Elderly destitution in Ile-Ife community of Osun State, Nigeria

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International Journal of Nursing Practice 2007; 13: ••–••

RESEARCH PAPER

Elderly destitution in Ile-Ife community of

Osun State, Nigeria

Bolu R. Fajemilehin XX Department of Nursing Science, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State,

Nigeria

Emmanuel O. Ayandiran XX Department of Nursing Science, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State,

Nigeria

Kabiru K. Salami XX Department of Sociology, Faculty of Social Sciences, University of Ibadan, Ibadan, Nigeria

Accepted for publication October 2006

Fajemilehin BR, Ayandiran EO, Salami KK. International Journal of Nursing Practice 2007; 13: 0–0

Elderly destitution in Ile-Ife community of Osun State, Nigeria

Many studies have been conducted on the elderly, but none has ever paid particular attention to the increasing rate of destitution in the rural communities, where the elderly serve as agents for sustenance and transmission of culture. This study is descriptive in nature and has adopted qualitative perspective in order to identify and examine the factors that have contributed to the state of elderly in destitution in Ile-Ife, Nigeria. It has also examined the feelings and reactions of the subjects of the study and has documented how their lifestyles affect their health status. Sixteen elderly people in destitution were traced and interviewed in Ile-Ife community. At each location, where an elderly in destitution was located, at least an elderly chief and a resident were located for interview. Data collected were analysed using Textbase Beta package for qualitative analysis. The study found that communal feud, violence and conflicts were factors that created unhappiness for the elderly, and the lack of adequate support from the immediate households consequently led to their homelessness. The study documented that the elderly in destitution lack good hygiene and nutrition, and equally suffer self-neglect and mental confusion. The study concludes that peaceful coexistence, communal security, and familial care and support are important factors that promote happiness and successful ageing. It also maintains that focused health education is highly essential for the households and caregivers of the elderly in rural community.

Key words: conflict, elder abuse, elder neglect, elderly, street people.

INTRODUCTION

From the traditional African society to the modern, the elderly individuals are the most

cherished heritage and people depend on them for the survival of their culture and performance

of other traditional roles.1 The elderly are found in their traditional family homes with several

social networks including those of their wives, children as well as close and distant relatives

within the traditional extended family system. The elderly provide important services in the

transmission of culture from generation to generation and they help to connect modern society

with the traditional one through oral history. Given the role they perform at home, it is not

surprising that family members revolve around their elderly persons and support them in some of

their domestic chores and in their different chosen means of livelihood. The young and agile

never compromise support for the elderly and they shower abundant love and care on them

because they believe that they would reap the reward during their own old age. Hence the elderly

are highly valued in African society. Highest positions are accorded them in any sociocultural

gathering and they preside over all traditional events in the family and community, irrespective

of their individual social status (be it rich or poor), meaning that old age was the only parameter

for leadership.2, 3

Nowadays, however family institution, through which the elderly were cared for, has

become not only partially separated but also culturally devalued to such a level that values, care

and support for the elderly subgroup has become so strongly tied to financial and other material

worth,4 to the extent that the individual elderly of today is now abandoned in transition of

change.1 Of importance therefore is the level of confusion, state of insecurity and hostility which

do not augur well for peaceful living among the people within the Ife-Modakeke crisis

community,5 and worse in particular for the vulnerable elderly subgroup. Today, many elderly

are found wandering around aimlessly in pathetic physical conditions, begging for alms and

sleeping at indecent open places (which make the community see them as having mental illness);

yet little or no concern is shown by either the community or government to remedy their pathetic

situation. Psycho-cultural school of thought maintains that functional psychogenic disorders

represent man’s reaction, in terms of his own personality, to the stresses and strains of his socio-

cultural environment.6 In fact, ‘what we call mental illnesses are really “problems of living”, a

perverse representation of man’s continuous struggle with the problems of survival or

livelihood’,7 such occurrence among the elderly in Ile-Ife is what herein referred to as elderly

destitution. Consequently, elderly destitution is one of the major social set backs for family and

community integrity in Yoruba culture.1 This poses a lot of challenges not only to Public Health

and Community Health Nursing but to Geriatric Nursing in particular.

This study was informed by the theoretical construction of social exchange theory of

Gouldner, which posits that social exchange is based on the principle of equity, or balanced

exchange.8 This theory views informed care-giving family members most especially for the

elderly and social exchange to be contractual with each individual as an exchange agent and

relationships maintained in part due to the personal and future benefits each individual receives

from the interaction.9, 10 People prefer and seek out relationships in which elderly and their

social network give and receive more or less equal amounts of support.11 In Neufeld and

