Africa is population-wise a young continent and will be the youngest region on the globe for the foreseeable future. This young face of the continent however masks a silent longevity revolution with increasing absolute numbers of older people in all their diversity across all levels throughout pan-Africa (He et al., 2020). Africa is a continent with many voices and her people grow old in a variety of settings. Recognising the foundational importance of gender in shaping later life experiences it is important to acknowledge the heterogeneity and the diversity of older persons’ life courses, lived realities, disabilities, impairments, experiences, inequalities and opportunities, perspectives, and choices and contexts.
It is thus pertinent and opportune to celebrate and problematize research on ageing in Africa in this special edition: twenty years after the Madrid International Plan of Action on Ageing (MIPAA) (UN, 2002) and the adoption in 2002 of the first African Union Policy Framework and Plan of Action on Ageing (AUPFPAA) (AU, 2003), and almost 20 years since the establishment of the African Research on Ageing Network (AFRAN) at the Oxford Institute of Population Ageing (University of Oxford) as pivotal signposts for and catalysts of research and policy development in Africa. Not only is this edition a coming-of-age celebration of research on ageing in parts of the continent but also evident of the still existing gaps in the research / policy endeavour towards a critical home-grown Gerontology in Africa.
In her commentary, Aboderin reflects on this journey and its relative attainments over the past two decades (albeit that the gerontological community on the continent barely scratched the surface), and critically engages with the issues that should still be addressed: both scholarly and in the policy realm; both conceptually and on a methodological level. Notwithstanding, an ever-increasing body of knowledge is generated by an expanding core group of researchers across the continent.
In this volume, Mokgolodi qualitatively explores the agency and reinvention of retired educators and their contributions through intergenerational transmission towards underwriting the career development of younger persons. While many older people live in poverty and ill-health across the region, others enjoy agency, influence and robust health. Although not generalizable, this Botswana case is illustrative of how specifically acquired capabilities are transferable to other domains more generally (in this case from educators to mentoring). It is in line with the need of younger job seekers for enhancing their self-efficacy and self-esteem (soft skills) as found in Paver et al., (2020), where the authors specifically measured the psychosocial needs of unemployed people through a pre- and post-intervention programme.
Mokgolodi’s study is illustrative of the interrelated strategic objectives on which the newly revised AU Framework draw upon, namely:
“…the recognition of the worth and inherent dignity of Africa’s older persons and to recognise, support and harness older people’s intergenerational roles and influences to adapt existing or forge new social, health, political and economic systems and structures to enhance the capacities, engagement and well-being of all generations;”
an “…indelible realization that investments in ageing and older populations are not separate from, marginal to, or detracting from objectives to enhance the prospects of children, youth, and women in pursuit of social and economic development.”; and
“…that strategic investments across the life course to enhance capacities and well-being in older age can benefit both older and younger people today and in future as well as foster cohesive and prosperous societies. This is because such investments can harness the linked lives of old and young, and the intergenerational influences that older persons wield on the exposures, opportunities and perspectives of young people, at family- and community- and societal levels. Moreover, investments in capacities and well-being in later life have the potential to leverage older people’s latent transformative assets: their experience and generativity.” (AU, 2022: Section A2).
With the verticalization of family structures due to increasing longevity where more generations live together for longer periods; interfaced with the feminization of care, Iwuagwu, et al. explores the challenges of older female carers caring for their older relatives (the so called “old-old” - 80 years and older). This is an under-researched aspect of research on care and the family in Africa. Given the obvious caregiver burden, the findings are to be expected. Of particular interest is, however, the need to better understand sibling care dynamics in view of, in this case, poor or lack of support from male siblings.
Africa looks to families and their communities as key social groups in which older people’s lives unfold and which challenges and opportunities of later life are to be understood. At the same time – and whilst recognising the strain on families’ capacities and resources – Africa looks to families and communities as a strength upon which development in the continent can and must build (see AU, 2022).
Apart from poverty, internal challenging family dynamics, and systemic infrastructural challenges; families and individuals in Africa are also impacted by displacement due to economic, political, and environmental shocks. In two related articles from a group of Nigerian scholars, Ekoh, et al. and Okah, et al. respectively explore the issue of internal displacement and its impact on family structures and roles, and then more systemically, the impact of displacement in terms of abuse on older individuals in an Internally Displaced Persons (IDP) Camp, Lugbe, Abuja, Nigeria.
Africa is experiencing a set of major demographic, social and environmental trends, key among which are migration and displacement, urbanization and the growth of urban informal settlements, climate change and emergencies as well as their implications for rural development. Older people are affected by- and at the same time, can shape the form of, and responses to these critical concerns. The integration of responses on these trends with responses on ageing and older persons is vitally important, therefore, ageing must be applied as a lens to inform responses across each of these critical concerns and, vice versa (see AU, 2022).
The next corpus of three articles interrelatedly focusses on access to health and integrated care, on levels of institutionalisation, the community, as well as the family.
