Exploring the experiences of the older adults who are brought to live in shelter homes in Karachi, Pakistan: a qualitative study

Daughters and daughters-in-law providing elderly care: a qualitative study from Karachi, Pakistan

BACKGROUND AND CONTEXT

Providing care to the elderly is an emerging area of interest due to the increase in elderly population not only in the developed world but also in low and middle income countries. In Pakistan a country with an overall population of over 200 million, the elderly population amounts to 11.3 million. Caregiving of the elderly tends to occur within the kinship motivated by sociocultural norms as well as absence of government support facilities. While quantitative literature exists in Pakistan describing the "caregiver's burden," an in-depth analysis into the experiences of familial caregivers is missing.

METHODS

The research used qualitative methods with the aim to explore the lived experiences of 7 daughters and 3 daughters-in-law, living in Karachi, Pakistan providing care to the elderly requiring assistance in at least two tasks of daily living.

RESULTS

Five themes were developed inductively through the phenomenological method. All participants were Muslim and belonged to the upper economic strata of the society. Findings reveal that obligations to care are dominant in kinship circles particularly among women. Participants highlighted the importance of elderly in the Pakistani society, especially due to the religious lens that considers them as blessings. Daughter caregivers spoke about caregiving of their parents as a form of role reversal, emphasizing also upon the life-long emotional bond that served as a strong motivator. On the other hand, for daughter-in-law caregivers, motivations to care also stemmed from social expectations and kinship obligations. All participants reported multiple difficulties during the caregiving experience, despite existence of paid formal help, with respect to balancing multiple role demands and the nature of caregiving that requires constant effort. Results also illustrate that despite the desire to care for the elderly within a collectivist and patrilocal society, participants experienced multiple physical and emotional effects. However, a few also reported an increase in self-mastery and self-worth.

CONCLUSION

This study reveals that despite increasing urbanization and more women working outside the home, providing care to the elderly appears to be centered within the kinship circle. The research makes important contributions to the ageing literature in Pakistan with relevance to other South Asian contexts.

Exploring the priorities of ageing populations in Pakistan, comparing views of older people in Karachi City and Thatta

As a lower middle-income country, Pakistan faces multiple issues that influence the course of healthy ageing. Although there is some understanding of these issues and the objective health outcomes of people in Pakistan, there is less knowledge on the perceptions, experiences, and priorities of the ageing population and their caretakers (hereafter, "stakeholders"). The aim of the study was to identify the needs and priorities of older adults and stakeholders across both urban and rural locations. We sought to explore the views of two groups of people, older adults and stakeholders on topics including the definition of ageing as well as areas of importance, services available, and barriers to older people living well. Two-day workshops were conducted in one rural city, Thatta and one urban city, Karachi. The workshops were designed using the Nominal Group Technique, which included plenary and roundtable discussions. The responses were ranked through rounds of voting and a consensus priority list was obtained for each topic and group. Responses were categorized using the socio-ecological framework. Responses were compared between stakeholders and older people and between different geographical areas. 24 urban and 26 rural individuals aged over 60 years and 24 urban and 26 rural stakeholders attended the workshops. There were few areas of agreement with respect to both geographical region and participant group. Comparing older adults' definition of ageing, there was no overlap between the top five ranked responses across urban and rural locations. With respect to areas of importance, there was agreement on free health care as well as financial support. In terms of barriers to healthy ageing, only nation-wide inflation was ranked highly by both groups. In addition, there were relatively few areas of congruence between stakeholder and older adult responses, irrespective of location, although engagement with family, adequate nutrition and monetary benefits were responses ranked by both groups as important for healthy ageing. Both groups ranked issues with the pension system and financial difficulties as barriers. When categorized using the socio-ecological model, across all questions, societal factors were prioritized most frequently (32 responses), followed by individual (27), relationship (15), and environment (14). Overcoming barriers to facilitate healthy ageing will require a multi-faceted approach and must incorporate the priorities of older individuals. Our results may serve as a guide for researchers and policymakers for future engagement and to plan interventions for improving the health of the ageing population in Pakistan.

Addressing the elephant in the room: understanding functional neurological symptom disorder through the lens of culture and religion

Owing to the dearth of scholarly works to understand the presence of Functional Neurological Symptom Disorder (FNSD) among mental health patients in Pakistan, this study sought to understand how cultural and religious conflicts are implicated in the aetiology of FNSD. The study recruited 22 participants, comprising five men and 17 women. The participants were recruited from the Department of Psychiatry at Services Hospital, Lahore, Pakistan. Semi-structured interviews were conducted and analyzed through Thematic Analysis. The two main themes identified in this study were cultural and religious values and beliefs about romantic relationships. Within the cultural and religious values theme, subthemes of self-perception, a conviction in religious beliefs, and sexual suppression were identified. Furthermore, the subthemes of beliefs about romantic relationships were family's approval, engagement against wishes, and fear of exposure. The two main themes are interconnected: beliefs about romantic relationships were interpreted and experienced through the perspective of religion and culture. To summarize, this study concluded that stressors related to culture and religion are significant contributing factors in the development of FNSD. This study has important implications for mental health professionals, as awareness around the interplay of cultural as well as religious beliefs and FNSD will enable them to devise effective and holistic therapeutic intervention.

