Unmet Needs for Care and Support for the Elderly in Nigeria: Gaps in Experiences and Expectations of the Aged in Ilesa, South-West Nigeria DOI: 10.36108/NJSA/4102/12(0120) Akanni Ibukun Akinyemi 1 Ambrose Akinlo Department of Demography and Social Statistics Obafemi Awolowo University, Ile Ife, Nigeria 1Corresponding author: [email protected] Abstract The study is focused on understanding the broad issues of care and support of the elderly with a view to explaining factors influencing the gaps in their expectations and experiences. This is an empirical attempt with a view to understanding and under- scoring the importance and limitation of the domains of support from core family members (spouses and children) within the available support networks for the elderly. The study utilized primary dataset including quantitative and qualitative data collected in Ijesa communities in South-west, Nigeria. The findings showed that children and spouses ranked highest among sources of support networks rated by the elderly for five patterns of support identified. Logistic regression results showed that individual variables including age, education, family of orientation, and living in same town with children to a large extent determine level of unmet need for support. The study concluded that personal attributes rather than other social variables are important determinants of high level of unmet need for elderly. Keywords: unmet needs, care and support, elderly, Ilesa, Nigeria Introduction Increasing trend in the population of the aged or elderly has been a big challenge for many developed countries. Their prevailing high life expectancy and low total fertility rates, hovering around the replacement level of 2.1, have given rise to a population structure with a large proportion of the aged relative to the working population. The steady increase of life expectancy in the developing countries coupled with gradual decline in fertility implies that the aging phenomenon deserves more well-structured attention. Currently, the elderly account for almost 5 per cent of over 200 million populations in the sub-Saharan Africa region; it is projected that the elderly will constitute about 10 percent of the over 600 million population in 2050 in the sub-region (UN, 2002; UN, 2012). Nigeria, with over 170 million population, is a youthful population with a progressive growth rate of 2.8% and a median age of 17.3 for males and 18.4 for females (NPC, 2008), and about 45 per cent of the country’s total population are under 15 years of age. This broad description of the country as a Unmet Needs for Elderly in Nigeria 29 youthful population, however, beclouds the population dynamics as it relates to the growing elderly population. By these statistics and figures, there is a tendency of a rising proportion of Nigerians who are expected to reach age 60 years and beyond (see table 1). This huge population is characterized with attendant social and economic challenges and consequences particularly on social and public infrastructures. Table 1: Nigeria Survival Rate and Life Expectation at age 60 years+ Survival Rate Expectation of life 2000-2005 2025-2030 2045-2050 2000-2005 2025-2030 2045-2050 At Birth -- -- -- 52.1 62.5 69.3 60 years 49.3 64.1 75.7 16.3 18.5 20.1 65 years 43.4 58.5 70.8 13.2 15.0 16.3 80 years 17.6 29.4 39.9 5.7 6.5 7.1 United Nations 2002: World Population Ageing 1950-2050 As documented in a current review of ageing situation in Nigeria (Togonu- Bickersteth and Akinyemi, 2014), care and support of the elderly in Nigeria is based on a generalist view within the public space . As noted by Akinyemi and Isiugo-Abanihe (2014), there is no formal social security benefit for the elderly in Nigeria except for only about two states (Osun and Ekiti) that provide some paltry sum of money of between five to ten thousand naira (less than USD70) as monthly benefit to selected vulnerable elderly population. However, informal arrangement through the family system, religious organizations, non-governmental organizations and community-based organizations dominate the bulk of network of support for the elderly (Akinyemi, 2006). With the growing proportion of the elderly and the lack of direct policy and programme intervention relating to social security and non- work related support to the elderly, it is important to understand the expectation of the elderly as well as their experience. A recently published Global Age Watch Index, with the objective of measuring older people’s wellbeing as well as the enabling attributes of older people and the enabling social environment for their wellbeing (Taipale, 2014), ranked Nigeria in the 85 th position (on a 91-nation list) with an overall ageing index of 24.0. Ghana is West Africa’s highest ranked country (69 th ) with an index of 39.2, while Mauritius’ ageing index of 58.0 makes it the highest ranked African country (33 rd ). Sweden is the