Review Article, J Aging Geriatr Med Vol: 2 Issue: 2

Conducting Social Research with Elderly: Methodological Concerns for Researchers and Older People in Southwestern Nigeria

Omolara O Ejiade and Kabiru K Salami^*

Department of Sociology, University of Ibadan, Nigeria

*Corresponding Author : Kabiru K Salami
Department of Sociology, University of Ibadan, Nigeria
E-mail: kabsalami@yahoo.co.uk

Received: January 17, 2018 Accepted: March 16, 2018 Published: March 22, 2018

Citation: Ejiade OO, Salami KK (2018) Conducting Social Research with Elderly: Methodological Concerns for Researchers and Older People in Southwestern Nigeria. J Aging Geriatr Med 2:2. doi: 10.4172/2576-3946.1000116

Abstract

Keywords: Rural population; Elderly population; Salutation; Gerontology; Older persons

Background

Globally, the demographic transitions of people aged 60 years and above are growing rapidly in both absolute number and proportions [1]. The world’s proportion of aging people increased from almost eight percent in 1950 to twelve percent in 2013 while projecting additional fast increase of nine percent by the year 2050 [2]. However, the rate and growth differ from one region to another. It is expected that older people would grow to thirty-two percent from 23 percent in more developed regions, while aging population in least developed regions is projected at 19 percent in the year 2050 [2]. Conversely, Nigeria had the largest elderly population in sub-Saharan Africa with 6.6 million people above 60 years in 2006 and predicted to have over 12 million elderly in the year 2030 [3]. The projected elderly population alone in the year 2030 in Nigeria will be larger than the projected total population of many individuals in advanced countries [4].

However, the increasing growth of elderly population in Nigeria will propel research on the elderly category, in diverse disciplines to spring up in an effort to understand, describe, and treat problems of aging. Social research will investigate impact of availability or non-availability of social programs and services; and psychological research will be conducted on memory, personality and cognition. In addition, medical research will involve physical aging, diseases and conditions and other interventions, while marketing research will be conducted to influence the buying decisions of a growing market sector [5]. Basically, the three major research paradigms in social and behavioural sciences can be conducted among the elderly. The qualitative research which rely primarily on the collection of openended and qualitative data, the quantitative data which depend on the collection of quantitative data and mixed research which involve the mixing of quantitative and qualitative methods or paradigm characteristics [6,7] are all relevant and useful ways to collect data among elderly.

Conducting social research among the elderly can be quite challenging and demanding especially as elderly is considered one of the most vulnerable groups in a society [8,9]. The health domains of the vulnerable populations can be mainly classified into three categories vis-à-vis social, physical and psychological domains. The social domain of vulnerable population includes those living in abusive families, the homeless, immigrants and refugees [10]. The needs of these populations are vital, serious, debilitating and characterised by poor health either experiencing single illness or more significant comorbidities. The physical domain includes population who are pruned to medical conditions such as respiratory diseases, heart disease, hypertension and diabetes. Invariably, 87% of elderly experience at least one or more chronic conditions and sixty-seven percent of this population have two or more chronic illnesses [11]. The psychological domain include those with chronic mental conditions such as bipolar disorder, major depression, schizophrenia, history of substance abuse, prone to homelessness as well as attention-deficit/ hyperactivity disorder [11].

Contextually, not every elderly or aging people are considered as vulnerable. In fact, aging constitutes a continuum category of (a) independence, (b) dependence and (c) interdependence [12]. Older people who are essentially independent and coping well with daily life belong to the first category. This set of elderly is few. Elderly people who require some assistance in their day-to-day lives are in the second category and they constitute more population than the first category, while those who depend on others for support and care are the last category and constitute majority among elderly [12]. Understanding the appropriate methodological framework to use among different categories of elderly for research from study design to sampling criteria and data collection increases the quality of research outcomes [13,14].