Equipping pharmacists for delivering pharmaceutical care to seniors: a qualitative systematic review of Asian seniors' social support

BACKGROUND

Pharmacists must cater to seniors' needs and communicate better in delivering pharmaceutical care. However, pharmaceutical care for seniors is unique since they commonly depend on support from their social environment. Our study aimed to collect perceptions and experiences of Asian seniors regarding social support.

METHODS

A qualitative systematic review of peer-reviewed articles between January 2012 and January 2022 was conducted using PubMed, Scopus, Academic Search Complete via EBSCOhost, ProQuest, and Google Scholar. Selected studies were extracted, and thematic synthesis was performed.

RESULTS

A total of 23 qualitative studies with diverse rigor were included in this review. Themes that emerged around perceptions and experiences of social support were (1) family orientation, (2) having faith in religion, (3) the importance of the elderly providing support, (4) taboos, (5) elderly self-reliance, (6) elderly fear of being a burden, and (7) differences on perceptions and experiences regarding social support. A discussion on how these results may contribute to pharmacy practice is provided.

CONCLUSION

This study reviews the available social support for seniors and highlights its importance for pharmacists.

Determinants of physical, psychological, and social well-being in older adults: a cross-sectional study in senior care facilities of Pakistan (2019/20)

BACKGROUND

Published research on senior care facilities in Pakistan is scarce and no large-scale study has been conducted to assess factors affecting well-being of older adults in these facilities. This study, therefore, investigated the effects of relocation autonomy, loneliness, and satisfaction with services along with socio-demographic characteristics on physical, psychological, and social well-being of older residents living in senior care facilities of Punjab, Pakistan.

METHODS

This cross-sectional study collected data from 270 older residents living in 18 senior care facilities across 11 districts of Punjab, Pakistan from November 2019 to February 2020 using multistage random sampling. Existing reliable and valid scales were used to collect information from older adults related to relocation autonomy (Perceived Control Measure Scale), loneliness (de Jong-Gierveld Loneliness Scale), satisfaction with service quality (Service Quality Scale), physical and psychological well-being (General Well-Being Scale), and social well-being (Duke Social Support Index). A psychometric analysis of these scales was carried out followed by three separate multiple regression analyses to predict physical, psychological, and social well-being from socio-demographic variables and key independent variables (relocation autonomy, loneliness, and satisfaction with service quality).

RESULTS

The results of multiple regression analyses showed that the models predicting physical (R² = 0.579), psychological (R² = 0.654), and social well-being (R² = 0.615) were statistically significant (p < 0.001). Number of visitors was a significant predictor of physical (b = 0.82, p = 0.01), psychological (b = 0.80, p < 0.001), and social (b = 2.40, p < 0.001) well-being. Loneliness significantly predicted physical (b = -0.14, p = 0.005), psychological (b = -0.19, p < 0.001), and social (b = -0.36, p < 0.001) well-being. Control over relocation process significantly predicted physical (b = 0.56, p < 0.001) and psychological (b = 0.36, p < 0.001) well-being. Satisfaction with services significantly predicted physical (b = 0.07, p < 0.001) and social (b = 0.08, p < 0.001) well-being.

CONCLUSION

Pragmatic, equitable and cost-effective interventions are needed to improve the wellbeing of older residents living in senior care facilities. Friendly behavior of mobilizing staff and adjusted residents to facilitate new residents, therapeutic interventions such as relocation support programs, reminiscence therapy and intergenerational support, and increasing their exposure and connection to the outside world, can raise their physical, psychological, and social well-being.

Connecting the Dots between Social Care and Healthcare for the Sustainability Development of Older Adult in Asia: A Scoping Review

Globally, we face a rapid double growth of the ageing population that urges an integrated framework plan by connecting the health and social care disciplines as a shared and continuum of care approach. Bridging the gap between health and social care is required to meet the demand of ageing population needs, the readiness of the stakeholders, and community as a holistic approach. This article provides an overview of the evidence gap between social care and healthcare through a scoping review. Articles retrieved related to social and health care for older adults in the Asia region were identified through a compilation of PubMed, SAGE, Springer, and Google Scholar searches between the years 2015 to 2021. Only twelve articles were used for result generation. The majority highlights the constraint on financial support, issues related to culture, human resource competency and community participation. The systematic review of the current work provides valuable insight for future researchers and policymakers in designing sustainable development integrated long term care (LTC) framework models and plans.