Evaluation of the Attitudes and Practices of Kahawa West Residents towards the Care of

the Elderly

October, 2012

Table of Contents
Students Declaration .....................................................................Error! Bookmark not defined.
Supervisors Declaration ................................................................Error! Bookmark not defined.
Dedication ......................................................................................Error! Bookmark not defined.
Acknowledgements ........................................................................Error! Bookmark not defined.
Abstract ........................................................................................................................................... 5
CHAPTER 1.0: INTRODUCTION ................................................................................................ 6
1.1 Background to the Study ....................................................................................................... 6
1.2 Problem Statement ................................................................................................................ 7
1.3 Justification ........................................................................................................................... 8
1.4 Research Questions ............................................................................................................... 9
1.5 Research Objectives ............................................................................................................ 10
1.5.1 Broad objective ............................................................................................................. 10
1.5.2 Specific objectives ........................................................................................................ 10
1.6 Study Assumptions.............................................................................................................. 10
1.7 Significance of the Research ............................................................................................... 10
CHAPTER TWO: LITERATURE REVIEW ............................................................................... 12
2.1 Introduction ......................................................................................................................... 12
2.2 Where the Elderly should Receive Care ............................................................................. 13
2.3 Attitudes towards the Care of the Elderly ........................................................................... 14
2.4 Resources and Facilities for the Care of the Elderly ........................................................... 14
2.5 How the Elderly are Cared for in the Community .............................................................. 15
CHAPTER THREE: METHODOLOGY ..................................................................................... 17
3.1 Research Design .................................................................................................................. 17

3.2 Study Area ........................................................................................................................... 17

3.3 Study Population ................................................................................................................. 18
3.4 Inclusion and Exclusion Criteria ......................................................................................... 18
3.4.1 Inclusion criteria: .......................................................................................................... 18
3.4.2 Exclusion criteria: ......................................................................................................... 18
3.5 Sample Size and Sampling Technique ................................................................................ 18
3.5.1 Sampling technique ...................................................................................................... 18
3.5.2 Sample size ................................................................................................................... 19
3.6 Data Collection Procedures ................................................................................................. 19
3.7 Data Management and Analysis .......................................................................................... 20
3.8 Ethical Considerations......................................................................................................... 20
3.9 Study Limitations ................................................................................................................ 20
3.10 Study Variables ................................................................................................................. 20
3.10.1 Independent variable: ................................................................................................. 20
3.10.2 Dependent variables: .................................................................................................. 20
CHAPTER FOUR: RESULTS ..................................................................................................... 21
4.1 Demographic Profile of the Study Sample .......................................................................... 21
4.2 Attitudes Towards Caring for The Elderly......................................................................... 23
4.3: Practices Involved in Caring for the Elderly ...................................................................... 25
CHAPTER 5: DISCUSSION ........................................................................................................ 30
5.1 Preferences of Care for the Elderly ..................................................................................... 30
5.2 Perceptions and Attitudes towards Elderly Care ................................................................. 31
5.3 Importance of Resources and Facilities for Elderly Care ................................................... 32
5.4 Modalities of Care for the Elderly in the Community ........................................................ 33
Conclusion .................................................................................................................................... 34
3

References ..................................................................................................................................... 36
APPENDICES .............................................................................................................................. 37
APPENDIX I: QUESTIONNAIRE .......................................................................................... 37
APPENDIX II: WORK PLAN .................................................................................................. 42
APPENDIX III: BUDGET ........................................................................................................ 43

Abstract
This study aims at evaluating the attitudes and practices of Kahawa West residents towards
caring for the elderly people. Caring for the elderly is fulfilment of the special physical,
psychological, social and spiritual needs that are unique to senior citizens. The importance of this
research lies within the fact that explains to the health care sector and to educational institutions
the ways in which the members of the community perceive the care of the elderly and how their
attitudes impact on their practices in caring for the elderly. The survey participants were selected
through random sampling while avoiding bias in the response rates to ensure equal
representation of individuals and responses throughout the population. Data gathered in this
study was categorized, coded, analyzed and reported through frequency tables, bar graphs, pie
charts and cumulative percentages. In this study, a generally positive attitude towards
involvement in elderly care was observed among the respondents with regard to helping them
fulfil their activities of daily living. In particular, most people preferred home care to institutional
care as far as caring for their elderly relatives is concerned. The need for time convenience
prompted some respondents to opt for formal institutional care with the reason that this allowed
them time to fulfil their other socioeconomic responsibilities. It is important to note that the
people involved in caring for the elderly need to hold the right attitudes towards the needy
individuals and their needs in order to be able to carry out the appropriate care modalities by
willingly and effectively fulfilling their specific healthcare and needs and activities of daily
living. Concisely, this study gives a good insight into how the peoples perceptions of caring for
the elderly influence the actual care that they provide and, therefore, gives the way forward for
improvement of the care accorded to senior citizens.

