Background

Aging is a critical phenomenon in human society; hence it must be addressed in the manner in which population related issues such as family planning, maternal and infant mortality, HIV/AIDS and literacy etc. are being addressed (Makama 2011). According to Ajomale (2007:2), ‘before modernization the extended family, as a social structural phenomenon, served more or less as a form of social insurance (traditional safety net) for old age.’ The African society had a tightly knit family structure. It promoted the extended family system because of the nature of its production system. The family was the unit of production and consumption, with family members as the productive workforce. For this reason, it became imperative for the man of the home to retain his children within the same household so that the domestic labour force could be enlarged. By reason of the fact that parents and children resided within the same household, it was not difficult for the aged parents to be catered for by the immediate children and the grandchildren; as well as being socially involved as they were made to play some traditional roles within the household in particular and community social milieu in general. This was the typical regular household, especially in pre-colonial era. Even in modern Nigeria, this pattern of settlement seems to remain relevant. In the 1991 census, for instance, of the 4,598,114 elderly persons in Nigeria, 96 % were living in regular households while about 4 % were in other types of households, including those with absentee heads. Regular household is necessarily not in terms of living with the adult children, but generally in terms of living among relatives. The situation remained the same in 2006 census, with 97 % of elders in regular households compared to the 3 % that were in other forms of households, including those with absentee heads (Makama 2011).

However, the family and community based informal social supports which this type of settlement pattern provides are declining generally because of urbanization, migration; and most especially the dwindling socio-economic fortunes of the caregivers. The Western professional careers, along with the aesthetics of social life and the new administrative job opportunities created by colonialism in the urban settlements, where the colonial masters resided, became the pull-factors for rural–urban drift in Nigeria. This consequently led to the migration and labor disengagement of the able-bodied workforce from the family domestic economic activities and the re-investment of labor power in urban work organizations. This has been the trend even in modern times, following the poor state of infrastructure and social services as well as lack of modern industrial base in the rural areas in Nigeria. According to Egwu (2013), the traditional values which underpinned the informal support of family members to the older adults within the family unit are under pressure and hence beginning to change. The consequences of this social change, for the family and the elderly members of the family were that the hitherto tightly knit family structure was weakened while the face-to-face daily communication and the physical care for the elderly in the family was adversely affected by the distance in the residences of both the parents and the children or caregivers. The problem here does not rest mainly on the pattern of settlement, but on the inability of the children/caregivers to meet up with their financial obligations towards parents because of the worsening socioeconomic impasse in Nigeria.

Over the years, the socioeconomic conditions affecting the ordinary Nigerians have equally aggravated the conditions of the elderly. First and foremost, Nigeria is an emerging economy with a whole lot of issues to grapple with: poverty, unemployment, inadequate access to clean water, healthcare challenges, mortality of sundry dimensions, low life expectancy, low income per head, relatively high illiteracy level, and poor infrastructure and so on. Ironically Nigeria, with its population size and enormous wealth potentials as the 8th biggest producer of oil, and the 6th largest gas deposit all over the world (Soludo 2006), experiences a situation in which poverty (presently 69 %) and unemployment (presently 23.9 %) (NBS 2011) go up with increasing revenue base. All these challenges affecting the ordinary Nigerians, according to Asiyanbola (2008), have put into doubt the ability of children to continue in their moral obligations of providing care for their elderly parents. The dilemma of the humble and willing child with respect to parental care giving, under excruciating conditions in Nigeria, was well summarized by Ajomale thus:

Diminishing economic power has hindered the willing family member’s capability to give. Priorities are given to the needs of the members of the nuclear family at the expense of older family members…. The notion that investment in one’s children serves as a social security in old age is now being disputed as adult children find it difficult securing employment and receiving an income sufficient to meet their immediate needs (Ajomale 2007:4).

Conceptual Issues in Aging in Nigeria

Although there is relatively limited literature on the elderly and aging issues in Nigeria, when compare with some countries of the West, the available literature is replete with socioeconomic, nutritional, physiological and political issues among others. Some of these issues are discussed below.

