Policies on the elderly in Zimbabwe are based on social networks and social capital in which the care of the elderly rests with the adult children and other relatives including the community. It is argued that social networks and social capital are informal and the weakness in these informal types of social support is that they are difficult to maintain in cases of urbanization, migration and socio-economic hardships. The study sought to examine the relationship between social support and the perception of being institutionalized among the elderly aged 65 years and above who were in institutions in Bulawayo urban. A descriptive quantitative cross-sectional correlational survey method was used. A simple random sampling method was used to recruit respondents. The sample size in this study was 81 respondents. Data was collected using the interview schedule. Analysis was done using the Statistical Package Social for Sciences (SPSS) package, descriptive and inferential statistics. The Pearson’s correlation coefficient showed the relationship between social support and perception of being institutionalized as follows; r = 0.181, p = 0.107. This shows that there is no relationship between social support and perception of being institutionalized among the elderly aged 65 years and above who are in institutions in Bulawayo urban, Zimbabwe.
Aging is inevitable. The elderly’s ability to carry out activities of daily living becomes difficult and deteriorates forcing them to be cared for in an institution. With the epidemiological transition, the rate of institutionalization of older adults has increased in various countries, and this process is occurring in Zimbabwe as well [
Perception of being institutionalized is a socially constructed way of thinking about institutionalization. Positive perception of being institutionalized is when the elderly accept that ageing has physiological, psychological and social determinants such that institutionalization is necessary at some point in time [
In a study conducted in India, 50% of the respondents felt neglected by family, 32% had no contact with the outside world, and 68% felt that the attitude of people towards the elderly was that of neglect [
In some West African countries such as Kenya, the elderly especially the women flee from their rural homes to be destitute in cities for fear of being labelled as witches and being burnt alive, hence they are found in institutions. They view institutions as their only salvation, hence in that context, they tend to perceive institutionalization positively [
Due to socio-economic and demographic changes in Zimbabwe, more and more elderly people now accept that they can no longer depend on the adult children for support hence the need to be institutionalized [
A study on institutionalisation of the elderly revealed that relatives had differing perceptions of institutionalization, some being happy their elderly relatives were better cared for and others expressing guilty conscience over having their elderly relatives in an institution [
・ To determine the level of social support of the elderly aged 65 years and above who are in institutions in Bulawayo urban.
・ To determine the perception of being institutionalized among the elderly aged 65 years and above who are in institutions in Bulawayo urban.
・ To examine the relationship between social support and the perception of being institutionalized among the elderly aged 65 years and above who are in institutions in Bulawayo urban
The researchers chose the descriptive quantitative cross-sectional correlational survey method as it gives a “snapshot” of the events at a particular moment in time [
This study was conducted in institutions in the urban area of Bulawayo in 2015. The institutions selected were Ekuphumuleni, Ingutsheni, Bartley Block and Edith Duly. A simple random sampling method was used to recruit respondents. The institutions were conveniently picked. The institutions were put into four strata. In the order of Bartley Block, Edith Duly’s, Ekuphumuleni and Ingutsheni Hospital, a ratio of 1:1.25:1.75:2 was used to draw the respondents until a sample size of 84 was drawn. 14 respondents were drawn from Bartley Block, 17 from Edith Duly’s, 24 from Ekuphumuleni and 29 from Ingutsheni Hospital. From each institution simple random sampling was used to recruit the respondents. The study included elderly persons who were 65 years and over who were in an institution. The respondents were able to communicate in isiNdebele or English. The study excluded elderly who did not communicate in isiNdebele or English.
To calculate the sample size, the formula
Power of 0.80
The study used the stratified random sampling method. Stratified random sampling is a variant of simple random sampling in which the population is divided into two or more strata [
Preliminary permission was sought from the Joint Research Ethics Committee of Parirenyatwa Group of Hospitals and College of Health Sciences (JREC) through the Nursing department, then from the respective Chief Executive Officers (CEO) and the matrons of the respective institutions. The final permission was granted by the Medical Research Council of Zimbabwe. The unit matrons and the sisters-in-charge were informed to gain co-operation and arrange interview dates and times. When permission had been granted, individual respondents had the study explained to them including risks and benefits so that they could consent to participate. Interviews were conducted in a place where other clients and staff of the institution did not disturb and no one was allowed to be present during interviews. Data was analysed using the Statistical Package Social for Sciences (SPSS) package, descriptive and inferential statistics.