CHAPTER ONE: INTRODUCTION

1.1 Background to the Study
Elderly care refers to the fulfilment of the special physical, psychological, social and
spiritual needs and requirements that are uniquely needed by senior citizens. The care for ageing
parents, elderly spouse, or a close friend can be really challenging especially in the case of a
crisis when the carer is not at home. Certainly, it is a noble task to take care of the elderly as it is
just like caring for a little child because the carer has to ensure that the elderly under their care
are safe and secure (Saltvedt, Fayes, Kaasa & Sletvold, 2002). For instance, given that senior
citizens are prone to falling, it is crucial to follow the safety guidelines in order to prevent such
accidents.
It is also imperative to take notice of the fact that while a good number of families still
take care of their old within the family, there are a number of facilities that care for the elderly in
the country. These include religious institutions, charitable institutions, and informal institutions.
In particular, religious institutions intervene for destitute old persons through church
programmes in which Christians visit the old people and assist in their care (Linda et al., 2001).
The charitable institutions within communities also provide formal support to the elderly through
donations and community service. There are also informal institutions within communities that
intervene and participate in caring for the old citizens with the support of relatives and wellwishers.
The attitudes of the relatives who are mostly the primary carers of the elderly determine
the practices and, thus, the quality and effectiveness of the care accorded to the elderly citizens.
While some elderly persons are cared for at home by their relatives, other destitute elderly people
6

are taken to care homes for the aged around Nairobi. However, those ones who are physically
dependent cannot be admitted into the available homes because there are no facilities that are
sufficiently equipped to support the care of the elderly who are in need of constant medical
attention (Nhongo, 2009). There are so many elderly persons who are found loitering in the
streets of many towns in the country because they have no relatives to support them (Nhongo,
2009). This elicits the need for a critical assessment of the attitudes held by the relatives of these
destitute senior citizens and the commissions and omissions that they make regarding the care of
the elderly.
1.2 Problem Statement
The current lifestyles and challenging economic times pose great difficulty to family
members worldwide when it comes to coordinating care for their old relative (HelpAge
International, 2010). As such, most people in western countries prefer to hire trained healthcare
providers, mostly nurses, to provide formal care for their relatives at home or in care institutions
for the elderly instead of providing informal care themselves at home (Saltvedt et al., 2002). In a
good majority of African countries, while old people prefer spending their lives with their
families in the community, there is a fast-growing trend concerning the ease with which the
community members are willing to commit the elderly persons to care institutions (Helge et al.,
2007). In earlier years, the elderly were culturally cared for in the community settings in the past
but family members are currently considering adopting the western practice of taking them to
formal care institutions (Kemper, 2002). The institutions in Kenya are already filled beyond their
capacity owing to the high numbers of abandoned old people that they try to assist (HelpAge
International, 2010).

Even with the hope of establishment of more nursing homes in the country for the
elderly, the current attitudes and practices towards the care of the elderly need to be evaluated in
order to inform future strategies aimed at improving the care. The attitudes of people towards the
elderly and their needs for daily living greatly influences the actions and practices of the people
as far as their care for the elderly is concerned. Although there are some forms of care
interventions in place to support the older citizens in their later years, the facilities and resources
within the communities, hospitals and nursing homes are not sufficient to provide adequate care
for the increasing population of old people within the country (Helge et al., 2007). This
inadequate availability of facilities and resources influences the attitudes of people towards
caring for the elderly because the situation forces them to work only with the available facilities
and resources. Therefore, it is necessary to evaluate how people perceive the care of the elderly
and determine the measures they take in order to establish feasible strategies to enhance and
improve the care of the seniors both at home and care facilities.
1.3 Justification
The care accorded to the elderly is determined by the attitudes of their carers towards
utilization of the monetary, material and time resources used in caring for this population. At this
point, it is salient to note that provision of sufficient care services to the elderly is indeed costly
and necessitates that the old people be relocated away from their homes and communities. This
poses the challenge of an elderly living in a nursing home away from other family members
thereby influencing their attitudes towards formal care outside their homes. Equally important is
the fact that many elderly people maintain ample robustness to remain in their homes, which is
actually more preferable to them, and is also better for their welfare. As such, the choice of
home-based care seems more preferable for some families because they believe that being with
8

heir significant other also facilitates their well-being. This study is important in discovering what
the carers of elderly clients do at home as this will facilitate recommendation of corrections and
improvements to be made to the available care modalities for old people.
The approach of providing care to the elderly mostly emanates from the attitudes held by
relatives towards the health care centres in the country that mainly offer preventive, promotive,
curative and rehabilitative health care for elderly population. This makes the attitudes held and
practices executed by people towards the care for the elderly to be of paramount importance in
strategizing and implementing both home-based and facility-based care. There are only a few
care facilities specifically intended for the care of the elderly in Kenya, thus, the burden of
responsibility for the old generation is shifted to the relatives who have other obligations to work
and secure steady incomes for the upkeep of their families (Nhongo, 2009). This necessitates
evaluation of how they perceive the care needs of the elderly and what they do about them. In a
nutshell, this research is of great value to the theory and practice of care for the elderly because it
describes the attitudes and practices of the research population towards the care of the elderly. It
explains the current conditions regarding care for senior citizens and acts as a basis for future
planning and research on the care of the elderly.
1.4 Research Questions
i.

Where should the elderly receive care from?

ii.

What are the attitudes of the residents towards the care of the elderly?

iii.

How are the elderly cared for in the community?

iv.

Are there resources and facilities for the care of the elderly in the community?

1.5 Research Objectives

1.5.1 Broad objective
The broad objective of this research was to evaluate the attitudes and practices of Kahawa West
residents towards the care of the elderly citizens.
1.5.2 Specific objectives
i. Establish where the elderly should receive care - in the community or at healthcare facilities
and the rationale for the decisions
ii. Determine attitudes towards provision of care for the elderly in the community.
iii. Describe how the elderly were cared for by their relatives and significant others.
iv. Depict whether there were resources and facilities to aid the care of the elderly.
1.6 Study Assumptions
i.

All respondents were employed and were therefore responsible and accountable for the
care and upkeep of their elderly relatives and friends.

ii.

All participants were capable of contributing in both decision-making and/or execution of

care for their elderly relatives and friends.

