Chapter 1

Introduction.

Aging is a silent process whose consequences are difficult to anticipate. It creeps insidiously on people with some of the elderly finding it difficult to admit the reality of their transition into adulthood. The aging process is brought about by a progressive and universal deterioration in various physiological systems related to mental, physical, behavioural and biomedical domains. These changes are irreversible, independent of pathological conditions and contribute significantly to general loss of function or death.1 The elderly are the old people and are equally referred to as seniors, senior citizens, older adults, or simply elders depending on the culture and the context in which the reference is being made. Traditionally the age of 60 was seen as the beginning of old age. Most developed countries have accepted the chronological age of 65 years as a definition of elderly or older person.2 In Nigeria, the retirement age from the civil service is 60 years for most categories of workers and that accords them the statues senior citizens. Apart from the chronological age, certain physiological changes like greying of hair, wrinkles, and changes in voice as well as adoption of certain role like being a grandparent confers on people the statues of an old person.3

The elderly are usually chronologically classified into young old (60-74 years), aged (75-79years), and the oldest old at 80 years and above4 or based on their capability to take care of themselves hence the elderly and fit, elderly and infirm, elderly and sick, elderly and psychiatric5 and these gives an indication of the level of care required by the elderly person. The elderly are very important as they are a repository of cultural and traditional values and are indispensable in the peaceful settlement of disputes especially in the cases of land and landed

2

properties like economic trees and land itself. They are equally indispensable especially in the care of orphaned children in HIV ravaged communities where their children had succumbed to the scourge of AIDS as well as in the provision of household income especially in the rural areas where they are custodians of landed properties like economic trees like palm trees, oil-bean trees, bread-fruit trees etc.

Much of the world is aging rapidly.6 Both the number and proportion of people aged 60 years and older are increasing; although at different rates in different parts of the world. According to the WHO publication, the proportion of people aged 60 years and above is growing faster than any other age group as a result of both longer life expectancy and declining fertility.7 While this can be seen as a success story for public health policies and for socioeconomic development, it also challenges society to adapt; in order to maximize the health and functional capacity of older people as well as their social participation and security.8 The number of older adults has raised more than threefold since 1950; from approximately 130 million to 419 million in 2000, with the elderly share of the population increasing from 4% to 7% during that period. In Africa, the same scenario is being re-enacted as the population is aging rapidly and it is being projected that by 2050, the number of people over 60 years living in Africa will increase from just fewer than 50 million to just fewer than 200 million.10

Various published demographic projections indicate that the number and proportion of elderly persons in Nigeria is on the increase. According to the 1991 population census, the elderly population is 4,598,114 representing about 5.2% of the Nigeria population of 88,992,220 while in 2006 the elderly population is 6,987,047 representing about 4.9% of the overall population of 140,431,790.11 The decrease in the percentage may be attributed to a more proportionate increase in the younger age group within the two periods of

3

enumeration. It is being projected that the population of the elderly in Nigeria will be 15 million in 2025, a rank of 11th in the whole world.12 In some demographic survey, the population of the elderly in Nigeria had remained static at 3.0% to 3.4% from 1950 to 2010 which is an indication of the high mortality rate of this age group occasioned by the lack of comprehensive government policy and implementation of health and social care for the elderly. The aforementioned accounts for the low level of the life expectancy from birth and the characteristic peak of Nigeria’s population pyramid. In principle however, and according to the Demographic Transition Theory, Nigeria should be having a low birth rate and a low death rate hence the population of the elderly in Nigeria should be increasing.

According to the 2006 census, one-third of the elderly population are within the age range of 60 and 65 years while the remaining two-third are of 65 years and above and females accounts for 46% of the overall elderly population. This demography runs counter to the feminization of the old as seen in developed countries though this finding may be attributed to the low statues of women which increases their mortality rates relative to men over the entire life course. The literacy level of the elderly in Nigeria according to the 2006 census is quite alarming with 75% of the elderly being unable to read or write in one of the Nigerian languages and it equally revealed that males are three times more likely to be literate than females.13 This finding can be attributed to the fact that most of the elderly people enumerated in the 2006 census lived much of their younger lives prior to the period of accelerated socio-economic development in Nigeria which saw a massive investment in education.

Older men and women throughout Africa make vital contributions to their families and communities. Across the continent 64% of men and women over 60 years continue to work across the formal and informal sectors. They continue their domestic and subsistence farming roles. Increasing number of older

4

women as do men whose older children have migrated to the cities in search of work or have died are bringing up grand children; paying their school fees, fulfilling their health needs as well as other social needs. It was documented that most of the elderly in Nigeria do engage in active labour till death with about two-third of them engaged in agriculture and related occupation. Disabilities which is an umbrella term covering impairment, activity limitations, and participation restriction.14 increases with age and according to the 1991 census 56,768 of the 4,598,114 elderly population have one form of disability or the other.15 Disability and destitution are more pronounced in males than females and the disparity in the demographics may be attributed to female children taking the role of care-givers to their aged mothers as practiced in Nigeria.

The number of the elderly in a population and their proportion in that population is of great concern to policy makers and bodies concerned with the health care delivery in any nation. The number of older adults we can expect in the future tells us something about how many hospital beds, geriatricians, home health aides, and nursing home beds will be needed. Similarly, the proportion of the old, especially the oldest old in a population, will have a direct effect on the working population that are supposed to cater for them as well as the budget of the government on social security for countries that have such policy for the elderly. The old-age dependency ratio, which measures the number of elderly people as a share of those of the working age, is steeply at an increase in most countries of the world according to the European Union.16 Old-Age dependency ratio measures the percentage of people aged 64 years and above (dependent) relative to those within the age range of 15 to 64 years which forms the productive group of the population. Industrialized developed countries like Japan, Italy, and United States, have double digit figures of 39%, 32%, and 20% respectively while African countries like Cameroun, Liberia, and Nigeria are at a single digit of 6%, 6%, and 5% respectively.17 The scenario above is bound to

5

change especially in the African countries as the improved health delivery, better living conditions, adequate nutrition if implemented in the government policies will increase the longevity of our elderly population.

Years, they say wrinkles the skin, but worry, doubt, fear, anxiety and self-distrust wrinkles the soul.18 Aging brings with it a deterioration of the functional capacity of the organs and systems of the body and this decline in homeostatic reserve of each organ system is influenced by diet, environment and personal habit, and equally important genetic factors.19 These physiological changes includes, the reduction in total cell mass of the heart and increase in the deposition of fats in the arteries, decrease in the functional capacity of the lungs and bronchial cilliary function. There is als