Evaluation Of Health Care Service For Older Adults In Nigeria

Project and Seminar Material for Public Health

Evaluation Of Health Care Service For Older Adults In Nigeria


Abstract


With the global trend towards an increasing aging population, there is a corresponding increase in the health problems associated with elderly population especially in developing Countries including Nigeria. With this increase in the growth of the aging population, the number of people that will need health care will undoubtedly increase, which motivated this study. The study was aimed at the evaluation of health care services for older adults in Nigeria using University of Calabar Teaching Hospital, Calabar, Cross River State. The study adopted a cross sectional descriptive design. The population of the study was health workers, which was made up of Doctors, Nurses, Dentists and Physiotherapists that provided direct clinical care for older adult patients. The sample was calculated using simple random sampling giving a sample of 461 health workers. The instrument for data collection was questionnaires, the reliability of the instrument was done using test retest method and a reliability co-efficient of 0.91 was obtained. The criterion mean of 2.5 was also used and results of the study revealed that 95% of the health workers had good knowledge of health care services for older adults. Majority of the health workers had positive attitude above rating scale of 2.5. The health workers moderately practiced health care services for older adults. The factors that positively influenced health workers attitude to the health care services for older adults were years of experience, age and mental state of the elderly. There was significant association (P<0.05) between attitude of Health Workers and mean years of experience.


Table of Content


Chapter One:

Introduction

  • 1.1 Background of the study
  • 1.2 Statement of the problem
  • 1.3 Objective of the study
  • 1.4 Research questions
  • 1.5 Research Hypothesis
  • 1.6 Significance of the study
  • 1.7 Scope of the study
  • 1.8 Limitation of the study
  • 1.9 Definition of terms
  • 1.10 Organizations of the study

Chapter Two:

Review of Literature

  • 2.1 Conceptual
  • 2.2 Theoretical framework
  • 2.3 Empirical study

Chapter Three:

Research Methodology

  • 3.1 Research Design
  • 3.2 Population of the study
  • 3.3 Sample size determination
  • 3.4 Sample size selection technique and procedure
  • 3.5 Research Instrument and Administration
  • 3.6 Method of data collection
  • 3.7 Method of data analysis
  • 3.8 Validity of the study
  • 3.9 Reliability of the study
  • 3.10 Ethical consideration

Chapter Four:

Data Presentation and Analysis

  • 4.1 Data Presentation
  • 4.2 Answering Research Questions
  • 4.3 Test of hypothesis
  • 4.4 Discussion of Findings

Chapter Five:

Summary, Conclusion and Recommendation

  • 5.1 Summary
  • 5.2 Conclusion
  • 5.3 Recommendation
  • 5.4 Suggestion for further studies
  • References
  • APPENDIX
  • QUESTIONNAIRE 

Chapter One


Introduction

1.1 Background to the Study

Ageing is the accumulation of changes in a person over time (Bowen and Atwood 2004). It involves a multidimensional process of physical, psychological and social change. Some dimensions of aging grow and expand over time, while others decline. Research shows that even in late life, potentials exist for physical, mental and social growth and development (Papalia, Sterns, Feldman, and Camp, 2002). It is not a disease; but phase of life where there is retrograde biological process in growth and development which leads to decreased powers for survival and adjustment. Aging is an important part of all human societies reflecting the biological changes that occur and also reflecting cultural and societal convention.

An estimated 100,000 people worldwide die each day of age related causes (Aubrey de Grey, 2007). According to National Population Commission (NPC, 2006), persons who are old enough to receive pension who are between ages of 60-65 years are regarded as the elderly. The elderly are classified by age into young old for those aged 60-74years, middle old for those aged 75-84years, old for those aged 85-94 years and oldest old for those 95years and above. (Barman, Snyder, Kozier & Erb , 2008).

Care for the older adults is the fulfillment of the special needs and requirements that are unique to senior citizens. It covers such services as assisted living, adult day care, long term care, nursing homes, hospice care and home care. Elderly care emphasizes the social and personal requirements of senior citizens who need some assistance with daily activities and health care, but who desire to age with dignity. The care for the older adults is multidimensional and these include physical, emotional, spiritual and social care (Ayres, 2008).

However, improvement in primary health care with focus on prevention of childhood diseases through immunization did not highlight the care for the older adults which should be one of the components of primary health care programme in most developing countries (Olise, 2011). A cursory look at the implementation of Millennium Development Goals (MDGs) by the federal government shows that there is little or no consideration of this very important segment of the population – the elderly. Also most curricula for training Health Manpower in Nigeria do not highlight the care for the older adults (Donatelle, 2011). Yet the population of this segment of the society is increasing in developing countries with their special care needs. Traditionally, in Nigeria elderly care has been the responsibility of family members and was provided within the extended family system (Ting and Woo, 2009).But with modernization, elderly care is now being provided by state or charitable institutions. This is attributable to decreasing family size, the greater life expectancy of elderly people, the geographical dispersion of families, and the tendency for women to be educated and work outside the home (Lee, 2009).