The elderly category has global nomenclature which comprises: seniors (American usage); older adults or older people (in the social sciences); the elderly, elders (in many culture); senior citizens (American and British usage), and old people (worldwide usage) [15]. For the purpose of this paper, the terms elderly or older people would be used interchangeably to refer to old people, while cut off age is placed at 60 years, the retirement age in Nigeria. This paper pays attention on some criteria for consideration while about to conduct survey research among elderly population in Nigeria especially using questionnaire as a tool to elicit information from older people who do not live in nursing or care homes.

The following are indispensable methodological issues in conducting Social research with elderly in Nigeria.

Questionnaire Design and Methods

Designing questionnaire for the elderly population also entails some general rules of designing good questionnaire for general population. Identification of variables of interest, through study objectives guiding developing questions that would capture the needed information of those study interests in simple and clear manner is important [16]. Methods to administer questionnaires among elderly play critical roles in determining the acceptance and also in influencing research findings, hence, suffice to know is the position of Tourrangeau et al. [17] which indicates that researchers should determine the type of methods to be used to administer the instrument before the onset of designing questionnaires [17].

Researchers have to consider the choice of design in questionnaire administration. Features of questionnaire for intervieweradministered would be different from self-administered questionnaire based on different target population [18]. While self-administered questionnaires can be mailed or given in person to the respondents with questions in the instrument short and simple, the intervieweradministered questionnaires which can be face-to-face (personal) or through telephone conversation, with questions which could be little complex or nested or featuring significant probing ways may be more appropriate for elderly population in the Nigeria context. For the interviewer-administered, target respondents are not necessary to be literate since it allows probing for additional information and participation potentially increased by personal contact [19]. Leverage on several factors in Nigeria such as elderly literacy rate of 26.4% [20], moribund mailing system in the country while a study intends to capture large participants of elderly and build participation, the appropriate and recommended way to administer questionnaires on the population is intervieweradministered method.

Research skill of the researcher and research assistants

Invariably the research skill characteristic of research assistants can influence the research output and its quality. Thus, researchers among the elderly in Nigeria need to consider some salient factors that research assistants should possess. The age range of research assistants speaks and attracts a lot of respect from the elderly. Clearly, elderly prefer a research assistant who is sensitive, patient and of good ability to connect with the population by showing empathy, ability to speak local language and express appreciation for their participation. These prompt elderly people to develop trust for the study and participate actively. According to Minocha et al. [21], the older people show preference to conversations interview such as researcher-administered questionnaire to self-administered interview protocol while enjoying conversations with the researchers. In other words, when conducting research with the elderly, it is of importance for research assistants to listen adequately with patience. Some elderly will like to talk more as if they are trying to recollect and coordinate their thoughts. Also, difficulty in recalling details of events could be problem for elderly hence researchers require some flexibility of time with procedures. A great deal of time and patience is needed to ensure elderly recall rightly.

Obtaining informed consent

The issue of informed consent among the elderly may present some complications even though elderly are always ready to participate as it provides an opportunity to interact. However, in other not to take this for granted the Belmont Report [22] identifies three components to adequate informed consent: information, comprehension, and voluntariness. Researchers will need to ensure that elderly are presented with information regarding respect for persons, risks and benefits procedures for the study. Thus it is advised that an assessment of subjects’ decisional capacity may be required prior to completing the informed consent process. As regards issues of consent of the elderly adults with cognitive limitations the Mini-Mental Status Exam (MMSE) or the MacArthur Competence Assessment tool for Clinical Research were suggested to determine the decisional capacity of the elderly with mild to moderate cognitive impairment [23-26].

Also it is expedient that the consent forms should be clear, concise and be presented in large text/font so as to facilitate easy comprehension because it is observed that as we get older the lenses of the eye gets less elastic. Extensive and repetitive communication with the elderly regarding study purpose and protocols may be necessary to ensure and promote understanding of risks, benefits, and study procedures. Researchers may also involve permission of relatives, loved ones or caregivers of the elderly for obtaining consent if the subject is unable to do so on his or her own or in the case of an elderly with severe cognitive impairment. It is important to take as much time as necessary to check the understanding of participation in a gentle, non-threatening way, and to be very tactful when excluding people who cannot provide informed consent.