The Challenges of the Elderly in Nigeria

Although the decline in the functional activities of the human physiology is universal among the elderly globally; long period of suffering due to poverty tends to have worsened and accelerated such decline, especially among the rural elderly persons, in Nigeria. Many years of hard labour, as parents struggled to fend for their family members, in a system or environment where large family size was the norm, speedily weakened their physique. Many of them lack the knowledge of what it takes to live a healthy life because of illiteracy. Although the literacy rate in Nigeria now stands at 66.6 %, it was not as high as this when the present day older adults in Nigeria were young. In 1991 for example, of the 4,598,114 elderly persons in Nigeria only one-quarter was literate. The same was the situation with respect to the 2006 census in Nigeria. Studies have shown that older adults are predisposed to low literacy including health literacy (Wister et al. 2010). Educated older adults who read more often are better able to process information on health practices and healthy lifestyles (Roberts and Fawcett 2003); and this gives them an edge with respect to a healthy and successful aging process (O’Rand and Hamil-luker 2005; Wister et al. 2010). As Baker et al. (2007) agued, adults with high functional literacy are less likely to die than those with low functional literacy. This shows that health literacy is very vital to sustaining the quality of life. This is so because it helps in the understanding of the risks and benefits involved in medical treatments, and in the sustenance of a healthy lifestyle as well as a better self-management of illness (Canadian Council on Learning 2007; Wister et al. 2010). What this suggests is that ‘older adults who read manuals, reference books, or journals to learn and those who use the computer or internet to learn are more likely to be health literate than those not engaging in these types of learning practices’ (Wister et al. 2010: 846). In Nigeria, the highest illiteracy rate occurs among the oldest in age, as increase in age tends to lead to percentage decrease in literacy rate in the elderly population (Makama 2011). This implies that, there is hope in the future that the present literate young Nigerians will likely age successfully. However, this is equally tied to the opportunity provided for them to be economically empowered in order to have the means to attain such ends.

One of the serious impediments to the nutritional needs of the older adults in Nigeria is the excruciating poverty faced by majority of them. Logically if 69 % of Nigerians are said to be poor, it therefore implies that most of the older adults and those who are supposed to care for them are experiencing poverty condition. Because of long period of hardship occasioned by worsening socio-economic conditions in Nigeria, people carry poverty into old age. According to Makama (2011), contrary to the common perception, the 1991 and 2006 census reports in Nigeria show that the rate of labour force involvement of the Nigerian elderly exceeds any other significant population group in Nigeria. Most of them get engaged productively till their last breath. For instance, two-thirds of them were contributing to agricultural production more than other groups. Although they are engaged in agriculture, most of them produce for subsistence. That they still exert their physical energy in strenuous farm work with crude instruments in order to meet survival need, when they are supposed to retire into less strenuous activities, underscores the extent to which the elderly struggle with poverty in Nigeria. The situation is better summarized by Ismail’s studies on the nutritional assessment in Africa, in which he observed that some older adults go into old age after a lifetime of poverty and deprivation, a diet that is inadequate both qualitatively and quantitatively as well as a lifetime of illnesses and poor access to health care (Olasunbor and Olubode 2006).

Even with their economic involvement, many of them are still dependents. According to the 1991 census in Nigeria for instance, for every 100 working age persons in Nigeria, there were 6.3 dependent elderly (National Population Commission NPC 2004). This is probably slightly higher than the old age dependency rate in Africa put at six (6) persons age 65 and older for every 100 persons age 15 to 64 years (Bailey and Turner 2002). ‘Poor health may make some older people more dependent with disabilities and hence reduced functional capacity’ (Olasunbor and Olubode 2006:99). This predominant involvement of the elderly in agricultural activities provides a context in which we can understand Stewart and Yermo (2009) observation that, 90 % of Nigerians work in the informal sector of the Nigerian economy. The remaining percentage works in the public and organized private sectors. This seems to be universal across the African continent. In Sub-Saharan Africa, for instance, about 75 % of the labour force works within the informal sector, often in subsistence agriculture. Consequently, on the average, formal traditional social security programs only cover 10 % of the workforce because they are not well suited for most African workers in that most of the workers are not wage employees. Therefore, most workers not covered by these programs depend largely on the support provided by the family when they can no longer work (Bailey and Turner 2002). For those in the public sector, upon retirement, the pension system of the government of Nigeria is supposed to help in realizing the crucial objective of providing these senior citizens with access to formal social security programme geared towards a successful aging process. However, the pension scheme is afflicted with satanic fraud and mismanagement on the part of government officials put in charge of its management. Consequently, even the few pension beneficiaries do not find it easy to collect the meager pension allowances due to them as at when due.

Socio-economic conditions define the health and nutritional status of the elderly. Good nutrition fights against illnesses, but when there is no money to afford it illness comes in. What you eat defines your state of health in the sense that, if you eat a very poor diet you are likely to have health problems. Poor health equally reduces one’s appetite especially when one is aging. People eat poor quality food in an unhealthy environment because poverty, in the first place, makes them to live in dirty households. Such condition invites litany of infectious diseases. Low level of education, which results in low income (in most cases) and lack of awareness of what it takes to achieve good health and nutrition status, is part of the issues affecting the nutrition of older adults in Nigeria. In terms of nutritional status, Olasunbor and Ayo (2013) observed that in Nigeria as high as 40 % of households experience food insecurity. As a result, the elderly often suffer negative health consequences since they often depend on others for their daily needs. However, the figure might even be more than what Olasunbor and Ayo (2013) observed when such food insecurity is seriously weighed against the quality of what food is available to the households. In a study conducted by Olasunbor and Olubode (2006), among the Yoruba speaking states of Nigeria for instance, age was reported as a vital factor in recommended dietary allowances as well as the nutritional status of the senior citizens. In the study, age of respondents correlated negatively with body mass index. They also reported a decrease in body weight as well as chewing difficulties, physical disabilities, memory loss as well as an increase in the level of nutritional vulnerability as people aged.

