Population ageing is occurring globally and sub-Saharan Africa (SSA) is no exception. Sub Saharan Africa’s population aged 60 and older was estimated at 52 million as of 2019 and is projected to increase three-fold to 158 million by 2050 (UNDESA, 2019). This means that this share of SSA’s population will increase from 4.8% to 7.4% in the next three decades. Compared to all United Nations Sustainable Development Regions, SSA witnesses the largest gains in life expectancy at birth since 2000 and will remain the leader in life expectancy gains until 2040 (UNDESA, 2019). Despite these improvements, significant disparities in life expectancy at birth and age 60 exist, both for gender and across the sub-region (UNDESA, 2019). For instance, average life expectancy at birth in the Central African Republic stood at 53 years in 2019 as opposed to 75 in Mauritius (UNDESA, 2019). In spite of the fact that older adults in SSA are still an important source of support for the younger generation, an increasing number of people who survive beyond 60 years and advance in age will experience dependency (Aboderin & Hoffman, 2015; Ardington et al., 2010; Uwakwe et al., 2009). An increasing number of studies indicating an increasing prevalence of chronic conditions and functional disabilities among older people in SSA may deepen this dependency (Mugisha et al., 2016; Wandera, Ntozi, & Kwagala, 2014). This will inevitably lead to an increased need for support by older adults to survive, and to continue to participate physically and socially in society.
Older adults in African families are regarded as essential partners in the generational support system, where they provide and receive support, normally in settings of considerable economic and infrastructural limitations (Hoffman & Pype, 2016; Lloyd-Sherlock, 2010; Therborn, 2006). Despite this pivotal role played by older adults in families, public support for the welfare of the younger generation (e.g. educational subsidies and youth employment programmes) takes precedence over support for the older generation in SSA (Aboder 2010; Adamchak, 1989). Given that public support in terms of pensions and health insurance is largely non-existent for the majority of older people in SSA, family support remains the main (if not the only) source of support for many older persons across the region (Hoffman & Pype, 2016; Unanka, 2002). Families may help older family members by providing different forms of support – instrumental, emotional, and structural (Rossi & Rossi, 1990; Seeman & Berkman, 1988). Typically, instrumental support includes practical forms of support such as providing financial or material support, help with household chores, and personal care, as well as informational support (Rossi & Rossi, 1990; Shumaker & Brownell, 1984). In contrast, emotional support involves providing love, affection, care, companionship, identity, and belonging (Rossi & Rossi, 1990; Vaux, 1988). However, the distinction (whether instrumental or emotional support) between some support behaviours may not always be straightforward since some may accomplish multiple functions simultaneously (Shumaker & Brownell, 1984). Structural forms of support encompass the social network of individuals available who may provide support such as frequency of contact, size of social network, and proximity of relations and friends (Seeman & Berkman, 1988; Barrera, 1986). Intergenerational family support principally refers to the provision of either instrumental or emotional support by the older to the younger generation (downwards); but also includes support by the younger to older generation (upwards) within the family (Attias-Donfut, Ogg, & Wolff, 2005; Litwin, 2004). These forms of support are mostly reflected in parent child or grandparent-grandchild relations (Merz, Consedine, Schulze, & Schuengel, 2009; Grundy & Henretta, 2006).
Family support provided to older people has been associated with the health and well being outcomes of older people in different countries (Bélanger et al., 2016; Nyirenda et al., 2015; Teerawichitchainan, Pothisiri, & Long, 2015; Chen & Silverstein, 2000). Previous research on associations between family support received in later life and indicators of health and well-being has produced mixed findings (Mao, Chi, & Wu, 2019; Teerawichitchainan et al., 2015; Zunzunegui, Béland, & Otero, 2001; Silverstein & Bengtson, 1994). While some studies suggest beneficial effects of family support received on the well-being of older people (Teerawichitchainan et al., 2015; Silverstein, Chen, & Heller, 1996), others suggest family support received has little or a negative influence on well-being in later life (Merz & Consedine, 2009; Lowenstein, Katz, & Gur-Yaish, 2007). Different aspects of family support like support intensity, normative expectations, and attachment security have different effects on health and well-being in later life and may explain the contrary findings reported (Merz & Consedine, 2009; Chen & Silverstein, 2000). Despite these contradictory findings, the majority of studies suggest beneficial effects of family support depending on the type of support provided and the health and well-being outcomes examined (Teerawichitchainan et al., 2015; Cong & Silverstein, 2008).
