Older Persons’ Views and Experience of Elder Abuse in South Western Nigeria

Abstract

Objectives: Conventionally, existing information on elder abuse has been institution based, professionally driven, and in high-income countries. This study addresses the prevailing gap in knowledge through direct consultation of older persons in the community about their perceptions of elder abuse. Method: Eight focus group discussions were carried out among males and females aged 60 years and above in a rural and an urban community in south western Nigeria. Data were transcribed and analyzed based on emergent themes. Results: Findings from the study show that the perception of abuse by the respondents included the standard typologies except sexual abuse as well as societal issues such as disrespect and lack of recognition. Discussion: Our study revealed a high level of awareness and experience of elder abuse among the participants in both communities. Effective social welfare and health services aided by targeted government policies are needed to improve the quality of life of the elderly.

Keywords

elder abuse rural aging well-being social factors

Introduction

Global reports have revealed that all populations are aging at an unprecedented rate (Kinsella & Velkoff, 2001). Although the proportion of older people is higher in high-income countries, predicted estimates have shown that the total number of older persons living in many low-and middle-income countries will increase twofold by 2025 and will account for 12% of the overall population of the developing world (Randal & German, 1999; United Nations Secretary General, 2002). This projected increase in the proportion of elderly suggests that there will be an increase in both the incidence of abuse and the number of individuals who will experience abuse. Although elder abuse has been identified as a global problem, most research conducted to date have been in high-income countries.

Elder abuse, like any other form of abuse, is a violation of human rights and has serious consequences for the health and well-being of older people (Dong, Chang, Wong, Wong, & Simon, 2011; McCreadie & Tinker, 1993). Elder abuse has been shown to be associated with increased morbidity and mortality (Dong, Simon, et al. 2011; Dong, 2005; Dong, Simon, & Evans, 2013). For instance, the Chicago Health and Aging Project found that elder abuse and self-neglect predicted all-cause mortality over one year especially among older persons with diminished levels of cognitive and physical function (Dong et al., 2013). Furthermore, other studies have shown that mortality among victims of abuse was higher among individuals with lower levels of psychological and social well-being (Dong, Simon, et al. 2011; Dong et al., 2009). Apart from the association between elder abuse and negative health outcomes, elder abuse is also associated with reports of higher utilization of health services and associated financial burden to the family and the government (Dong, Simon, & Evans, 2012; Schonfeld, Larsen, & Stiles 2006).

Elder abuse can take various forms: physical, financial, emotional, and sexual. However, these typology are based on research carried out in highly industrialized countries and have been suggested to ignore wider societal issues which are ingrained in other cultures (Dong, Chang, et al., 2011; Ferreira & Lindgren, 2008; O’Brien et al., 2011; World Health Organization [WHO], 2014). As such, there is a need to put into consideration cultural norms, values, and expectations of the individual when contextualizing elder abuse in these settings (Ferreira & Lindgren, 2008; WHO, 2014).

Research on elder abuse is sparse in Africa and usually does not fit into the standard typologies of research from Western countries (Ferreira & Lindgren, 2008; WHO, 2014). However, where studies have been conducted, the definition of elder abuse often includes issues of marginalization, disrespect, and systemic abuse. These issues typically do not strictly ascribe to the hitherto known definition of elder abuse but are perceived by the victims to be discriminatory and a violation of human rights and therefore constitutes abuse (Ferreira & Lindgren, 2008; Keikelame & Ferreira, 2000). Furthermore, studies in some countries in Africa have revealed that elder abuse victims are more often women and may be more violent forms (Cadmus & Owoaje, 2012; Mba, 2007), extremes of which involve killings due to accusations of witchcraft (Kibuga & Dianga, 2000). In this regard, the older persons are blamed for life events including death, poor crop yield, or other events like flooding and are therefore punished (Kibuga & Dianga, 2000).

