The role of care-giving in the well-being of the older persons in Kirinyaga County, Kenya

INTRODUCTION

Older persons refer to 65 and above years old persons.¹ Older person’s population is divided into three groups. These are young old 65-74 years, the middle-old aged 75-84 years and the old-old aged 85 years and above. There are four phases of care for older persons. In phase one the old has just retired. Loneliness is the issue hence regular contact with loved ones is important to prevent depression. In Phase 3 the older person is partially dependent on the care giver. This is because the older functions starts declining, coping with chronic illness and multiple disabilities making them partially dependent on the care giver. Worldwide population for the old is projected to reach 1.4 billion by 2030 and 2.1 billion by 2050. This could increase to 3.2 billion in 2100.^2,3 The population of the older persons in sub–Saharan Africa was estimated at 43 million in the year 2010. This was projected to reach 67 million by 2025 and 163 million by 2050. African continent and Sub-Saharan Africa too are facing increase in ageing population amidst challenges of increasing budget constrain, changes in environment and poor healthcare accessibility. The older population has status disparities ranging from those living in poverty while a small fraction enjoys wealth.⁴

In Kenya an older person is one aged 60 years old similar to the stipulated official retirement age. In 2019 census, Kenya had a population of 1.5 million persons who were 60 years old or more and the number was projected to reach 2.2 million in 10 years’ time. Modern Kenyans begins admitting their ageing parents to retirement homes. Health problems are one of the major challenges that face older persons as age sets in. The older persons lack consistent access to enough source of income for example employment, older person’s support system or even pension. This makes it difficult for them to cater for their health needs. Lack of specialized geriatric doctors and other health workers worsen the situation further.⁵ Elder abuse is an act or lack of required act which could be done once or repeatedly, occurring in an expected trustworthy relationship and causes the older person harm or distress. The violence constitutes a violation of human rights. Elder abuse includes physical, psychological, emotional and sexual, abuse. It also includes financial and material abuse. Another one is abandonment, neglect, loss of dignity and respect.^6–8 The older population is a key wealth to nations and hence their welfare needs to be looked after by all the policy makers in all nations.^4,5

Kirinyaga County’s older person population has increased from 9,778 in 2009 to 29,842 in 2019. This means increased demand for healthcare, care givers, institutions of care, old age services and increased budgetary allocation to pension. Kirinyaga County is also characterized by NCDs which has a prevalence of 14-17% against 11% national prevalence. In Kirinyaga County, the older person’s populations have poor health seeking behavior partly contributed by lack of medical insurance schemes where only 10% against 14% nationally have medical insurance cover. There is also lack of specialized geriatric doctors, enough institutions of care and other old age services. High level of poverty among the phase three older persons in Kirinyaga County leads to poor housing, poor hygiene and poor diet leading to poor health. Older persons in Kirinyaga County also face the problem of neglect and abuse due to loss of family with changes in family set up and poverty, urbanization and mortality from HIV and other chronic diseases.

METHODS

This was a cross-sectional descriptive study design using mixed method approach including qualitative and quantitative methods. The study was carried out in Baragwi, Njukiini and Ngariama wards in Kirinyaga East subcounty, Kirinyaga county between September 2019 to January 2020 among older persons aged 75 years and above who gave an informed consent to participate in the study, mentally stable and had lived in the area for over one year. A structured questionnaire was administered to the caretakers of older women and men aged 75 years and above. Multi-stage sampling method was applied to select participating units starting with Sub County, wards then village. Households with an older person(s) were selected and formed the sampling frame. Systematic random sampling using the sampling frame formed was used at household level to select participating respondents. First household was identified and then the fourth household where K=4. One older person per household was selected. Where a household had more than one older person the head of the family or the oldest one was selected. In case of a polygamous family will several wives and the household head was not alive, the first wife was selected. Quantitative data was analyzed using statistical package for social science (SPSS) version 26.0. Descriptive data was presented using frequencies, percentages, means and standard deviation while inferential statistics used chi-square test to measure association between independent and dependent variables, p≤0.05 was considered statistically significant.

