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Abstract
This paper examines how care-giving to adults and/or children and care-receiving is associated with the health and wellbeing of older people aged 50+ in rural South Africa. Data used are from a cross-sectional survey adapted from World Health Organization's Study on Global Ageing and Adult Health (SAGE) conducted in 2009/10 in rural South Africa. Bivariate statistics and multivariate logistical regression were used to assess the relationship between care-giving and/or care-receiving with functional disability, quality of life or emotional wellbeing, and self-rated health status, adjusted for socio-demographic factors. Sixty-three per cent of 422 older people were care-givers to at least one young adult or child; 27 per cent of older people were care-givers due to HIV-related reasons in young adults; 84 per cent of participants were care-recipients mainly from adult children, grandchildren and spouse. In logistic regressions adjusting for sex, age, marital status, education, receipt of grants, household headship, household wealth and HIV status, care-giving was statistically significantly associated with good functional ability as measured by ability to perform activities of daily living. This relationship was stronger for older people providing care-giving to adults than to children. In contrast, care-givers were less likely to report good emotional wellbeing; again the relationship was stronger for care-givers to adults than children. Simultaneous care-giving and -receiving was likewise associated with good functional ability, but about a 47 per cent lower chance of good emotional wellbeing. Participants who were HIV-infected were more likely to be in better health but less likely to be receiving care than those who were HIV-affected. Our findings suggest a strong relationship between care-giving and poor emotional wellbeing via an economic or psychological stressor pathway. Interventions that improve older people's socio-economic circumstances and reduce financial hardship as well as those that provide social support would go some way towards mitigating this relationship.
Highlights
Older people in rural South African communities are a vital source of financial, physical and emotional support to children and adults alike (Ardington et al ; Hosegood and Timæus ; Nyirenda and Newell ; Schatz )
The aim of this paper is to examine whether care-giving to adults and/or to children by HIV-infected or -affected older people in rural South Africa is associated with poor functional disability and emotional wellbeing
Care-giving to adults was associated with a higher likelihood of reporting a poor quality of life
Summary
Older people in rural South African communities are a vital source of financial, physical and emotional support to children and adults alike (Ardington et al ; Hosegood and Timæus ; Nyirenda and Newell ; Schatz ). As observed by Aboderin ( ), a combination of declining capacity by young people to provide for older people and society norms changing to emphasising self-reliance in old age, has exposed an increasing proportion of older people in many African countries to destitution and poverty. This apparent decline in the flow of support from younger people may be cause for distress among older people. Despite these changes in intergenerational support relations (Lowenstein ), the family remains an important structure in the care by and towards older people. According to the role-enhancement and rolestrain perspective, performing this care-giver role could either enhance or weaken the health and wellbeing of older people (Goode )
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