Most elders in Nigeria do not have the knowledge and access to medical care for regular check up, let alone talk of a specific hospital devoted to geriatric health problems. A study conducted by Togonu-Bickersteth and Akinnawo (1989) among medical personnel in some hospital locations in Nigeria, on geriatric medicine in Nigeria, revealed that non availability of appropriate facilities and personnel, poverty of the elders, and government lack of interest are reasons why they are no geriatric medicine in Nigeria. Even at present, there has not been any deliberate policy to create such health centres specifically to attend to the peculiar health needs of the elderly. The transition from infectious diseases to chronic and degenerative illnesses, most of which are associated with old age, calls for the concern of public health practitioners (Williams and Torrence 2008). In the US, for instance ‘one in every five aged persons has diabetes; arthritis affects approximately 59 % of persons aged 65 years and more. As adults live longer, the prevalence of Alzheimer disease, which doubles every 5 years after age 65 also, is expected to increase. In fact approximately, 80 % of all American elderly persons aged 65 years and more have at least one chronic condition, 50 % have at least two’ (MMWR Weekly 2003). The situation tends to be worse in Nigeria, where there are no adequate personnel and the medical facilities needed to attend to the specific health needs of the elderly.

Furthermore, about two-thirds of the total population of Nigeria lives in the rural areas where they derive their livelihoods from agriculture and other allied economic activities (Oseni and Winters 2009). Rural areas in Nigeria have a poverty rate that presently stands at 73.2 %; while the unemployment rate currently stands at 23.9 % in an entire population of 140 million Nigerians (see NBS 2011). The implication of this is that the rural setting, which suffers a lot of infrastructural inadequacies and lack of social services, accommodates more of the older adults in Nigeria. In a study carried out in 2006 among the Yoruba speaking states of Nigeria, for instance, Olasunbor and Oludele reported that, apart from having a higher illiteracy rate and polygamous families, the rural elderly have low socioeconomic status compared to their urban counterparts. For instance, 72 % of those in the low socioeconomic status group, 88 % of the elderly in the lowest income per month group and 65 % of those without property were all from the rural areas (Olasunbor and Olubode 2006). More so, for those who do not engage in farming or other allied economic activities survive such harsh conditions by relying on their pension stipends and/or children to perform their filial obligations of regular communication and remittance. In southern Nigeria, according to Bah et al. (2003), between 50 and 80 % of households have at least one migrant member. However, Okali et al. (2001) study in Aba, South-East Nigeria, revealed that most respondents argued that the quantity and frequency of cash and goods sent from urban dwellers to their relatives back in the village have declined over the last decade owing principally to socioeconomic conditions Nigerians are generally exposed to these days.

Government Policy Attitude in Nigeria and the Population Aging

Until very recently, Nigeria scholars and policy formulators did not consider the aging issues as serious issues which needed deliberate attention. The Nigerian government which ought to lead the way, by way of definite course of action is yet to enact a concrete national policy that would guide the provision of care and social support to the older citizens (Aboderin 2006), in spite of the almost 53 years of our political history as an independent state. The reasons for government’s apparent lack of interest in aging issue are based on the notions that the population aging in Nigeria is minimal; and that traditionally, the children will always take care of their aged parents.

Globally, the developing nations are said to have the greatest increase in the numbers of older adults because they tend to experience rapid shift from high mortality and high fertility to much reduced fertility and greater longevity (Ajomale 2007:1). However, even with the reduction in fertility as observed by Ajomale, the Third World still has the highest population composition, compared with the so called First and Second Worlds, in virtually all age categories. It is therefore normal that given the improvement in education and health care, the aging population will increase. Troisi (2004) observed for instance that, whereas in 1985 only 56.5 % of the world’s elderly lived in the Third World, the proportion was estimated to reach 61.5 % by the turn of the century and 71.9 % by the year 2025. By 2030, 73 % of older adults will live in the Third World (Aboderin 2013).

This is worrisome given the depth of poverty and underdevelopment in the Third World countries; and the fact that the governments of some of the nations within this social category, Nigeria inclusive, have not been able to come up with concrete plans to arrest the upsurge in population aging in their respective political domains. In the world today, statistics show that more than 1 billion people live on less than US 1 dollar per day; and more than 2 billion live on less than US 2 dollars per day. At least 80 % of the entire human race lives on less than US 10 dollars per day. The most unfortunate thing is that, 95 % of the Third World population is said to live on less than US 10 dollars daily; and this perhaps explains why it has 98 % of the world hungry (see FAO 2010). While some of these countries are not poor in terms of resource endowment; how these resources are harnessed and utilized by political leadership creates problem for human and infrastructure development in those countries. Addressing these poverty indicators in the Third World is likely to impact positively on the care for the elderly.