RESULTS

Socio-demographic characteristics of study respondents

The respondents’ age ranged from 75 years to 99 years, the mode was 75 years, median 78.00 years and the mean age was 79.64±2.28. The findings showed that 212 (63.7%) were between 75-79 years, 22 (6.6%) 90 years and above and 128 (38.4%) were from Njukii-ini ward. More than half of the respondents 203 (61.0%) were married with 5 (1.5%) being single at the time of the study (Table 1).

Socio-economic characteristics of study respondents

On terms of occupation (this was occupation before and after reaching the phase three), more than three-quarter 254 (76.3%) of the respondents were farmers, 39 (11.7%) had no occupation while 8 (2.4%) were casual labourers. In terms of living arrangement of the older persons, slightly less than three-quarter 241 (72.4%) of the participants responded that they lived with family members, 68 (20.4%) lived alone while only 10 (3.0%) lived with an employed care-giver. On their health status, 220 (66.1%) of the respondents noted that they walk with support, 228 (68.5%) were unwell while 147 (44.1%) had chronic illness (Table 2).

Care-giving in personal hygiene practices

Majority of older persons respondents 208 (84.1%) were practicing personal hygiene by themselves during the time of the study.

Daily personal hygiene activities with care-giving in personal hygiene practices

Personal hygiene is the basic things that one does daily such as feeding, bathing, dressing, grooming, brushing, toileting etc. To the older persons these things may seem difficult and calls for assistance. Majority of older persons 79 (92.9%), 84 (92.3%) and 80 (94.1%) who practiced personal hygiene by themselves perceived their bathing, feeding and grooming was better and this was significantly associated with care giving in personal hygiene practices. Bladder control (p=0.213), bowel control (p=0.374) and toileting (p=0.216) were not significantly associated with care giving in personal hygiene practices (Table 3).

Nutritional activities with care-giving in cooking or feeding practices of the older persons

Slightly more than half 132 (61.7%) of older persons who had three meals per day cooked by themselves and 68 (57.1%) who reported that their food intake had moderately decreased had a caregiver giving the services, this was not significantly associated with care giving in cooking or feeding practices at p=0.109 and p=0.614 respectively. In addition, assisted feeding of older persons influenced care giving in cooking or feeding practices (p=0.029).

DISCUSSION

Most of older person’s respondents (84.1%) were practicing self-personal hygiene. The rate of practicing personal hygiene among the older persons reduced with increase in chronological age. Age was significantly associated with care giving in personal hygiene practices (p=0.0001).

This concurs with a study by Mangiola et al and Waudo et al personal hygiene and nutrition status of older persons correlates with educational level of the older person, availability of a care giver and living independency.^9,10 An older person living alone has a tendency of taking few or no baths at all and taking few monotonous meals. In case of urine and fecal incontinence the older persons should be encouraged to change and bath regularly to maintain hygiene, which calls for a care giver. Mangiola concluded that good personal hygiene will not only promote physical health well-being among the older persons, but also good psychological health. Bladder control (p=0.213), bowel control (p=0.374) and toileting (p=0.216) were not significantly associated with care giving in personal hygiene practices.⁹ In Kenya nutritional needs of the older persons are neither documented clearly nor understood. Older people are acknowledged as vulnerable to malnutrition yet their nutritional needs are not adequately met. Efforts to improve the malnutrition should be made by both health professionals and care givers. This is more important especially for the demographic changes. In the study 68% male and 44% female reported that they were ailing out of which 119% males and 28% females were chronically ill.

Specific training should be done on knowledge about nutrition. Another important area of training is community-based diagnosis entailing screening of malnourished/vulnerable groups. Nutritional interventions for the poor and those living with multiple comorbidities should be done. Similarly, nutritional guidelines for older persons should be developed.^1,10

Limitations

The limitation of the study was low level of literacy among the respondents; however, the questionnaire was translated into local language. Confounders like critical illness, wealth and physical strength/stamina contributed a significant challenge.

CONCLUSION

The role of care giving in enhancing well-being of the older persons was hygiene, nutrition, environment and older persons abuse whereby feeding and older persons abuse were the most significant.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

ACKNOWLEDGEMENTS

Authors would like to thank to school of public health for guidance and support. Authors would also like to thank all University administration, Kirinyaga county director of health, caretakers and older persons who participated make this study successful.

REFERENCES

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