Harrison words, a discrepancy or imbalance in the exchange of support threatens the

continuation of the relationship.12

Recent cross-cultural research on assessment of the relationship had expressed that

personal benefits may not be the primary reason for affiliation, nor meeting individual needs be

the over riding concern. Rather, engagement within a group offers the benefits of security,

despite the obligation of personal sacrifice. Nemoto studied social exchange norms in a sample

of elderly Japanese in New York and found that received support required reciprocity.13 Those

who valued these cultural norms and were unable to reciprocate, like in case of the elderly in

destitution, were more depressed and show more symptoms of ageing, and were less likely to

feel satisfied with their lives than those who valued those cultural norms less. Therefore, the

fundamental symptoms about the nature of the social exchange and relationship showed that

culture defines the dynamics of both the relationship and the exchange. Hence, this study

explores possible factors contributing to increased number of homeless elderly in Ile-Ife Osun

State, Nigeria, as against the background of history that the community was the cradle of culture

for the Yoruba race. The study also explored with elderly homeless people their views of their

situation and the views of the community members in close proximity with them on why

destitution has become part of the socially defined characteristics of old age in a culture where

the subgroup should enjoy total level of care and support for their cultural values.

METHODS

The study is descriptive and cross-sectional by design. It adopted qualitative method to

examine the possible factors for the increased number of elderly in destitution in Ile-Ife, Osun

state, Nigeria, and the indigenes’ reactions and feelings in this respect. Ile-Ife is a medium-sized

town in the eastern part of Osun state, Nigeria. The town is located in the tropical zone of Africa

and endowed with alternate wet and dry seasons. It is traditionally referred to as the cradle of

Yoruba race. Ile-Ife was accredited to have a population of 147 938 (72 346 males and 75 592

females) as at 1991 Census but the 1996 projection put the population at 168 636. The major

occupations of the people are farming and trading.

The study considered the elderly in destitution, elderly volunteers, and community chiefs

who had seen and could provide information about the incidence of the elderly in destitution in

the community. Consent was sought, at two levels, prior to the study. The first consent was

sought from the local government council, and the second from the community traditional

leaders and the elderly in destitution themselves.

The study started with pilot interview with three elderly volunteers who had seen some of

the elderly in destitution. The in-depth interview format consisted of eight open-ended questions

with selective probes, and was developed prior to the interviews, based on the previous

experiences of the investigators. The outcome of this, coupled with review of literatures,

informed the interview for the elderly persons, family heads, and chiefs. The interview questions

explored the relationships and context of elderly people’s family members and the others focused

on sociocultural factors in change, feelings and reactions of the indigenes and what could be

done to reverse the state for healthy ageing. Following the pilot interviews, the study instrument

(Protocol) was reviewed and some minor changes were made. Several visits were made to the

areas to observe and document their life styles.

Sample selection employed a purposive sampling technique. Inclusion criteria were: (i)

Respondents must be elderly; (ii) Homeless; and (iii) Wandering. The 16 respondents that met

these criteria were intercepted at different times and interviewed individually at the different

spots they were met (i.e. streets, under deserted and partially collapsed buildings, in the vicinity

of refuse dumping ground and market places). Adequate care was made not to interview an

elderly twice. In such situation where an already interviewed elderly was met, interviewers

politely avoid them. In addition 12 other concerned members of Ile-Ife community, especially

those living in the neighbourhoods where the elderly in destitution were found, were also

interviewed. This was done for the purpose of proper identification of the elderly in destitution

and to capture their feelings and reactions on this sad development. Consequently, the interviews

of the community members centered on whether the elderly destitute were known to them, for

how long have they been seen roaming the streets, how and who has been assisting them with

daily demands and their feelings. Two persons who are conversant with behavioural research

skills conducted the interviews and the duration of the study spanned through 2 months since

every parts of the community had to be combed. All interviews were tape-recorded and later

transcribed to facilitate detailed analysis.

Narrative data from in-depth interviews were coded and analyzed using TextBase Beta

software. TextBase Beta software was developed by Bo Summerlund and distributed by

Qualitative Research Management of Desert Hot Springs, California. The software is designed

to code and sort qualitative data transcripts that have been entered with standard word processing

software and saved as ASCII text files. Using TextBase Beta software, a standard node tree of

domains and concepts of interest was developed for coding the text. The program allows files to

be given variable assignments, and thus it was possible to sort and then to compare responses of

both the elderly in destitution, chiefs and the residents in the vicinity of where the elderly

destitute were found.

Results

A total of 16 elderly in destitution who were successfully traced participated in the study,

13 of them were male while the remaining three were female. The participants’ age ranged from

68 to 82 years with a mean age of 71.5 years. The elderly in destitution were searched for

through the whole community and overall, two were found sleeping on the streets, three were

found in 2 motor parks within the community, and three of them were found at bus stops.

Another two elderly persons were found in open school areas, and the last three elderly were

found in uncompleted buildings. Among the three women traced, one of them was found at a

bus stop while the remaining 2 were found at motor packs.

Regarding the immediate and the remote factors that could be responsible for the elderly

destitution in a culture that defines elderly as a symbol of wisdom, the interviews showed that

the communal feud between the two dominant indigenous groups in the environment (Ife and

Modakeke crisis) impacted negatively on the elderly destitution. The fighting was fierce and ran

for several months. Many houses were burnt down with properties worth hundreds of thousands

of dollars destroyed resulting in migration of a good percentage of people in the crisis zone.