In most developing countries including Nigeria the population for the older adults is increasing rapidly but the government does not seem to be making any major commitments to elderly healthcare (Adio-Moses, 2001). The government is still assuming that families should take care of their elderly without recognizing that the extended family system is at the verge of collapse. Currently most families find it difficult to manage their own homes and face their challenges. This is gradually leading to neglect and abuse for the older adults (Gubrium, 2002). Care for the older adults requires adequate knowledge of the ageing process, nutrition and daily needs for the older adults. In Nigeria, marginalization for the older adults especially in their care is a common episode (Abdulraheem & Parakoyi, 2005). Those involved in the provision of health care have important roles to play in programmes relating to elderly care especially in screening and detecting abuse.

Unfortunately doctors do not diagnose abuse because it is not part of their formal or professional training hence does not feature in their list of differential diagnosis (Donatelle, 2011). The health worker, according to Abdulrahem & Parakoyi (2005) plays major roles in determining and implementing desirable standards of health care, acting as a professional in developing core of professional knowledge and should have ability to impart same to others. They are often the providers of services designed to maintain health and prevent illness. Research has also shown that the quality of health care service provided to older population is strongly influenced by care givers attitude towards older people (Gallaghar, Bennet & Halford, 2006). This underscores the need to evaluate the health care services for older adults in Nigeria using University of Calabar, Calabar Cross River State as case study.


1.2 Statement of the Problem

The population for the older adults in the world is increasing rapidly (United Nations, 2004) and the rate of increase is higher in developing countries including Nigeria. Currently, Nigeria has the highest number for the older adults people in Africa estimated to be about 5.6% of the Nigeria population (NPC, 2008). With this increase in the growth of the aging population, the number of people that will need health care will undoubtedly increase. Donatelle (2011) posited that in most curricula for health professionals, little or nothing is indicated about the care for the older adults showing absolute neglect in this area Mclafferly and Morrison (2004) stated also that most health workers have very poor knowledge of mental health conditions which are common with the elderly and as such health workers come to service with deep seated, negative, diluted and superstitious belief about caring for the elderly. This lack of adequate knowledge and negative attitude towards the care for the older adults may result in serious problems in our society in the near future. In a recent study for the older adults in Ibadan by Oyetunde, Ojo & Ojewale (2013) show that attitudinal relational gaps exist, resulting in negative patient outcome. From my clinical practice in different hospitals in Calabar, frequent misunderstanding between elderly patients and health care providers especially the young ones, was observed. Based on these, the researcher seeks to evaluate the health care services for older adults in Nigeria using only tertiary health facility in Calabar, University of Calabar Teaching hospital.


1.3 Objectives of the Study

The main objective of the study is an evaluation of health care services for older adults in Nigeria. Specifically the objectives of the study include to:

  1. Determine the health workers level of knowledge of the physical, emotional and social healthcare service of the older adults in University of Calabar Teaching Hospital ,Calabar, Cross River State
  2. Determine the attitude of the health workers towards the healthcare service of the older adults.
  3. Determine the health workers practices in the provision of care for the older adults.

1.4 Research Questions

  1. What is the level of knowledge of the healthcare service for the older adults among health workers in a tertiary health facility in Calabar, Cross River State?
  2. What is the attitude of health workers towards healthcare service for the older adults in a tertiary health facility in Calabar?
  3. What are the health workers practices in the provision of healthcare service for the older adults in a tertiary health facility in Calabar, Cross River State?

1.5 Hypothesis.

1. There is no association between years of experience of health workers and their attitude towards healthcare service for the older adults in UCTH, Calabar.


1.6 Significance of Study

The result will help to provide basic information for designing structures and programmes for the care for the older adults in the community. It will also provide evidence based information for health education on graceful ageing. It will serve as a reference material to other researchers in the field of community health practice.

Findings of the study will help in showing the level of knowledge and attitude of the health workers towards the healthcare services for the older adults and will help improve the decision making. The result will also help in building up knowledge base on the care for the older adults patients. Improving data base on elderly health nutrition and standard of living which will help for further research, advocacy, policy dialogue and programming.


1.7 Scope of Study

The study focused on the Evaluation Of Health Care Services For Older Adults In Nigeria in University of Calabar Teaching Hospital, Calabar. The study was delimited to only health workers providing direct clinical care (hand on care to the elderly) consisting of nurses, doctors, dentists and physiotherapists in University of Calabar Teaching Hospital.


