|Year : 2018 | Volume
| Issue : 2 | Page : 73-78
Assessment of factors affecting self-rated health among elderly people in Southwest Nigeria
Adedoyin O Ogunyemi, Foluke A Olatona, Kofoworola A Odeyemi
Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
|Date of Web Publication||19-Jul-2018|
Adedoyin O Ogunyemi
Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos
Source of Support: None, Conflict of Interest: None
Context: Self-rated health (SRH) is a subjective measure of health considered valid to predict mortality among the elderly. With the rapid increase of older people living in Nigeria and the lack of adequate social security, it is important to identify factors affecting their SRH. Social support has also taken on added importance among the elderly in view of scarce resources. Objective: To determine the level of satisfaction with the forms of social support received by the elderly and the factors associated with their SRH. Settings and Design: The study was a descriptive cross-sectional study design among the elderly in Southwest Nigeria. Subjects and Methods: A multistage sampling technique was employed to select 360 elderly respondents for the study. A standardised questionnaire, Short Form Health Survey-36 was interviewer administered. The data were analysed using Statistical Package for the Social Sciences version 20. Significant associations between categorical variables were evaluated using Chi-square (χ2) test. Multiple regression test and adjusted odds ratios (ORs) were employed to assess the relationship of the various predictors of SRH. The level of significance was set at P < 0.05. Results: The mean age of the 360 elderly respondents was 73 ± 9.3 years, 60.3% were female and 43.9% were widowed. Almost all (91.9%) the respondents received emotional while domestic support was the least in 50.3%. About 30.0% of the elderly self-rated their health as poor. The predictors of good SRH after multiple logistic regression included being married (OR = 1.84, 95% confidence interval [CI]: 1.01–3.33, P = 0.04); engagement in work (OR = 2.27, 95% CI: 1.11–4.63, P = 0.02); the absence of morbid conditions (OR = 12.6, 95% CI: 2.86–55.4, P = 0.001) and higher levels of education (OR = 0.41, 95% CI: 0.19–0.91, P = 0.03). Conclusions: About one-third of the elderly had poor SRH. Targeted interventions such as creating employment fit for the elderly and improving healthcare access is recommended.
Keywords: Elderly, satisfaction, self-rated
|How to cite this article:|
Ogunyemi AO, Olatona FA, Odeyemi KA. Assessment of factors affecting self-rated health among elderly people in Southwest Nigeria. Niger Postgrad Med J 2018;25:73-8
|How to cite this URL:|
Ogunyemi AO, Olatona FA, Odeyemi KA. Assessment of factors affecting self-rated health among elderly people in Southwest Nigeria. Niger Postgrad Med J [serial online] 2018 [cited 2018 Dec 14];25:73-8. Available from: http://www.npmj.org/text.asp?2018/25/2/73/237082
| Introduction|| |
Self-rated health (SRH) is a subjective measure of health considered to be valid and reliable and also a predictable measure of mortality among the elderly. It is their perceived health status and has been linked with the influence of social and economic variables. Also associated with health perception is the social support received which is an important social determinant of health in the quality of life of older people.,, The lack of implementation of social security policies for old age in Nigeria coupled with the apparent decline in the adequacy of material and family support has given rise to their exposure to deprivation and poverty. About half (47.1%) of 704 older adults in a Nigerian study had poor SRH.
Although often ignored, social issues such as social resources and various forms of social support are the subjective perceived losses of older people., Social support comprises meeting tangible needs such as assisting with domestic chores, personal care as well as emotional support and this has been recognised as an important social determinant of health that impacts positively on their quality of life., Several studies have shown a strong positive association between social engagement and physical and mental health outcomes.,,,,, The effect of social support in mediating SRH directly or indirectly within the Nigerian context needs to be explored. Ageing is associated with reliance on social support; however, the minimal or often absent social safety net for older adults in Nigeria, makes it important to investigate the social support received, SRH of this group and other factors associated with their SRH.
| Subjects and Methods|| |
This was a descriptive cross-sectional study conducted in Southwestern Nigeria. Older adults aged at least 60 years and not senile were selected from communities and four old people's homes. The minimum sample size of 272 was calculated using formula for a descriptive study  P = prevalence estimate of poor SRH among 23.0% or 0.23 of older adults from a previous study;q = 1 − p (0.77); z = standard normal deviate corresponding with a 95% confidence interval (CI) (1.96) and; d = degree of precision (0.05). Data collection took place between 3 June 2013 and 29 August 2013. A multistage sampling technique was used to select the respondents.