The sample was composed of eighty-one respondents who were selected randomly after the stratification of the institutions. The modal age was eighty-one. The age ranges with least frequencies were 71 - 75 with twelve (14.8%) and 76 - 80 with ten (12.3%). The steep downward slope can be explained by the AIDS/ HIV pandemic that was claiming a lot of lives before the introduction of antiretroviral drugs. At the time HIV prevalence was around 33%. This was followed by a steep upward slope of the 65 - 70 range with twenty-two (27.2%), the range with the highest frequencies. Literature revealed that the elderly population is fast growing due to improved health care and living standards the world over [
There were fifty-three (65.4%) males and twenty-eight (34.6%) females in the sample, indicating that there are more males in the institutions than females. Culturally, the care of the elderly lies with the daughters-in-law because it is perceived to be easier to care for the elderly female than males at home [
Earlier research has identified marital status as a predictor of using institutional care among the elderly [
Forty (49.4%) respondents were sent to the institutions by their relatives, while twelve (14.8%) went to the institution on their own, twelve (14.8%) were sent by the social worker. Seventeen (21%) were sent by others who included neighbours, police, former employers and church mates. The general perception of institutionalization was that institutions were for foreigners who had no-one to look after them [
The same number of respondents, thirty-five (43.2%) were institutionalized because they were either not feeling well or had no-one to care for them. Eleven (13.6%) did not know why they were institutionalized. These are the people who could have been institutionalized against their will and no-one bothered to explain to them why they are institutionalized, making them very bitter resulting in a negative perception towards institutionalization [
Seven items were used to assess perception of being institutionalized. Responding to whether the elderly enjoyed staying at the institution, twenty-five (30.9%), constituting the majority, strongly disagreed showing negative perception of being institutionalized. It has been observed that institutionalization is a borrowed culture and dilemma for black Zimbabweans, some are still resistant to institutionalization [
Fourteen (17.3%) somewhat disagreed and twenty (24.7%) somewhat agreed that they enjoyed being in an institution. This shows that the elderly are indifferent about institutionalization. Since institutionalization seems fairly new among black Zimbabweans, it has been pointed out that the elderly may be in the transition period, needing intervention so that adaptation can occur [
With increasing health care requirements and failing family care the majority; twenty-eight (34.6%) elderly reported being less sick post institutionalization. Previous studies found that there were improvements in health after moving into institutions [
The study further showed that (59.3%) of respondents strongly disagreed that they could contribute to the community. Previous studies have indicated that the elderly in institutions lose their self-worth and feel that they have nothing to contribute to the community [
There is a small difference between those who strongly agreed (twenty-six; 32.1%) and those who strongly disagreed (twenty-five; 30.9%) that they have control over their lives despite institutionalization. Empirical evidence has observed that lack of autonomy was common among elderly resident in institutions [
Studies done in developed countries such as America show that institutionalization is an alternative to home care [
Forty (49.4%) strongly accepted institutionalization as a way of looking after the elderly when the family is no longer able to care of them. As noted in earlier studies in Zimbabwe that the elderly are becoming aware that they can no longer rely on family members for care and support due to socio-economic and cultural dynamics, more are turning to institutions for care [
Human beings are naturally commune and being among other people reduces feelings of loneliness and rejection. Thirty-eight (46.9%) respondents strongly agreed that it is better to be in an institution than being at home alone. As observed from earlier studies that the elderly preferred to be in an institution where they get better care and have other people to talk to. The elderly have also been reported to have observed that their children/significant others are too busy to talk to them resulting in them spending more time on their own culminating in feelings of isolation [
Results from this study show that the majority (thirty-two; 38.3%) of the elderly in institutions had an indifferent perception of being institutionalized. Twenty-eight (34.6%) had a positive perception while twenty-one (27.2%) had a negative perception of being institutionalized. This can be explained by a number of factors. Indifference may be explained by prevailing poverty in institutions, especially public institutions [
The second factor may be that the country was in a transition period at the time of the study. The general perception used to be that institutions are for foreigners and destitute, but now people are coming to institutions seeking admission [
Ten items were used to measure social support of the elderly in institutions. Social support is complex. It is personal and can only be defined by the beholder. Several studies argue that sources of emotional support, in order of importance, are spouse/partner, children, other relatives, friends, neighbours and formal organizations [
Asked whether there was someone who offered the elderly help when they needed it, twenty-nine (35.8%) who constituted the majority strongly disagreed. This is connected to the fact that the majority had lost contact with their relatives. They, however, failed to recognise the institution, nurses and other residents as a social support system. Instrumental support is more evident and appreciated when it is coming from significant others [
Responding to the questions on whether the elderly had people with whom they felt at ease to talk to about what was on their minds, twenty-four (29.6%) strongly agreed, while the majority, twenty-nine (35.8%) somewhat agreed. If they had no communication with relatives, friendships might have developed within and among the residents and had become so strong they could confide in one another in a satisfactory manner.
Twenty-six (32.1%) being the majority of the respondents strongly agreed that there was someone who appreciated them as a person and made them happy. Responding to the question on whether there was someone who made the elderly feel loved and honoured, the majority, twenty-seven (33.3%) strongly agreed. From the above results, it is clear that the elderly had established social support systems within the institutions and these systems were serving a purpose. Such elderly people were less likely to feel lonely.