In Nigeria, survey reports and demographic projections point to an unprepared reality of the increasing nature of both the absolute and proportional numbers of the elderly population. In 1991, for instance, whereas the proportion of the elderly in the total population of Nigeria was 5.2 %, the 2006 census recorded a decrease to 4.9 % of the total population. However Makama (2011:3) observed that, ‘even though there is slight decrease in the percentage of the elderly population from the 1991 census, there is an observable increase in the absolute number of the elderly population.’ In other words, whereas the absolute figure of the elderly population in 1991 was 4,598,114 that of 2006 were 6,987,047. It must be emphasized that these figures might not be true reflection of the actual size of the elderly population in Nigeria. This argument is buttressed by the fact that, some Nigerians in public and organized private sectors often alter their age in order to stay longer than necessary in service, because of the sickle cell nature of the pension scheme as old age social safety net in Nigeria. However population estimations project that by year 2025, Nigeria will rank 11th among countries with over 15 million elders (60 years and above) in its population; also the population of the elderly is projected to reach 16 million by 2030 and 47 million by 2060 (National Population Commission NPC 2004; Makama 2011). In 1991 elders within the age bracket of 60–64 years occupied one-third of the total population of the elderly, while those 65 years and older constituted two-thirds of the population. Within this population 9 % were 85 years and above. While the same compositions were maintained in 2006, the only difference was that the percentage of the oldest-old, more specifically those from 85 years and over, went up to 10 % of the total population of the elderly (National Population Commission NPC 2004), despite the fact that the proportion of the elderly in the total population dropped from 5.2 to 4.9 %. According to the NPC and ICF Micro (2009), one of the observable reasons accounting for this is decline in fertility as indicated by the demographic and health survey report. The likely implication of population aging on the family is that, it will increase the dependency ratio such that the number of those who need to be cared for will likely outnumber the family caregivers. This is likely to be a drain on the caregivers’ time, effort and resources as they try to care for their aged parents. This will even become a serious stress, if by reason of poverty; the caregivers find it difficult to fend for their own immediate families.

Lessons from the USA

The USA has made available a lot of opportunities for the elderly to access in their process of aging. Some of the provisions and policies are Skilled Home Health Care; Non-medical Home Care (home aides; respite care; home delivery meals; etc.); Adult Day Care; Nursing Home/ Assisted living; Retirement community; Hospice care; Medicare; Medicaid; Age Discrimination in Employment Act (ADEA); Social security benefit etc. All these, with the knowledge of a healthy lifestyle, assist older adults to age successfully. Although these provisions are not without challenges, it thus at least shows the responsiveness of government through policy guidance.

Government’s influence in terms of moving from the position of non-participant to participant status in the US healthcare systems has equally been instructive in shaping the health and healthcare utilization. This had positive impact on the aged. Government intervention in the areas of policy, reforms and financing have been very handy. For instance, in the 1960s ‘the passage of Medicare and Medicaid totally changed the role of government’ (Williams and Torrence 2008: 6) in healthcare provision in the US. There is expanded access to health care today in the US because of the insurance industry whose presence as a major player in healthcare utilization has rendered out-of-pocket payment obsolete. However, there is an ever increasing set of government regulatory guidelines and rules for the operators to adhere to. Generally, the emergence of Medicare and Medicaid has deepened government responsibility in the health sector as this “has made greater responsibility for healthcare policy development to move to federal and state governments’ legislatures” (Williams and Torrence 2008). These two products of government health policy, apart from benefiting the seniors, have had a lot of financial implication on healthcare financing, as they account for almost half of all the financing of healthcare in the US (Ball 1995; Moon 2000). This has, in part, made both financing and health insurance the major drivers of healthcare delivery in the US. With government financing the Medicare and Medicaid, to some extent, health insurance coverage has been expanded.

Furthermore the emergence of the Older American Act (OAA) in 1965 actually revolutionized the care for the elderly adults in the USA. According to Pardasani and Thompson (2010:53), ‘one of the chief goals of OAA was to enhance the wellbeing of community dwelling of older adults and delay or prevent institutionalization.’ Generally, the essence of the US legislations on aging was to provide series of alternatives for individuals to make choices and access for the purpose of a successful aging process. The review of American legislation for the older adults’ welfare is quite useful to Nigeria, especially now that we anticipate drastic increase in the aging population in few years to come. We need the type of legislative reviews that introduced Medicare, Medicaid, Older Americans Act, the Age Discrimination Act and the Supplemental Security Income programs in the 1960s and 1970s in the US.

