Our review sought to provide an overview of the studies on family support provided to older adults in SSA and to summarize the effects on health and well-being in later life, considering the increasing number of older adults in SSA. We identified only eight studies that met all eligibility criteria and were included in the review. The few studies identified is a clear indication of a gap in the literature that needs to be filled. We found that instrumental (i.e. financial support), emotional (i.e. social support), and structural (frequent contact with non coresident family) support provided to older adults were beneficial to their health and well being. Specifically, social support and frequent contact with non-coresident family members were protective against poor psychological health and protective of general well-being and quality of life of older adults (Gyasi et al., 2019; Ojagbemi et al., 2018; Olagunju et al., 2015 Gureje et al., 2008). These findings corroborate previous observations on the buffering effects of social support networks and social relationships of older adults against poor mental health outcomes in low-and middle-income countries (Miao, Wu, & Sun, 2019; Teerawichitchainan et al., 2015) and high-income countries (Roh et al., 2015; Thompson & Heller, 1990). Our review suggests that very little is known about family support provided to older adults and the effects on health and well-being in later life compared to other regions of the world. Social support is considered to act as a resource for coping with adverse mental health events (Cohen & Wills, 1985). For example, frequent in-person meetings and phone contact with non-coresident adult children was associated with a reduced risk of depression among older adults in Korea (Roh et al., 2015), while Thompson and Heller (1990) observed social support from family members improved the psychological well-being of older women in the USA. Since studies suggest that the family is the main source of social support for older adults in SSA, this finding is not unexpected (Unanka, 2002; Van der Geest, 2016). In many societies in SSA, families tend to reside in proximity in order to share resources between generations within multigenerational households and to support one another through difficult times. This encourages intergenerational family interdependence in the face of limited economic security and social services, typical of most low-resource settings (Pelcastre-Villafuerte, Treviño-Siller, González-Vázquez, & Márquez-Serrano, 2011; Peil, 1991). This social integration into the extended family system widens one’s social network and increases the chances of receiving social support from kinsmen.
National Institute of Health (NIH) Quality Assessment Tool for Observational Cohort
Olagunju et al., 2015
Gureje et al., 2008
Kodzi et al., 2010
Ojagbemi et al., 2018.
Gureje et al., 2011
Gyasi et al., 2018.
Gyasi et al., 2019
1 Was the research question or objective in this paper clearly stated?
Y
Key Y Yes N No NA Not Applicable NR Not Reported CD Cannot Determine
2 Was the study population clearly specified and defined?
3 Was the participation rate of eligible persons at least 50%?
4 Were all the subjects selected or recruited from the same or similar populations (including the same time period)? Were inclusion and exclusion criteria for being in the study prespecified and applied uniformly to all participants?
5 Was a sample size justification, power description, or variance and effect estimates provided?
N
6 For the analyses in this paper, were the exposure(s) of interest measured prior to the outcome(s) being measured?
7 Was the timeframe sufficient so that one could reasonably expect to see an association between exposure and outcome if it existed?
8 For exposures that can vary in amount or level, did the study examine different levels of the exposure as related to the outcome (e.g., categories of exposure, or exposure measured as continuous variable)?
NA
9 Were the exposure measures (independent variables) clearly defined, valid, reliable, and implemented consistently across all study participants?
10 Was the exposure(s) assessed more than once over time?
11 Were the outcome measures (dependent variables) clearly defined, valid, reliable, and implemented consistently across all study participants?
12 Were the outcome assessors blinded to the exposure status of participants?
13 Was loss to follow-up after baseline 20% or less?
14 Were key potential confounding variables measured and adjusted statistically for their impact on the relationship between exposure(s) and outcome(s)?