In Nigeria, like many traditional African societies, older persons are ascribed roles which include leadership, settling disputes, maintaining law and order as well as ensuring proper behavior in the community. In return, the family is expected to care, support, and provide for all the needs of the elderly (Abdulraheem & Parakoyi, 2005; Aboderin, 2006; Ajomale, 2007). In recent times, however, this expectation of care is threatened by issues such as increased education, reduction in family size and increased involvement of women in the workforce which reduce the number of the traditionally recognized primary caregivers for the elderly (Ajomale, 2007). Other issues contributing to the increased risk of elder abuse in the society include urbanization, modernization, and increased economic hardship due to the high level of unemployment (Ajomale, 2007). Therefore, elder abuse hitherto foreign to the traditional African setting is fast becoming a social problem (Ajomale, 2007). In addition, the advisory role previously ascribed to the elderly has also been eroded by civilization and exposure to information as the world is now a global village. The removal of this important role of the elderly has led to a perceived reduction in their significance and importance in the community. The elderly are therefore often left without purpose in the community which makes them less likely to be cared for and more prone to all forms of abuse and neglect.

Traditional African culture dictates that while the elderly are expected to play certain roles in the community, in return they are expected to be treated with respect and have their needs supplied for the remaining years of their existence (Ajomale, 2007). This symbiotic relationship is deeply engrained in the African ethos and is supported by norms in the culture including proverbs. Hence, the popular saying “when an individual grows old, he/she feeds off the younger ones.” Therefore, in such a setting, any deviation from the expected care and treatment constitutes elder abuse (Ajomale, 2007).

Few studies have explored the views of older persons in the community where they live and little is known about the experience of abuse in developing countries such as Nigeria. The aim of this study was to shed light on views of older persons’ understanding of elder abuse and proffer possible solutions for the prevention and support of the victims of elder abuse thereof.

Method

Conceptual Framework and Definition

There are various definitions of elder abuse but the definition developed by Action on Elder Abuse in the United Kingdom and adopted by the International Network for the Prevention of Elder Abuse states as follows: “Elder abuse is a single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person” (McCreadie & Tinker, 1993). There is global recognition however that elder abuse needs to be viewed within specific cultural contexts which differ significantly between developed and developing countries. Similar to a study conducted in the Republic of Ireland, the conceptual framework for our study adopted a wider definition of elder abuse (O’Brien et al. 2011). In this framework, elder abuse is defined as follows:

The physical, psychological, emotional, financial or sexual maltreatment or neglect of a vulnerable adult by another person. The abuse may be a single act or repeated over a period of time. It may take one form or a multiple of forms. The lack of appropriate action can also be a form of abuse. Abuse can occur in a relationship where there is an expectation of trust and can be perpetrated by a person/persons, in breach of that trust, who have influence over the life of a dependant, whether they be formal or informal carers, staff or family members or others. It can also occur outside such a relationship. (p. 16)

This definition of elder abuse suggests that for elder abuse to occur there must be three major components. First, an older person which in this study includes all persons aged 60 years and above. Second, a trust relationship between the older person and a caregiver either familial or informal (in the health care setting) where there is expectation of freedom from any harm or injury. Finally, this definition includes abuse by non-family members who may target and commit crimes against the older individual in the society. The presence of these three components guided the analysis of our study.

Study Design

This study is part of a larger study on elder abuse in a rural and an urban community in Oyo State, south western Nigeria using both quantitative and qualitative methods. The qualitative aspect of the study is reported in this article. Details of the study design have been described previously (Cadmus & Owoaje, 2012).

Briefly, the study was conducted in Oyo State, south western Nigeria, which has a population of about 5,580,894. Persons aged 60 years and above constitute 6% of the population numbering approximately 334,853.(National Population Commission, 2006; Oyo State Ministry of Health, 2008). Two sites were selected for this study, Ibadan South East (urban) and Iwajowa (rural) Local Government Areas of Oyo state. The residents are mainly of Yoruba ethnicity and are similar culturally and speak the same language, Yoruba.

A total of eight focus group discussions (FGDs) were conducted over a 2-week period in August 2010 in the chosen communities in Oyo State, Nigeria. The FGDs were conducted among males and females and for the purpose of this study, adults living in the selected communities and aged 60 years and above at the time of study were considered eligible to participate. The participants from the urban community consisted of low- and middle-class inhabitants according to Nigerian socioeconomic classification. Compared with the urban population, the rural population was less educated, with a higher proportion having no formal education and in the lower wealth index. Older persons, who could not provide information themselves due to health issues and communication problems, were excluded from the study.