More so, another major influence on health and healthcare of the elderly was the degree of enlightenment; especially education on health and illness. Public perception about healthcare began to change in the US following massive enlightenment on health and illness. This affected attitude towards healthcare utilization as more and more people became aware of the need to access health facilities, as well as how and where to access such facilities. A belief in the modern medicine is made possible by knowledge of how it works as well as its efficiency. This has been made effective by advancement in information technology. The internet and other web resources provide additional information on health and illness issues. Hence, according to Williams and Torrence (2008), wider access to information has also spurred interest in alternative and complimentary healthcare for the elderly.

Adapting the US Elder Care Institutions/Policies to Nigerian Situation: What is Possible?

The implication of global interaction is that it affords us the knowledge of the aging process in other nations, and the remediation efforts of stakeholders in addressing the challenges of aging across human cultures. This helps us to compare notes and determine the way forward in terms of policy framework for older adults in our individual countries. Global interaction enables emerging societies, with population aging issues, to blend the traditional approach of its citizens with care giving methods that work elsewhere and can be adapted to present realities in such societies.

In the US, some senior centers are designed purely as fitness and wellness institutions. For instance the Seniors in Motion (SM), located in Denton, Texas was established in 2003 as a center for fitness and wellness. Its mission is to assist the senior citizens to keep healthier, through regular exercises and health education, which will enable them to age gracefully and avoid frequent visitation to the hospitals. This is based on the understanding that it is possible for 80 years old and above to reduce their medical problems, while staying healthy through regular exercises. Exercises are planned on the basis of age and health conditions of clients. This is necessary in order to ascertain which exercise will fit which age and health condition. The center does not have many specialized employees; as it relies on a pool of student based staff on internship. This means that too many employees are not necessarily required before the center can take off. It has more than the normal specialists we can find in a typical fitness center in Nigeria. It has not just a physiotherapist, but also a dietician, a taichi specialist, and a yoga laughing expert. The latter is an indication that laughing is a necessary component of effective living and healthy aging. Just like the typical fitness and wellness center, SM is an outpatient/client services center. It has a schedule work duties and as such does not operate 24 h daily.

Developing such program in Nigeria is possible but with some restriction. We can begin the experimentation process by consolidating on what we already have in urban centers in Nigeria. In most urban centers in Nigeria there are many fitness and wellness centers already in existence. Many are not as organized as Seniors in Motion in the sense that, though they have aerobic specialists, there are no physiotherapists, dieticians, taichi instructors and laughing specialists. However, they have many exercise equipment already. They are not equally age-specific. This therefore means that, parts of the resources needed are already being provided in terms of the building and equipment though can be improved upon. What is indeed needed is a form of political intervention in which the local government authorities select some of these existing fitness centers and designate them as health and wellness centers for the seniors. The local authorities should enter into a kind of partnership agreement with the owners of these designated centers to expand the building facility where necessary; and assist in upgrading the facilities. The local authorities should as well provide some financial support that would augment and reduce whatever cost the elderly need to pay for using the facility. Although it will be easy for these centers to engage the services of dieticians and physiotherapists physically because there are available, they have to make do with video clips for taichi and yoga exercises. Although internship programme, in this context, is not readily available now, we can reach out to the surrounding universities to design a programme that would engage their physical and health education students on internship to these centers. However, the success of this depends on how well information is disseminated among the elderly on the presence and relevance of this facility to the aging process.

Furthermore, some senior centers go beyond fitness and wellness by injecting some forms of social engagement for the comfort and relaxation of the elderly. Good examples are the Senior Activity Center (SAC) at Lewisville and Heritage Senior Center (HSC) at Irving, both in Texas USA. They are not just recreation centers for games, exercises and social interaction; but also centers where the elderly get information and access to services with respect to the aging process. In these centers, seniors are exposed to different kinds of social activities to keep them physically, mentally and socially fit for the challenges of old age. Some of these are art and craft, music, dance, exercise, drama, billards, pinochle, bunco, bingo, potluck, and seminars on chronic pain solution, chiropractic (how to stay young), tips on how to make your house safe, investment planning, cooking competition, etc. Every activity is fun filled and an opportunity for the seniors to make new friends. Many of these programs and activities are free of charge, while others are paid for by the seniors. Some of these free activities include: Medicare assistance, annual income tax assistance, blood pressure and blood sugar screening and health seminars. There are volunteers and permanent staff. The volunteers are trained in the best practice for community service before they are taken. These centers perform virtually the functions of Adult Day Services (ADS). In the US, ADS started as an outpatient services in the 1940s, and was further expanded in the 1990s with the introduction of national standards for the industry. Today, there are over 4,600 ADS centers taking care of about 260,000 older adults in the US. The essence of the ADS is to provide health, nutritional, social, psychological and daily living needs support to older adults with functional limitations in a community setting during day time hours. This type of assistance helps family caregivers to concentrate on their office jobs (National Adult Day Services Association (NADSA) 2011; Fields et al. 2014). Most of the older adults who participate in ADS activities live in the homes of their adult children (Partners in Care giving, 2002).

