CHAPTER ONE

INTRODUCTION

1.1            Background of the Study

Geriatric is the social factor shaping the future of the vast majority of nations today. Geriatric is the accretion of changes in a person over time.It involves a multifarious process of physical, psychological and social change. Somedimensions of aging grow and expand over time, while others decline. Research shows that evenin late life, potentials exist for physical, mental and social growth and development (Papalia,Sterns, Feldman, and Camp, 2002). It is not a disease; but phase of life where there is retrogradebiological process in growth and development which leads to decreased powers for survival andadjustment.Geriatric is an important part of all human societies reflecting the biological changesthat occur and also reflecting cultural and societal conventions.

Geriatric refers to generalisations about the elderly age groups in a given society. However, some individuals and societies havestereotype particularly marked with negative regard to older people and others have respect for the elderly. The negative stereotype affects expectations of older people and beliefs about their preferences, capabilities, weaknesses, reactions, and personalities, while the positive promote their longevity and creativity.

According to National Population Commission (NPC, 2006), persons who are oldenough to receive pension who are between ages of 60-65 years are regarded as the elderly. Theelderly are classified by age into young old for those aged 60-74years, middle old for those aged75-84years, old for those aged 85-94 years and oldest old for those 95years and above (Barman,Snyder, Kozier andErb, 2008).

Care of the elderly is the fulfillment of the special needs and requirements that are unique tosenior citizens. It covers such services as assisted living, adult day care, long term care, nursinghomes, hospice care and home care. Elderly care emphasizes the social and personalrequirements of senior citizens who need some assistance with daily activities and health care,but who desire to age with dignity. The care of the elderly is multifarious and these includephysical, emotional, spiritual and social care (Ayres, 2008).Care of the elderlyrequires adequate knowledge of the ageing process, nutrition and daily needs of the elderly. InNigeria, marginalization of the elderly especially in their care is a common episode (Abdulraheem and Parakoyi, 2005). Hoyer (2008) argued that geriatric is reflected in the common view that older people are a burden, contribute little and are largely dependent on the finances of others. Smith (1996) also noted the commonly-held beliefs that growing older is associated with increased dependence, loss of self control, social isolation, and disengagement from life.Those involved in the provision of health care have importantroles to play in programmes relating to elderly care especially in screening and detecting abuse.

          Human’s longevity has increased due to advances in health and by controlling communicable diseases. Therefore, the number of elders is increasing in developed and developing countries (World Health Organization, WHO, 2011, 2012). In almost every country, the ratio of the population over 60 has grown more than any other age group. According to WHO, the world is aging with a rapid pace in such a way that the ratio of people who are 60 and more in the world will double between 2000 and  2050 ; reaching to about 11 to 22  percent.Furthermore, reduction of relationships and social interactions, due to reasons such as loss of wife/husband and relatives, poverty, and loneliness are common social issues which make them face a big challenge to maintain a healthy lifestyle (Rasel and Ardalan, 2007). Currently, developing appropriate and effective plans and strategies to solve these issues have become a global common concern.

In Nigeria, geriatrics care has not yet received its desire attention. In Akwa Ibom State, there are no known available social support services, elderly homes and designated health facilities where health care for the elderly population is prioritised. In some situations, most elderly persons tend to depend on their families, relatives and friends for utmost care. This accounts for why they are care-dependent. However, studies have shown that utilization of health care services among the elderly is suboptimal.

Family life, with all the support and help it provides, is the only key to a well and long life. In Nigeria, as people get older,family life becomes more and more central to their lives and the elderly completely surround their lives, where they live with their families, elders have a central place and role in the family (Güven, 2006). For elders, family is the major social and psychological supportsystem.Depending upon such facts, one can say that aging is a phenomenon which develops hand in hand withrelationships between couples, between children and parents and other members of a family (Baker, 1990) andwhile addressing the issue of aging, family structure is the first social institution to examine. Agingand the term being old can best be evaluated within the familial structure.