Advocacy and Community Entry

Through the help of the Medical Officer of Health (MOH) in the two Local Government Areas, the research team was granted audience by the community heads. The purpose of the research was explained and permission was obtained to carry out the study in the communities. The research team was also assisted with participant recruitment and data collection by research assistants who were trained for the purpose by the first author. The research assistants were Community Health Extension Workers (CHEWs) who had been involved in several Public Health programs in the communities and were familiar with the area. As such, the research team had no difficulty gaining access and mobilizing elderly persons in the community to participate in the study.

Participant Selection

In the urban area, Ibadan South East Local Government area, the authors utilized existing social groups or clubs such as landlord’s association and pensioner’s association to facilitate the process of engaging men and women to participate in the discussions. In the rural area, Iwajowa Local Government Area, four CHEWs facilitated participant recruitment and eligible participants were approached in their homes to participate in the study. Those who were willing to participate in the study were asked to assemble in a centrally accessible venue which was a recreational center in the urban area and a building near the Primary Health Care center in the rural area. Verbal informed consent was obtained after the participants had been informed about the study objectives. All the participants were provided with refreshments and reimbursement for their travel-related expenses after the sessions.

Data Collection

FGDs were used to explore the views of older persons concerning elder abuse in the community. Each focus group was made up of 8 to 10 people, a moderator, and a recorder. To make the group discussions as homogeneous as possible and to reflect possible gender-based differences in the experiences and perception of elder abuse between the two groups, we conducted four FGDs with women aged 60 years and above only and four FGDs with men aged 60 years and above only. A semi-structured focus group discussion guide was utilized for the study. The guide was translated to Yoruba, the local language, for ease of communication and subsequently back-translated to English to ensure the original meanings were maintained before administration. The discussions were facilitated by the first and third authors who both had public health background as well as training in qualitative research methods. Both facilitators were fluent in Yoruba as well as English languages.

Prior to each group discussion, the designated facilitator discussed the issue of confidentiality with all the participants, obtained informed consent, and ensured that the atmosphere was conducive for the discussion. A semi-structured interview guide comprising open-ended questions and suitable probes was designed collectively by the research team members and was used for all the discussions. FGD topics covered included the roles of older people within the community, the main problems faced by older women and men in the community, and perceptions about elder abuse and the different types prevalent in the community. The sessions were tape-recorded while a designated note taker took detailed notes to assist in the transcription process. The first and third authors took turns in supervising all the discussions and acted as observers when they were not facilitating a discussion.

Each discussion lasted for about 60 to 90 minutes. At the end of each FGD, there was a debriefing between the moderator, scribe, and the authors to discuss the emerging themes and possible differences from the other FGDs. After eight FGDs had been conducted, we felt that saturation had been achieved and no new information could be obtained.

Qualitative Data Analysis

All the FGDs were conducted in Yoruba, transcribed verbatim from the audio recordings and translated to English by the facilitator of each FGD groups. The English transcripts for each of the audio recordings were then exchanged among the two facilitators immediately after completion for further evaluation to ensure translation accuracy. However, due to time constraints, member checking by the participants for verifying the authenticity of the results was not done. Nevertheless, there was peer debriefing among the research team to enhance the accuracy of the account. The data interpretation process involved reflection by the research team for clarification and discussion of possible bias which may have been introduced to the study. The audit trail was also documented for accountability.

The English transcripts were imported into NVIVO Version 8 and analyzed for discussion on the definitions, perception, and prevalent types of elder abuse in the community. The authors, following the grounded theory approach, independently reviewed the transcripts several times to become familiar with the content before labeling the key words and phrases. Afterwards, sorting and coding for emergent themes which represented the examples of elder abuse given by the participants was done (Barbour, 2010; Liamputtong & Ezzy, 2005). The categorized emergent themes were then compared among the authors before deciding on the dominant themes to report. The authors had to reach a consensus before the categorization of each response could be finalized. Following this process, a final list of themes was derived and applied to the data. In presenting the findings from the study, relevant verbatim quotes are reported to aid conceptualization.

Ethical Consideration

The study was part of a larger study which had received approval by the Ethical Review Committee of the Oyo State Ministry of Health. Participants were informed of their right to decline or withdraw from the study at any time without any adverse consequences. A pamphlet introducing the researcher and describing the nature and procedures of the study, as well as the personal benefits, risks, and rights related to participating, was read to all the participants. Verbal consent was obtained from each participant and a commitment was made by the investigators to safeguard the confidentiality and anonymity of the data collected.

