) 0.231 1 0.811 No 242(96.8) 240(96.0) 481(96.4) Other people better off than me Yes 35(14.0) 103(41.2) 138(27.6) 46.281 1 <0.001** No 215(86.0) 147(58.8) 362(72.4) **P≤0.05

145

A slightly higher proportion of rural respondents 43(17.2%) reported they often felt helpless compared to the urban respondents 29(11.6%) but this difference was not statistically significant.

A higher proportion of respondents in the rural areas 139(55.6%) compared to those in the urban areas 100(40.0%) reported that they preferred to stay at home. A higher proportion of the rural respondents 113(45.2%) reported more problems with memory compared to the urban respondents 42(16.8%). A higher proportion of the respondents in the urban areas 180(72.0%) felt full of energy compared to their rural counterparts 143(57.2%). A higher proportion of the rural respondents 103(41.2%) opined that other people were better off than them compared to the urban respondents 35(14.0%). There was a statistically significant difference in the reports concerning preference to stay at home, memory problems, energy capacity, feeling of other people being better among respondents in both urban and rural locations.

Most of the respondents in both urban 242(96.8%) and rural 232(92.8%) areas reported that it was wonderful to be alive and the difference was not statistically significant. Only few of the respondents in the urban 8(3.2%) and rural 10(4.0%) areas reported that their situation was hopeless and the difference was not statistically significant.

146

Table 43: Depression scores in urban and rural areas

Variable Urban Rural Total χ2 Df P-value Freq.(%) Freq.(%) Freq.(%) 250(50.0) 250(50.0) 500(100.0) Depression (summary measure)

No depression 203(81.2) 138(55.2) 341(68.2) 41.261 2 <0.001**

Mild depression 44(17.6) 96(38.4) 140(28.0)

Severe depression 3(1.2) 16(6.4) 19(3.8)

Total 250(50.0) 250(50.0) 500(100.0)

P<0.05

There was a statistically significant difference in the prevalence of depression in both locations with more of the rural respondents having mild 96(38.4%) and severe depression 16(6.4%) compared to the urban respondents 3(1.2%) and 16(6.4%) respectively.

147

Table 44: Association between types of elder abuse and depression in urban and rural areas

Variable Depression Depression (Urban) (Rural) Yes No Total Yes No Total 47(18.8) 203(81.2) n=250 112(44.8) 138(55.2) n=250 (100.0) (100.0) Psychological abuse Yes 17(26.6) 47(73.4) 64(25.6) 8(36.4) 14(63.6) 22(8.8) No 30(16.1) 156(83.9) 186(74.4) 104(45.6) 124(54.4) 228(91.2) χ2=3.395 df=1 P=0.094 χ2=0.694 df=1 P=0.503 Physical abuse Yes 3(37.5) 5(62.5) 8(3.2) 4(44.4) 5(55.6) 9(3.6) No 44(18.2) 198(81.8) 242(96.8) 108(44.8) 133(55.2) 241(96.4) χ2=1.893 df=1 P=0.174* χ2=0.000 df=1 P=1.000 Financial abuse Yes 3(16.7) 15(83.3) 18(7.2) 10(58.8) 7(41.2) 17(6.8) No 44(19.0) 188(81.0) 232(92.8) 102(43.8) 131(56.2) 233(93.2) χ2=0.058 df=1 P=1.000* χ2=1.451 df=1 P=0.313 Sexual abuse Yes 0(0.0) 6(100.0) 6(2.4) 2(33.3) 4(66.7) 6(2.4) No 47(19.3) 197(80.3) 244(97.6) 110(45.1) 134(54.9) 244(97.6) χ2=1.423 df=1 P=0.597* χ2=0.327 df=1 P=0.694 Neglect Yes 3(100.0) 0(0.0) 3(1.2) 2(66.7) 1(33.3) 3(1.2) No 44(17.8) 203(82.2) 247(98.8) 110(44.5) 137(55.5) 247(98.8) χ2=13.115 df=1 P=0.006** χ2=0.587 df=1 P=0.589* Elder abuse Yes 18(24.3) 56(75.7) 74(29.4) 18(45.0) 22(55.0) 40(16.0) No 29(16.5) 147(83.5) 176(70.4) 94(44.8) 116(55.2) 210(84.0) χ2=2.101 df=1 P=0.159 χ2=0.001 df=1 P=0.978 *Fischer’s exact **P<0.05

148

In the urban location, a higher proportion of the respondents 17(26.6%) who reported psychological abuse had depression compared to the rural respondents 30(16.1%) but this difference was not statistically significant. A higher proportion of urban respondents who had experienced physical abuse were depressed compared to the rural respondents although this difference was not statistically significant. A higher proportion of urban respondents who were not financially abused 44(19.0%) were depressed compared to those who had experienced financial abuse 3(16.7%) and this difference was not statistically significant. None 0(0.0) of the respondents who were sexually abused were depressed compared with 47(19.0%) of those who were not sexually abused and the difference was not statistically significant. In the urban location, there was a significant association between the experience of neglect and depression with all the respondents who had experienced neglect 3(100.0%) more likely to be depressed compared to those who had not experienced neglect 47(17.8%). A higher proportion of urban respondents who reported elder abuse 18(24.3%) were depressed compared to those who had no experience of elder abuse 29(16.5%) but the difference was not statistically significant.

In the rural location, a higher proportion of respondents who were not psychologically abused were depressed compared to elders who were psychologically abused and this difference was not statistically significant. Similar proportions of physically abused 4(44.4%) and non-physically abused 108(44.8%) rural respondents were depressed. A higher proportion of financially abused rural respondents 10(58.8%) were depressed compared to those who were not financially abused

102(43.8%) but the difference was not statistically significant. A higher proportion of rural respondents who were not sexually abused 110(45.1%) were depressed compared to those who were sexually abused 2(33.3%) and this difference was not statistically significant. A higher proportion of rural respondents who were neglected 2(66.7%) were depressed compared to those

149 who were not neglected 110(44.5%) but this difference was not statistically significant. Almost similar proportions of respondents who had experienced elder abuse 18(45.0%) compared to those who did not report any form of abuse 94(44.8%) were depressed and therefore the difference was not statistically significant.

150

PART 2

FOCUS GROUP DISCUSSION RESULTS

4.2 QUALITATIVE RESULTS

The participants’ age ranged from 62 to 98 years. The FGD reports were analyzed and with five

(5) categories emerging out of which themes were derived. The categories are:

i. Problems faced by the elderly in the community

ii. Roles of the elderly in the community

iii. Types of elder abuse experienced

iv. Perception of the causes of elder abuse

v. Consequences of elder abuse

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Table 45a: Problems of the elderly in the community

Theme Subtheme Sex Location Sample statement

Problems of the elderly Physical Lack of F Urban “the elderly have a lot of health problems and health financial there is no money to pay for health bills, when we problems access to get to the hospital, they usually ask us to pay and

health care it is not as if this money is readily available. Who

can we go and meet for money? God should have

mercy on us”.

F Rural There are problems in this land. “This ward does

not take care of the elderly. The hospital may not

have doctors. When we get to the hospital, the

doctors shout at us. They do not take care of the

elderly. The hospital card is 500 naira. They do

not give you drugs for the ailment you present

with. For headaches they give you worm

medicine”.

Hunger M Rural “Older people’s systems are weak and we

do not have free medical checkups and

having good food to eat is a major

problem”.

152

Table 45b: Problems of the elderly in the community contd

Theme Subtheme Sex Location Sample statement

Problems of the elderly

Financial Pension M Urban “The pension is too small, some people are still

Difficulties inadequacies working after retirement, older children live with

us because they cannot afford their own

accommodation”.

The major themes derived from comments by the respondents include health care challenges, difficulty in paying for health care services and financial difficulties.

153

Table 46: Roles of the elderly in the community

Theme Subtheme Sex Location Sample statement Advisory Correcting F Urban “We discipline children within our environment. We

children have to correct the children. The adults have the

responsibility of reporting wayward children to

their parents.

When we report unruly children to their parents,

they complain about us correcting their children, so

we see the children and ignore their faults and mind

our own business. In the past it is one person that

bears the child, it is the whole world that trains the

child but it is not so anymore. The elderly do not

have roles in the community anymore”.

M Urban “We advice the younger generation”.

Conflict Security M Rural “We resolve problems in the community”. resolution provision “at Imota, the elderly men supervise the vigilante

groups so that we can sleep with our eyes closed,

we don’t want trouble in the land”.

Offering F Rural “Our roles include praying for our children and

Prayers greeting our neighbours”.

154

The participants’ roles included correcting wayward children, providing leadership and advising the younger generation within their environment. Conflict resolution and provision of security also featured as roles of the elderly in the community.

155

Table 47a: Perceptions about psychological elder abuse

Theme Subtheme Sex Location Sample statement Psychological Being ignored F Urban “It is my grandchild that is giving abuse me problems. I call her several

times and she ignores my call.

This gives me headaches and

hypertension. What is in the world

now? I wonder what kind of world

we have around us now. Is it

because these children have now

grown breasts?”

F Rural “For me I have not seen my

children in the past 2 years; when

I call, they do not answer my

telephone calls; tell me if I would

not go hungry if I have to depend

on them to feed”.

Disrespect M Urban “when we send children on

errands they refuse to go”

“Children disrespect us saying

this old man keep your mouth

shut”.

156

Table 47b: Perceptions about psychological abuse

Theme Subtheme Sex Location Sample statement

Psychological abuse Improper manners F Rural “some children do not even

greet us when they see us”.

M Urban “their mannerisms also show

that they disrespect us,

children these days cannot be

told to kneel down and greet

elders. Even our wives do not

respect us because they are

the ones providing for us. The

wives cannot even kneel down

to greet us”.

Accusation of witchcraft F Rural “When some of the youths see

elderly women they call us

witches”.

The participants described psychological abuse in the form of being ignored, disrespected, not being greeted in a proper manner and being accused of witchcraft.

157

Table 48: Perceptions about physical abuse

Theme Subtheme Sex Location Sample statement Physical abuse Cult gangs M Rural “the cult boys are a major

problem in this community.

Incidents of cultism are a lot in the

town. The cult boys do not respect

the elderly. The cult boys shout

down at us. If we retaliate or talk

too much, they will visit you in the

middle of the night with guns or

broken bottles”.

Rare M Urban “it is rare to see children beat

their parents except the child is on

hard drugs”.

The rural male participants made mention of their unemployed youths joining cult gangs and this constituted a source of elder abuse in their community while the rarity of physical abuse by family members was emphasized by urban male respondents.

158

Table 49: Perceptions about financial abuse

Theme Subtheme Sex Location Sample statement Financial abuse Unemployed children M Urban “there is no employment for the

children; my children have

graduated from the university but

still do not have jobs. The children

are unable to assist because they

are not working; now it is the

children that collect from parents.

“It is also common to see children

sell off their parent’s properties in

this Surulere even when the old

man is still alive”.

M Rural “The youths in this town are

unemployed and so they resort to

grabbing older people’s land and

joining cults. When the youths or

cult members are high on hard

drugs and when they are drunk,

they threaten the elders”.

The male respondents in both locations mentioned financial abuse which was opined to take the form of catering to the needs of adult unemployed children.