Salutations/Greetings

Social researchers regard greetings as conditions for establishing social relationship and are expected to occur before and after social encounters in research. Methods and styles of greetings defer greatly around the world and it is important to know what is expected in different circumstances and across age categories. Each society has their own uniqueness when it comes to greetings; what is applicable in Europe might not be applicable in Africa. In some parts of Europe, it is appropriate to bow with a slight click of the heels, in Japan, the deep respective bow is appropriate. The widespread evidence that greetings are an important part of the communicative competence necessary for a researcher. Good communication is needed in research and communication starts from the greeting pattern. In Africa, elderly are known to be custodians of culture and they are fond of passing information and wisdom to younger generations [27]. For instance, Yoruba people have diverse ways of greetings for various activities, time and seasons. Thus, for researcher to engage Yoruba elderly in an interview, ways of greetings must be well understood. For instance, a male researcher must know how to prostrate at half way while female researchers knee down, perhaps half way to greet people around the respondents. However, Nigeria as a country has several ethnic groups and each of these ethnic groups has their own specific and unique way of giving accolades to the elderly, so what is obtainable among the Yoruba which is simply kneeing down or prostrating may not be required among the Igbo in the eastern Nigeria or Hausa in northern Nigeria. Simply put, it is important for researchers conducting studies among the elderly to understand what is obtainable in that particular society. The researcher must understand the culture of the society in terms of the form of greeting the elderly, this will greatly help the researcher to connect, gain rapport, get the attention of the elderly and a shared field of interaction may be established with appropriate greeting.

Availability and timing for interviews

Knowing the appropriate time to conduct interview with elderly is very crucial to the result outcomes. Basically, most elderly do not really engage in formal economic activities since many of them would have retired from formal jobs. However, it is expedient to understand how time is available to them in order to get best responses out from them. In a study conducted by Hall, Longhurst and Higginson [13] among elderly, it was documented that avoiding busy times of the day such as mealtimes or regular visits by relatives was necessary to approach the elderly and preferably allowing them time to recover from previous activities before commencing the interview. It was also found in the study that it was best not to interview residents after lunch as they were often tired and lethargic at that time. Interviews were often postponed at moments when the researcher noticed the elderly didn’t feel well or had an unexpected visitor, or simply did not feel like participating at a particular moment. Hence, the researcher had to spend a great deal of time waiting for the elderly to finish activities.

Conversely, the environmental uniqueness and dynamics of a society also influence the elderly's availability for participation in a study. For instance, the elderly people in the southwestern geopolitical zone in Nigeria would possibly give audience to researchers from around ten o’ clock in the morning especially when their caregivers might have gone out for their daily activities. Even those that live alone definitely need people to interact with; and the time may be a very good time for elderly to attend to researcher without distractions. Similarly, as part of ethical responsibility to minimize risks to the elderly when conducting research, it is important to observe their nonverbal signs of fatigue or anxiety during the interview [28].