1.7 Significance of the Research

The significance of this study lies within the fact that explains to the health care sector
and to educational institutions the ways in which the members of the community perceive the
care of the elderly and how their attitudes impact on their practices in caring for the elderly.
Proper understanding of the attitudes held and the elderly care modalities practiced by the study
population facilitate formulation of even more effective research-based knowledge and practices

10

to enhance improvement of the quality of care. Moreover, this study equips decision-makers and
policy-makers in both the public and private sectors with an adequate knowledge base on which
to base their strategies to positively influence the attitudes and practices of the public towards
caring for the elderly. Additionally, other organizations, governmental and non-governmental
will benefit greatly from this study because they will better understand the perceptions and
practices of people towards the elderly in order to intervene appropriate in enhancing better care
for the senior citizens.
Moreover, evaluating the attitudes and practices of the society towards care of the older
citizens will unveil what the future providers and facilitators of the care think about the research
problem and avail feasible recommendations on how to improve their attitudes as well as their
practices in caring for the elderly. Equally crucial is the fact that the findings of this study will
lead to formulation of practical proposals for application in theory and practice regarding the
care of the elderly. The residents of the study area as well as other Kenyans will benefit from the
findings of this research as they will be available to health care and education facilities for
consideration of the recommendations made herewith for application to influence the attitudes
and practice of caring for senior citizens. This work will also be important in guiding future
research regarding the attitudes and practices of people regarding the care of the elderly.

11

CHAPTER TWO: LITERATURE REVIEW

2.1 Introduction
The attitudes and practices of people towards caring for the elderly determine whether the
senior citizens are cared for by relatives, friends and/or hired carers at home, or whether they are
taken to formal nursing homes for the aged. It is of paramount importance to note that it can be
quite costly to pay for formal care of an elderly relative. Truly, the cheapest choice is to give care
to the elderly relatives at home. All one needs is to make some minor house repairs and
renovations to make the house and the entire home environment suitable for the old ailing
individual. In order to make sure that the remaining days of life of the loved ones are spent well,
there is a great need to make the right adjustments. Moreover, to make sure that there will be no
accidents one can opt to hire a nurse or a caregiver to provide specialized care and carry out care
procedures requiring some advanced expertise (Greene et al., 2005).
The specific health care needs as well as the needs for assistance with activities of daily
living necessitate that the carers of the elderly hold the right attitudes towards the needy
individuals in order to be able to carry out the appropriate care modalities. It is worth noting that
the elderly who are physically dependent cannot be admitted into the available homes for the
elderly. This is because there are no ample facilities to support such elderly people in need of
constant attention (Ochola, Wagah & Omalla, 2000). Elderly persons loiter the streets in Nairobi
as well as other towns because they have no families to turn to for support. There is a great need
for enough homes for the old people (Nhongo, 2009). A good number of families, however, still
take care of their old within the family.

12

2.2 Where the Elderly should Receive Care

The population of the aged is increasing at an alarming rate, raising questions among
policymakers, decision makers, the elderly citizens and their families concerning where and how
the aged should be cared for (Saltvedt et al., 2002). Most of the elderly prefer care at home rather
than in a nursing home, and some see care at home as potentially less costly than nursing home
care. Understanding the factors that determine the type and amount of home care used is
important for predicting use in the future and developing long-term care policy (HelpAge
International, 2010).
In the study area, elderly persons just remain in their own homes where members of the
extended family support them. There are church programmes in this in most parts of Kenya
whereby Christians visit fellow members of the community. During such visits, people with
needs are identified and their needs looked at and solutions provided. For instance, those without
food are provided with food. When the groups come across elderly persons, they identify their
needs and purchase food for them and the children, among other things (Nhongo, 2009).
In addition, there are charitable institutions that exist within communities and provide
support to the needy in the community. For instance, Kenyatta National Hospital League of
Friends provides wheel chairs to immobile patients because the elderly form a large percentage
of the immobile patients and hence, the majorities benefit from such donations (Saltvedt et al.,
2002). Apart from the above formal institutions, there are also informal institutions that exist
within communities that can intervene. The efficacy of such institutions in intervention today
are, however, very doubtful given the changing community structures (Ochola et al., 2000).

13

2.3 Attitudes towards the Care of the Elderly

The great availability of family members is expected to enable the use of less formal care
and increase the use of informal care. Whether the person is married or not and has children or
not act as the indicator of the availability of family, although information on the opportunity cost
of potential caregivers' time, their attitudes toward caregiving, and other characteristics would
also be desirable (Saltvedt et al., 2002). An elderly person can live alone with the caregiver
visiting to provide care, or with a caregiver. Sharing households makes it easier to give care and
saves time. When living together, no time is spent traveling back and forth between two
households, and there are economies in home production when two households are combined for instance, cleaning one house, preparing one meal, and so on, instead of two (Kemper, 2002).
As a result, the quantity of formal and informal care used and living arrangement are jointly
determined such that any factor that affects one also affects the other.
The elderly people living in homes and in need of help with such basic activities of daily
living as bathing, cooking, or eating can depend on care paid for in the formal health care market
or on informal care provided by the family and friends (Greene et al., 2005). Greater need for
care leads to the elderly utilizing even more formal and informal care. The higher price of formal
home care is expected to increase the use of informal care and decrease the use of formal care
(Linda et al., 2001). Higher income is expected to lead to use of more formal care and because
higher income permits the purchase of more informal caregiver time for activities other than care
giving, such as paid work, home production, or leisure-use of less informal care.
2.4 Resources and Facilities for the Care of the Elderly
Regarding the interventions provided for the elderly within health institutions, very few
interventions exist within hospital structures that specifically address the needs and rights of
14