159

Table 50: Atypical forms of elder abuse

Theme Subtheme Sex Location Sample statement Abuse by Payment of M Rural “We are suffering. The government still collects government Bills tenement rates from us. I am 98 years of age. I

could not build a proper house. It was the sand

the neighbours gathered that I used to build my

small hut. Yet the government always threatens to

collect my land if I do not pay my tenement rate”.

F Rural “The government is lying, health care is not

free”.

F Urban “We have to pay for disposal of our refuse,

electricity use, this is not fair”.

Tokenism F Urban “The politicians also tell us lies. It is because of

poverty that old women join the campaign train of

politicians, because of “ankara” and money. We

are too old for these kinds of things”.

Pension M Urban Some people collapse while trying to collect their bureaucracy pension. The government is not considerate. They

forget that they will grow old one day”.

Destruction M Urban “sometimes the government destroys our homes;

of homes where do they want the old man to go since he

has lived in Lagos most of his life”.

160

The presence of previously undefined types of abuse also featured in our theme derivation. This form of abuse was said to be caused by the government and politicians. This included insincerity on the part of the government declaring that health care was free for the elderly, irregularity of pension payment and tokenism. Also, the fact that the elderly still had to pay bills for land charges, electricity and waste disposal also featured as elder abuse in both urban and rural areas.

161

Table 51: Perceived cause of elder abuse

Theme Subtheme Sex Location Sample statement

Substance abuse Use of drugs and F Urban “When children go to the joints we

have around, they become involved in Alcohol drugs and alcohol. Hard drugs and alcohol are influencing our children badly. Peer pressure is a major cause. It is the government that makes them use these hard drugs. A lot of rich children also take these drugs and this makes them disrespectful to their parents”. Government Unemployment M Urban “Government is the cause of the problem. There are no jobs and the pensions we get are used to solve children’s problems. There are no jobs for the youths, they are being used for politics and all they are offered are bread and beans cake”. Modernization M Urban “Modernization has turned the world upside down; most children do illegal deals to get money. They join cult and have tattoos on their body” Lack of home Poor home F Rural “some elders are good and some are training training bad, so how will the children not behave badly to the bad elders: some children do not even respect their parents, so how will they respect other elders in the community”.

162

Table 52: Consequences of elder abuse

Theme Subtheme Sex Location Sample statement

Health Hypertension F Urban “It makes us worry a lot and

Problems this can lead to high blood

pressure”.

F Rural “It can cause a lot of worry

and high blood pressure.” Societal confusion Embarrassment M Urban “This kind of behavior is

embarrassing to us; we are fed

up of the whole system; it has

caused confusion in the

society”.

Insecurity Insecurity M Rural “It makes us feel unsafe”.

The urban and rural female participants agreed that a major consequence of elder abuse was hypertension. The rural elderly male participants stated that insecurity was a consequence of elder abuse.

163

CHAPTER FIVE

DISCUSSION

This study reported a prevalence of 22.8% for elder abuse in the total study population.

Comparable prevalence rates were obtained in studies conducted in Hong Kong and India but higher rates were obtained in studies conducted in Kenya, Egypt, Macedonia and China17, 19. 43. 60,

65, 70 Lower prevalence rates were obtained in studies conducted in developed countries such as

United States of America, United Kingdom and Israel.57, 61, 63 These differences could be due to the different definitions of elder abuse used in each study and may also be due to variations in willingness to disclose abuse. The prevalence obtained in this study indicates that elder abuse is occurring and is relatively common in our environment.

This study reported a prevalence of 29.6% and 16% for elder abuse in the urban and rural LGAs respectively and this difference was statistically significant. This could be due to the effects of urban lifestyles which may stimulate higher stress levels in the daily lives of caregivers of the elderly in the urban population compared to the rural population.140, 141 It may also be attributed to westernization that has caused shifts in values and practices such as respect towards the elderly especially in the urban areas.8, 11

Regarding the different types of abuse, psychological abuse was the most commonly reported form of elder abuse in both rural and urban locations. A higher prevalence was reported for psychological abuse in the urban (25.6%) than the rural (8.8%) location and the difference was statistically significant. This finding was in contrast to what was found in a previous study in the

USA in which rural women had significantly higher experience of psychological abuse compared to the urban respondents.44 This finding may be accounted for by urbanization and

164 socioeconomic factors that has led to increased women in the workforce facing stressful events and could also be due to western influences on our cultural environment.24, 25, 142 Studies conducted in urban areas of Germany, Lithuania and Sweden reported similar prevalence rates as was reported in the urban areas in this study of 27.1%, 24.6% and 29.7% respectively.59 The reported prevalence for psychological abuse in the rural location in this study was much lower than the prevalence of 36% reported in rural Kenya but higher than the prevalence in rural Egypt of 5.1%.43, 70 Possible reasons for this may be due to high poverty rates in the location used for the Kenyan study.

There was no statistically significant difference in the prevalence of physical, financial, sexual abuse and neglect the urban and rural LGAs. Low prevalence rates were reported for these subtypes of elder abuse. These types may be underreported as these forms may have been perceived as more serious forms. A study done in New York did not show any significant differences in physical, sexual, and emotional abuse in urban and rural areas.21

A prevalence of 7.2% and 6.8% was obtained for financial abuse in the urban and rural location with a total prevalence of 7.0% in both locations. Some developed countries such as the United

States of America, United Kingdom and Israel reported lower prevalence rates for financial abuse of 5.2%, 0.7%, and 6.4% respectively in the urban areas.57, 61, 63 In the rural locations of

Egypt and China, much lower figures of 3.8% and 2.0% were obtained for financial abuse.19, 70

The relatively high rates of financial abuse may be as a result of huge burden of unemployment in Nigeria and economic hardship. Financial abuse among the elderly was however much higher in a study done in other locations such as Kenya and Ado-Ekiti in Nigeria in which a prevalence of 10% and 41.6% were obtained.43, 72 The higher rates in other studies compared to ours may have been as a result of differences in the location of the study.

165

In this study, a slightly higher prevalence of physical abuse was reported in the rural LGA, 3.6% compared to the urban LGA 3.2% although the difference was not statistically significant. This may be due to the social context in the rural areas in which youth cult gangs were reported to perpetrate physical abuse. The total prevalence of 3.4% for physical elder abuse in this study is higher than the prevalence obtained in previous studies done in developed countries like the USA and UK of 2.2% and 0.4% respectively.57, 61 Similar prevalence was obtained in studies conducted in Germany and Greece.58 However, a higher prevalence was found in a study conducted in Enugu Nigeria of 7.8% while a study done in Zaria Nigeria, did not report any physical abuse.74, 143This lower prevalence than that obtained in Enugu may have been due to the culture of respect for elders for which the south western part of the country is known.

The prevalence of sexual abuse in this study was the same in both urban and rural locations at

2.4% which is higher than the prevalence reported in the European survey of seven countries ranging from 0.3%-1.5% with the highest being in Greece.59 The prevalence of neglect of 1.2% was also the same in the urban and rural populations. This low prevalence may be due to the high levels of social support enjoyed in both rural and urban locations. Higher prevalence rates for neglect were found in Ado-Ekiti and Akwa-Ibom.69, 78 This difference may be accounted for by higher levels of poverty in these parts of Nigeria compared to Lagos state and rural-urban migration where children leave their elderly ones to come to the big cities like Lagos and consequently are left with no caregivers.

In this study, the most common form of abuse reported was psychological with financial being the next, followed by physical abuse and sexual abuse with neglect being the least common. This finding follows a similar pattern to that of a study conducted in Macedonia and Australia in

166 which psychological abuse was the most commonly reported followed by financial abuse but differs in that the least reported form of abuse was sexual abuse.60, 144

In the urban LGA, 20.8% of the respondents had experienced one type of abuse and 8.8% multiple types of abuse. In the rural LGA, 9.6% had experienced a single form of abuse while

6.4% multiple types. This same pattern was reported in a study conducted in Macedonia in which single forms of abuse occurred more frequently than multiple forms.60 The frequency of occurrence of all types of elder abuse was not significantly different in both locations.

Several factors have been found to be associated with the experience of elder abuse. Elder abuse among the urban respondents was found to be associated with having financial dependants in old age and not being satisfied with the level of involvement in social activities. The respondents who had financial dependants were 2 times more likely to have experienced elder abuse in the urban location compared to those who had no financial dependants. Some studies have shown that cases of elder abuse occur because the perpetrators may be financially dependent on the elderly for their source of livelihood especially if the perpetrators are unemployed.84, 89Also, when adult children depend on the elders for housing and financial help predisposes the elderly to abuse. In the rural location this association was not statistically significant. During the FGDs, urban male participants complained of having to share accommodation with their adult children.

This study showed that elders who were not satisfied with their level of participation in social activities were more likely to have experienced elder abuse in the urban area. This relationship was not statistically significant in the rural locations. With increase in age, there may be a reduction in the participation of the elderly in social activities which may result in decreasing social interactions with their peers whose presence may protect them from abuse.7 This situation

167 may also predispose to social isolation which has been found to be a risk factor for elder abuse.7,

62, 85

In the rural location, only educational status was found to be significantly associated with elder abuse. Respondents with secondary school education were more likely to report the experience of elder abuse compared to those with lower levels of education. Most studies have found an opposite effect in which lower levels of education were positively associated with the experience of elder abuse.63,64,78, 93, 96 These studies suggest that advances in education may increase the likelihood of the elders being respected. An explanation for the result of this study may be that respondents with higher levels of education may be more aware and open about reporting their experience of abuse compared to those with lower levels of education. Some studies however, have reported elders with higher educational status to be more vulnerable to abuse.58, 95

Regarding psychological abuse, this study reported that respondents in the urban location who were not satisfied with their level of involvement in social activities were significantly more likely to experience psychological abuse while this association was not significant in the rural location. This situation makes the elderly population in urban areas lonely and they are left to interact with their children most of the time, which explains why female working adult wards majorly perpetrated psychological abuse in this study. Increased stress levels caused by work in urban areas may contribute to perpetration of psychological abuse by the females.24, 25 A study conducted in Northern Ireland showed that adult children were majorly responsible for perpetrating several forms of elder abuse which is in contrast to what was observed in India where daughters in law were largely responsible for perpetrating elder abuse.63, 66

168

In the rural location, the experience of psychological abuse was associated with not having regular contact with the children and not having any source of financial support. After logistic regression, elders who did not have financial support were 3 times more likely to have experienced psychological abuse compared to those who had financial support in the rural location. A previous study found a similar result.61 In Nigeria, majority of the elderly live in the rural areas and usually work in informal settings, therefore do not earn pensions, making them more reliant on the on their children for financial support which may not be available due to poor economic situations. 25, 145 This situation may create more avenues for reliance on other people.

This may be the reason why neighbours were majorly responsible for perpetrating psychological abuse in the rural location.

The factors found to be associated with the experience of financial abuse in the urban areas include being male, taking alcohol and having financial dependants. These factors did not show a significant association in the rural areas. After logistic regression, the only significant predictor of financial abuse was having financial dependants in the urban location. Respondents who had financial dependants were 3 times more likely to have experienced financial abuse compared to the elderly who did not have financial dependants in the urban location. This study showed that most perpetrators of financial abuse in the urban location were male adult children who were mostly unemployed which indicates that they may be dependent on the elderly for their livelihood. This situation may create situations in which force is used to make the elderly concede to the demands of the unemployed children leading to financial abuse. Other studies have corroborated this finding.103, 107, 146, 147

In contrast with findings from the United States of America and United Kingdom where more females than males were the victims of financial abuse, this study found that more males were

169 likely to be victims of financial abuse compared to the females.57, 61 Another study found males to be more at risk of financial abuse.59 This may be due to the fact that men usually have more economic resources compared to females in our setting and so are more likely to own landed properties compared to women. Men are also more likely to manage financial matters in our setting and thus run a higher risk of financial abuse. It may also be possible that females were reluctant to report financial abuse as they may be more tolerant of financial abusive acts or interpreted as provision of financial help to their adult children or grand children.59

Use of alcohol was also associated with the experience of financial abuse in the urban location.