This type of facility is much needed in Nigeria to assist the elderly in some form of social engagement. We might not need all the sources in SAC and HSC, but there should be a blend of some of these modern facilities with some traditional instruments we use for recreation in Nigeria. It equally requires a dietician, physiotherapist, medical doctor who will come in on part time basis. With permanent staff of not more than 4 and some Applied Gerontology/social work students on internship, a recreation center for the aged can take off in several communities in Nigeria. The political action needed at the moment is for government at the local level, through its social welfare department, to come up with a blueprint in designing a programme for such center at the local government headquarters first in order to experiment with it. Since it is a new idea and given the level of poverty at the moment the government should also take up the responsibility of funding it at this first instance; and later allow for private-public partnership arrangement. However this initial or formative stage may not succeed without massive enlightenment of elders about the presence and relevance of this center in their respective communities.

More so, the excessive libertarianism in the US which has weakened the sense of traditional communal life, equally aggravated the problem of empty nest. To redress the crisis this freedom has generated for communal living, the American society has tried to make the elderly feel involved and needed by creating a contemporary community of elders. Consequently, there has been increase in Home and Community-Based Services (HCBS) as possible answer to the graying of the American society. This is partly informed by the fact that the older adults prefer to have the needed care delivered to them in their homes or in a community setting (AARP 2000; Fields et al. 2014). The Neighborhood Naturally Occurring Retirement Community (NNORC) is a service model which emphasizes this desire (see Bronstein et al. 2011). Hunt and Gunter-Hunt (1986) coined this term to mean a housing settlement that is not designed for the older adults, but which overtime come to house largely older adults. NNORC is a community development model that provides both formal and informal home and community-based support. Such informal supports are seen to assist the elderly in maintaining normal daily activities (Bronstein et al. 2011). Other good examples of this are the Robson Ranch (RR) and Primrose Senior Center (PSC) both in Denton, Texas. Both centers are active adult communities of aged 55 years and over, designed for independent living. To make life and their stay in the apartment more meaningful and worthwhile for residents, a whole lot of almost similar facilities, services and programs are provided by the management of these centers. For instance, Robson Ranch (RR) has sport inspired amenities and creative arts including indoor/outdoor pool and spa. It equally provides many social opportunities such as membership of clubs, social groups, leagues and organizations for residents to enjoy and feel at home. On the other hand, Primrose Senior Center (PSC) equally provides the services listed above. For instance, it is designed with lifestyle filled with social gatherings, educational and recreational activities such as weekly resident social event, wellness programs, computer and educational classes, exercises and water aerobics, health screening and wellness education, monthly news letter and activity calendar, yoga, tiachi, card games, bingo, red hat etc. However, these elder communities are organized in a lone-living format in the sense that, children or grand children are not allowed to live with their grandparents.

On the other hand, Lewisville Estate (LE), also in Texas, is quite different from RR and PSC in some respect. LE has provisions for both independent living (which is what is obtainable in both RR and PSC) where residents eat from common room(s); and Assisted living. Under the Assisted living, lots of services are being provided for residents by different care givers who assist them with, among others, the activities of daily living such as: bathing, dressing, eating, transfer, toileting, re-toileting schedule, doctor appointment, medication management, home health and hospice assistance.

While it can be argued that elder communities are really working effectively well in the US because of the peculiar atomized life they live, the situation may be different in Nigeria for obvious reasons. The typical Nigerian man is a community man, who likes to live among his community of kinsmen. More so, the US has a complex social structure which, over the years, has promoted excessive individualism (and perhaps liberty) at the expense of communal living. So what we see today as the proliferation of the senior centers and /or communities are products of atomization which, in itself, is a by-product of a strong capitalist impact on family and community life. For now, Nigeria does not have such a complex social system. Perhaps, it will take another 30 years for us to begin to experience this at least in relative terms. The attachment to communal and kinship ties is still strong, especially in the rural communities where you have heavy concentration of the older adults. It is very difficult for seniors in rural areas in Nigeria to live isolated life; because the Durkheimian Mechanical solidarity still exists in those areas. Almost everyone is related to almost every one; and almost everyone knows almost every household. Most of the households are still being organized along compound system; and virtually everyone has a roof over his head. Elders hardly live a life of isolation except in extreme cases. Perhaps for instance, you may be isolated if a case of witchcraft has been established against you; or you might have lived a very wicked life in your active years without children.