older persons in Kenya. Whilst policies exist to protect the rights of everybody in general, they
are sorely lacking in serving the elderly because of the negative attitudes with which older
persons are viewed (Nhongo, 2009). Compounding the inadequacy of the existing policy is their
insensitivity to the unique needs of older persons as a vulnerable group. So while a policy might
be quite efficient in serving the rights of a young male, it would be grossly wanting in protecting
the rights of an older person.
However, the existence of these policies have somewhat improved the situation among
older persons because many social workers exist in public hospitals to investigate the situation of
patients with financial needs and who require support. In many cases, the elderly who have been
abused by relatives turn to these social workers to help in placing them into the homes of the
aged (Ochola et al., 2000). It is, therefore, necessary to find out from the study respondents their
attitudes and perceptions towards the care of the elderly to determine whether they should be
cared for in the formal care facilities or in the community setting. In keeping with the spirit of
the HelpAge International (2010), interventions to support older people should promote
independence, participation, care, self-fulfilment and dignity.
2.5 How the Elderly are Cared for in the Community
It is of paramount importance to take note of the observation that caring for the ageing
parents is not an easy task especially while attempting to handle other individual and family
responsibilities (Helge et al., 2007). In that connection, lack of a care taker becomes a serious
problem for the elderly who are suffering from chronic medical conditions and have limitations
of their ability to care for themselves and their homes (Ochola et al., 2000). These problems are
often compounded by inflated medical costs because of poor health and the need to have more

15

supportive services. There are those older people who cannot even dress, bathe or feed
themselves.
As far interventions within the Kenyan society is concerned, while older persons prefer to
spend their lives within their communities and families, a worrying trend today is the ease with
which the community is willing to commit its old to institutions. Moreover, while the older
citizens were culturally taken care of within the communities, today, family members often try to
get them committed to institutions. These institutions are already stretched beyond capacity due
to the high number of abandoned older persons whom they try to absorb. Commenting on how
the community cares for the elderly today, researchers observe that some destitute elderly
persons are taken to homes of the aged around Nairobi city (Ochola et al., 2000).

16

CHAPTER THREE: METHODOLOGY

3.1 Research Design
This was a survey research design as it was used to collect self-reported data form the
participants. The data gathered from the respondents in this survey was both factual information
as well as the opinions expressed by the survey takers. For time efficiency, this survey applied
the method of a questionnaire whereby the participants filled in the questionnaires on their own.
This method was preferred as it allowed collection of large amounts of data within a relatively
short time. Moreover, the survey technique was appropriate for this study because it enabled
collection of information on a wide range of things including personal facts, attitudes, past
behaviours and opinions.
3.2 Study Area
The survey was conducted in Kahawa West, a residential area located approximately 25
kilometers from the capital city (Nairobi) in an easterly direction along Kamiti Road off Thika
Super Highway. The main borders of this area are Kahawa Garrison and Kenyatta University in
the North-East, Kamiti Prison in the West and Kamiti Road in the South. Kahawa West covers
an area of approximately 13.90 square-kilometers and holds an estimated multi-ethnic population
of thirty nine thousand nine hundred and ninety four (39 994) people according to the 2012
National Census. The population of interest in this study consists of people aged between 18 and
65 years (51 per cent of the population) because they are the ones responsible for caring for the
elderly citizens who need assistance with their activities of daily living.

17

3.3 Study Population

The study population included all employed and self-employed adults aged between 18
and 65 years. This was the population expected to be in charge of the care for the elderly through
facilitation and/or direct involvement.
3.4 Inclusion and Exclusion Criteria
3.4.1 Inclusion criteria:
The respondents of this study included all people within the age brackets of young
adulthood (18 years) to late adulthood (65 years) and who consented to participate in the study
by virtue of their role in caring for and/or facilitating the care of the elderly and their capacity to
respond to questions to be asked in this survey.
3.4.2 Exclusion criteria:
The study excluded individuals aged below 18 years because they were considered as
minor citizens who lack reliable sources of income and autonomy to care for older people. The
senior adults aged over 65 years were also excluded because this is the starting age of senior
adulthood that may need the attention and care of younger persons to meet their daily needs as
they continue ageing.
3.5 Sample Size and Sampling Technique
3.5.1 Sampling technique
Survey participants were selected through random sampling while avoiding bias in the
response rates to ensure equal representation of individuals and responses throughout the

18

population. Survey respondents were randomly picked from a sampling frame of the residents of
Kahawa West who fulfill the inclusion criteria of this study.
3.5.2 Sample size
The sample size was determined systematically to ensure reliability and validity of the
survey. The formula used was the one proposed by Fischer et al. (1998).
n equals pqz2 over d2
where:
z is the standard normal data set at 1.96 and corresponds to 95 % confidence interval
p is the proportion of population estimated to have the characteristic of interest being measured
and it is 0.5
q is 1 p, that is, 1 0.5 = 0.5
n is the desired sample size
d is the level os statistical significance set at 0.05
n = 0.5 x 0.5 x 0.1962 divided by 0.052
= 0.3760 divided by 0.00025
n = 384
therefore, the appropriate sample size for this study will be 384 respondents
3.6 Data Collection Procedures
A structured data collection questionnaire developed systematically on the basis of the
study objectives was the major tool for data collection. It was used to collect general respondent
information as well as their responses to the questions seeking information on their attitudes and
practice regarding caring for the elderly.

19

3.7 Data Management and Analysis

Data was categorized, coded, analyzed and presented using frequency tables, bar graphs,
pie charts and cumulative percentages.
3.8 Ethical Considerations
Authority to undertake this research project was obtained through a letter of introduction
from the Department of Nursing Sciences at Kenyatta University. Official permission was also
be sought from the chief covering Kahawa Location to collect research data from the locals of
the area. Moreover, all participants were presented with consent forms where they expressed in
writing their willingness to participate in the survey. Additionally, confidentiality was strongly
upheld throughout and after the research process.
3.9 Study Limitations

Financial limitations: This study was limited in its scope due to financial constraints,
therefore, its sample size was small due to the high cost of producing and administering
questionnaires.