Results

Participant’s Characteristics

A total of 64 elderly persons participated in the eight focus groups with a mean age of 70.9 years ranging from 60 to 92 years. Majority of the participants were from the Yoruba tribe, which is the dominant tribe in the south western region of Nigeria.

Qualitative Analysis Results

In this study, we explored the perceived roles and problems faced by the elders in the community, frequently mentioned types of elder abuse as well as factors responsible. We also analyzed the possible consequences of elder abuse as well as the participant’s suggested solutions to curb the increase of elder abuse in the community.

Respondents’ Views About the Role of Older People and Problems Faced by the Elderly in the Community

Respondents in both the rural and urban areas had similar opinion about the role of the elderly in the community. Many were of the opinion that elders constituted an important aspect of the society and play a prominent advisory role in conflict resolution (Table 1). Likewise, the views of respondents about problems faced by the elderly were similar in both areas. Respondents opined that the aging process leads to loss of strength, health, and financial capability and that many elderly persons are neglected, maltreated, and ignored. Among the urban dwellers, many of the respondents complained they had financial problems which stemmed from irregular payment of retirement benefits, pension, and gratuity. Others identified the high level of unemployment and irregular payment of their children’s salaries as major contributors to their financial difficulties. Similarly, participants in the rural area revealed that many of the older persons in the community still had to work to be able to fend for themselves as their children themselves could not “afford” to do so. Medical problems were also reported to be rampant among the elderly in both areas and the lack of free health care provision for the elderly came up in both discussion groups. Likewise, in both areas, the participants lamented that they could not understand why the government did not subsidize health care and affirmed that due to the fees that are required in hospitals, many elderly persons have little or no access to health care.

Table 1.

Role of the Older People and Problems Faced by the Elderly in the Community.

Theme	Subtheme	Sample statements
Role of the elderly
Advisory	Leadership	“Elders are fathers in the community we look up to them”
Advisory	Conflict resolution	“ . . . they help in settling disputes and quarreling. They help to solve problems.”
Problems of the elders in the community
Problems due to aging
Loss of health	Poor access to health care	“There are no provisions for medical treatment unlike abroad where medical care for the elderly is free and so many other benefits.”
Loss of strength	Inability to work	“We still have to work although the strength is no longer there and we are not as agile as we used to be but if you don’t work, how can you eat?”
Financial deficiencies
	Delayed payment of retirement benefits	“The government is abusing us. I have retired for over seven years now and I am yet to collect my gratuity talk less of pension and my survival has been totally by God’s grace.”
	High unemployment rate among children	“The children we have trained rely on us for sustenance. We who are being fed (pensioners) are also feeding people (children).”

Respondent’s Perceptions About Elder Abuse

Participants were asked to characterize elder abuse based on their views and experience. Their given classifications included the standard typologies of elder abuse including emotional abuse, physical abuse, and financial exploitation. Conversely, caregiver neglect and sexual abuse were not mentioned by any of the participants; rather, other atypical forms of abuse such as disrespect, lack of recognition, and name calling were recurrent especially among the female groups in both the rural and urban areas (Table 2).

Table 2.

Types of Elder Abuse.