Effective communication

Research requires effective communication to optimize participants’ responses. A researcher needs a caring and respectful attitude towards the elderly. Being an attentive listener conveys this attitude to the elderly [29]. It is important to make eye contact, make use of calm voice, and refrain from talking down to the elderly, contradicting their statements, or quizzing about details [30]. Also, researchers need to understand the communication challenges for those with special conditions, for example in cases of dementia mild difficulties in word finding, abstract reasoning, and following complex conversations may occur [31]. In addition, it takes longer for individuals to register verbal stimuli such as interview questions. Individuals with such condition also experience fluctuating awareness and attention and concentration lapses in the early stages [32]. In situations of elderly with unique conditions, it is important for the researcher to have understanding of the condition in order to aid communication. Also the researcher must be open-minded and be available to acknowledge varying degrees of communication challenges. Hence, restructuring questions that may be too abstract or sometimes simplifying the questions for the elderly to comprehend [33] and or use terminology that is familiar and understandable to the participant [28] is an effective strategy to confront communication challenges. In addition, the researcher must allow ample time for the participant to respond to a question or remark. If they are struggling to find a word, the researcher can reassure respondents [30]. Providing cues such as photos or using reminiscence to trigger memories may encourage the elderly to respond to an issue [34]. A useful strategy to use when participants dwell on a topic is to first validate the meaningfulness of their experience, and then gently redirect them to a different topic [35].

Older people may experience some cognitive or functional deficits as a part of normal developmental changes, such as memory deficits, diminished vision, hearing difficulty, increased reaction time, and fatigue [36]. Age related memory deficits may decrease the accuracy of recall [14]. Corser et al. [37] found that increased age was associated with poorer levels of concordance between patientreported co-morbidity data and medical record documentation. Thus, frequent verbal or written follow up and prompting may be necessary during the study. Any written materials should be presented concisely and in large print in order to increase participant understanding of instructions, study aims, and protocols [38,39]. Furthermore, options for alternative forms of communication and information delivery, such as oral and visual demonstrations, should be considered if literacy levels of older adult participants preclude written materials. For instance, if a study was to be conducted in the Eastern part of Nigeria, it is very important that the questions are translated to the local language being spoken and understood in the region in order to facilitate easier comprehension.

Interview site

When considering interview sites for the elderly, the home happens to be the suitable place to conduct such interviews. The elderly will be more relaxed while it allows the investigator to be privy to much information that he or she would not have access to if the research was conducted in another setting. As a consequence, the researcher may be more likely to be a witness to something that is threatening to the participant's health or life. This is not an unusual occurrence because homebound older adults may be especially vulnerable to elder abuse due to their increased social isolation, physical impairment, cognitive impairment, and dependence on others for care [40-43]. Elder abuse is a broad term that includes physical abuse, sexual abuse, emotional or psychological abuse, financial or material exploitation, neglect by a caretaker, and self-neglect. Furthermore, considering where to use for the study, it is important for the researcher to make use of quiet places in order to eliminate extraneous noise. This is because at old age, some elderly experience difficulty in hearing properly.

Conclusion

The paper examines the various ways and approaches to conducting research among various categories of elderly in Nigeria. Looking at the literacy level of the elderly population in Nigeria, it is suggested that questionnaires would be a suitable tool to use to generate data from the elderly, while interviewer-administered questionnaires method deemed appropriate in conducting quantitative research among elderly. Researchers and research assistants need to possess some cultural skills which are acceptable to the elderly population, thus creating viable means of increasing research quality outcomes.