Furthermore, a typical urban dweller in Nigeria is an absentee villager who sends remittance home to assist his aged parents economically. In other words, ‘there still exists a relative attachment to kinship groups’ (Dokpesi, 2010:64) in the city. The issue of strong communal attachment is enhanced by membership of urban based socio-cultural organizations. These organizations do not only provide a platform for social attachment of cultural like-mind individuals in the city; they also assist in linking the urban man to his village. This helps in constantly reminding him of his own obligation towards his parents in particular and his community in general. Some of these urban based organizations do assist the elderly who do not have children. There is always the tendency for the urban dweller to think homeward when retirement or old age draws near. This explains why a typical Nigerian, while thinking of building a house, considers his own rural community of origin.

Also since these elder communities, like Lewisville Estate, which provide independent living and assisted living for senior citizens are not for free, many people may not be able to afford it given the relative high rate of poverty in Nigeria at the moment. Those who have the money to pay will not patronize the facility because they would have built mansions and have domestic servants around them; while those pensioners who would have perhaps patronized such facilities are suffering from irregular payment of their pension allowances. Most of them fall back on their village buildings, either built by them or inherited as a family house. This type of facility will suffer lack of patronage and likely run out of business at least for now.

Whereas in the US about 1.4 million aged persons live in the nursing homes (National Center for Health Statistics 2012), the estimation is that by 2050, 19 million older adults will receive long term care from the nursing homes (U.S. Department of Health and Human Services USDHHS 2011; Brown et al. 2012). However, the nursing home facility is likely not to work in Nigeria because relatively, it still remains a taboo in Nigeria to allow your loved one to be isolated from your household simply because he/she is not well. It is an act that is still being scorned at with social disapproval. This makes the informal social support for the senior adults very relevant even in modern times; and this is not peculiar to the Africans. Jackson (2002), for instance observed that individuals in most countries in Asia still depend greatly on family support for the older adults as they face the challenges of old age. Indeed, this informal support is considered as an expected role the family should play as the most appropriate provider of care to one of its own (Phillips and Chan 2002; Yap et al. 2006). In Korea for instance, traditionally while dependency in old age is considered normal, independence is regarded as a Western concept that is alien to the Korean culture (Yeon 2000). However, the doubt raised by Goodman et al. (1998) about the sustainability of this kind of model of care is quite in order. In the case of Nigeria for instance, Ajomale (2007) assertion, as presented in the background of this paper, of a willing child whose desire to provide informal support to his/her aged parents is being frustrated by unemployment and poverty, rightly fits into this doubt. This situation thus provides a justification for a synergy of formal and informal models of care.

Skilled Home Health Care, which is part of the formal in-home care in the US, which comes in form of physician house calls and in-home nursing, would work well in Nigeria. This is because; he who is sick does not consider filial attachment in seeking for solution. Some children are already paying for the services of medical officers to take care of their parents’ health needs in both the rural and urban communities. However, this practice is not widespread because poverty is a serious challenge to the older adults and their caregivers in accessing such opportunity. Because most of them do not have the means to hire the services of the physicians and nurses, they resort to the traditional method of health care delivery.

The non-medical home care such as home aides; respite care; and home delivery meals; may not work in Nigeria because of several factors. Again, the attachment to communal and kinship ties is still relatively strong, especially in the rural communities. These older adults tend to prefer a kinsman to a stranger in providing non-medical home care. This is also hinged on the issue of trust. They are likely to trust and have confidence in close relations, they have known overtime, for the purpose of continuity of family ties. Language barrier may also be a serious obstacle especially if the older adult is not literate and the care provider does not understand the older adult’s language. Finally, affording the services of nonmedical home care providers requires financial commitment. Since the level of poverty is quite high among the elderly, affording such services will be very difficult. However, the Non-medical home care also exists in some measure in the urban areas among the rich who hire house helps to do domestic chores; whereas in the rural areas this is provided in an informal setting.

Summary and Concluding Remarks

There is no single global approach to solving aging issues in human society. What is required is societal specific methods because environmental conditions differ from society to society. Globalization has made it possible for a country to have knowledge of what is happening in other parts of the world with respect to care giving. What is therefore needed is a blend of the existing methods of care and the culturally diffused methods from other societies. However, this blending must take cognizance of the prevailing environmental conditions of the society. Therefore, we need to prioritize them according to our needs. Let us begin from the foundation, by accepting senior centers and other facilities that are of necessity to us now as a people given our peculiar cultural circumstances; while we allow the dynamics of social life to take its course. In summary, fitness and wellness centers and elder day care centers are feasible for now in Nigeria; while active living centers and assisted living centers may not be needed for now. They may be institutions of the future in Nigeria.