The relationship between alcohol use and abuse is complex and may be dependent on the amount of alcohol used. However, it may be suggested that impaired judgement and memory due to harmful use of alcohol by older persons may make them prone to financial abuse. It is also possible that older persons may use alcohol to cope with abuse.106

In the rural LGA, financial elder abuse was associated with having a poor health status. This is because a poorer health status may predispose to situations in which the elderly trusts other people to manage their finances and assets thus making them more prone to financial exploitation. A study showed that rural residing adults are more likely to report being susceptible to financial abuse due to illness because of its impact on the ability to attend to personal affairs.146Another study also corroborated this finding.61

In this study, sexual abuse in the rural location was found to be significantly associated with educational status. Respondents with higher levels of education were more likely to report sexual abuse compared to those with lower levels of education. This was an unusual finding although a study conducted among low income Latinos reported a similar finding.95 The reason for this may

170 be that respondents with higher levels of education may be more aware about this form of abuse and may easily report their experience compared to those with lower levels of education who may view it as a normal occurrence. More females than males were victims of sexual abuse in the urban location while only females were victims of sexual abuse in the rural location and the majority of perpetrators were male neighbours or friends in both locations. Elderly females have been found to be more vulnerable to sexual abuse compared to males. 58, 85, 148 This is probably because women are traditionally seen as weaker than men and are less able to protect themselves.

Factors found to be associated with the identified cases of neglect in the urban location include being older than 80 years of age, having a poor health status, being functionally impaired, not being satisfied with involvement in social activities and having fewer contacts with the children.

However, it was not possible to do a regression because the prevalence of neglect was low in this study. Advances in age predisposes to physical and cognitive deterioration which may increase the risk of neglect. Studies have shown that poorer health status and functional impairment were associated with increased experience of neglect.104, 105 Caring for the elderly with functional impairments requires considerable support and often personal sacrifice on the parts of caregivers and other family members .149 In the urban areas, family members may have busy schedules and this may be the reason why paid caregivers were most likely to be responsible for neglect in this study. The paid caregivers of the elderly in our environment are often inexperienced in the care of the elderly and may see this work as stressful which eventually results in neglect of the elderly.

In the rural location, not having regular contact with the children was associated with the experience of neglect. Having fewer contacts with family members have been found to be associated with the experience of elder neglect.61 This may be due to rural-urban migration and

171 the resultant effect is that the elderly in rural areas are left with no care givers. It may also be as a result of the extended family system which has gradually disintegrated over time.

The relationship between social support and elder abuse has not been extensively explored in previous studies conducted in African countries. In this study, the elderly exposed to physical abuse in the urban location reported significantly lower or worse scores in total perceived social support than those not exposed to physical abuse. Also, perceived social support from friends in the urban areas was significantly lower or worse among respondents who had experienced physical abuse and neglect compared to their counterparts. The anonymity associated with urban living may reduce the number of friends the elderly has and this results in reduced social support.

On the other hand, total social support, family support and support from significant others were perceived to be significantly lower among respondents who were exposed to neglect compared with those not exposed to neglect in the rural locations. Lower social support reduces the emotional, physical and financial assistance elderly persons receive. This predisposes to the elderly suffering neglect and physical abuse may become worse if the elderly has no friends or close family members to which reports can be made. Studies have found low levels of social support to be associated with the experience of physical abuse.56, 144Lower levels of social support may predispose to loneliness and this may increase the elder’s risk of physical abuse.145

A constant finding from studies conducted in developed countries is that lower levels of social support are strongly associated with the occurrence of all types of elder abuse although in this study we only found it to be associated with physical abuse and neglect.66 The elderly who are lonely or isolated are much more vulnerable to elder abuse than elders who have strong social support systems. Having limited social support also increases the risk of more severe abuse for elders who encounter mistreatment.56, 146 The reason is that the perpetrators may take advantage

172 of the person’s loneliness to inflict more physical abuse. Majority of perpetrators of physical abuse in both locations were males while more of the victims were females. Other studies have found similar associations.61, 62, 101, 150 In male-dominated countries like Nigeria, violence is used by men to control women and this unequal distribution of power increases the vulnerability of elderly women to violence.43

Perceptions about what constitutes elder abuse were mentioned during the Focus Group

Discussions. Psychological abuse was frequently reported during the FGD session. This type ranged from subtle forms such as being ignored, disrespected, not being properly greeted to more obvious and severe forms like being shouted at and being branded as a witch. Similar reports were made in India, Ireland and Brazil.110, 111, 116 Accusations of witchcraft have been found to lead to grave consequences especially for women such as being banished and ostracized.30, 113

The male FGD participants in both locations opined that financial abuse was common in the form of selling off properties without permission and land grabbing practices. This was attributed to high unemployment rates and dependence of adult children on the elderly. Physical abuse was only mentioned in the rural location as occurring in the community through activities of youth cult gangs. The unemployment situation of the country may lead to frustration of the youths because they are forced to depend on the elderly and compete for their meager resources. This can result in tensions during interactions with the elderly and may therefore predispose the elderly to abuse. Due to unemployment, the youths in the rural areas also become involved in cult gangs leading to perpetration of physical abuse. Sexual abuse was not mentioned in both locations and this may be because issues of sexuality are not easily discussed in public.

Apart from abuse at individual and community levels, the government was also blamed for the ways elders were treated in the community. Abuse among the elderly was reported to take the

173 form of being required to pay bills for waste disposal, health care, electricity and land use charges. Paying medical bills also featured as abuse in Kenya.109 The elderly may no longer be in a position to work and earn a living anymore, therefore having to pay bills for social amenities is actually a huge burden they have to bear. The inadequacy of pensions and the sour experience of government pensioners while trying to collect their retirement benefits also featured as elder abuse. A similar finding was documented in a study conducted in Argentina.112 An unusual form of abuse reported in this study was that of tokenism, with politicians being accused of giving seasonal gifts only during political campaigns to elderly women on their campaign train as opposed to developing sustainable programs focusing on care and welfare of the elderly.

Perceived causes of elder abuse mentioned during the FGDs were substance abuse, peer pressure, youth unemployment and modernization. Abusing substances such as alcohol and hard drugs may make perpetrators financially dependent on older people for funding of their addiction and this may result in elder abuse. Caregivers who consume alcohol may also neglect their responsibilities to the elders due to the lack of inhibition caused by alcohol..106 Youths involved with friends that have bad characters may be influenced by such behaviours and may therefore behave rudely towards the elderly.

More than half(60.8%) of the urban respondents and 42.5% of the rural respondents who had experienced any form of elder abuse reacted emotionally by being angry while more of the rural respondents reported being ashamed and depressed as a result of elder abuse. A study conducted in the United Kingdom showed that 77% of the respondents reported anger as a consequence of elder abuse.61 Reactions to elder abuse and neglect was frequently emotional in the Macedonian study.103 Care, love and respect are usually expected behaviours the elderly desires from relatives

174 and community members which is why they would be angry if they experience abuse. Other consequences mentioned during the FGDs include feelings of embarrassment and insecurity.

In this study, less than one-fifth (18.8%) of the respondents were depressed in the urban areas compared to 44.4% of the rural respondents. Elder abuse was not significantly associated with depression in both locations. This is in contrast to some studies which have found elder abuse to be associated with higher incidents of depression.19, 103, 151 Nigerians are generally very spiritual and places of worship readily provide comfort and encouragement to those who are sad and depressed. This may explain why depression was not a consequence of elder abuse in this study.

Only those who had experienced neglect in the urban areas had depression. A study found neglect to be associated with depression in the urban areas.152 Being neglected is a serious form of elder abuse and can be a harrowing experience which may result in mental health consequences such as depression.

The prevalence of elder abuse in this study, its risk factors and effects indicate that it is a public health problem that needs to be addressed in Lagos State.

175

5.1. CONCLUSION

The prevalence of elder abuse was significantly higher in the urban 29.6% than the rural LGA

16% (p<0.001). Psychological abuse was the most common form of elder abuse reported in this study followed by financial and then physical abuse. Sexual abuse and neglect were the least common forms of elder abuse reported.

Elder abuse in the urban areas was best predicted by the presence of financial dependants in old age and not being satisfied with involvement in social activities. Psychological abuse in the rural areas was predicted by not having a source of financial support. Financial abuse in the urban areas was predicted by having financial dependants in old age while in the rural areas it was associated with having a poor health status. Elders who were physically abused in the urban location had lower social support scores from friends and reduced total social support scores compared with those who had not experienced physical abuse. Neglect in the rural areas was associated with reduced social support from family and not having contact with the children.

Perception of what constitutes elder abuse includes being ignored, disrespected, being required to pay bills and administrative bottlenecks encountered when trying to collect retirement benefits.

Substance abuse by the perpetrators, peer pressure, youth unemployment and modernization were mentioned as perceived causes of elder abuse.

The effects of elder abuse included emotional reactions such as being angry, and only those who experienced neglect in the urban areas were more likely to be depressed.

176

5.2. RECOMMENDATIONS a. Awareness about elder abuse should be created among different groups in the community

through various media such as radio and television programs and community meetings by

Community Development Associations, Local Governments, religious organizations and

Non Governmental Organizations with a view to improve family and community

attitudes towards the elderly and thus prevent the occurrence of elder abuse by

community and family members. b. Opportunities should be created for social interaction of elders in the community through

the establishment of culturally appropriate social clubs suitable for the elderly by the

Community Developmental Associations, Local Governments or Non Governmental

Organizations. Social support groups should be formed by elderly community members

in rural areas to help build their social networks. This will help improve social support in

the community and prevent social isolation of the elderly. It will also provide

opportunities for the elders to share experiences about their situation and foster solutions. c. The government should improve socioeconomic and developmental conditions in the

rural areas which may in turn help improve the family support available to the elderly as

this will reduce the number of children or youths moving from the rural to the urban

areas. d. The government should initiate social welfare packages such as providing regular

stipends to the indigent elderly population, reducing the cost of services and social

amenities and making free and quality health care services available for the elderly. Day

care centers should also be established to provide daily care and free meals for the

indigent elderly in the community.

177

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195

APPENDIX A

RESPONDENT’S INFORMED CONSENT FORM

QUESTIONNAIRE NUMBER

LGA------STREET------

I am Dr Onigbogi M.O, a resident doctor in the Department of Community Health and Primary

Care of the Lagos University Teaching Hospital, Idi-Araba, Lagos.

Research Title- A comparative study of the prevalence, pattern, determinants and effects of elder abuse in an urban and a rural Local Government Area of Lagos State.

Purpose of research- To find out the way elders are being treated in the community. To determine the prevalence, pattern and determinants of elder abuse rural and urban residents of

Lagos state

Procedure of research- An interviewer will politely ask you some questions in private.