highest ranked country with the overall ageing index of 89.9. Within the four scoring domains, Nigeria’s index was 14.2 in terms of income security, 26.4 in terms of health, 30.5 in terms of employment and education and 53.6 in terms of enabling environment. The statistics clearly show that even in Africa, Nigeria lags behind in terms of support for the elderly. The objective of this paper, therefore, is to examine the available support provided to the elderly by the immediate family including children and spouses with reference to Ilesa, south-western Nigeria and also to assess their level of 30 The Nigerian Journal of Sociology and Anthropology Vol. 12 no. 1 unmet expectations and significant factors influencing high unmet needs among the elderly. Review of Literature Culture, norms and values are naturally part of normal way of life in traditional Nigerian societies. Such were passed from one generation to another and were held in high esteem (Akinyemi, 2009). The issue of support for the elderly is one of such values. In any traditional African society and in most countries of the world the family is charged with the responsibility for the provision of support for the elderly (Chappell, 1985). Such support predominates and it is provided voluntarily without any remuneration (Kosberg, 1992; Brown, 1999). The emerging challenges of the elderly population caught most countries in the African region unawares and exposed their insensitivity to this crucial demographic issue. The expectation of the elderly is built in anticipation of adequate support from the family when “inactivity time comes.” The social and economic needs of the elderly were therefore expected to be catered for through the extended family system, which was a three-to-four generation bounded together by strong kinship ties. Several reasons supported the anticipation of the elderly and the expected roles of the family towards their support in older ages. History and generational trend has always been that elderly care is a responsibility of the family in which he had been part of. Informal sanctions were sometimes meted out to the “irresponsible family members” who failed in supporting the elderly (Kosberg, 1992). Traditional religious belief of ancestral worship largely supported that family members should cater for the elderly. For instance, in Yorubaland some traditionalists believed that the spirits of their ancestors are always around them, and that favour or reprisal from such spirits depends on how well the spirits are pleased. Also, the transfer of land ownership through inheritance in a predominant agrarian society contributed to the traditional expectation of old age support. Infertility and childlessness are also crucial issues in the expectations of the elderly. However, several living arrangement patterns including foster and surrogate parentage were aimed at cushioning the effect of childlessness. It is generally believed that having surviving children at old age is a blessing. The premise is that informal systems of age integration and support by the family will continue to play critical roles in the support of the elderly. There are customs and adage that supported this orientation. The elders provided care to the children who in turn provided care to them in their old age, hence the Yoruba adage, “ ti okete ba dagba tan, omu omo re ni o ma nmu ” (As rodent aged, it sucks the child’s breast). The more children one has the more chances of receiving better care when one is no longer able to support oneself. There was a system that ensured that the needs of individuals were catered for within the family. Nobody would starve when other members of the family had plenty. However social and economic changes currently occurring have put into doubt the continued viability of such traditional arrangements for the Unmet Needs for Elderly in Nigeria 31 elderly. Such changes like increased emphasis on small family units, migration to urban areas, more working wives, new life styles and changing values all have effects on the entire society, as well as the youth who are less disposed to supporting their elderly parents. Methods The study was conducted in Osun State in South-western Nigeria. Osun State was created out of the old Oyo State in 1991 and the state has 30 local government areas (LGAs). The total population of the state was 3,423,535 in the 2006 population census. The state comprises various ethnicities including the Ijesa, Ife, Oyo, and Igbomina. This study however covered only the predominantly Ijesa communities which consist of six local government areas (LGAs), namely Ilesa West, Ilesa East, Oriade, Atakumosa East, Atakumosa West and Obokun LGAs, with a combined population size of over 700,000. Of the six LGAs in Ijesa, Ilesa East and West are urban (municipal) LGAs, Atakunmosa East and West are semi-urban while Oriade and Obokun comprise of predominantly rural settlements.