In order to be able to mitigate the consequences of the likely population surge among the older adults in Nigeria, there is need for the setting up of a Commission for the elderly. This Commission, among others, will provide data and update data on the aging population, provide policy framework for planning, monitoring and evaluation of aging programs, regulate formal agencies for providing care to the elderly and spearhead advocacy with respect to finding solution(s) to the challenges of the elderly in Nigeria. However, the success of this policy instrument will be a function of government political will to address the issues of aging in Nigeria as well as how well it is ready to address the human development problems of Nigeria.

The insurance industry is a very critical player in the health care delivery systems in the US; and the elderly benefit from this. This is a lesson for Nigeria. We need policy that would generally develop the insurance industry for it to be used as a veritable machine that will drive the healthcare systems in Nigeria. Since the full implementation of the National Health Insurance Scheme (NHIS) in 2005 in Nigeria, its efforts are more felt in the public and organized private sectors than other sectors of the society. Even in this sector, the NHIS has not been able to go beyond 3 % coverage. More fundamentally, it does not seem to cover health issues after retirement, unless fresh application is made upon retirement; and this is the stage in which healthcare attention is most needed. The retired elder may not be able to foot his medical bills because of the meager pension income and the delay process in collecting such income. Besides this, 80 % of Nigerians work in informal sector; and the meager income they get may not be able to take care of their nutritional needs, let alone their healthcare needs. Most of these people may not have the resources for health insurance coverage; while most elderly especially in the rural areas are not officially covered by the NHIS. It is in this context that Old Age Health Insurance Program (OHIP) will become relevant as a programme specifically designed to enhance health coverage for institutional and ambulatory care for the elderly.

Furthermore, the success of government programmes in addressing the aging process in Nigeria is very much tied to how well government is able to address some socioeconomic factors inhibiting the elderly from attaining a graceful aging. To this end, there is need for the establishment of Adult Literacy centers across the several Local Government Areas in Nigeria. This will help to massively promote a nationwide literacy programme for the elderly citizens, as literacy program goes to them at grass root level. For those who wish to further their acquisition of knowledge beyond the college level, they should be encouraged with free tuition fees and non-credit course program as it is provided in the USA. This is necessary in the sense that apart from other benefits, literacy directly or indirectly promotes healthy living. According to Wister et al. (2010:828), ‘For older adults, health literacy skills are fundamental to the maintenance of quality of life in virtually all realms’.

More so, as the Nigerian aging population is increasing the government should put in place an effective pension scheme for those who are entitled to it; and old age financial allowance to non-pensioned elders, drawn from a contributory fund to which all levels of government and community based organizations could contribute to.

Massive economic empowerment programme that will reduce unemployment and poverty is equally needed. Government should create the enabling environment for manufacturing sector of the economy to thrive. Opening the economy in this way will encourage massive job creation from the private sector so that children will be economically empowered to provide informal social support for the nutritional and health attentions of their aged parents. In summary, the formal structure for care giving is not enough in proving adequate and sustainable care for the elderly. There should be some form of synergy between government and the family/community. Massive economic empowerment of individuals is likely to revitalize the waning support system of the family in providing informal care to the elderly. In a related development, the best way to provide non-medical care is through the informal family support mechanism. Even the Madrid International Plan of Action (MIPA) recommends the revitalization of family responsibility and the strengthening of community forms of support to the elderly. According to MIPA,

Traditionally, informal social protection has been effective in reaching the poorest and most vulnerable in rural as well as urban areas. The potential for strengthening the characteristically weak resource bases of these systems and the re-energizing of commitment to family and community responsibilities are areas for action on ageing. Policy action is required to revitalize a sense of family responsibility in society and strengthen traditional community forms of support (Madrid International Plan of Action 2007).

Therefore, regular visitation and communication by children to parents is recommended especially in this era of information technology. More so, children should endeavour to strengthen the family bond that binds people together by visiting community relations and also buying gifts for them any time they visit their parents in their communities. This is necessary so that in their absence their relations, within the neighborhood of their aged parents, will assist them in seeking the welfare of their parents.

More so, there should be involvement of community based socio-cultural organizations; and private individuals in meeting the needs of poor elders in their respective communities. Since membership of such organization in the city reminds members of their communal obligation(s) to their communities, it is therefore possible to tap into this form of community attachment in order to be able to solve the challenges of older persons in rural communities in Nigeria. There is always competition among these organizations as they scheme to outdo one another and make impact in the provision of community development projects in their respective communities. This community development attitude could be capitalized on in accessing their resources for the care of the elderly in their respective communities. Consequently, they should be made to pay certain fee for the elderly at the point of renewing the registration of their clubs or associations every year. They can equally be encouraged to pick up the bills of the very poor elderly in their communities who do not have someone to cater for them either by reason of childlessness, or lack of income; or because the adult children are so poor that they cannot fend for themselves let alone talk of fending for them. However, this community based assistance should be coordinated by the Commission for the Elderly through its local structures at the local government areas.