Selection of states
Only two states, Oyo and Lagos that had registered homes to care for the elderly in the Southwest geopolitical zone were purposively selected from the six Southwestern states and included so that all older adults in the region were well represented. Selection of local government areas (LGAs):First, two LGAs were selected from each state using simple random sampling (balloting) to give a total of four local governments.
Selection of wards
In each of the four LGAs, two political wards were selected to give eight wards.
Selection of respondents
First, ten streets were selected in each of the eight wards using simple random sampling (balloting) from the list of streets. On each selected street, the starting point for administration of the questionnaire was determined by balloting between numbers 1 and 5. Questionnaires were then administered to every other house from there onward. One questionnaire was administered to one older adult in each selected house. In houses with more than one household, and household with more than one older adult, one household and one older adult were selected, respectively. This was done until 30 respondents were selected in each of the eight wards and therefore 240 respondents. All the 120 eligible respondents in the four old people's homes in the two states were included totalling 360 respondents.
A pre-tested, structured, interviewer-administered Short Form-36 (SF-36) questionnaire  was used to collect information from respondents. The most widely used health status profile in the world is the SF-36. It is a reliable and valid measure in multiple populations., It has been used for older adults in many surveys., It consists of 36 questions to cover 8 domains of quality of life. Section A consisted of questions on sociodemographic details on the respondents. Section B consisted of questions on socioeconomic details. Section C consisted of questions on the respondent's perception of care and social support and the forms of social support received. Section D had questions regarding their quality of health. Four research assistants who were proficient in both English and Yoruba languages were trained for the data collection process.
Ethical Considerations: Ethical approval was obtained from the health, research and ethics committee of the Lagos University Teaching Hospital with Ref No: ADM/DCST/HREC/VOL. XVI/APP/722 on 9 October 2012. Permission to conduct the study was obtained from the Chairman of the LGAs and the officials of the old peoples' homes. Written informed consent was obtained from each respondent by signature or thumb printing on each questionnaire Confidentiality and anonymity were maintained throughout the study.
The SPSS (Statistical Package for the Social Sciences) Version 20.0 (IBM, Armonk, NY, United States of America) was used for data entry and analysis. The demographic, socioeconomic, medical and SRH variables were presented in the form of frequency tables and cross-tabulations. SRH was assessed with one question asking the respondents to rate their health., Responses were made on a 5-point scale with scores as follows: Excellent – 100, Very good – 75, Good – 50, Fair – 25 and Poor – 0. The outcome variable was dichotomised into 'Good' and 'Poor' from the respondent's scores which ranged from 0 to 100. Those with scores which ranged from 0 to <50 were graded to have a poor SRH while those with a score from 50 to 100 were graded to have a good SRH. Significant associations between categorical variables were evaluated using Chi-square (χ2) test. Multiple regression test and adjusted odds ratios were carried out to assess the relationship of the various predictors of SRH. The level of significance was set at P < 0.05.
| Results|| |
The mean age of the 360 elderly respondents was 73 ± 9.3 years and about two-thirds were female (60.3%), widowed (43.9%) and 89.4% had children who were alive. Over a quarter (28.9%) had no formal education and the family was the main income provider in 68.6% of the respondents in [Table 1]. Emotional support was highest (91.9%) among the respondents and this was followed by financial support in 80.8% of them. Domestic support was received by only half (50.3%) of the respondents. More than half (52.9%) of the respondents had their child/children as their main financial provider and 44.2% as their most significant emotional provider while 6.7% of respondents had no emotional provider. When asked why they had no emotional provider, the reasons included relatives living faraway (2.2%) and not caring enough (0.6%). About two-thirds of the respondents were satisfied with the forms of support received from family members while only 5.0% were either dissatisfied or very dissatisfied [Table 2]. Eighty-four per cent of respondents reported one illness condition or the other with arthritis (35.3%) and eye problems (34.4%) being the two most predominant. Other morbid conditions included hypertension in one-quarter of them and diabetes in only 6.7% of respondents. The predominant health facility choice for more than half (51.1%) of the respondents was the government facility, followed by the private hospital in 23.3% of respondents and only 2.2% utilised faith-based care [Table 3]. Poor SRH was statistically significant with age (P< 0.001), marital status (P< 0.001), education (P = 0.003), work status (P< 0.001), health condition (P< 0.001) and type of health facility (P< 0.001). There was no statistically significant association between support satisfaction and SRH [Table 4]. In [Table 5], the predictors of good SRH after multiple logistic regression included being married (odds ratio [OR] = 1.84, 95% CI: 1.01–3.33, P = 0.04) as those married were 1.8 times more likely to have a good SRH compared to those who were not, engagement in work (OR = 2.27, 95% CI: 1.11–4.63, P = 0.02) and the absence of morbid conditions (OR = 12.6, 95% CI: 2.86–55.4, P = 0.001) while those with lower levels of education were 0.4 times less likely to have a good SRH (OR = 0.41, 95% CI: 0.19–0.91, P = 0.03).