Theme	Subthemes	Sample statement
Emotional abuse	Verbal abuse such as name calling, blaming the elderly for lack of progress in the children’s lives	“Some elderly are not welcome in their son’s house by their daughter-in-law, some even call their mothers-in-law witch.”
		“ . . . Some elderly people are not cared for by the children due to hear-say received by the children that the parents are witches and are the reasons why the children are not successful in their careers.”
	Accusations of witchcraft	“I am a witch for caring and correcting a child, they (members of the community) shun the adult like an insignificant figure and hurl insults at us.”
	Verbal insults	“Abuse in my opinion is when a small child can insult me thoroughly in public to the extent of calling me a witch and goes scot-free.”
	Lack of access to children (especially male)	“The wives of our children in the cities don’t want to see us. I was once sent back to the village when I tried to visit my son and his family in the city. My daughter-in-law asked why I did not use the phone set they gave me to call ahead that I wanted to visit my own child.”
	Disrespect	“Civilization has made the youth to disrespect the elderly in the community; they only respect you as long as they are dependent on you but once the roles are reversed, you are in trouble.”
	Disrespect	“Disrespect is rampant in the society and training of our youths today in matters of respect is not optimal. Why can’t a young person give up his seat for an elderly person?”
	Ignoring	“They (the youths) ignore us and that is a bad thing, if you try and correct a bad behavior among the youth they will tell you to shut up and mind your business.”
Financial abuse	Adult children forcing the elderly assist financially	Complained “After all they are our children and we should be willing to help them but when you insist that you can no longer cope, their behavior toward you change.”
		“To avoid being ignored and for peace sake you share your resources among the family members.”
		“The children we (the elderly) rely on themselves are hungry and bring with them financial dependants (wife, in some cases husband and children) so we (the elderly) are forced to share the little we have which would have been just okay for our upkeep but now is too small to go round.”
Physical abuse	Abuse faced in transportation system	“In other cases they try to hurry us up to get down from the cab and if you don’t hurry up they may move the vehicle and in some cases, the elderly have fallen down.”
Physical abuse	Abuse faced in transportation system	“You will nearly be pushed into the gutter if you are not careful because we no longer have the strength to rush like the younger people.”
Atypical forms of abuse	Bureaucratic bottle-necks faced in collecting entitlements	“The government is abusing us. I have retired for over seven years now and I am yet to collect my gratuity talk less of pension and my survival has been totally by God’s grace.”
Atypical forms of abuse	Bureaucratic bottle-necks faced in collecting entitlements	“When you think of all the verification and screening you have to go through the stress is enough to send one to an early grave.”

Respondents in both study areas viewed elder abuse as common and the main perpetrators were their adult children. The main contributory factors for elder abuse identified by the discussants were being female, widowed, financially dependent, and with diminished physical or mental capacity.

Types of Abuse

Emotional abuse was the most commonly mentioned form of abuse among the female respondents and was described in the form of name calling, accusations of witchcraft, and being blamed for lack of financial progress of their children. Most times, the perpetrator was the daughter-in-law who was not only abusive but also restricted the elder’s access to their children and grandchildren. Disrespect of the elderly was also commonly mentioned as a form of abuse in both groups. The main perpetrators were the youth as a participant complained that Western education has led to individualism among the youths.

Financial abuse was the most common form of abuse experienced among men especially in the urban group. They spoke of the way many older persons are made to assist their unemployed children financially. Many of the older persons were of the opinion that the high level of unemployment was highly contributory to the need for financial assistance by the children. However, there were reports of maltreatment such as social isolation, lack of visits, and silent treatments when the elders declined to help financially which was seen to be abusive. Financial abuse by non-family members was also frequently mentioned among participants in both study groups. The financial abuse was in form of theft and property grabbing from the vulnerable adults who no longer have the strength to supervise their property. In addition to the reported financial exploitation within family and non-family members in the community, a recurrent classification of financial abuse by the respondents was the delayed payment of post-retirement benefit especially among the urban group.

Physical forms of abuse in the family setting were rarely mentioned by the participants. However, in the community setting, difficulties and harassments faced while trying to use commercial transportation was a major concern for the discussants. These forms of abuse were classified as atypical forms because they did not fit into the hitherto recognized standard typologies of abuse. Furthermore, the participants in both study areas recounted other acts they considered as abusive experienced while trying to access public transportation. Quite a number of the participants complained about physical manhandling, pushing, and shoving especially while trying to board the public transportation. Another atypical form of abuse reported in the urban group was experienced while waiting to undergo the verification exercise for pension and gratuity claims. Most of the participants in the urban group complained about the extreme stress experienced during this process especially because they had to wait for long periods of time with no seats, shade from sunlight, or water. In fact, there were claims that some of their colleagues fainted from sheer exhaustion and some eventually died while waiting to be paid their retirement benefits. In the opinion of one of the respondent, “If that isn’t the highest form of elder abuse, then tell me what is.”