Time limitations: The tight schedule and limited time allowed for this research project
also limited the scope of the study because only a small sample size could studied within
the time available.

3.10 Study Variables

3.10.1 Independent variable: The independent variable in this study was the care
provided to the elderly citizens in the study area.
3.10.2 Dependent variables: The dependent variable in this research was the attitudes
and practices of the respondents towards the care of the elderly.
20

CHAPTER FOUR: RESULTS

4.1 Demographic Profile of the Study Sample
As far the age distribution among the population is concerned, this study classified the
respondents in accordance with various conventional age brackets representing the age groups of
people who qualify as capable caregivers for the elderly. Out the study sample, 26 (n=99) per
cent were aged between 20 and 30 years, 32 per cent (n=122) were aged between 31 and 40
years, 28 per cent (n=108) were aged between 41 and 50 years, while 14 per cent (n=55) were at
least 51 years old. This is well demonstrated by the first pie chart in Figure 1 below. The second
pie chart shows the distribution of the male and female genders among the study population. Out
of the study sample, 14 per cent (n=54) of the respondents were single, 23 per cent (n=88) were
engaged, 48 per cent (n=184) were married, 13 per cent (n=50) separated and 2 per cent (n=8)
divorced as shown in Figure 3. A majority of this population were christians (93 per cent,
n=357); only 1 per cent (n=4) were muslims while the remaining 6 per cent (n=23) were
classified as others meaning that they had no specific religion.

Figure 1: Pie charts showing the age and gender distribution among the participants
21

The participants reported appreciable education levels with 31 per cent (n=119) having
advanced to bachelors degree level, 28 per cent (n=106) held diplomas in various professions, 23
per cent (n=88) had certificates while 18 per cent (n=69) had education qualifications below the
certificate level as shown in Figure 2 below. In that connection, 79 per cent (n=303) of the study
sample were employed, 12 per cent (n=46) were self-employed whereas 9 per cent (n=35)
reported to be jobless.

Figure 2: Bar graph showing education levels of the participants

22

4.2 Attitudes Towards Caring for The Elderly

Regarding their attitudes towards caring for the elderly, 52per cent (n=199) of the study
participants reported preference for home care, 31 per cent (n=) 119 opted to take their elderly
relatives and friends to nursing homes meant for the elderly, 16 per cent (n=62) were of the
opinion that the elderly should be cared for in their childrens homes whereas 1 per cent (n=4) of
them went with the option of caring for the elderly in the homes of other relatives.
Among those participants who stated home care as their preferred mode of care for the
elderly, 28 per cent (n=109) cited affordability as the main reason for their preference, 29 per
cent (n=111) reported that home care allowed for family support, 26 per cent (n=99) believed
that home care provided chances for the ageing relative to participate in family issues and 17 per
cent (n=65) viewed it as as convenient for the care takers

23

On the other hand, 42 per cent (n=161) of those who preferred institutional care
cited convenience as their main reason for their preference, 46 per cent (n=177) preferred
institutional care because it is economic allows opportunities to earn a living and at the
same time pay for the care, while 12 per cent (n=46) reported that institutional care
eliminates the burden of having to care for an ageing relative.

Figure 4: Reasons for preference of institutional care.

50
45
40
Percentage (%)

35

30
25
20

15
10
5
0

Institutional Care
Convenience - 42%

Eliminates Burden - 12%

Economical - 46%

24

4.3: Practices Involved in Caring for the Elderly

In describing their attitudes towards caring for the elderly in terms of how much
the respondents would like to be directly involved in care, their responses were graded on
a Likert scale and reported as indicated in the table. It is seen freom the Likert scale in
Table 1 below that 27 per cent (n=104) of the participants strongly liked participating in
direct care provision for the elderly, 22 per cent (n=123) merely liked it, 19 per cent
(n=73) were not sure, 14 per cent (n=54) disliked the idea while 8 per cent (n=30) were
strongly opposed to participation in direct care of the elderly.
Level of
Agreement
Frequency

Strongly

Like

Not Sure

Dislike

Like

Strongly
Dislike

104

123

73

54

30

27%

22%

19%

14%

8%

(n)
Percentage

Table 1: Likert scale indicating participants preferences of involvement in elderly care

Further analysis shows that 49 per cent (n=188) of the study population preferred
involved in making decisions on the mode of care for the elderly, 28 per cent (n=108) preferred
participating in covering the expenses of the care, 22 per cent (n=84) wanted only passive
involvement and 1 per cent (n=4) did not want to be involved in caring for the elderly in any
way.

25

Regarding participation in institutional visits for the elderly, 22 per cent (n=84) reported
that they would always attend the visits, 26 per cent (n=99) said they would be present in most of
the visits, 39 per cent (n=150) would go there sometimes, and the remaining 13 per cent (n=51)
would only avail themselves on rare ocassions to see their elderly relatives in care institutions.
On the issue of who mainly takes care of the elderly among the study popu;lation, 31 per cent
(n=119) reported that formal care givers should care for the old people, 22 per cent (n=84)
preferred that the elderly be cared for by family members only, 45 per cent (n=173) advocated
for collaboration between formal caregivers, family members and friends, and 2 per cent (n=8)
reported that relatives and neighbours should be the primary care givers for the ageing
population as represented in Figure 6 below.

26

The respondents also gave their sentiments regarding the specific facilities that provide
care for the elderly in their communities. It was observed that a majority of the study population
(57 per cent, n=218) cared for their elderly loved ones informally at home while 39 per cent
(n=149) relied on hospitals as the main facilities that provide care for the elderly. Due to the
unavailability of nursing homes for the elderly in the country, only 4 per cent (n=53) regarded
nursing homes as the main providers of elderly care while 1 per cent (n=4) relied on communitybased facilities to care foro the elderly as indicated in Figure 7 below.