1.8 Limitation of study

Finance, inadequate materials and time constraint were the challenges the researchers encountered during the course of the study.


1.9 Operational Definition of Terms

  1. Knowledge of physical care are expressing understanding of bed bath, skin care, oral hygiene, feeding, elimination and ambulation.
  2. Knowledge of Emotional care; refers to expressing attention, acceptance and love.
  3. Knowledge of social care; means financial support and visitation by family members and friends (co-workers, church member’s, social club, and neighbors).
  4. Practice of physical care expressing competence in providing skin care, oral hygiene, feeding, ambulation and elimination.
  5. Attitude means health workers’ expression of cheerfulness, listening to patient’s complaints and prompt attention, positive attitude while negative attitude means expression of harsh words, lack of respect and “stone face”.
  6. Health Workers refers only to Nurses, Doctors, Physiotherapists and dentists that are directly involved in the clinical care for the older adults.
  7. Elderly refers to people aged 60 years and above.

1.10 Organizations of the Study

The chapter one consist of the introductory part of the study which includes the study background, the statement of the research problem, the study objective and scope of the study.

The second chapter is a critical review of other literatures relevant to the study and its objectives including the theoretical framework for the study. While the third chapter is methods of data collection, sampling and data analysis used in conducting the study. The fourth chapter centres around the research findings including an analysis of how it relates to previous findings. The fifth chapter consists of the summary of findings, conclusion and recommendations base on the study objectives.


Chapter Five


Summary, Conclusion and Recommendation

5.1 Summary

The study focused on the evaluation of health care services for older adults in nigeria using University of Calabar Teaching Hospital, Calabar as case study.

The specific objectives were to

  1. Determine the level of knowledge, the physical, emotional and social health care services for the older adults patients in the University of Calabar Teaching Hospital, Calabar
  2. Determine the attitude of health workers in the health care services for the older adults patients,
  3. Determine the level of health workers practices in the provision of health care services for the older adults patients.

The hypothesis for the study tested the association between years of experience of health workers and their attitude towards health care services for the older adults patients in UCTH. Calabar. The study adopted a cross sectional descriptive design. The population of the study was all the health workers, made up of Doctors, Nurses, Dentists and Physiotherapists that provided direct clinical care to elderly patients. The sample was calculated using random sampling technique giving a sample of 461 health workers. The instrument for data collection was questionnaire, the reliability of the instrument was done using test retest method and a reliability co-efficient of 0.91 was obtained. The questionnaire had five sections, section A covered socio demographic data, section B, C, D consisted of items which explored level of knowledge. Attitude, practice and section E elicited information on factors influencing the care for the older adults patients. The completed questionnaire was coded and analyzed using E.P.I info-7.

Descriptive statistics of percentage, mean, standard deviation were used for data analysis. The criterion mean of 2.5 was also used and results the study revealed that 95% of the health workers had good knowledge of care for the older adults patients. Majority of the health workers had positive attitude above rating scale of 2.5. The health workers moderately practiced care for the older adults patients. The factors that positively influenced health workers attitude to the care for the older adults were years of experience, age and mental state for the older adults.

There was significant association (P<0.05) between attitude of Health Workers and mean years of experience. Workers with less years of experience had negative attitude, while those with more years of experience had positive attitude, towards the care for the older adults patients.


5.2 Conclusion

In conclusion, health care professionals need to have the right skills to manage a more demanding role in the future. In order to offer effective services for the elderly patients, a skilled workforce of health professionals is therefore very necessary.


5.3 Recommendations

Although the findings of the study show that health workers have good knowledge on the care for the older adults, the attitude of the health workers was statistically significant with mean years of experience i.e. the years of experience is associated with attitude of health workers. There is need to provide more resources and also training of personnel in area of elderly care.

  1. Special wards / department should be created for the elderly in the hospitals with well trained staff in the area of specialization. The researcher also suggested that the government should develop a health policy for the elderly that will capture the care for the older adults.
  2. Develop a system of periodical health workers evaluation to determine strategies of upgrading their knowledge and enhancing practice.
  3. Development of follow up courses and in service training programs should be conducted to maintain efficient performance of individuals previously trained in the care for the older adults
  4. Encouraging health workers to attend national and international congresses, seminars symposiums and workshops on care for the older adults.

5.4 Suggestion for Further Studies

The researcher suggests that similar study on the knowledge of care for the older adults should be done in other health facilities in other States. Other studies that include the problems associated with health workers attitude towards the care for the older adults.


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