OVERALL RATING (GOOD, FAIR, POOR)
POOR
FAIR
GOOD
(Continued) Table 37.3 Quality Assessment on Included Studies
Our review found financial support from non-coresident adult children and extended family members positively related to better psychological, self-rated health and subjective well-being among recipient older adults. This finding is in line with other studies in similar non-Western contexts such as Thailand, Vietnam, and Brazil (Bélanger et al., 2016; Guo, 2014; Teerawichitchainan et al., 2015). In this context, where public support for older adults is hardly available, financial support from family members, especially adult children, may help older parents utilize health services and cope with financial stress for better health outcomes and well-being. Additionally, receiving financial support from one’s adult children can be culturally desirable, because it is often interpreted as being ‘successful’ in life, and may boost one’s social status in society, which could lead to an older adult experiencing greater life satisfaction (Teerawichitchainan et al., 2015). Furthermore, society considers providing support to older parents by adult children their moral duty and it also fits into the assertion that children are old-age economic security in SSA (Aboderin, 2004; Apt, 2002). It should be noted however that in this context, financial support from adult children to older parents is usually motivated by the needs (e.g. health care costs) of older parents (Hogan, Eggebeen, & Clogg, 1993). In contrast, while beneficial effects of financial support from adult children to older parents have been reported in Western contexts (Zunzunegui et al., 2001; Silverstein & Bengtson, 1994), some other studies associate financial support from adult children with poor psychological well-being of older parents (Lowenstein et al., 2007). It is argued that older persons who receive financial support in Western contexts normally prefer to remain functionally independent and may feel dependent on adult children, causing distress and subsequently deterioration in well-being (Pyke & Bengtson, 1996). The differences in the effect of receiving financial assistance from adult children in the two scenarios above may be explained by the socio-cultural perspective.
We believe that our review contributes to the ageing literature in SSA in two different ways. Firstly, a considerable number of research studies have been conducted on support provided by older adults in SSA (reflecting the role of the elderly in African families) and the effects on health and well-being, but limited research on support provided to older adults and the effects on their health and well-being. It is worth iterating that there is quite some evidence for support provision to older people and its effect on health and well-being in later life in other world regions, including low-and middle-income countries, but it’s not really clear how much we know about SSA (Teerawichitchainan et al., 2015; Lowen stein et al., 2007; Lee, Netzer, & Coward, 1995). Our review therefore highlights the posi tive effects of family support on the health and well-being of older sub-Saharan Africans. To the extent that the family plays a central role in the social protection of majority of older people in SSA, and given that the population is rapidly ageing, coupled with the high cost of establishing and running social welfare programmes for the elderly, for now, countries in SSA may be better off implementing programmes that motivate families to continue their support functions.
Secondly, while our findings suggest the need for more research on the topic in SSA, it also draws scholarly attention on the need to differentiate the forms (instrumental or emo tional) and source of family support in research as these are known to exhibit distinct effects on the health and well-being of older people (Merz & Consedine, 2009; Silverstein et al., 2006; Cong & Silverstein, 2008). In the study by Olagunju et al. (2015) the relationship of the provider and specific social support provided (e.g. emotional or instrumental) was not indicated, while in the case of Kodzi et al. (2011) the researchers failed to indicate the relationship of the provider. For instance, the provision of instrumental support (e.g. help with household chores) by daughters and daughters-in-law and financial support by sons and sons-in-law to older parents is considered customarily appropriate in African society, hence may exert different effects on health and well-being than a support relationship viewed as customarily inappropriate as found in other low-resource settings (Okoye, 2012; Coe, 2011; Cong & Silverstein, 2008). For example, a study in China reported help with household chores from daughters-in-law resulted in reduced depressive symptoms of older parents compared to their counterparts who received support from sons (Cong & Silverstein, 2008). This suggests that future research should be mindful of this in order to detect a more nuanced picture of the relationship between family support received and the health and well-being of older persons.
This review presents evidence regarding the effect of various types of family support provided to older adults in SSA on their health and well-being. To the best of our knowl edge, this is the first systematic review on the topic in SSA. The evidence presented is based on a systematic search of eight databases, including searches in other sources for unpublished works.
It was not feasible to conduct a meta-analysis as a result of the different types of family support and varied measures used to assess support (e.g. different response scales were used in assess ing frequency of contact with family) and health or well-being in this review. This review may miss evidence from French-speaking SSA countries. But, if there were many of them at all, we would have identified them through the bibliography of other articles. Also, this review could not account for the extent to which socio-demographic, socio-cultural, health-related, and country level factors influenced the effect of family support on the health and well-being outcomes of older adults within and between countries, since these are known to moderate support effects.