Understanding social support and determinants of health in old age in South Africa using a mixed method approach.

Abstract

The study attempted to understand social support and determinants of health of people aged 60 years and older living in South Africa and provide a comprehensive definition of the concept of old. This research was motivated by the fact that South Africa has witnessed an increase in the proportion of older people. They have to live with threats inherent in the demise of the extended family, their traditional support networks as well as the risk of being marginalised as a result of modernisation and urbanisation. In the absence of alternative social support, the elderly are left to fend for themselves. For decades, population aging has been overlooked and there is nearly no empirical evidence on factors that affect health in old age in Africa, let alone South Africa. Furthermore, there is no consensus on the concept of old among scholars. The study made use of both qualitative and quantitative methods to explore the issue at hand. For this study, both descriptive and explanatory research designs were used, drawing on 18 in-depth interviews from a primary study among participants in an old age home and a nationally representative quantitative sample of publicly available data. The motivation for this methodological approach was to improve the outcome of this study since strengths of one data source will compensate for the weaknesses in the other source. A total of 3545 respondents aged 60 years and older who took part in NIDS wave 5, conducted in 2017, were included in this study. The findings from the in-depth interviews seem to suggest that the current concept of old was flawed and irrelevant. Old age cannot be described using a one-size-fits-all approach, instead, it is heterogeneous and depends on some factors including lifestyle. Old age was well explained according to others and health played an important role in this regard. An older person was regarded as a sickly individual who depended on others for performing activities of daily living. In terms of gender, men and women were believed to age differently. Moreover, from a cultural standpoint, the elderly were those who have procreated and lived long enough to see their children becoming mature and independent members of the community. The elderly reported having at least one monthly medical appointment. The frequency of visits to health care facilities was dependent on the number of medical conditions. It was found that older people were affected by several conditions uncommon at younger ages and some have been on medication for more than a decade. Despite the multiplicity of these medical conditions, many older people were not living healthy. Old age pension was found to be the main source of income of the households headed up by the elderly. In becoming recipients of old age pensions, the elderly were able to keep their medical appointments as they were able to afford taxi fare. The likelihood of receiving emotional and instrumental support was higher than gifts and other donations. Adult children, notably daughters and sons were the main source of support for their parents. It turned out that childless older parents were less likely to receive gifts. Working adult children or family members were more supportive than their unemployed counterparts. Social support was associated with improved well-being and better health. This study could not confirm the abandonment of the elderly highlighted by the modernisation and aging theory. A great deal of ill-health in old age can be prevented by raising awareness about the positive impact of a healthy lifestyle. Providing health care workers with adequate training and making them knowledge about health challenges in old age is likely to change their perception and care of older patients.