Factors Responsible for Elder Abuse

Respondents in both study areas viewed elder abuse as common. The participants highlighted a number of factors during the FGDs that contributed to the increasing incidence of elder abuse in the communities. A major factor blamed for the upsurge of the various forms of elder abuse was financial vulnerability of the older person. This vulnerability was said to be due to factors such as delayed, irregular, or non-payment of gratuity and pensions which places the older persons at the mercy of others for their sustenance. Furthermore, poor remuneration and a high level of unemployment among many of the adult children has necessitated increased reliance on the older parents. The increased dependence may cause a strain in the relationship with their children and affect the level of care given to the elders by the children. Another contributory factor to the distortion of care in the family is the reduction in the number of available caregivers for the elderly caused by rural–urban migration for better employment opportunities and increased number of females in the workforce. Furthermore, formal education was said to have brought with it individualism as well as loss of traditional values and disregard of the elder’s counsel. Also, grandchildren who were formally the constant source of companionship for the elderly were being sent to school at very tender ages thus reducing their contact with the grandparents to the holiday period only.

Respondents’ Views About Possible Consequences of Elder Abuse and Suggested Solutions

Respondents in both settings had similar views regarding possible consequences of elder abuse which include worry, anxiety, fear, depression, and even death. As one of the discussant said, “It (abuse) shortens the life of the elderly because you worry about the future and how long you can cope. It (abuse) gets to a level whereby you think it might be better if the creator takes you soon.”

In both groups, the suggestions for the prevention of elder abuse were similar. Although emotional abuse was the most frequently mentioned form of abuse by the respondents, participants were of the opinion that the government had a major role to play in improving the situation of the older persons in the community. In their opinion, the first step toward solving the problem of elder abuse is the provision of essential needs of older people such as stipends for their upkeep, elder-friendly transportation, and access to free health care by the government. The concept of institutional care was foreign and unacceptable to the participants in both groups. This perception is against a traditional background whereby parents should have all their needs taken care of by their children when the time comes. Other suggestions to curb the rise of elder abuse include the implementation of policy for prompt and regular payment of post-retirement benefits, pensions as well as job creation for the children who are unemployed exemplified by the statement “Pay salaries for our children as at when due so they can have money to take care of themselves and us.”

Discussion

We collected qualitative data on views of the elderly in a rural and an urban community about their understanding of elder abuse, risk factors, and possible solutions for the problem. Studies have shown that the perceptions of elder abuse vary according to cultural norms and expectations (Soneja, 2001: Tatara, 1998; WHO/International Network on Prevention of Elder Abuse, 2002). In our study, the perception of situations of elder abuse ranged from emotional abuse, financial abuse, physical abuse, and atypical forms such as societal abuse and disrespect. Although many of the respondents in our study perceived abuse to be a violation of individual rights, the most frequently mentioned form of abuse was emotional in nature. Similar to other community-based studies in India and Brazil (Machado, Gomes, & Xavier, 2001; WHO/International Network on Prevention of Elder Abuse, 2002), other forms of abuse identified by the participants include not getting enough respect from the family members, as well as lack of money for their basic requirements like food and medicines.

Research has shown that the likely victims of abuse are women, particularly isolated with some form of physical or mental incapacity (Marmolejo, 2008; Tareque, Islam, & Rahman, 2008; Yan & Tang, 2001). Our study revealed that both male and female participants agreed that elder abuse was common in the community. However, it was emphasized that there are differences in the type of abuse experienced. Discussions with male respondents revealed that financial exploitation was the most common type of abuse they experienced. On the other hand, among the female participants, emotional abuse was identified as the most common form of abuse experienced in both study communities. In particular, daughters-in-law were identified as the main perpetrator of emotional abuse because of verbal abuse and name calling as well as setting up barriers such that parents did not have access to their sons. Financial exploitation of the elderly was identified as a common form of abuse in both the rural and urban groups and among the males and females. Several studies have reported that financial dependence of adult children on the elderly for their sustenance can cause abuse if care and support is withdrawn when the older person refuses to give financial support (Machado et al., 2001; Soneja, 2001). In our study, the participants attributed the upsurge of financial abuse to the high level of unemployment in the country as well as the erratic payment of pension and other post-retirement benefits.