Willingness and confidentiality- Your participation in this study is entirely voluntary and you can stop the interview at anytime you feel uncomfortable. Information given and obtained would be kept confidential as your name would not be required. This cannot be linked to you in anyway and your name will not be used in any publication or reports from this study.

Potential benefits- The information obtained from this study will add to the body of knowledge and will provide a baseline for which interventions can be carried out in your community

Potential risks- Some of the questions might be sensitive but your responses will be kept confidential.

Statement of person obtaining informed consent

I have fully explained this research to the respondents and given sufficient information including the risks and benefits to make an informed decision

196

Name of interviewer------Date------

Time------

Statement of person giving informed consent

The study has been explained to me, I understand that my participation is voluntary. I know the purpose, procedure, risks and benefits of this study and I know that I can decide not to continue at anytime in this study

Signature------Date ------

Thumb print------

197

QUESTIONNAIRE ON PREVALENCE, PATTERN, DETERMINANTS AND EFFECTS

OF ELDER ABUSE IN AN URBAN AND A RURAL LOCAL GOVERNMENT AREA OF

LAGOS STATE.

ALL INFORMATION OBTAINED IN THIS STUDY WILL BE KEPT CONFIDENTIAL

AND USED FOR RESEARCH PURPOSE ONLY.

SECTION ONE: SOCIO-DEMOGRAPHIC DATA

1. Age (last birthday) ------

2. Sex (a.) Male ( ) b. Female ( )

3. Marital status : (a) Single ( ) (b) Married ( ) (c.) Separated/Divorced ( ) (d.)

Widowed ( ) (e.) Cohabiting ( )

4. Religion: (a.) Christianity ( ) (b.) Islam ( ) (c.) Traditional ( ) (d.) Others, please

specify ____

5. Ethnicity: (a.) Yoruba ( ) ( b.) Igbo ( ) (c.) Hausa ( ) (d.) Others, please specify----

------

6. Occupation: What kind of work do you mainly do presently? (a.) Retired ( )

(b.) Employed full time as ------(c.) Employed part time as------

(d.) Others please specify------

7. What was your previous occupation before retirement? ------

8. What is your highest level of education? (a) No formal education ( ) (b) Primary ( )

(c) Secondary ( ) (d) Tertiary ( ) (e) Postgraduate ( ) (f) Others: please

specify______

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SECTION TWO: LIVING ARRANGEMENT

9. How many living children do you have?------

10. Number of working children (a) None [ ] (b) 1 [ ] (c) 2 [ ] (d) 3 [ ](e) All [ ]

(f) Others------

11. With whom do you live? Please tick one or several alternatives Yes No

a. Alone [ ] [ ]

b. My husband/wife/cohabitant [ ] [ ]

c. Married child(ren) [ ] [ ]

d. Unmarried child(ren) [ ] [ ]

e. Grandchild(ren) [ ] [ ]

f. Living with paid caregiver [ ] [ ]

g. Living with other family member (please specify) [ ] [ ]

12. Total number of people living in your household including yourself?------

13. Who is your main care provider?

a. Spouse [ ]

b. Self [ ]

c. Children [ ]

d. Relatives [ ]

e. Others please specify------

199

14. Do you live in your own house? (a) Yes [ ] (b) No [ ] ( rented, owned by me,

Someone else’s)

15. What type of house do you live in?------

a. One bedroom self contained [ ]

b. One bedroom with shared amenities [ ]

c. One room and parlour with shared amenities [ ]

d. 2 bedroom flat [ ]

e. 3 bedroom flat [ ]

f. Duplex [ ]

g. Bungalow [ ]

h. Hut [ ]

i. Others please specify------

16. What is the main source of water for domestic use?

a. Pipe borne water inside dwelling [ ]

b. Pipe borne water outside dwelling [ ]

c. Public tap [ ]

d. Bore hole [ ]

e. Well [ ]

f. Water vendor/tanker truck [ ]

g. Rain water [ ]

h. Lake/pond/stream [ ]

i. Others; please specify ______

200

17. What type of toilet do you use in this household?

a. Water closet [ ]

b. Pit latrine [ ]

c. Public toilet [ ]

d. Bucket toilet [ ]

e. No facility/bush/field [ ]

f. Other : please specify______

18. Which of the following items do you have in your household?

Yes No

a. Electricity [ ] [ ]

b. Radio [ ] [ ]

c. Television [ ] [ ]

d. Mobile telephone [ ] [ ]

e. Refrigerator [ ] [ ]

f. Generating set [ ] [ ]

g. Air conditioner [ ] [ ]

h. Electric iron [ ] [ ]

i. Fan [ ] [ ]

19. What type of fuel do you use mainly for cooking?

a. Electricity [ ]

b. Gas [ ]

c. Kerosene [ ]

d. Charcoal [ ]

201

e. Firewood [ ]

f. Animal dung [ ]

g. Others: please specify ______

20. What is your present main source of income?

a. Self [ ]

b. Spouse [ ]

c. Children [ ]

d. Others please specify ______

21. If answer to Q.18 is self, then in what way?

Pension [ ]

Salary [ ]

Others please specify ______

22. How much is your monthly allowance from all sources? ______

23. If receiving pension, when last did you receive your pension?______

SECTION THREE: HEALTH PROBLEMS AND CURRENT DISABILTY

ASSESSSMENT OF THE ELDERLY

24. Do you have any health problems? (a) Yes [ ] (b) No [ ]

25. If yes, which health problems do you have?

a. Cardiovascular system related ( high blood pressure, heart failure) [ ]

b. Central nervous system (difficulty remembering, difficulty concentrating, stroke[ ]

c. Gastrointestinal related (ulcer, piles, faecal incontinence) [ ]

d. Endocrine ( Diabetes mellitus) [ ]

e. Eye disease ( blurred vision, cataracts, glaucoma) [ ]

202

f. Genitourinary (difficulty urinating, incontinence, frequent urination) [ ]

g. Respiratory diseases (Cough, breathing difficulty, asthma) [ ]

h. Musculoskeletal(arthritis, joint pain, back pain) [ ]

i. Others, please specify ______

26. How would you assess your health generally?

a. Excellent [ ]

b. Very good [ ]

c. Good [ ]

d. Fair [ ]

e. Poor [ ]

27. Are you on drugs for any medical conditions? (a) Yes [ ] (b) No [ ]

28. If answer to Q25 is yes, how would you rate your compliance with treatment?

(a) Always[] (b) Sometimes [ ] (c) Never [ ]

29. How would you rate affordability of your drugs? (a) Always affordable [ ] (b)

Sometimes affordable [ ] (c) Never affordable [ ]

30. Do you drink alcohol? (a) Yes [ ] (b) No [ ]

31. If yes, how often do you drink alcohol? (a) Once a month or less [ ] (b) 2-4 times a

month [ ] (c) 2-3 times a week [ ] (d) 4 or more times a week [ ]

32. Do you smoke cigarrettes? (a) Yes [ ] (b) No [ ]

33. If yes, how often do you smoke cigarrettes? (a) Once a month or less [ ] (b) 2-4

times a month [ ] (c) 2-3 times a week [ ] (d) 4 or more times a week [ ]

203

SECTION FOUR: ACTIVITIES OF DAILY LIVING (ADL)

34.

Activity Degree of Assistance For each item Who performs Does the 1. Unaided indicate if the activity? elder live 2. With assistance situation is 1.childrenF/M with the from others 1. Temporary 2. In laws caregiver? 3. Totally Dependent 2. Permanent 3. Neighbour 1. Yes on others 4. Nurse 2. No 4. Activity not 5. Maid performed (1-4) Bathing

Dressing

Toileting

Eating

Walking

Transferring

Meal preparation

Medication Administration Shopping

Transportation

House chores- washing clothes, cooking Going to the farm or some other place of work

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SECTION FIVE: PATTERN OF ELDER ABUSE

35. In the last 12 months

TYPE OF ABUSE No Yes (How By whom Cause

frequently within 1)Spouse

the last 12 months) 2)ChildF/M

1. Only once 3)Son/ daughter

2. A few times in law

3. Weekly 4)Grand child

4. Monthly 5) relative

5. Always 6)Neighbour

7) friend

8)paid care giver

9))others specify

Psychological Abuse

Has anyone close to you ever--- a. ever insulted you or sworn at you? b. undermined or belittled what you do? c. excluded you or repeatedly ignored you? d. threatened to harm others that you care about?

(e.g. relatives) e. prevented you from seeing others that you

care about? f. shouted or yelled at you?

205 g. did something to spite you? h. threatened to hit or throw something at you? i. blamed you for the misfortunes of society? j. prevented you from participating in social

activities as a form of punishment?

Physical abuse

Has anyone close to you ------k. slapped you? l. kicked you? m. pushed /shoved you? n. burned or scalded you on purpose? o. threw something on you that hurt? p. twisted your arm? q. used a weapon on you (knife etc)? r. punched or hit you with something that could

hurt? s. beat you? t. tied you down? u. locked you in your room? v. gave you too much medicine to control you or

make you feel sleepy? w. used a weapon on you e.g knife? x. slammed you against a wall or door?

206

Financial abuse

Has anyone close to you ------y. made you give him/them your money,

possessions or property against your will? z. tried to use fraud to take money, possessions

or property from you? aa. attempted to steal money, possessions or

property from you/ stolen anything from you

or used things that belonged to you without

your permission? E.g. ATM, cheques,

personal property or documents. bb. forced you to sign documents against your

will or pay for services against your wish? cc. Pretended to be you to obtain goods and

money/ refused to pay money owed to you

such as your rent?

Sexual abuse

Has anyone dd. tried to touch you in a sexual way against your

will? ee. tried to have sexual intercourse with you

against your will? ff. Had sexual intercourse with you against your

207

will or by using force/threatening you?

Neglect

Has anyone close to you------gg. prevented you from having food? hh. prevented you from having clothing? ii. prevented you from having medical care?

36. Could you provide the following information about the perpetrator?

Perpetrator 1 Perpetrator Perpetrator Perpetrator Perpetrator

(psychologica 2 3 4 5

l) (physical) (financial) (sexual) (neglect)

a. Sex

b. Age

c. Marital status

d. Professional

situation (employed

or unemployed)

e. Educational level

208

37. Concerning the perpetrator

Perp 1 Perp 2 Perp 3 Perp 4 Perp 5

a. Do you consider that he/she is under stress?

b. Does the person take alcohol?

c. Does the person smoke cigarettes?

d. Does the person use illegal drugs?