The majority of the respondents (49.4%) strongly agreed that they got help from nursing staff when they needed it always. The majority (35.8%) also strongly agreed that they had enough information they needed to undertake activities of living so that they could live with limited dependency on nursing staff and other clients. As ageing progresses, dementia may set in and the elderly constantly needs to be reoriented to reality and be updated on daily activities and may need to be reminded about engaging in activities of living [
However the fact that respondents get help when they need it from the nursing staff but fail to appreciate the support aspect may be due to limited time and staff shortages where procedures are done in a hurry and clients only realise them as duty being done [
Twenty-four (29.6%) respondents somewhat agreed and twenty-three (28.4%) strongly disagreed that there was someone who gave the elderly information they needed and kept them updated so that they did not feel out of touch with what was happening around them. This shows that clients lack informational social support. This confirms earlier findings from research that when an elderly is admitted to an institution they lose touch with family and outside world and social networks are interrupted [
To check if the elderly realised situations where they needed to ask for support (support seeking behaviours), two items were used. According to available literature, support seeking behaviour is especially important during appraisal of stress if one assesses if the demand exceeds his/her personal resources [
The Pearson’s correlation coefficient showed the relationship between social support and perception of being institutionalized as follows r = 0.181, p = 0.107, p < 0.05. This shows that there is no relationship between social support and perception of being institutionalized among the elderly aged 65 years and above who are in institutions in Bulawayo urban. Form the study, the age was negatively correlated with the perception of being institutionalized (r = −0.247, p = 0.026), the elderly’s ability to contribute to the community (r = −251, p = 0.024), the elderly’s feeling of being in control of their lives despite being institutionalized (r = −0.222, p = 0.047) and whether the elderly accept institutionalization as an alternative to home care (r = −0.382, p = 0.000).
From the results, there is no relationship between social support and perception of being institutionalized among the elderly in institutions in Bulawayo. This disputes the earlier findings that the elderly in institutions in Zimbabwe are bitter and have negative perception about institutionalization and that they have poor social support [
However there are important findings regarding age. Form the study, the age was negatively correlated with the elderly’s perception of being able to contribute something to the community (r = −0.251*). This shows role loss and low self-esteem. Admittedly, they may not be able to contribute physically or financially but they are the custodians of a culture that needs to be passed on. That, they can contribute. On the other hand, they have no-one to teach in the institutions but instead, they themselves are the ones being taught by younger people (staff caring for them). So the institutions have usurped that role from them. This can explain the bitterness and resentment towards role loss as observed in a related study among the elderly in Masvingo [
Age was also negatively correlated with the elderly’s feeling of being in control of their lives since being institutionalized (r = −0.222*). This shows that as age increases, people tend to give up on life and just wait to die. This is described as fatalism [
Age was also negatively correlated with the elderly’s acceptance of institutionalization as an alternative to home care (r = −0.382*). This may be influenced by deterioration in the ability to independently carry out activities of living where the elderly would prefer to depend on family members rather than nursing staff with whom they have an impersonal relationship. The elderly prefer to be at home with their families [
Age was also negatively correlated with perception of being institutionalized (r = −0.247*). This means that as the age increases perception of being institutionalized becomes more negative. As noted in literature that negative perception of being institutionalized is associated with several negative physical and mental outcomes, its combination with advanced age can be deleterious for the elderly [
Results from this study showed that thirty-two (38.3%) respondents were indifferent about being institutionalized, twenty-one (27.2%) had negative perception of being institutionalized. This shows poor mental health. A mentally healthy individual should be able to adjust and adapt to any situation, including institutionalization. The elderly with negative perception are at risk of worsening age-related illnesses resulting in unsuccessful aging leading to fast deterioration in mental and physical health and death.
With more people living to old age, if not adequately prepared for institutionalization, there may be an increase in age-related mental problems affecting the elderly. The fact that more elderly will be institutionalized, there is going to be an impact on the quality of care of the elderly in the institutions which can either be positive or negative. Quality of care may improve if more nursing homes are opened and compete for clients. If the existing institutions remain the only ones available, quality of care is likely to deteriorate due to decreasing returns to scale.
There is need for psychiatric nurses to advocate for programs that focus on improving the perception of being institutionalized as noted by its negative correlation with age.
There were few limitations encountered during the carrying out of the study.
1) The results of the study cannot be generalized beyond Bulawayo because the study was done on a small sample.
2) The instrument was designed by the investigator and has never been subjected to validity testing.
Dhlamini-Sibanda, S.I., Dube-Mawerewere, V., Nkhoma, G. and Haruzivishe, C.O. (2017) A Study to Examine the Relationship between Social Support and Perception of Being Institutionalized among the Elderly Aged 65 Years and Above Who Are in Institutions in Bulawayo Urban, Zim- babwe. Open Journal of Nursing, 7, 905-917. https://doi.org/10.4236/ojn.2017.78067