Amegbor and Rosenberg analyse, using the WHO SAGE (wave 1), data to determine the effect of place, chronic health conditions, and socioeconomic status on the risk of overnight hospital admission; in other words, the frequency of hospitalisation among older persons in Ghana. As expected, the findings show that older adults with functional limitations and chronical health conditions were more likely to have experienced an overnight hospital admission. However, the analysis highlights that socioeconomically vulnerable older persons were less likely to have overnight hospital admission with lower admission rates: poor socioeconomic status and vulnerabilities may imply underutilization or limited access to healthcare.
The socioeconomic lower- and middle older groups in Nigeria negotiate the issue of poor access to health care at the interface with the proliferation of counterfeit drugs sold by drugstores and street vendors. Findings of this explorative qualitative study by Ekoh, et al. revealed that, particularly rural poor older women, navigate towards the use of similarly unregulated alternative medicines. The call by the authors is for regulation and the provision of health insurance.
The responsiveness of health care services to the more chronic and complex health problems and priority health needs of older people remains minimal. At the same time older persons face geographical, physical, financial, technology-related and other barriers to accessing health care, as well as obstacles related to conditions in health facilities and ageist attitudes on the part of health workers. Action is needed to align health systems to the needs of older populations within the context of Universal Health Coverage. The overall aim must be to remove access barriers and provide services that maintain or enhance older persons’ ‘intrinsic’ physical, mental and psychosocial capacities and prevent care dependence (see AU, 2022).
Makiwane, et al. tackles the issue of integrated care by evaluating South Africa’s hybrid care system as it is operationalised through older persons’ services in the province of Gauteng, South Africa on the levels of family, residential and community care. This study argues for the use of an integrated approach of the three existing care models: in essence an Ethics of Care approach is suggested in which, anchored in a strong case management system, the person / relation centredness of an individual is linked to multi-dimensional contextual factors (see Pot et al., 2022).
This special edition concludes with a contribution by Curreri, et al. on what make communities to create environments that support older adults? To get a unique and macro Global South perspective, a scoping review was undertaken to determine the state of knowledge of what elements of rural and remote communities influence the well-being of older adults in Central/East/Southern/West (CESW) Africa and Latin America. Findings highlight communities’ limited control over external services, infrastructure and formal partnerships that influence the well-being of older people. The involvement of policy makers are crucial in that they should take note that community capacity to support older persons must be evaluated in light of these macro / meso level constraints that are often beyond the agentic control of older persons themselves, and even communities.
Given the recent approval of the revised the African Union Policy Framework and Plan of Action on Ageing by the Heads of Member States of the African Union at the 41st Ordinary Session of the Executive Council, 14–15 July 2022, Lusaka, Zambia as Executive Council Decision [EX.CL/Dec.1169(XLI)], it is aspirational and apt to conclude and summarize these editorial comments with parts of the preamble as a vision on ageing in Africa for the next two decades (see AU, 2022):
The Assembly of Heads of State and Government of the African Union (the Assembly) is,
the equality and value of all older persons in all their heterogeneity and the diversity of their lived realities, disabilities, impairments, experiences, opportunities, perspectives and choices as full members of society;FormalPara Further recalling
that the rights of those living in the most vulnerable situations, including persons with disabilities, were recognised in achieving the Millennium Development Goals and the succeeding Sustainable Development Goals;FormalPara Acknowledging
that older persons have inherent dignity and individual autonomy including the freedom to make one’s own choices;FormalPara Further acknowledging
the will and preferences of older persons through their full and active participation and inclusion in society;FormalPara Concerned
that older persons continue to experience human rights violations, systemic discrimination, social exclusion and prejudice within political, social and economic spheres;FormalPara Recognising
that families, guardians and caregivers play essential roles in the lives of older persons and that they should be supported in such;FormalPara Concerned
that effective and adequate measures have not been taken to ensure that older persons may exercise their full rights on an equal basis with others;FormalPara Noting
with appreciation the contributions of civil society, particularly Older Persons Organisations and their families, to the progress achieved, including through continuous awareness-raising of the rights of older persons, innovation of good practices, and engagement in policy influence;FormalPara Further noting
with concern the disproportionate impact on older persons in Africa of armed conflicts and other emergencies including natural disasters, health epidemics, and climate change impacts;FormalPara Determined
that the rights and dignity of older persons should be promoted, protected and ensured to enable them to enjoy all their human rights and fundamental freedoms entirely on an equal basis with other.
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Pot, AM., Oliveira D., & Hoffman J. (2022). Towards healthy ageing in China: shaping person-centred long-term care. Lancet. Dec 3; 400(10367): 1905–1906. doi: https://doi.org/10.1016/S0140-6736(22)02361-3.
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Hoffman, J. Ageing in Africa as the Youngest Region: Research-Policy Emergence. Population Ageing 15, 879–883 (2022). https://doi.org/10.1007/s12062-022-09407-0