Other reasons please state

SECTION SIX: RISK FACTORS OF ABUSE OF THE ELDERLY

38. I will read the following statements to you. Please indicate your level of agreement or

disagreement with the statements

Statement Strongly Disagree Neutral Agree Strongly

disagree agree a. There is a special person who is

around when I am in need b. There is a special person with whom

I can share my joys and sorrows c. My family really tries to help me d. I get the emotional help I need from

my family e. I have a special person who is a

source of comfort to me f. My friends really try to help me

209 g. I can count on my friends when things

go wrong h. I can talk about my problems with my

family i. I have friends with whom I can share

my joys and sorrows j. There is a person in my life caring

about my feelings k. My family is willing to help me

make decisions l. I can talk about my problems with my

friends

39. Are you involved in social activities (religious activities, social clubs)

(a) Yes [ ] (b) No [ ]

40. Are you involved in social activities as frequently as you would like to be?

(a) Yes [ ] (b) No [ ]

41. If not, what prevents you?

a. Health problems [ ]

b. No one to take me [ ]

c. Not availability of the activities that I would like to participate in [ ]

d. Too expensive [ ]

e. Others, please specify ______

210

42. Are you involved in family activities as frequently as you would like to be?

(a) Yes [ ] (b) No [ ]

43. Do you feel that you have enough contact company you need with your children?

(a) Yes [ ] (b) No [ ]

44. How often do your children visit you? (a) Daily [ ] (b) At least weekly [ ] (c) At least

monthly [ ] (d) At least yearly [ ] e. Never [ ]

45. Do you feel that you have enough contact company you need with your relatives?

(a) Yes [ ] (b) No [ ]

46. How often do your relatives visit you? (a) Daily [ ] (b) At least weekly [ ] (c) At least

monthly [ ] (d) At least yearly [ ] e. Never [ ]

47. Do you feel that you have enough contact company you need with your friends?

(a) Yes [ ] (b) No [ ]

48. How often do your friends visit you? (a) Daily [ ] (b) At least weekly [ ] (c) At least

monthly [ ] (d) At least yearly [ ] e. Never [ ]

49. Do you feel that you have enough contact company you need with your neighbours? (a)

Yes [ ]

(b) No [ ]

50. How often do your neighbours visit you? (a) Daily [ ] (b) At least weekly [ ] (c) At

least monthly [ ] (d) At least yearly [ ] e. Never [ ]

51. What is your present financial situation?

a. Financially self-sufficient [ ]

b. Partly self-sufficient [ ]

211

c. Total financial dependence [ ]

d. Unknown [ ]

52. Do you have financial support? (a) Yes [ ] (b) No [ ]

53. If yes, who your major source of financial support?

a. Spouse [ ]

b. Child(ren) [ ]

c. Grandchildren [ ]

d. Niece/nephew [ ]

e. Pension [ ]

f. Others please specify ______

54. In the past 12 months, has anyone depended on you for money? (a) Yes [ ] (b) No [ ]

55. If yes, who?

a. Spouse [ ]

b. Son/Daughter (s) [ ]

c. Grandchildren [ ]

d. Niece/nephew (s) [ ]

e. Others please specify______

56. To what degree is this person dependent on you financially?

a. Totally [ ]

b. Partially [ ]

c. Episodically [ ]

57. Is this (a) Permanent [ ] (b) Temporary [ ]

212

58. Has there been any problems regarding finances between you and that person in the last

12 months? (a) Yes [ ] (b) No [ ]

SECTION SEVEN: EFECTS OF ELDER ABUSE

59. What effects did you experience as a result of being abused?

a. I felt cut off from family or friends [ ]

b. I felt angry [ ]

c. I felt frightened [ ]

d. I felt upset [ ]

e. I felt ashamed [ ]

f. I felt depressed [ ]

g. It caused economic problems [ ]

h. Injuries [ ]

i. Other feelings please specify------

60. Did you experience any injuries as a result of being physically abused?

(a) Yes [ ] (b) No [ ]

61. What type of injury did you experience?

a. Cuts/lacerations/bruises [ ]

b. Burns [ ]

c. Swellings on any parts of the body [ ]

d. Falls [ ]

e. Fractures/broken bones [ ]

f. Physical pain [ ]

g. Fainted or passed out from being hit [ ]

213

h. I visited the doctor after being injured [ ]

i. Others Please specify------

62. For financial abuse, what effects did you experience

a. I lost property [ ]

b. I lost money [ ]

c. It caused economic problems [ ]

d. I had to economise for a while [ ]

e. Others, please specify------

63. What actions did you take to prevent the recurrence of abuse?

a. None [ ]

b. Resolve the problem with the perpetrator [ ]

c. Break contact with the perpetrator [ ]

d. Ask relatives for help [ ]

e. Ask for spiritual help [ ]

f. Withdrawal from social life [ ]

g. Others------

64. Geriatric Depression Scale (In the past one month) No Question Yes No Score a. Are you basically satisfied with your life? b. Have you dropped many of your activities and interests? c. Do you feel that your life is empty? d. Do you often get bored? e. Are you in good spirits most of the time? f. Are you afraid that something bad is going to happen to you?

214 g. Do you feel happy most of the time? h. Do you often feel helpless? i. Do you prefer to stay at home rather than going out and doing new things? j. Do you feel you have more problems with memory than most people? k. Do you think it is wonderful to be alive? l. Do you feel pretty worthless the way you are now? m. Do you feel full of energy? n. Do you feel your situation is hopeless? o. Do you think that most people are better off than you? Total

215

APPENDIX B

FOCUS GROUP DISCUSSION GUIDE

Explain the meaning of elder abuse to the participants. Elder abuse is a single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person).

 What are the main problems faced by elderly women and men in the community?

 What are the roles of older people within the community?

 Perceptions of what elder abuse is and what are the different kinds

 Perceptions of the contexts in which abuse occurs, and its perceived causes

 In your opinion, what are the possible consequences of elder abuse for older people, their

families and the community?

 Is elder abuse is common in the area and why?

 Patterns of abuse, for instance would abuse be related to the period of the month when a

pension is cashed or around festivities that can trigger special stress in the community

such as religious holidays, festivals etc

 Any comments or recommendations?

216

ÀLÀYÉÌTÉṆ ILỌRÙN FÚN OLÙDÁHÙN

NÓṆ́ BÀÀTÒJỌÌBÉÈRÈÌWÁDÌÍ

ÌJỌBA ÌBÍLÈ…̣ ……………….. ÒPÓPÓNÀ…………………….

Èmi ni Dókítà Onigbogi M.O. láti èḳ a ìtój̣ ú alábóḍ éàti pàjáwìrì ti ilé-èḳ ó ̣ gíga, ìtój̣ ú aláìsàn ti

Èkó níÌdí-Àràbà, Èkó.

Àkòrí iṣéị̀wádìí – Àgbéyèẉ ò èḳ ó ̣ nípa ìhùwàsì awon eniyan àwùjọ, ìlànààti ti awon tíóṣo-mó ̣ awon àgbàlagbà níìgbèríko àti ìlúńlá-ńlá ní awon ìjọba ìbílè ̣níìpínlèẸ̀ kó.

Ìdí iṣéị̀wádìí – Láti ṣe ìwádìí bí wóṇ ṣe ń tój̣ ú awon àgbàlagbà níàwùjọ. Láti mọ gbèdéke

ìhùwàsí awon eniyan láwùjọ, awon tíóṣomóạ̀ gbàlagbà, ìlànààti ìṣesí wọn níìgbèríko àti ìlúńlá-ńlá ní awon ìjọba ìbílè ̣níìpínlèẸ̀ kó.

Ìlànà iṣéị̀wádìí – Olùfòṛ òẉ ániléṇ uwò yóò fìrèḷè ̣béèrè awon ìbéèrè níìdá-kó-̣ ń-kó.̣

Gbígbààti ìpamó ̣ – Kíkópa ninu iṣéị̀wádìí yìí jéị̀finú-féḍ òṣ̣ e ẹ sì lè da dúró níìgbà-kúù-gbà tíó wù yín. Ohunkóhun tí ẹ bá sọ fún wa yóò wà níìpamó,̣ ìdí nìyí tí a kò fi nílò orúkọ yín.

Ohunkóhun tí ẹ bá sọ kò lè kàn yín níbì kan-kan àti pé a kò ní lo orúkọ yín ninu àbájáde tabi

àkọsílè ̣kan-kan.

Èrè tí a lè rí jẹ –Àbájáde ìwádìí yìí yóò dara pò ̣ móị̀ mò ̣tí a ti ní yóò sì tún ṣe ìrànwó ̣ipa rere tí a lè kó níàdúgbò yín.

Èṛ ù tó lè fé ̣wa –Òp̣ ò ̣lára awon ìbéèrè lè fé ̣nira díè ̣láti dáhùn ṣùgbóṇ , a ó pa ìdáhùn yín mó.̣

217

Òṛ ò ̣ẹni tóń gba ìdáhùn sílè ̣

Mo tíṣàlàyé ní kíkún fún olùdáhùn awon ìbéèrè wòṇ yí pèḷú ohun tó lè fa èṛ ùàti èrèèyí tí yóò fa

ìpinnu tíó múná dóko.

Orúkọ ẹni tóń fi òṛ ò ̣wá ni léṇ u wò…………………………………….…………

Déètì…………………………………………….. Àsìko…………………………

Òṛ ò ̣ẹni tó fínú-fíndò ̣gba Ìtèṣ íwájú ojú-ewé kìn-ín-ní

Wóṇ ti sạ̀ làyéìwádìí yìí fún mi, ó sì yé mi pé kíkópa mi jéẹ̀ yí tí mo fé.̣Mo mọìdí, ìlànà, èṛ ùàti

èrèìbí iṣé ̣yìí, mo sì tún mò ̣pé mo lè pinnu láti mó ̣kópa mó ̣nígbà tíó bá wùmí.

Ìfọwóṣ í…………………………………..… Déètì…………………………………

Ìka títè…̣ …………………………….

218

ÀTÒJỌÌBÉÈRÈÌWÁDÌÍ LÓRÍÌSESÍ (ÌTÓJ̣ Ú AWON ÀGBÀLAGBÀ) LÁTI ÒḌ Ò.

AWON ENIYAN ÀWÙJỌ, ÌLÀNÀÀTI AWON TÓṢO-MÓ-̣ WỌN NÍÌGBÈRÍKO ÀTI

ÌGBORO NÍÌJỌBA ÌBÍLÈ ̣ KAN NÍÌPÍNLÈẸ̀ KÓ

GBOGBO ÌDÁHÙN TÍ A BÁ RÍ GBÀ NÍNÚ IṢÉ ̣ YÌÍ YÓÒ WÀ NÍÌPAMÓẠ̀ TI LÍLÒ

FÚN IṢÉỊ̀ WÁDÌÍ NÌKAN

ÌPÍN KÌN-ÍN-NÍ: ÀKÓJỌÌBÁṢEPÒ ̣ ẸNI

1. Ọjó ̣orí (àjòḍ ún ọjóìbị́ tó kọjá)……………………………….

2. Irú eniyan (a) ọkùnrin [ ] (b) obìnrin [ ]

3. Ipòìgbéyàwó (a) àpóṇ /omidan [ ] (b) ọkọ/ìyàwó [ ] (d) awon tó ti kọra wọn sílè ̣[ ]

(e) Opó [ ] (ẹ) wóṇ jọń gbé [ ]

4. Èṣ ìn: (a) ìgbàgbó ̣ [ ] (b) músùlùmí [ ] (d) àbáláyé [ ] (e) òmíràn jòẉ óṣ̣ àlàyé

…………………………………………………….

5. Èỵ à: (a) Yorùbá [ ] (b) Íbò [ ] (d) Haúsá [ ] (e) òmíràn

(jòẉ óṣ̣ àlàyé)…………………………………………………………….

6. Iṣé:̣ Irú iṣé. Wo lèṇ́ ṣe lóẉ ó,̣ lóẉ ó?̣ (a) mo ti pèḥ ìndà [ ] (b) mòńṣiṣé ̣kéḳ ùn-ún-réṛ é ̣[ ]

(d) Mòńṣiṣé ̣ ni ààbò ̣ bí i [ ] (e) òmíràn ṣàlàyé)

……………………………………………………………….

