Later-life challenges: Assessing socio-demographic risk factors in - PDF document

Later-life challenges: Assessing socio-demographic risk factors in Uganda Abel Nzabona Abstract Demographic studies in Uganda reveal fairly rich data on population sub-groups such as infant and women in reproductive age but comparatively less is known about older persons especially the challenges they face. This paper discusses risk factors of challenges among persons aged 60 and above. A structured questionnaire was used to collect data on 605 persons selected from four rural districts and one urban area. A total of ten Focus Group Discussions and 12 key informant interviews were also conducted to collect qualitative data. Loneliness, inadequate nutrition, dilapidated housing, sight problems, hearing constraints and mobility difficulties were the key challenges investigated. Using scaling technique, these constraints were subsequently aggregated into a single wholesome indicator of challenges. Binary logistic regression indicates that widowed and divorced older persons were more likely to experience severe aggregate challenge than their married counterparts. Household conditions and housing materials predicted severe aggregate challenge. Type of household cooking and shelter material also determined severe aggregate challenge. In comparison with the central region of the country, older persons living in the Northern rural region and Kampala urban area were more likely to experience severe aggregate challenge. Empowering widowed older persons, establishing a special old age fund and addressing regional disparities are recommended. Key Words : Aggregate challenge Severe challenge Socio-demographic Older persons 1

Introduction Population ageing is gaining momentum in Africa, a region often described as having the youngest age structure in the world. For example whereas the number of people aged 60 and above on the continent in 1950 numbered approximately 12 million (ECA, 2007), this figure had increased five- fold to about 60 million people by 2007 (UNFPA & HAI, 2012). Older persons present both a celebration and a challenge (UNFPA & HAI, 2012) . The celebration arises from older persons’ value, while the challenge stems from constraints faced in later-life (Nzabona, 2014). The absolute number of older persons has been rising in Uganda. For example, while the number recorded during the 1969 census was 559,000, this figure increased to 686,300 as per the 1991 national census (Ministry of Finance and Economic Planning [MFEP], 1995). The 2002 national census indicated that older persons numbered 1,101,000 (UBOS, 2005) while the 2006 Uganda National Household Survey showed that this figure was 1,196,400. The recent national household survey has shown that there were 1,304,500 elderly persons in the country (UBOS, 2012). This population is projected to reach 5,420,000 by 2050 (UNFPA & HAI, 2012). This trend, unfortunately, is associated with more and more people living alone in later life (UNDESA, 2007) and may be linked with other later life challenges. Older persons face daunting challenges although differentials in magnitude exist between developing and more developed countries. The challenges include loneliness, poverty, poor housing, inadequate nutrition and ailment (UNFPA & HAI, 2012). Decline in health is one of the several challenges that aging populations face. This includes hearing, sight and memory loss in addition to a host of other health problems. Income short fall is another challenge older persons have to contend with (Barrientos, Gorman & Heslop, 2003). Owing to exclusion from the workforce upon reaching retirement age, older persons need to rely on their pensions and social security where they exist. However even in situations where social security systems are institutionalised, there are some older persons who continue to experience social and economic hardships (HelpAge International, 2004). In countries with high per capita incomes, older persons can retire earlier and thus survive the rigours of work at older ages. However, in low per capita income countries, older persons remain economically active for longer period because of the limited coverage of pension programmes and the relatively small incomes they provide (MoGLSD, 2009). In Uganda, almost 3 in 10 older persons remain actively engaged in income-generating activities well beyond age 60 (Nzabona, Ntozi & Rutaremwa, 2013). This could continue to cause stress and strain on the lives of these individuals. Loneliness is another challenge that older persons have to grapple with (Nzabona, Ntozi & Rutaremwa, 2015; Victor & Scambler, 2009). Because men tend to have a shorter life expectancy than women, more older females than older males become widows as they age (UNFPA & HAI, 2012). While some children stay with their older parents, some live too far a distance away to provide the proper support during emergencies. Furthermore, social relationships might be difficult to maintain in old age because of health limitations, death of family member, friends or workmates (Green, Richardson, Lago & Schatten-Jones, 2001). The lack of transportation is likely to greatly compound the problem (Gilhooly et al., 2002). 2

Older persons in many Ugandan communities live in semi-permanent, grass-thatch and mud and wattle houses which are dilapidated (MoGLSD, 2009). The conditions of these structures are said to put older persons and their dependants in grave danger, especially during rainy seasons (Nzabona, 2014). Occurrence of similar poor living conditions has been established in Tanzania (Spitzer, Rwegoshora & Mabeyo, 2009). A study conducted in the country found that most of the older people did not live in decent housing environment. The study also established rural-urban differences as was indicated by a large proportion of respondents living in mud grass-roofed houses in rural Kineng’ene in contrast with residents of relatively more urban Kingugi where 88 percent lived in houses having an iron roof. Many of those iron roofs were, however, reported to have been in dilapidated condition with big holes through which rain water could have entered (Spitzer, Rwegoshora, & Mabeyo, 2009). Nutritional deficiency is another challenge experienced in later-life. Studies have indicated that older persons in Uganda are hard-hit by food insecurity, poor nutrition and mainly feed on carbohydrates while most take one meal a day (MoGLSD, 2009). Inadequate food and poor diet pre-disposes older persons to malnutrition, ill health, emaciation and chronic energy deficiency. In a study of nutritional status and functional ability of the elderly in Central Uganda, it was found that large percentage of older persons were malnourished and this influenced their daily activities, especially mobility and feeding (Kikafunda & Lukwago, 2005). In Uganda, some studies on the plight of older persons have been conducted, but most of them have concentrated on the HIV/AIDS challenge (Ntozi & Nakayiwa, 1999; Scholten et al., 2011; Ssengonzi, 2007). Many of these studies have yielded rich data on the adverse effects of the HIV/AIDS pandemic, but information on broader later-life challenges remains scanty. Paucity of information is particularly rife with respect to the risk factors as many of the studies have not gone beyond the traditional demographic factors in explaining the challenges. This paper provides evidence for socio-demographic risk factors that predict challenges facing older persons in the country. Data and methods The paper uses primary data from a large cross sectional study on Determinants of Value and Challenges of Older Persons in Uganda (Nzabona, 2015). Loneliness, inadequate nutrition, housing quality, sight problems, hearing constraints and mobility difficulty were the six challenges studied. In the study, stratification was used to select four districts from four strata that comprise the major national zones of the country namely; Central, Eastern, Northern and Western regions. Using simple random sampling, Mukono, Tororo, Lira and Kisoro districts respectively were selected from the four regions. In addition, Kampala City was purposively selected as the fifth regional stratum to represent the urban sector. From each of the four rural districts, one sub-county was randomly selected and one municipality was similarly randomly chosen from the Kampala urban region. The randomly selected sub counties were Nyakabande, Kisoko, Adekokwok and Goma from Kisoro, Tororo, Lira and Mukono districts respectively. Makindye Municipality was the municipality randomly selected from Kampala urban area. Probability sampling approach was adopted to ensure ultimate national representativeness of results. An interviewer-administered questionnaire was used to collect data. 3