|Table 4: Relationship of sociodemographic variables, support satisfaction and self-rated health among respondents|
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|Table 5: Multivariate logistic regression of factors associated with good self-rated health|
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| Discussion|| |
Almost all the respondents in this study received emotional support, followed by financial support. The support with finances received by older people in this study was higher than among respondents in an urban study done in Delta State, Nigeria. Children were the main providers of financial and emotional forms of support in this study. This is similar to a study in China were children were the most important source of support to their older ones followed by spouse and relatives. More than two-thirds of respondents in this study received support in forms of material items and about half with domestic chores. This was similar to the study in Delta State where material and domestic support was received in 56.9% and 46.6% elderly respondents, respectively. Eighty-seven per cent of respondents were satisfied with the forms of support they received. High satisfaction with forms of support received by the elderly in this study could be attributed to the increased forms of supports received and also higher levels of socially desirable responses that have been shown to correlate with increasing ages and among older people.
Eighty-four per cent of respondents in this study had at least one self-reported morbid condition, a finding similar to other studies in which 80% of those aged over 65 years had one or more chronic conditions., The most common morbidity among the respondents was arthritis, followed closely by eye problems and hypertension and consistent with a Nigerian study in Ilorin where arthritis was highest and recorded by over half of the respondents. The SRH condition in this study was lower than in the study done in Kwara State, Nigeria, with eye problems in 61.2% and hypertension in 38.9% of the elderly respondents. This difference may be attributed to the fact that the Ilorin study was hospital based.
The mean SRH score in this study was 49.7 ± 22.4 and the proportion of respondents with a poor SRH was 30.6%. About two-fifth (41.7%) of older adults in a similar study in Delta State, Nigeria, self-rated themselves poor, higher than in this study. In China, the mean score was higher (72.5 ± 15.6) among elderly persons in Beijing and a higher proportion (77.1%) of older respondents in a Brazilian study rated their health as good., This may be adduced to better standards of living and higher life expectancies in these countries. Poor SRH scores increased with increasing age in this study, and this was statistically significant (P< 0.001). Thirty-nine per cent of those aged 80 years and above had poor SRH compared to 25.5% of those aged 60–69 years. There was no statistically significant association found between gender and SRH among the respondents in this study and this was similar to a study among Spanish elderly where the self-perceived health did not show any association with gender. However, in a Brazilian study, poor SRH was associated with low age, low income, not working, poor functional capacity and depression in both men and women, while more somatic health problems were associated with poor SRH in women. The widowed respondents in this study had poor SRH compared to the married and this difference was statistically significant (P< 0.001). In another study, poor SRH was associated with aged 80 years or more, females, those divorced/separated and dissatisfaction with social network. Other studies done among the elderly have linked loneliness and social isolation with poorer quality of life.,
In this study, lack of formal education, being retired and not receiving pension was associated with poor SRH and this finding was statistically significant. Health and lifestyle behaviours are related to economic and social influences that affect physiological and psychosocial pathways and disease. In older adults, social support helps in coping with chronic illnesses and stressful life events. Socioeconomic factors such as not having enough money are important to perceived self-health rating and places lower-income adults at a serious disadvantage. Since pension and social security schemes are inadequate and homes for the elderly virtually non-existent, the burden is on the welfare provider to give the needed support. The implications are far-reaching for older adults who do not have anyone to receive such support from and for the society due to rapidly increasing numbers of older people.
In this study, the majority (98.2%) of respondents with at least one morbid condition reported poor SRH and this difference was statistically significant (P< 0.001). This is consistent with another study in Poland, in which the respondents with more than one disease condition and increased frequency of hospital consultations had poorer SRH and this was statistically significant. There was no statistically significant relationship between respondents' satisfaction with the forms of supports received and their SRH in this study. This may be attributed to the high levels of satisfaction among respondents which is in keeping with socially desirable responses. Other studies in Japan and Ireland have linked low support satisfaction, especially social and family support with poor SRH among older people., Despite the contributions of this study to knowledge, the findings are limited because of the cross-sectional design which unlike longitudinal studies is unable to determine a causal sequence of social support and SRH.
| Conclusions|| |
In conclusion, the factors associated with good SRH in this study after multiple logistic regression were being married, higher levels of education, work engagement and those without a morbid condition. Social support satisfaction was not related to SRH in this study. While sustaining emotional support, it is recommended that targeted interventions should be directed older people by creating employment fit for the elderly and improving their access to healthcare.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]