7. Iṣé ̣wo ni èṇ́ ṣe kí ẹ tó fèỵ ìn tì? ……………………………………….

8. Ìwéèṛ í wo ló gajù tí ẹ ní? (a) N kò kàwé rárá [ ] (b) alákòọ́ ḅ èṛ è ̣[ ] (d) girama [ ] (e)

tiléìwé-gíga [ ] (ẹ)Léỵ ìn ìwé-èṛ íàkóḳ ó ̣ ti Yunifásítì [ ] (f) òmíràn ṣàlàyé)

……………………………………………………………….

219

ÌPÍN KEJÌ: ÈTÒ NÍPA IBI GBÍGBÉ

9. Omo mélòó lẹ bí tí wọn wà láàyè?......

10. Iye omo tóńṣiṣé?̣ (a) rárá [ ] (b) ẹyọ kan [ ] (d) méjì [ ] (e) méṭa [ ] (ẹ) gbogbo

wọn [ ] (f) awon mìíràn (ṣàlàyé) …………………………….

11. Àwọn wo ni ẹ jọń gbé? Jòẉ ó ̣fọwó ̣sí òḳ an tàbí jùbéẹ̀ ̣lọ

Béẹ̀ ̣ Béẹ̀ ̣

ni kó ̣

a. Mòń dá gbé [ ] [ ]

b. Ọkọ/ìyàwó/alabágbé [ ] [ ]

d. Ọmọ/àwọn ọmọ tó tii ṣe ìgbéyàwó [ ] [ ]

e. Ọmọ/àwọn ọmọ tí kò tíì ṣe ìgbéyàwó [ ] [ ]

ẹ. Ọmọ/àwọn ọmọ, ọmọ [ ] [ ]

f. Àwọn tí óń gba owó fún ìtój̣ ú mi [ ] [ ]

g. Pèḷú àwọn ẹbí (ṣàlàyé) [ ] [ ]

12. Èỵ in mélòó ni ẹ jọń gbé?......

13. Ta ni óń tójụ́ yín ní pàtàkì?......

a. Ìyàwó/ọkọ [ ]

b. Fúnra ara mi [ ]

d. Àwọn ọmọ [ ]

e. Àwọn ẹbí[ ]

ẹ. Àwọn mìíràn (ṣàlàyé) [ ]

14. Ṣé ilé ara yín lèṇ́ gbé? (a) Béẹ̀ ̣ni [ ] (b) Béẹ̀ ̣kó[̣ ]

15. Irú ilé wo ni èṇ́ gbé? Béẹ̀ ṇ i Béẹ̀ ḳ ó ̣

220 a. Yàrá kan pèḷú ohun gbogbo tí a nílò [ ] [ ] b. Yàrá kan pèḷú àjọlò ohun gbogbo tí a nílò [ ] [ ] d. Abala ilé oní yàrá méjì [ ] [ ] e. Abala ilé oní yàrá métạ [ ] [ ] ẹ. Ilé pèṭéẹ̀ ṣ ì aládàágbé [ ] [ ] f. Ilé ilè ̣aládàágbé [ ] [ ] g. Abà [ ] [ ] gb. Òmíràn jòẉ ó ̣ṣàlàyé ……………………………………………………….

16. Ibo ni ẹ ti ń pọn omi fún ìlò yín? a. Omi èrọ̣ nínú ilé [ ] b. Omi èrọ̣ ní ìtàn ilé [ ] d. Omi èrọìtạ gbangba [ ] e. Omi inú ilè ̣tí wóṇ fi èṛ ọ gbé ̣ [ ] ẹ. Kànga [ ] f. Àwọn tí óń pọn tà [ ] g. Omi òjò [ ] gb. Òmíràn ṣàlàyé………………………………………………………….

17. Irú ilé ìyàgbé ̣wo lẹń lò nínú ilé yìí? a. Ilé ìyàgbé ̣aláwo [ ] b. Sáláńgá [ ] d. Ti gbogbo gbòò [ ] e. Ilé ìyàgbé ̣alábó ̣ [ ] ẹ. Kò sí/inú igbó [ ]

221 f. Òmíràn s àlàyé………………………………………………………….

18. Irú àwọn ohun èlò ilé wo lẹ ní? a. Ináìjọba [ ] b. Èṛ ọ asòṛ ò-̣ má-gbèèsì [ ] d. Èṛ ọìléwó ̣ [ ] e. Èrọ̣ a-móhùn-má-wòrán [ ] ẹ. Èrọ̣ a-mú-nǹkan-tutù [ ] f. Èrọ̣ amúnáwá [ ] g. Èrọ̣ a-múlé-tutù [ ] gb. Èrọìlọsọ̣ oníná [ ] h. Èṛ ọ tó ń fátég̣ ùn [ ]

19. Irú nǹkan ìdáná wo lèṇ́ lò ní pàtàkì? a. Ináìjọba [ ] b. Aféf̣ é ̣gáàsì [ ] d. Karosínì [ ] e. Èédú [ ] ẹ. Igi ìdáná [ ] f. Ìgbé ̣ẹranko [ ] g. Òmíràn, ṣàlàyé …………………………………………………………..

20. Ònạ̀ wo ní pàtó ni ẹ fi ń rówó? a. Láti ọwó ̣mi [ ] b. Ìyàwó/ọkọ mi [ ] d. Àwọn ọmọ [ ]

222

e. Ònạ̀ mìíràn, ṣàlàyé………………………………………………………..

21. Bí ìdáhùn sí ìbéèrè ogún bá jé ̣ọwó ̣mi, lóṇ à wo?

a. Owó ìfèhìntị̀ [ ]

b. Owó oṣù [ ]

d. Ònạ̀ mìíràn, ṣàlàyé…………………………………………………………..

22. Èló ni èṇ́ rí láti gbogbo òṇ à tí owó ń gbà wọlé fún yín?......

23. Bí ó bá jé ̣owó ìfèḥ ìntì, ìgbà wo ni ẹ gba owó ìfèḥ ìntì kéḥ ìn?......

ÌPÍN KẸTA: ÀGBÉYÈẈ Ò ÀWỌN ÀGBÀLAGBÀ NÍPA AKÙDÉÌLERA ÀTI ÈỴ À ARA

WỌN TÍ KÒ ṢIṢÉ ̣ MÓ ̣

24. Ǹjé ̣ẹ ní ìdojúkọ nípa ti ìlera? (a) Béẹ̀ ̣ni [ ] (b) Béẹ̀ ̣kó ̣ [ ]

25. Bí ó bá jé ̣béẹ̀ ̣ni, irúàìsà wo lẹní? a. Èj̣ è ̣ríru/àìsàn ọkàn [ ] b. Gbígbàgbé nǹkan, rọpá, rọsè ̣ [ ] d. Egbò inú, jèḍ íjèḍ í [ ] e. Ìtò ̣súgà [ ] ẹ. Àìsàn ojú [ ] f. Ìṣòro nípa ìtò ̣títò ̣ [ ] g. Àìsàn nípa èémí (ikó,̣ ìṣòro nípa mímí, ikóf̣ ée) [ ] gb. Àìsàn oríkèéríkèé ara (oríkèéríkèé ara ríro, èỵ ìn ríro) [ ] h. Àìsàn mìíràn, ṣàlàyé ………………………………………………….

26. Ẹ ṣe àgbéyèẉ òìlera yín a. Ó péye [ ] b. Ó dára gan-an ni [ ]

223 d. Ó dára [ ] e. Ó dára díè ̣ [ ] ẹ. Kò dára [ ]

27. Ǹjé ̣ẹń lo òògùn fún àìlera kan kan? (a) Béẹ̀ ̣ni [ ] (b) Béẹ̀ ̣kó[̣ ]

28. Bí ìdáhùn sí ìbéèrè kẹèḍ óg̣ bòṇ (25) bá jé ̣ béẹ̀ ̣ ni báwo ni oògùn náà ṣe ń ṣiṣé ̣ lára yín

sí?(a) Ní gbogbo ìgbà [ ] (b) Léḳ òọ̀ ḳ an (d) Rárá [ ]

29. Ṣé àwọn òògùn náà kò wóṇ jù fún yín láti rà?

(a) kò wóṇ nígbà kan kan [ ] (b) Ó ṣe é rà nígbà kòọ̀ ḳ an (d) Ó ti wóṇ jù [ ]

30. Ǹjé ̣èṇ́ mu ògógóró? (a) Béẹ̀ ̣ni [ ] (b) Béẹ̀ ̣kó[̣ ]

31. Bí ó bá jé ̣béẹ̀ ̣ni, báwo ni ẹ ṣe ń mu ú?

(a) Èẹ̀ ḳ an lóṣù tàbí kó má tó béẹ̀ ̣ [ ] (b) Èẹ̀ ṃ ejì sí èẹ̀ ṃ ẹrin lóṣù [ ]

(d) Èẹ̀ ṃ ejì tàbí èẹ̀ ṃ ẹta lóṣ̣ è ̣ [ ] (e) Èẹ̀ ṃ ẹrin tàbí jù béẹ̀ ̣lọ lóṣ̣ è ̣ [ ]

32. Ǹjé ̣ẹń mu sìgá? (a) Béẹ̀ ̣ni [ ] (b) Béẹ̀ ̣kó[̣ ]

33. Bí ó bá jé ̣béẹ̀ ̣ni, báwo ni ẹ ṣe ń mú?

(a) Èẹ̀ ḳ an lóṣù tàbí kó má tó béẹ̀ ̣ (b) Èẹ̀ ṃ ejì sí èẹ̀ ṃ ẹrin lóṣù [ ] (d) Èẹ̀ ṃ ejì tàbí èẹ̀ ṃ ẹta

lóṣ̣ è ̣ [ ] (e) Èẹ̀ ṃ ẹrin tàbí jù béẹ̀ ̣lọ lóṣ̣ è ̣ [ ]

224

ÌPÍN KÉṚ IN: OHUN TÍ ẸŃ ṢE LÓJOOJÚMỌ

34.