The effect of various types of family support received by older adults have been associated with reduced depressive symptoms (Bélanger et al., 2016; Cong & Silverstein, 2008), self-rated health (Mao et al., 2019; Bélanger et al., 2016; Zunzunegui et al., 2001), mental health (Davey & Eggebeen, 1998), and functional health status (Liu, Liang, & Gu, 1995) of older adults. For instance, Cong and Silverstein (2008) found that assistance with household chores and personal care from daughters-in-law reduced depressive symptoms of rural older Chinese adults. Likewise, other studies have also found the receipt of instrumental family support by older people to be positively associated with better mental health in later life (Silverstein et al., 1996; Silverstein & Bengtson, 1994). Other researchers, however, have found instrumental family support received by older adults associated with deterioration in subjective health among older adults (Zunzunegui et al., 2001; Seeman, Bruce, & McAvay, 1996). The provision of instrumental support has been shown to accompany feelings of dependence, subsequently inducing poor subjective health status of older adults (Zunzu negui et al., 2001; Seeman et al., 1996). Emotional and financial support received from family members have been found to be positively related to improved self-rated health, lower levels of depression, and better psychological health in later life (Bélanger et al., 2016; Teerawichitchainan et al., 2015; Guo, 2014; Silverstein, Cong, & Li, 2006; Zunzunegui et al., 2001). For example, financial transfers from adult children improved psychological health among Thai, Vietnamese, and Myanmarese older adults (Teerawichitchainan et al., 2015). Financial support is more likely to directly act as a resource for health service use and indirectly reduce stress for optimal cognitive health (Lee, Lyu, Lee, & Burr, 2013). Social family support has been found to be associated with the recipient’s health-related behaviours and health status (Thoits, 2011; Cohen, 1988). It is argued that lack of social support and social isolation is related to an increased risk of cognitive decline (Green, Rebok, & Lyketsos, 2008). Emotional and financial support provided by family to older adults have been positively linked with higher levels of subjective well-being in older adults (Bélanger et al., 2016; Lee et al., 2013; Merz & Consedine, 2009; Chen & Silverstein, 2000). In contrast, other researchers have found that older adults who were only recipients of support from adult children and did not provide any support in return reported lower life satisfaction than their counterparts who provided some support (Merz et al., 2009; Lowenstein et al., 2007). Studies indicate that receiving support in old age can have negative consequences on well-being due to the desire of older persons to maintain self-esteem and to stay autonomous (Lee et al., 1995; Lieberman and Tobin 1983;). Chen and Feeley (2014) argue that social support from children indirectly improved subjective well-being through the absence of loneliness. Social support received may help one to de-stress and reduce loneliness thereby indirectly leading to improved well-being (Choi, Park, Cho, Chun, & Park, 2016). Generally, studies from very different cultural and socioeconomic backgrounds suggest that family support to older people has mainly positive effects for the health and well-being of the elderly.
There has been a steady growth of research on the effect of support provided by older people to the younger generation in the past two decades in SSA, particularly in the context of HIV/ AIDS, labour migration, and poverty (Ardington et al., 2010; Ferreira, 2006; Posel, Fairburn, & Lund, 2006). In comparison to these studies, relatively little attention has been paid to studies on family support from younger to older people in SSA and its effects on their health and well being as opposed to support from older to younger people. What forms of support do older people in SSA receive from their family and wider network of relatives and how does it affect their health and well-being? Are there any inconsistencies in the health and well-being effects of the support older people receive? Therefore, the aim of this systematic review is to provide an overview of intergenerational family support provided to older adults in SSA and summarize its effects on their health and well-being. Given the rapid population ageing occurring in SSA, there is the need to systematically analyze existing work on family support provided to older people living in SSA and its association with their health and well-being. Bringing these to the fore will fill a gap by highlighting the health and well-being effects of family support in later life in this context. Also, it may drive the urgently needed policy change and public discourse on family support for older people, triggering appropriate policy and programmatic action. At the population level, the impact of this systematic review on policy and interventions may contribute towards an improved health and well-being, and the general welfare of the older adult population of SSA.