27

On the availability of facilities for the care of the elderly in the study area, it was
observed from the data that there was no facility that was readily or conveniently available. Most
id the respondents (67 per cent, n=257) reported that facilities and resources were only scarcely
available, 31 per cent (n=119) responded that they were not available at all; only 2 per cent (n=8)
reported that the facilities and resources for the care of the elderly were avaiable and accessible
to them.

28

Table 2 below shows the attitudes of the respondents towards the affordability of the care
that is available to the elderly in their community. A majority of the participants (44 per cent,
n=169) said that the avalable care was fairly costly, 39 per cent (n=149) regarded it as barely
affordable, 13 per cent (n=50) reported the care as being easily affordable and 4 per cent (n=16)
thought that caring for the elderly was too costly. This gives a view of the economic significance
of caring for the elderly given that the care involves sacrificing time and resources to accomplish
the goals of care.
Affordability

Easily
affordable

Just affordable

Fairly costly

Too costly

Frequencies (n)

50

149

169

16

Percentage

13 %

39 %

44 %

4%

Table 2: Tabulation of the perception of the affordability of available elderly care by

proportions of the study population
Finally, the participants also expressed their perceptions regarding the suitability of the
care that is provided for the elderly in their community. Out of those studied, 12 per cent (n=46)
reported that the care was very satisfactory, 28 per cent (n=108) said that the care was just
satisfactory, 36 per cent (n=138) regarded the care as somewhat satisfactory, 13 per cent (n=49)
saw it as unsatisfactory while 11 per cent (n=43) perceived the care accorded to the elderly as
very unsatisfactory. This information is well represented by the Likert scale in Table 3 below.
Satisfaction
Level

Very
Satisfactory Somewhat Unsatisfactory
satisfactory
satisfactory

Frequencies
(n)

46

108

138

49

43

12 %

28 %

36 %

13 %

11 %

Percentage

Very
unsatisfactory

Table 3: Likert scale representing perceptions of the suitability of the care accorded to the
elderly in the respondents' family and community.
29

CHAPTER 5: DISCUSSION
5.1 Preferences of Care for the Elderly
When family members decide their loved one needs help caring for himself or herself, the
most appropriate mode of care and level of involvement in the care can be determined by need,
emotional closeness, and location. Need is based on the ability of the old person to perform tasks
like showering, preparing and eating meals, and communicating their other personal and social
needs. Closeness entails how one sees their relationship with the ageing individual in need of
care. Emotional closeness is measured by how close one is to their parent and is largely a result
of life experiences. Location or proximity of the elderly to the caregiver is important for different
reasons especially when it comes to taking the elderly to a home or a nursing facility for the
elderly. In this regard, literature findings are confirmed by the results of this study that most
people prefer care at home rather than in a nursing homes, and some see care at home as
potentially less costly than formal home care although this puts the carers under pressure due to
their other socioeconomic responsibilities (Saltvedt et al., 2002).
The process of deciding where the elderly should receive their care requires adequate
deliberation on the appropriateness of the specific care modality for the particular needs of the
elderly relative as well as the availability of resources and facilities for that care. As such, adult
children who have parents that do not live with them or close by have a difficult time
participating in their care. If the person acting as caregiver lives too far away, his/her attention is
more easily taken up with his/her own family and employment responsibilities. As such, this
study confirmed the findings of Ochola et al. (2000) who discerned that relatives choose where
their elderly relatives receive their care depending on how convenient the method of care is to
them. This brings in the options of care highlighted in literature which include formal care in
30

facilities set up to care for the elderly, and formal and informal care in the community where the
elderly are cared for by their relatives and formal care givers.
5.2 Perceptions and Attitudes towards Elderly Care
As far as attitudes towards caring for the elderly is concerned, many people regard caring
for an elderly relative as a privilege, but when one is in the middle of the situation characterized
with limited knowledge and scarce resources, life can sometimes be very hard. In this regard, the
remarks made by Greene et al. (2005) are in line with the findings of this research that it is
crucial that carers have the right attitudes and perceptions towards the elderly and their need of
assistance with activities of daily living depending on the care paid for in formal health care for
the elderly or the type of informal care availed by the family and friends. This study indicated
that as much as people want to be involved in caring for their elderly relatives and friends, the
task of earning a decent living also remains a major priority in their lives. This means that the
attitudes towards caring for old people are generally positive but the need to fulfil other
responsibilities in life limits direct provision of care to the old citizens. Nevertheless, taking
responsibility for the welfare of an elderly person, and treating them with respect and dignity as
one helps them accomplish their daily needs, will have a huge impact on their life.
Sometimes it becomes necessary to make unpopular decisions about what is best for
those one loves dearly but this does not mean that people view care for the elderly from a
negative perspective. Respondents in the study indicated that they want the best outcomes for
their elderly relatives. This finding is in line with literature findings that relatives have positive
attitudes and are willing to participate in caring for their elderly relatives, be it in formal care
institutions or in the community where informal care is provided (Linda et al., 2001). These
challenges may be hard for the elderly people, as they may feel they are losing their
31