Ojúṣe Bí ìrànlóẉ ó ̣ṣe pò ̣tó Fún ojúṣe Ta ni óń ṣe ojúṣe Ṣe àgbàlagbàń 1. Kò nílòìrànlóẉ ó ̣ kòọ̀ ḳ an sọ bí òṛ ò ̣ náà? gbé pèḷú 2. Nílòìrànlóẉ ó ̣láti náà ṣe jé ̣ 1. Àwọn ọmọ olùtój̣ ú ni? òḍ ò ̣àwọn ènìyàn. 1. Fún ìgbà díè ̣ 2. Àwọn àna 1. Béẹ̀ ̣ni 3. Àwọn ènìyàn ni ó b. Bí yóò ṣe wà 3. Alábágbé 2. Béẹ̀ ̣kó ̣ bá a ṣe gbogbo nìyẹn láé láé. 4. Nóọ̀ ṣ ì nǹkan 5. Ọmọ òḍ ò ̣ 4. Wọn kì í ṣe nǹkankan (kùìkíní sí ìkẹrin) Ìwè ̣wíwè ̣

Aṣọ wíwò ̣

Lílọ ilé ìyàgbé ̣

Oúnjẹ jíjẹ

Irin

Gbígbé síbòmíràn Oúnjẹ wíwá

Oògùn lílò

Nǹkan rírà

Ọkò ̣wíwò ̣

Iṣé ̣ilé: Aṣọ fífò,̣ iná dídá Oko lílọ tàbí ibi iṣé ̣mìíràn

225

ÌPÍN KARÙN-ÚN: ÌṢESÍ/ÌHÙWÀSÍ TÍ KÒ DÁRA SÍ ÀWỌN ÀGBÀLAGBÀ

35. Ní bí ọdún kan séḥ ìn

Ojúṣe Rárá Béẹ̀ ̣ni báwo ló ṣe jé ̣ Látọwọ ta ni? Ohun tó ní nǹkan ọdún kan 1. Ọmọ /ìyàwó fàá séḥ ìn 2. Ọmọ 1. Èẹ̀ ḳ an 3. Ọmọ ọkùnrin/obìnrin 2. kò pòj̣ ù tí ó jéạ̀ na 3. Lóṣ òọ̀ ṣ è ̣ 4. Ọmọ, ọmọ 4. Lóṣooṣù 5. Ẹbí 5. Gbogbo ìgbà 6. Alábágbé 7. Òṛ é ̣ 8. Olùtój̣ ú tó ń gba owó 9. Òmíràn, ṣàlàyé Ìsesí tó lè fa ìrònú

Ǹjé ̣ẹnìkan tó súnmó ̣yín ti……. a. Dààmú tàbí sépè fún yín? b. Fojú téṇ́ béḷú ohun tí ẹ ṣe? d. Kò kà yín kún tàbí ṣe bí ẹni pé ó rí yín? e. dáyà já yín láti ṣe ẹni tí ẹféṛ àn lése? b.a. ẹbí yín ẹ. dí yín lóẉ ó ̣láti rí ẹni tí ẹ

226 fé ̣ f. pariwo tàbí jágbe móọ̣ yín? g. ṣe nǹkan tó bù yín kù?

Gb. Dáyà já yín látilù yín tàbí ju nǹkan lù yín? h. bú yín fún wàhálààwùjọ? i. dí yín lóẉ ó ̣láti kópa nínú ayẹyẹ láti fi ìyà jẹ yín?

Ìsesí tí kò dára ti ojúkojú

Ǹjé ̣ẹnìkan tí ó súnmó ̣yín ti… j. gbáayín? k. ta yín nípàá? l. Taari yín? m. Mòọ́ ṃ ò ̣finá jóoyín tàbí ha yín lára? n. ju nǹkan tó lè pa yín lára? o. yí ọwóṇ yín sódì? ọ. lo ohun ìjà olóró fún yín

227 bí òḅ ẹ? p. gbá a yín pèḷú ohun tó lè ṣe yín lése? r. Lù yín? s. So yín móḷ è?̣

Ṣ. Tì ín mó ̣yàrá yín? t. Fún yín ní òp̣ òḷ ọpò ̣ oògùn láit lè darí yín tàbí látu sùn? u. Tì yín lu ògiri tàbí

ìlèḳ ùn?

Ìṣesí tí kò dára nípa ti

ètòìsúná (owó)

Ǹjé ̣ẹnìkan tí ó súnmó ̣yín ti … w. Mú yín fún un/wọn ní owó yín tàbí dúkìá yín láì ti ọkàn yín wá? y. Lo òṇ à jìbìtì láti gba owó tàbí dúkìá yín? aa. Ti gbìyànjú láti jí owó, nǹkan tàbí dúkìá/ti jí nǹkan kan tí ó jé ̣tiyín láì-

228 gbàṣẹ lóẉ ó ̣ yín? bí I káàdììgbowó, ìwé sòẉ é dowó, dúkìá tàbí àkọsílè ̣ nǹkan tó jé ̣tiyín. bb. Fi agbára mú yín láti fi ọwó ̣sí ìwé tàbí sanwó iṣé ̣ tí kò té ̣yín lóṛ ùn? dd. Díbóṇ láti gba owó tàbí nǹkan yín/kíkò-̣ jálè ̣ láti san owó tí ó jẹ yín bí I owó ilé?

Ìṣesí tí kò dára nípa

ìbálòpò ̣

Ǹjé ̣ẹnìkan ti… ee. Gbìyànjú láti fọwó ̣kàn

ó ̣nípa ìbálòpò ̣tí kò sì té ̣ọ lóṛ ùn? ẹẹ. Gbìyànjú láti bá ọ ní

ìbálòpò ̣tíkò té ̣ọ lóṛ ùn? ff. Ti bá ọ ní ìbálòpò ̣lágídí léỵ ìn tí ó déṛ ùbà óṭ án?

Ìsesí tí kò dára nípa

àìbìkítà fún ni

229

Ǹjé ̣ẹni tó súnmó ̣yín ti… gg. ẸDíi yín lóẉ ó ̣láti jẹun?

Gbgb. Dí I yín lóẉ ó ̣láti rí aṣọ? hh. Dí i yín lóẉ ó ̣láti gba

ìtój̣ ú

36. Ǹjé ̣ẹ lè sọ àwọn nǹkan wòṇ yí fún wa nípa àwọn tí ó ṣe nǹkan wòṇ yí?

Olùsebi Olùsebi Olùsebi Olùsebi Olùṣebi

kìn-ín-ní kejì kẹta kẹrin karùn-ún

(nípa (ojú- (ètòìsúná) (nípa (àìbìkítà)

tìrònú) kojú) ìbálòpò)̣ a. Ọkùnrin/obìnrin b. Ọjó ̣orí d. Ipò nípa ìgbéyàwó e. Ipò nípa iṣé ̣(óń ṣiṣé ̣tàbí kò ṣiṣé)̣ ẹ. Irú ìwé tó kà

230

37. Nípa ti olùsebi

Olùsebi Olùsebi Olùsebi Olùsebi Olùṣebi

kìn-ín-ní kejì kẹta kẹrin karùn-ún a. Ǹjé ̣o rò pé ó ti rè ̣é ̣lásìkò yẹn ni? b. Ṣé ẹni náà mu ògógóró ni? d. Ṣé ẹni náà ń mu sìgá? e. Ṣé ẹni náà ń lo oògùn tí kò yẹ?

Ìdí mìíràn, ṣàlàyé

ÌPÍN KẸFÀ: ÀWỌN OHUN TÍ ÓŃ FA ÌSESÍ TÍ KÒ DÁRA SÍ ÀWỌN ÀGBÀLAGBÀ

38. Màá ka àwọn àkọsílè ̣wòṇ yí fún yín. Ẹ jòẉ ó ̣ẹ sọ bí ẹ ṣe gbà tàbí ẹ kò gbà

Àlàyé

Mo gbà

Mi ò gbà

Kò kàn mí Kò kàn

Mi ò gbà rárá Mi ò gbà

Mo gbà dáa dáa dáa Mo gbà a. Ẹnìkan wà ní àróẉ óṭ ó mi ní ìgbà-kúù-gbà tí mo bá nílò ohunkóhun b. Ẹnìkan wà tí mo lè ṣe alábàápín ohun tí mo ń là kọjá pèḷú rè,̣ ayò ̣tàbí ìbànújẹ d. Ẹbí mi máa ń ràn mí lóẉ ó.̣ e. Mo máa ní ìmárale nínú èṃ í láti òḍ ò ̣ẹbí mi ẹ. Mo ní ẹnìkan tí ó máa ń tù mí nínú. f. Àwọn òṛ é ̣è ̣mi máa ń ràn mí lóẉ ó ̣

231 g. Mo lè gbóḳ àn lé àwọn òṛ é ̣è ̣mi nígbà tí nǹkan bá dagun. gb. Mo lè sòṛ ò ̣nípa ìṣòro mi fún ẹbí mi. h. Mo ní òṛ é ̣tí mo lè jíròrò pèḷú nípa ayò ̣àti ìbànújé ̣mi i. Ẹnìkan wà tí ohun tí mo ń là kọjá ṣe pàtàkì sí j. Ẹbíì mi ń ràn mí lóẉ ó ̣láti ṣe ìpinnu k. Mo lè sòṛ ò. Nípa àwọn ìṣòro fún àwọn òṛ éẹ̀ ̣mi.

39. Ǹjé ̣ẹń kópa nínú àjọṣe pò ̣ (àjọṣepò ̣ nípa ti èṣ ìn tàbí ẹlég̣ béj̣ẹgbé)̣ (a) Béẹ̀ ̣ni [ ] (b) Béẹ̀ ̣

kó[̣ ]

40. Ǹjé ̣èṇ́ kópa nínú àjọṣepò ̣bí ó ṣe wù yín?

(a) Béẹ̀ ̣ni [ ] (b) Béẹ̀ ̣kó ̣[ ]

41. Bí béẹ̀ ̣kó,̣ kí ni óń díi yín lóẉ ó?̣

(a) Ìṣòro nípa ti ìlera [ ]

(b) Kò sí ẹni tó lè mú mi lọ [ ]

(d) Kò sí irú èyí tí mo fé ̣ [ ]

(e) Ó ti wóṇ jù [ ]

(ẹ) Òmíràn, jòẉ ó ̣ṣàlàyé……………………………………………………..

42. Ǹjéọ̀ ń kópa nínú àjọṣepò ̣ti ẹbí bí ó ṣe wù ó?̣

(a) Béẹ̀ ̣ni [ ] (b) Béẹ̀ ̣kó ̣ [ ]

43. Ǹjé ̣ẹ rò pé ẹń ní àjọṣepò ̣tí ó tó pèḷú àwọn ọmọ yín?

(a) Béẹ̀ ̣ni [ ] (b) Béẹ̀ ̣kó ̣ [ ]

44. Báwo ni àwọn ọmọ yín ṣe ń bè ̣yín wò?

232

(a) Ojoojúmó[̣ ] (b) Òṣ òọ̀ ṣ è[̣ ] (d) Osoosù [ ]

(e) Ọdọọdún [ ] (ẹ) Wọn kì í wá rárá [ ]

45. Ǹjé ̣ẹní ìbáṣepò ̣tó tó pèḷú ẹbí yín?

(a) Béẹ̀ ̣ni [ ] (b) Béẹ̀ ̣kó[̣ ]

46. Báwo ni àwọn ẹbí yín ṣe ń bè ̣yín wò?

(a) Ojoojúmó[̣ ] (b) Òṣ òọ̀ ṣ è[̣ ] (d) Osoosù [ ]

(e) Ọdọọdún [ ] (ẹ) Wọn kì í wá rárá [ ]

47. Ǹjé ̣ẹ ní ìbáṣepò ̣tó tó pèḷú àwọn òṛ é ̣yín?

(a) Béẹ̀ ̣ni [ ] (b) Béẹ̀ ̣kó[̣ ]

48. Báwo ni àwọn òṛ é ̣yín ṣe ń bè ̣yín wò?

(a) Ojoojúmó[̣ ] (b) Òṣ òọ̀ ṣ è[̣ ] (d) Osoosù [ ]

(e) Ọdọọdún [ ] (ẹ) Wọn kì í wá rárá [ ]

49. Ǹjé ̣ẹ ní ìbáṣepò ̣tó tó pèḷú àwọn alájọgbé yín?