Interviews with the community members revealed that the elderly who were found today

roaming the streets were survivors and victims of the feud at the impact zone. They explained

further that these elderly had lost contact with relations and/or had become homeless after their

escape from the scene. A respondent explained, ‘You see these elderly ones you see roaming

around, they were lucky ones who survived the communal conflicts but now without their people

to take care of them. In such situation, they do not have option than to move about looking for

where they can get support’. Chiefs and other elderly persons in the community felt so bad and

depressed when confronted with the sad occurrence stating, ‘it is a sad thing to happen to elderly.

Their feeding is not regular, no adequate bathing, and they do not have access to good sleeping

places’. The elderly ones intercepted on the streets as being in destitution were bitter and full of

disgust about the situation they have found themselves, the effects of the communal feud, and the

loss of lives of those to look up to in later life. One of them captures his ordeal and feelings this

way ‘when I think of those to take care of me but who have gone with the conflict in the

community, I would want to cry. Now one is wandering about the community, it is difficult to

eat, to sleep, and sometimes small children see you as a mad person and would want to stone

you’. Another adult claimed her condition is secondary to youth unemployment and adult

joblessness. In her words ‘I spent all I have to send my children to school in order to be able to

take care of me and themselve in later life. Now they don’t have job to feed themselves let alone

me. So I am forced to go out in the hope that some people would help me with money’. Many

elderly complained of ‘loss of all cherished property’ and therefore venture into looking here and

there in the dim hope that they could found them and in search of possible succour.

Among the elderly, some were unable to say why they were homeless and they not only

appear confused but also displayed disturbed behaviours. For instance, some (seven respondents)

of them sadly expressed that their wives, husbands and children had been killed and that they

could not face going to an empty house. Two of the elderly in destitution stated that it was a

tough life on the streets and a potentially dangerous one for the elderly who were not only

physically frail but also slow and very vulnerable. In the words of a 68-year-old elderly in

destitution, ‘we are always been abused and younger ones come around to steal our money and

we have lost contact with our relations, if any is still alive’. Furthermore, their look (i.e. the

homeless elderly people’s look) displays inadequate feeding/poor diet, poor hygiene and self

neglect, all of which makes them to be particularly prone to ill health.

Discussion

The elderly in destitution in this study became homeless secondary to the communal

feud, bereavement, joblessness, failure to locate relations and children to meet their needs due to

constraint of unemployment and inflationary trends in place. The finding that elderly were

roaming about looking for conducive environment, agreed with previous findings (Craine, 1990)

that elderly were peace loving people who would want to run away from any area of violence

and confusion.14 Jegede, et al. identified that conflict situation could be a strong factor towards ill

health for the entire community and could be more devastating in aged.5 This explains the

situation of the elderly after the crisis when none of the family members could be located to take

them to hospital during illness.

The crises experienced and expressed in this study about homelessness were much

similar to that reported by Crane 14. Medical implications displayed on assessment of the elderly

participants in the study agreed with the findings by the Great Chapel Street Medical Centre

report of 1987/88 with respect to the state of nutrition, hygiene, self neglect and vulnerability of

the elderly to hypothermia.15

Cohen and Sokolovskys’s observations on lifestyles of the

homeless elderly in relation to loss of contact with their significant others and abuse along the

streets was well corroborated by this study.16

Public Health Implication

The effects of the elderly in destitution like its causes and its aftermath, and the resultant

complications raise some significant public health questions. More so, in a culture that sees the

elderly not only as a source of wisdom but also as the hope of its cultural survival.

It is a general belief in this part of the world that when the aged are left to roam about the

streets, our culture is seen as being thrown into the mud and curse is hanging upon the younger

subgroup and other social networks for their failure in the cultural expectations of caring and

supporting the aged subgroup. Ageing and destitution combined, spell doom for healthy aging.

It promotes vulnerability, increases ill health, and makes the elderly to be prone to abuse and

untimely death through many street sources. This brings shame and disgrace and besides

tarnishes the public health image of such community. Therefore, efforts should be made by

Public Health Nurses/Officers, and health visitors to ensure a revisit to reuniting the members of

the extended family system so as to enable them maintain informal role of care and support and

promote early rehabilitation of those found on the streets rather than leave them to die and

become public health nuisance along our streets.

Government policy should be reviewed in line with the current state of family life and

economy to incorporate family assistance in form of financial aid to enable families to cope with

and/or continue their informal caregiving process. As a matter of policy, operation of elderly

day care center should be made a pattern for the survival of the deprived elderly and to promote

healthy ageing. The ‘doctor on the move’ van which was part of the former government health

care activities should be re-introduced and made to render care for the elderly people seen

roaming around the community. Their health is important and if left unattended to may lead to

outbreak of diseases. Besides, focused health education is highly essential for the households and

caregivers of the elderly in rural community.

In conclusion, successful ageing and longevity will only thrive where peaceful co-

existence and harmony prevail. Hence, peaceful co-existence is a vital feature of healthy

survival of the people in general and the elderly in particular.

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