Dr Eniola Olubukola Cadmus is an honorary consultant at the first specialized Centre for the Care of Older Persons in Nigeria, the Chief Tony Anenih Geriatric Centre (CTAGC). Dr Cadmus received her medical degree (MB; BS) and Masters degree in Public Health (MPH) in community health from the University of Ibadan, Oyo State, Nigeria. She also has an MPH (Health Promotion) from the University of Pretoria, and she is a Fellow of the West African College of Physicians (Community Health).
Dr Cadmus is a lecturer in the Rehabilitative and Social Medicine Unit of the Department of Community Medicine, University of Ibadan. Her research and publications span issues related to healthy ageing and its determinants, long term care provisions for older persons and elder abuse. She is the team leader of the Community Geriatrics Unit at the CTAGC. The unit aims to promote the health and well-being of older persons both within the health facility and, more importantly, in the community.
An exploration of a sustainable model for community care of older persons in Oyo State, southwestern Nigeria
Eniola Cadmus, University of Ibadan, Nigeria
Increasing age is associated with the presence of chronic diseases and functional decline among older persons. In many African settings, there is a huge reliance on the family for the provision of LTC. This arrangement is gradually becoming unsustainable due to the reduced availability of primary caregivers as a result of modernization and increased female participation in schooling and the workforce. The concept of “Aging in Place” (AIP) aims to support older persons in their preferred accommodation and communities in which they reside for a long as possible. Most research carried out to date on AIP has been in HIC with a limited focus in low and middle-income countries (LMIC) such as Nigeria. Resultant recommendations may not necessarily apply to African countries including Nigeria with their unique norms, values and cultural diversity. This study explored the preferred settings for LTC among community-dwelling older persons in rural and urban areas of Oyo State, Southwestern Nigeria.
A comparative cross-sectional survey was conducted in selected rural (Ibarapa Central Local Government Area) and urban (Ibadan North) Local Government Areas of Oyo State. Using a multi-stage sampling technique, older persons aged 60 years and above were selected. A semi-structured questionnaire was administered during house to house visits for the chosen houses Quantitative data were analysed using Stata version 14. Associations were tested using chi-square and logistic regression analysis at p<0.05.
Overall, 1,180 (588 urban and 592 rural-dwelling) respondents were interviewed. Over half were females in the rural (69.1%) and urban (70.0 %) communities. Significantly more rural respondents compared with urban respondents were older 74.2±9.5 years versus 72.3±8.9 years, owned the home they were residing in (67.0%) versus (61.6%) and had some form of assistance at home (79.8%) versus (74.7%) (p<0.05). More rural respondents desired to age in place (AIP) (61.6% versus 39.2%) (p<0.05). Predictors of AIP for rural respondents were older age (≥70 years) [OR: 2.07(95% CI: 1.37-3.14)], being male [OR: 2.41 (95% CI: 1.53-3.81) and having assistance at home [OR: 1.79 (95% CI: 1.15-2.79)]. Predictors of AIP for urban respondents were older age [OR: 1.54 (95% CI: 1.03-2.31)] and ownership of home [OR: 5.83 (95% CI: 3.82-8.91)].
This study provides hitherto scarce evidence about the preferred option of long term care among community-dwelling older persons in a low resource setting. Older persons prefer to age in place. Nevertheless, the respondents were open to the option of institutional care. The information hereby provided will assist the development of policy and programmes for the provision of long term care support for older persons within the communities in which they reside.