independence in fulfilling their activities of daily living. The carers may also feel that their role
has changed, and they are now no longer able to perform their daily activities without creating
time for their ageing parents as they have been in the past. Concisely, the perceptions towards the
care of the elderly are crucial in determining the effectiveness and efficiency of the care on the
basis of the convenience benefits realized in the process of care.
5.3 Importance of Resources and Facilities for Elderly Care
It is expected that the care for the elderly will continue to be more demanding for
households in the developing countries as people struggle to balance between working to earn a
living and at the same time concern themselves with the welfare of the elderly in their
communities, whether they care for them informally at home or in formal care facilities.
However, the main challenge that faces both formal and informal care for the elderly is the
scarcity of facilities and resources required to make the care more effective and efficient as
observed by Nhongo (2009) in a recent study on elderly care. As more employees are faced with
care giving duties for their loved ones, it is in the best interest for them to do what they can to be
as efficient and productive as they can be both at work and at home. The stresses and demands
on these working caregivers are overwhelming and they are often late to work, early to leave and
distracted throughout the workday just because they lack sufficient facilities and resources to
assist them in caring for their elderly people and allow them time to concentrate with their daily
chores as recommended by (Greene et al., 2005).
As observed from other studies, respondents in this study showed a great disappointment
in the unavailability of facilities and resources to care for the elderly given that most people are
not available to participate actively in the full-time care of their relatives (HelpAge International,
2010). This is reason as to why most respondents in the study reported preference for care
32

modalities of the elderly that allow them to commit to their workplace responsibilities. Important
to note is the fact that absence from work results into a adverse repercussions for employers in
terms of loss of workdays especially in unplanned absences, and the related loss of revenue due
to inefficiencies and ineffectiveness at work, and the employees may also lose their jobs. Herein,
the study recognized a dire need for establishment of adequate infrastructure and resources to
facilitate the care of the elderly.
5.4 Modalities of Care for the Elderly in the Community
As observed from this study, the care accorded to elderly people depends on the attitudes
held by the caregivers towards the care and the other responsibilities that the caregivers have to
fulfil in their lives. The care may involve living with them and acting as a primary caregiver or
taking them to formal care homes for the elderly. Along the same lines, enabling older people to
live independent and fulfilling lives can be equally demanding due to scarcity of facilities and
resources for elderly care. It is of paramount importance to take note of the observation this
research agrees with previous researches that caring for the ageing parents is not an easy task
especially while attempting to handle other individual and family responsibilities (Helge et al.,
2007).
If the ageing relative maintains their independence and stays in their own home, the level
of support they need may be quite high. It may be that he/she needs professional care, and so the
caring role is one step removed as one works with those caring for them. Moreover, while the
older citizens were culturally taken care of within the communities, this study demonstrates that
family members are presently more willing to commit their old and needy relatives to institutions
just as highlighted in recent literature that people are progressively embracing formal care
(Ochola et al., 2000). Deciding what is best for the relative formal or informal care or both, at
33

home or in formal facilities - can be hard both are feasible options that can be utilized in caring
for the elderly depending on the level of their needs and availability of the facilities and
resources.
Conclusion
Caring for an elderly person may appear to be a relationship where one person gives and
the other receives. However, research has shown that the relationship actually goes both ways. In
this study, it has been demonstrated that different people hold different attitudes towards the care
of the elderly, and it is these attitudes that influence the way they care for their elderly relatives
and friends. It is also discernible from this research that the availability of appropriate and
affordable facilities and resources to care for the elderly would influence people positively and
enable them to offer better care for their ageing relatives and friends. From previous studies, it is
observable that caregivers experience moments of warmth, comfort, pleasure, feeling
appreciated, and great satisfaction despite the challenges that come with caring for the elderly. In
fact, as human life expectancy lengthens, most people will need to deal with the challenges of
retirement and aging. By helping others deal with those challenges, caregivers not only learn to
deal with them themselves, but they are also better for having shared their time and resources
with those who need them.
The fact that the mode of care accorded to elderly relatives and friends depends largely
on the attitudes of the caregivers towards dedicating their time and resources towards the care
and the other responsibilities of the caregivers, people have the options of formal and/or informal
care at home or formal care in formal facilities for the elderly. Staying with the elderly people at
home and providing the relevant care promotes independence for both the relatives that the

34

receiver of care. Relatives also have the option of taking their elderly loved ones to residential
nursing homes. These residences are designed such that they fulfil the needs of the elderly. Every
option has pros and cons, but the important thing is to make the right decision at the right time.
People in charge of choosing the mode of care for their elderly relatives should develop positive
attitudes towards elderly care and think ahead because an acceptable situation now may become
very difficult in a few years time.

35

References
Greene, J., Young, J., Forster, A., Mallinder, K., Bogle, S., Lowson, K. & Small, N. (2005).
Effects of locality based community hospital care on independence in older people
needing rehabilitation: randomised controlled trial. British Medical Journal, 331, 317322.
Helge, G., Windspoll, R. & Johnsen, R. (2007). Intermediate care at a community hospital as an
alternative to prolonged general hospital care for elderly patients: A randomised
controlled trial. BMC Public Health, 7(68), 234-249.
HelpAge International. (2010). United Nations Principles for Older Persons. HelpAge
International.
Kemper, P. (2002). The use of formal and informal home care by the disabled elderly. Health
Services Reserve, 27(4).
Linda S. Noelker, L. & Bass, D. (2001).Home care for elderly persons: Linkages between formal
and informal caregivers. Journal of Gerontology, 49(6), 63-70.
Mugenda, O.M & Mugenda. A.G (1999). Research methods. quantitative and qualitative
approaches. Nairobi, Kenya: ACTS Press.
Nhongo, T. (2009). Elderly in the health care services in Kenya. Africa Regional Development
Centre.
Ochola, S, Wagah, M. and Omalla, J. N. K. (2000). An Assessment of the Nutritional Status and
Socio-Economic Contributions of the Elderly in Nairobi and Machakos Districts.
Nairobi: HelpAge International Africa Regional Development Centre.
Saltvedt I., Fayes, P., Kaasa S. & Sletvold, O. (2002). Reduced mortality in treating acutely sick,
frail older patients in a geriatric evaluation and management unit. A prospective
randomized trial. Journal of American Geriatric Society, 50, 792-798.