Educational status of individuals is also another critical factor in determining the care of the elderly. Education can impart a variety of benefits that improve the health trajectory of the recipient. Education contributes to human capital by developing a range of skills and traits, such as cognitive skills, problem solving ability, learned effectiveness, and personal control (Mirowski and Ross, 2005). These various forms of human capital may all mediate the relationship between education and health.In the view of Pampel (2010), adults with higher levels of education also tend to have lower exposure to stress related to economic deprivation or relative deprivation. According to (Brownell, 2010), individuals with more education tend to have greater socioeconomic resources for a healthy lifestyle and a greater relative ability to live and work in environments with the resources and built designs for healthy living. The educated individuals see the elderly as a pride and a fulfilled life. The attitude of educated individuals towards the geriatric differs significantly from the attitude of the illiterate and the poor.

The economic status of the family can make or mar health care of the elderly. The economic polarisation within the society and lack of social security system make the poor more vulnerable in terms of affordability and choice of health provider (Nyamongo, 2002). Poverty not only excludes people from the benefits of health care system but also restricts them from participating in decisions that affect their health, resulting in greater health inequalities. Possession of household items, cattle, agricultural land and type of residence signify not only the socio-economic status but also give a picture of livelihood of a family (Geissler, 2000). Richer households usually spend much higher absolute amounts out-of-pocket than poorer households and are much more likely than poorer households to be covered by national health insurance (OECD 2004, Thomson and Mossialos 2009, Sagan and Thomson 2016). Consistent evidence shows how user charges disproportionately negatively affect access, adherence to medication, cost-effective patterns of use and health outcomes among poorer people (Swartz 2010), even where the poor benefit from reduced user charges or exemptions.

Attitude of caregivers is a prerequisite to ensure the wellness of the elderly.Attitudes toward aging may be serious for alteration and survival. Attitudes may subsidize to perceived maladaptive performances among the aged, some of which may lead to premature death. Negative views of aging, life in general, and oneself may result in elderly people's reluctance or failure to seek required services, health care, or other types of assistance. Negative attitudes of elderly people may affect others in their surroundings, who in turn may feel free to respond negatively to or ignore elderly people (Eltantawy, 2013). Several studies on the nursing students’ attitudes, staff nurses and other health care givers, towards elderlypeople and their care have recognized negative results (Oyetunde, Ojo and Ojewake, 2013; Eltantawy, 2013).

Culture of the people can influence their attitude towards the geriatric. In many cultural settings in Nigeria, the elderly is respected and they obtained significant admiration within the family; (Abdulraheem and Abdulrahman 2008). In Akwa Ibom State culture, elderly people are viewed with abundant gratitude and respect. Conventionally, elderly people are valued and are preserved consequently; as example, it is habitual for everybody to stand up when old one enter a place, they are assigned the finest places and they are offered any beverages before others. The concept of who is an elderly comes as a result of interactions among individuals in the society. As far as assumptions and expectations on ageing is concerned, each culture holds its own perspectives or view-points on ageing, which in all, is part of socialization. Some define the elderly in measure of physical health while others define it in terms of chronological age (AMA – Openstax college sociology cap, 2012).

The rate of poverty and health challenges of the elderly has made people to concentrate on how to raise their immediate family. It has observed that there is low concentration to help the elderly outside the nuclear family. This has poised the researcher to venture into investigating the perception and attitude of elites towards geriatric services in Akwa Ibom North East Senatorial District.

1.2     Statement of the Problem

Family support is a critical factor in health determinant of the elderly in Akwa Ibom State. The attitude of the elites towards the geriatric is very important as the population of the elderly is increasing in recent times. The population of the elderly in the world is increasing rapidlyand the rate of increase is higher in developing countries including Nigeria. Currently, Nigeriahas the highest number of the elderly people in Africa estimated to be about 8.6 percent of the Nigeriapopulation (NPC, 2017. With this increase in the growth of the aging population, the number ofpeople that will need health care will undoubtedly increase. Donatelle (2011) posited that in mostcurricula for health professionals, little or nothing is indicated about the care of the elderlyshowing absolute neglect in this area, Mclafferly and Morrison (2004) stated also that most healthworkers have very poor knowledge of mental health conditions which are common with theelderly and as such health workers come to service with deep seated, negative, diluted andsuperstitious belief about caring for the elderly. This lack of adequate knowledge and negativeattitude towards the care of the elderly may result in serious problems in our society in the nearfuture.Based on these, the researcher seeks to find out the perception and attitude of elites towards geriatric services in Akwa Ibom North East Senatorial District.