Although the definition of elder abuse is limited to the family care setting especially in the home, our study, similar to other documented research (Machado et al., 2001; Nhongo, 2001; WHO/International Network on Prevention of Elder Abuse, 2002), revealed other forms of abuse outside the family setting. These atypical forms of abuse include bureaucracy faced while obtaining post-retirement benefits because of the long waiting and highly frustrating processes involved. The participants in our study also mentioned instances whereby these forms of abuse took place in the society as they went about their normal activities. The public transportation system was highlighted as a major source of societal abuse encountered by the elderly persons in our study. The discussants mentioned several occasions of ill-treatment suffered in the hands of both the transport workers and the general populace. Similar findings have also been documented by other studies (Machado et al., 2001; Soneja, 2001). As no special provisions are made for vulnerable people including the elderly in Nigeria, many older persons who either cannot afford personal vehicles or are unable to drive due to health reasons are forced to endure such maltreatment.

Reports from different studies have revealed that new family layouts and changes in family roles were the major reasons for the perceived increased prevalence of elder abuse in the community (Machado et al., 2001; Nhongo, 2001; Soneja, 2001). Similarly, in almost all the FGDs in our study, changes in the family structure were identified as the main reasons for increased vulnerability and therefore mistreatment and abuse the elderly face in the society. Likewise, in our study, the increased number of females in the workforce was said to be responsible for the decrease in available primary caregivers for the elderly. In some instances, the behavior of the elderly was identified as the trigger for abuse. Particularly among the female group discussions, many were of the opinion that intrusion into the affairs of the children made them targets of verbal abuse. This notion is alien to the traditional African culture which encourages the elderly to watch out for wrongdoing in the community and point out defects in training of children in the community. Increased focus on the nuclear family has nullified this role among the elderly, and in many instances, they are shunned for trying to intervene in the affairs of their children, which is considered to be emotional abuse by the elderly persons. Similar findings have been reported in Brazil (Machado et al., 2001).

Perceived ways of improving the welfare of the elderly were also explored in our study. Similar to other studies (Machado et al., 2001), the prevention of elder abuse was clearly seen as the government’s responsibility. The older persons were convinced that elder abuse should be addressed as a policy issue at the government level. Participants frequently mentioned issues such as financial support, provision of free medical services, and provision of employment for their children as possible solutions to reducing elder abuse. This suggests that the quality of life of the elderly could be improved through socio-economic empowerment of families and provision of effective social welfare and health services. The development and implementation of targeted government policies to this effect were strongly recommended to address the needs of this growing portion of the society.

Limitations

We did not set out to explore individual experience of abuse although we captured the experience of abuse by many of the respondents. Many of the participants were still active and healthy, and were able to come to the venue by themselves; therefore, truly dependent participants who were more likely to be abused may have been excluded.

Implications for Research, Practice and Policy

To our knowledge, this is the first community-based study to explore the views of older persons in the community. It was carried out among the Yoruba tribe which is one of the three major tribes in Nigeria. Nigeria has a large population and ethnic diversity with three major tribes that have distinct norms, values, and practices. There is therefore a need for the conduct of similar research in other parts of the country to better understand the problem, inform appropriate policies, and plan targeted intervention. There is also a need to conduct a similar study among older persons in the care settings like hospitals as well as explore the views of health care professional and the general populace concerning elder abuse.

The issue of elder abuse is not clearly recognized in the community especially among the younger generation as they were frequently mentioned regarding disrespect of the elderly. There is therefore a need to raise awareness in the community about the phenomenon of elder abuse and enable individuals to avoid occasions of abuse of the elderly in the community. There is also a need for advocacy for the development of government policies to expedite the payment of retirement and other benefits for those who retire as well as the identification of less strenuous and frequent verification exercises before the collection of due benefits. Finally, there is a need for policies whereby the medical treatment and transportation needs of the elderly are taken care of.

Conclusion

Elder abuse is a problem in both rural and urban communities in Oyo State, south western Nigeria. This information is necessary to develop targeted policies and interventions that will be best suited for the needs of this evolving group of individuals in the community. Our findings have revealed that other atypical forms of abuse not usually documented in high-income countries are more frequently mentioned in our environment. There is therefore a need to raise awareness, formulate policies, and develop targeted programs to curb the upsurge of the problem in the country.

Footnotes

Acknowledgements

We are grateful to our 64 wonderful study participants, the Medical Officers of Health (MOH), and the Community Health Extension Workers (CHEWS) in Ibadan South East and Iwajowa Local Government Areas who facilitated the conduct of this study.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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