36

APPENDICES
APPENDIX I: QUESTIONNAIRE
Questionnaire for Evaluation of the Attitudes and Practices of Kahawa West Residents
Towards the Care of the Elderly
Consent Form
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

I accept/I do not accept to participate

Respondents Signature: ___________________

Researchers signature _________________

General Instructions:

This questionnaire has four sections. Please respond to all the questions to the best of your
ability.

Do not write your name or contacts anywhere

Please tick or circle your opinion or choice. Answer as requested elsewhere.

Respond with utmost honesty to the best of your ability

37

SECTION A: DEMOGRAPHIC PROFILE

1. What is your age bracket in years?
a) 20-30 [ ]

b) 31-40 [ ]

c) 41-50 [ ]

d) 51 and above [ ]

2. What is your sex?

a) Female [ ]

b) Male

[ ]

3. Describe your marital status

a) Single

[ ]

b) Engaged [ ]

b) Married

[ ]

d) Separated [ ]

d) Divorced [ ]
4. Which religion do you belong to?
a) Christianity

[ ]

b) Muslim

[ ]

c) Hindu

[ ]

d) Other

[ ]

a) Certificate [ ]

b) Diploma

[ ]

b) Degree

d) Other

[ ]

5. What is your level of education/education?

[ ]

6. What is your basic career/profession/occupation?

a) Self-employed [ ]
b) Employed

[ ]

c) Jobless

[ ]

38

SECTION B: ATTITUDES TOWARDS CARING FOR THE ELDERLY

7. In your opinion, where should the elderly receive care from?
a) Their homes

[ ]

b) Their childrens homes [ ]

c) Other relatives homes

[ ]

d) Nursing home

[ ]

8. What are your reasons for preference for home care?

a) It is affordable

[ ]

b) It allows for family support

[ ]

c) It provides for participation in family issues [ ]

d) It is convenient for the care takers

[ ]

9. What are your reasons for the preference of institutional care?

a) It is convenient in terms of time

[ ]

b) It eliminates the burden of having to care for an old relative

[ ]

c) It is more economical as it allows for opportunities to make more money

[ ]

SECTION C: PRACTICES INVOLVED IN CARING FOR THE ELDERLY

10. What describes your attitude towards the care of the elderly through direct
involvement in their care? Answer in terms of how like being involved.
a) Strongly like

[ ]

b) Like

[ ]

c) Not sure

[ ]

d) Dislike

[ ]

e) Strongly dislike [ ]

39

11. What aspects of indirect involvement in the care of the elderly do you prefer?
a) Decision making on the type of care

[ ]

b) No decision making on the type of care at all

[ ]

c) Partial or passive involvement

[ ]

d) Payment of expenses of care for the elderly

[ ]

12. How much participate in institutional visits for continued care of the elderly?
a) Always

[ ]

b) Mostly

[ ]

c) Sometimes

[ ]

d) Rarely

[ ]

e) Never

[ ]

13. Who are involved in the care of the elderly in your community?
a) Family members only care for the elderly

[ ]

b) Relatives and neighbors care for the elderly

[ ]

c) Friends only care for the elderly

[ ]

d) Formal caregivers care for the elderly with friends and relatives [ ]
e) Formal caregivers care for the elderly only

[ ]

14. How do you perceive the suitability of the care accorded to the elderly in your family
and community?
a) Very satisfactory

[ ]

b) Satisfactory

[ ]

c) Somewhat satisfactory [ ]
d) Unsatisfactory

[ ]

e) Very unsatisfactory

[ ]

40

15. What types of resources and facilities are in place for the care of the elderly in your
community?
a) Nursing/care homes

[ ]

b) Hospitals

[ ]

c) Community based facilities [ ]

d) Home care

[ ]

e) None of the above

[ ]

16. How much are the facilities and resources for the care of the elderly available in your
community?
a) They are readily and conveniently available [ ]
b) They are available

[ ]

c) They are rarely/scarcely available

[ ]

d) They are not available at all

[ ]

17. How do you perceive the affordability of care interventions given to the elderly?
a) They are easily affordable

[ ]

b) They are just affordable

[ ]

c) They are considerably costly

[ ]

d) They are not affordable/too costly [ ]

THE END
Thank you so much for taking your time to participate in this study. God Bless You.

41

APPENDIX II: WORK PLAN

Gantt Chart Showing Research Project Schedule
Tasks to be
Completed

March March April

1-14 15-31 1-14

April
15-30

May
1-31

June
1-30

July
1-31

August
1-31

Sept
1-30

October
1-31

Research Proposal
Problem
identification &
background reading
Submit proposal
Supervisor meetings
Literature review
Methodology
Supervisors
feedback and
corrections
Data Collection Tools
Questionnaire
preparation
Supervisors
feedback
corrections

and

Printing
questionnaires
Administering
questionnaires
Analyzing Evidence and Data
Cleaning and coding
collected data
Data analysis
Results, discussion
and conclusions
Submit draft report
Supervisors
feedback
corrections

and

Submission of final
draft

42

APPENDIX III: BUDGET

Financial Budget for the Research Project
Item

Quantity

Cost (Ksh.)

1. Stationery
- Foolscaps

1 small ream

50

- Notebook

50

- Pens

50

- Pencils

50

2. Equipment
- 2 GB Flash disk

500

- Folder

100

3. Internet
- 1GB Data

1000

4. Typesetting and Printing

- Typing

400

- Printing

300

- Photocopying

1500

- Binding

100

TOTAL COST

Ksh. 4100

43