(a) Béẹ̀ ̣ni [ ] (b) Béẹ̀ ̣kó[̣ ]

50. Báwo ni àwọn alájọgbé yín ṣe ń bè ̣yín wò?

(a) Ojoojúmó[̣ ] (b) Òṣ òọ̀ ṣ è[̣ ] (d) Osoosù [ ]

(e) Ọdọọdún [ ] (ẹ) Wọn kì í wá rárá [ ]

51. Báwo ni ètòìsúná yín báyìí?

(a) Èmi ni mo ń gbó ̣bùkátà ara mi

(b) Mòń gbó ̣díè ̣níbè ̣

(d) Mo ròg̣ bòḳ ú lórí àwọn ènìyàn mi ni

(e) N kò mò ̣

52. Ṣé ẹ ní olùrànlóẉ ó ̣nípa owó?

233

(a) Béẹ̀ ̣ni [ ] (b) Béẹ̀ ̣kó[̣ ]

53. Bí ó bá jé ̣béẹ̀ ̣ni, ta ni olùrànlóẉ ó ̣ yín ní pàtó?

(a) Ìyàwó/ọkọ mi [ ]

(b) Àwọn ọmọ [ ]

(d) Àwọn ọmọ, ọmọ [ ]

(e) Àwọn ọmọ èg̣ bóṇ àti àbúrò [ ]

(ẹ) owó ìfèḥ ìntì [ ]

(f) Òṇ à mìíràn, ṣàlàyé……………………………………………..

54. Ní nǹkan bí ọdún kan séỵ ìn, ǹjé ̣ẹnì kankan wà tí èṇ́ náwó lé lórí?

(a) Béẹ̀ ̣ni [ ] (b) Béẹ̀ ̣kó[̣ ]

55. Bí béẹ̀ ̣ni, taani?

(a) Ìyàwó/ọkọ [ ]

(b) Ọmọkùnrin/ọmọbìnrin [ ]

(d) Àwọn ọmọ, ọmọ [ ]

(e) Àwọn ọmọ èg̣ bóṇ àti àbúrò [ ]

(ẹ) Òṇ à mìíràn, ṣàlàyé……………………………………………..

56. Tó báwo ni ìnáwó yín lórí ẹni náà?

(a) Gbogbo ìnáwó náà [ ]

(b) Ìwòṇ ba tí mo bá lágbára [ ]

(d) Léẹ̀ ḳ òọ̀ ḳ an [ ]

57. Ṣé èyí jé:̣ (a) Fún ìgbà pípé ̣ [ ]

(b) Fún ìgbà díè ̣ [ ]

58. Ǹjéạ̀ ìgbóṛ a-ẹni-yé ti wà láàrin èỵ in àti ẹni náà nítorí owó ní nǹkan ọdún kan séỵ ìn?

234

(a) Béẹ̀ ̣ni [ ] (b) Béẹ̀ ̣kó[̣ ]

ÌPÍN KÉJE: ÀBÁYỌRÍ ÀÌṢE DÁRA DÁRA SÍ ÀWỌN ÀGBÀLAGBÀ

59. Ipa wo ni àìṣe dcára dára ní lára yín?

(a) Ó dàbí ẹni pé mi ò léḅ í tàbí lóṛ èẹ́ ̣ [ ]

(b) Óń mú inú bí mi [ ]

(d) Ó máa fa èṛ ù fún mi [ ]

(e) Ó máa ń gbé mi lóḳ àn sókè [ ]

(ẹ) Ó máa ń fa ìtìjú fún mi [ ]

(f) Ó máa ń fa ìrèẉ èṣ í ọkàn [ ]

(g) Ó máa ń da ètò ọrò-̣ ajé rú [ ]

(gb) Mo fi ara pa [ ]

(i) Ohun mìíràn, ṣàlàyé………………………………………………….

60. Ǹjé ̣ẹ fi ara pa nípasèị̀kọlùìdojúkojú?

(a) Béẹ̀ ̣ni [ ] (b) Béẹ̀ ̣kó[̣ ]

61. Irúìfarapa wo ni ẹ ní?

(a) Ọgbé,̣ ara bíbó, ara yíya [ ]

(b) Kíiná jó ni [ ]

(d) Ara wíwú [ ]

(e) Sísubú [ ]

(ẹ) Kí egun là/kí egun dá [ ]

(f) Kí ara máa dunni [ ]

(g) dákú tàbí sémìí nípasè ̣gbígbá [ ]

235

(gb) Mo lọ rí dókítà léḥ ìn ìpalára [ ]

(h) Nǹkan mìíràn, ṣàlàyé…………………………………………..

62. Fún àìlówó lóẉ ó ̣ipa wo ló ní?

(a) Sísọ nǹkan ìní nù [ ]

(b) Sísọ owó nù [ ]

(d) Ó fa wàhálà ọrò-̣ ajé [ ]

(e) Mo ní láti dínwóị̀ náwó kù fún ìgbà díè[̣ ]

(ẹ) Òṇ à mìíràn, jòẉ ó ̣ṣe àlàyé……………………………..

63. Kí ni ẹ ṣe kí úàìseir dáradára sí ni yìí má baà wáyé mó?

(a) Mi ò ṣe nǹkan kan [ ]

(b) Mo yanjú wàhálà náà pèḷú ẹni náà [ ]

(d) Mi kò bá ẹni náà ni àjọṣepò ̣mó ̣ [ ]

(e) Mo bèèrèìrànlóẉ ó ̣lóẉ ó ̣àwọn ẹbí mi [ ]

(ẹ) Mo bèèrèìrànlóẉ ó ̣nínú èṃ í [ ]

(f) Èmi kò lọ sí àkójọpòạ̀ wọn ènìyàn mó ̣ [ ]

(g) Òṇ à mìíràn, ṣàlàyé …………………………………….

64. Ìpele ìrèẉ èṣ ì ní nǹkan bí oṣù kan séỵ ìn

Nóṇ́ bà Ìbéèrè

̣

n

ò

̣

w

i ó

é

n k

l

̣ ̣

é

̣ ̣

è è

b

é é

g

B B Ì a. Ṣé ìgbé ayé e yín té ̣yín lóṛ ùn? b. Ṣé ẹ tí fi ìfé ̣àti ojúṣe yín kan sílè ̣láìṣe? d. Njé ̣ẹ rò pé òfo ni ayé yín?

236 e. Ǹjé ̣nǹkan máa súuyín? ẹ. Ṣé ọkàn yín máa ń gbé sókè ní òp̣ ò ̣ìgbà? f. Ṣé èṛ ù máa ń bà yín pé ǹkan búburú yóò ṣẹlè ̣sí yín? g. Ṣé inú yín máa ń dùn ní òp̣ ò ̣ìgbà? gb. Ṣé è ̣é ̣máa ní ìmòḷ ára pé ẹ kò ní olùrànlóẉ ó?̣ h. Ṣé ó máa ń wù yín láti jókòó sílé ju kí ẹ jáde ṣe ohun tuntun lọ? i. Ǹjé ̣ẹ rò pé ẹ ní ìṣòrò nípa rírántí nǹkan jú òp̣ ò ̣ènìyàn lọ? j. Ǹjé ̣ẹ rò pé ó dára láti wà láàyè? k. Ṣé ẹ rò pé ẹ kò wuyì bí ẹ ṣe wà yìí? l. Ṣé okun yín sì wà digbí? m. Ṣé ẹ rò pé ìrètí sì wà fún yín? n. Ṣé ẹ rò pé òp̣ ò ̣ènìyàn dára jù yín lọ?

Àròpò ̣

237

ÀSOMÓ ̣ B

ÌTÓṆ ISÓṆ À LÓRÍ ẸGBÉ ̣ TÍ YÓÒ BÁ NI SÒṚ Ò ̣

Ṣàlàyé ìtumòạ̀ ìse dára dára sí àwọn àgbàlagbà.Àìse dáradára sí àwọn àgbàlagbà jé ̣ ṣíṣe tàbí títúnṣe àìgbéìgbésè ̣ tí óyẹ tí óń ṣẹlè ̣ nínú ìbáṣepò ̣ tí a ti ń retíìfọkàntán tí ó sì ń fa ìrèẹ̀ ṣ ì àti

ìpalára fún àwọn àgbàlagbà.

 Kí ni ìṣòro ní pàtó tí àwọn àgbàlagbà obìnrin àti ọkùnrin ń kojú ní àdúgbò wa?

 Kí ni ojúṣe àwọn àgbàlagbà ní àdúgbò wa?

 Ìhà tí a kọ sí àìṣe dáradára sí àwọn àgbàlagbà àti irúàìṣe dáradára wòṇ yí

 Irú ipò tí àìṣe dáradára yìí máa ń gbà wá àti ohun tí a rò pé óń fàá.

 Ní èrò tìẹ, kí ni àbáyọrí àìṣe dáradára sí àwọn arúgbó?

 Ṣéàìṣe dáradára sí àwọn arúgbó wóp̣ ò ̣ní àdúgbò yìí àti pé kí ló fàá?

 Òṇ ààìṣe dáradára sí, fún àpẹẹrẹ ṣé ó lè jẹ móạ̀ sìkò kan nínú oṣù nígbà tí wá bá gba owó

ìfèḥ ìntì tàbí ińgbà ayẹyẹ tí ó lè fa rírè ̣léḥ ìn wàhálà ṣíṣe bí I èṣ ìn, ìsinmi, ọdún àti béẹ̀ ̣béẹ̀ ̣

lọ.

 Ǹjé ̣òṛ òị̀ dásí wà tàbí ohun tí o rò pé a lè ṣe?

238

LIST OF LOCAL GOVERNMENT AREAS IN LAGOS STATE

URBAN LGAs

1. Agege

2. Ajeromi/Ifelodun

3. Alimosho

4. Amuwo-odofin

5. Apapa

6. Ikeja

7. Kosofe

8. Lagos Island

9. Lagos Mainland

10. Mushin

11. Ojo

12. Oshodi/Isolo

13. Shomolu

14. Surulere

15. Ifako Ijaiye

16. Eti Osa

RURAL LGAs

1. Epe 2. Badagry

3. Ikorodu

4. Ibeju Lekki

239

LIST OF WARDS IN SURULERE LOCAL GOVERNMENT AREA

1. Sanusi 2. Ogunsami/Koruwi 3. Baruwa 4. Ramoni 5. Agunbiade 6. Airways 7. Odolowu 8. Jinadu Ayetoro 9. Nuru Oniwo 10. Coker 11. Osho 12. Baale 13. Savage 14. Adeniran Ogunsanya 15. Eric Moore 16. Ara Lile 17. Gbaja/Obele Odan 18. Mosafejo/Ojuelegba 19. Babatunde Ayilare 20. Obele Oniwala 21. Akinhanmi Cole 22. Irone 23. Shitta Bank Olemoh

240

LIST OF WARDS IN IKORODU LOCAL GOVERNMENT AREA

1. Odogunyan 2. Erikorodo 3. Agbala Kasunwon 4. Olorunda 5. Isiu 6. Ipakodo 7. Majidun 8. Owutu 9. Ajaguro 10. Isawo 11. Maja 12. Abosun 13. Mokun 14. Baiyeku 15. Ibeshe 16. Elepe 17. Egbin/Itunoluwo 18. Ayegbani/Odoro 19. Oke/Oyinbo 20. Oke Eletu/Abule-Eko 21. Olori Eyita 22. Tonabu/Opopo 23. Aye/Solomade 24. Isele ward 25. Itunmaja 26. Aga /Ijoun 27. Sholafun/Agbele 28. Agura/Gberigbe 29. Atere 30. Igbokuta/Oke Agbo

241