References

1. WHO (2015) Ageing and Health.
2. United Nations, Department of Economic and Social Affairs, Population Division (2013). World Population Ageing 2013.
3. The Guardian (2012) Poorer Countries must Adapt to Health Needs of Elderly.
4. United Nations Population Fund (UNFPA) (2015) The State of World Population.
5. Centers for Disease Control and Prevention (2007) The State of Aging and Health in America 2007 Report.
6. Lafferty A, Treacy MP, Fealy G, Drennan J, Lyons I (2012) Older People’s Experiences of Mistreatment and Abuse, NCPOP, University College Dublin.
7. Anne van der Vorst GA, Zijlstra R, De Witte N, Vogel RGM, Jos MGA, et al. (2017) Explaining discrepancies in self-reported quality of life in frail older people: a mixed-methods study. BMC Geriatrics 17: 251.
8. Morrow BH (1999) Identifying and mapping community vulnerability. Disasters 23: 1-18.
9. Frigerio I, De Amicis M (2016) Mapping social vulnerability to natural hazards in Italy: A suitable tool for risk mitigation strategies. Environ Sci Policy 63: 187-196.
10. Aday LA (1991) Who are the vulnerable? In: At Risk in America: The Health and Health Care Needs of Vulnerable Populations in the United States. (2ndedn), San Francisco. Calif: Jossey-Bass 1-15.
11. Partnership for Solutions (2002) Chronic conditions: making the case for ongoing care. Johns Hopkins University
12. World Health Organization (2007) Women, ageing and health: A Framework for Action. Focus on Gender.
13. Hall S, Longhurst S, Higginson I (2009) Challenges to conducting research with older people living in nursing homes. BMC Geriatrics 9: 38.
14. Levy J, Holmes D, Smith M (2003) Conceptual and methodological issues in research on age and aging. J Acquir Immune Defic Syndr 33
15. World Health Organisation (2014) Definition of an older or elderly person. Proposed working definition of an older person in Africa for the MDS Project. Health statistics and information systems.
16. McColl E, Jacoby A, Thomas L, Soutter J, Bamford C, et al. (2001) Design and use of questionnaires: a review of best practice applicable to surveys of health service staff and patients. Health Tech Assess 5: 31
17. Tourangeau R, Rips LJ, Rasinski K (2000) The psychology of survey response. Mode of data collection. Cambridge University Press 289-312.
18. Bowling A (2005) Mode of questionnaire administration can have serious effects on data quality. J Public Health (Oxf) 27: 281-291.
19. Bower P, Roland MO (2003) Bias in patient assessments of general practice: general practice assessment survey scores in surgery and postal responders. Br J Gen Pract 53: 126-128.
20. World Data Atlas (2015) Nigeria elderly (65+) literacy rate.
21. Chase J (2013) Methodological Challenges in Physical Activity Research with Older Adult. West J Nurs Res 35: 76-97.
22. Federal Register (1979) Protection of Human Subjects: Belmont Report- ethical principles and guidelines for the protection of human subjects of research. U.S department of health, education and welfare.
23. Black B, Brandt J, Rabins P, Samus Q, Steele C, et al. (2008) Predictors of providing informed consent or assent for research participation in assisted living residents. Am J Geriatric Psychiatry 16: 83-91.
24. Jefferson A, Lambe S, Moser D, Bylerly L, Ozonoff A, et al. (2008) Decisional capacity for research participation in individuals with mild cognitive impairment. J Am Geriatrics Society 56: 1236-1243.
25. Kahn D, Courgeois J, Klein S, Iosif A (2009) A prospective observational study of decisional capacity determinations in an academic medical center. Int J Psychiatry in Medicine 39: 405-415.
26. Rubright J, Sankar P, Casarett D, Gur R., Xie S, et al. (2010) A memory and organizational aid improves Alzheimer disease research consent capacity: Results of a randomized, controlled trial. Am J Geriatric Psychiatr 18: 1124-1132.
27. Pew Research Centre (2014) Attitudes about aging: a global perspective.
28. Moore T, Hollett J (2003) Giving voice to persons living with dementia: the researcher’s opportunities and challenges. Nursing Science Quarterly 16: 163-167.
29. Proctor G (2001) Listening to older women with dementia: Relationships, voices and power. Disability & Society 16: 361-376.
30. Bouregeois M (2002) “Where is my wife and when am I going home?” The challenge of communicating with persons with dementia. Alzheimer’s Care Quarterly 3: 132-144.
31. Warchol K (2006) Facilitating functional and quality-of-life potential: Strength-based assessment and treatment for all stages of dementia. Topics in Geriatric Rehabilitation 22: 213-227.
32. Downs M (2005) Awareness in dementia: In the eye of the beholder. Aging & Mental Health 9: 381-383.
33. Beuscher L, Grando V (2009) Challenges in Conducting Qualitative Research with Person with Dementia. Res Gerontol Nurs 2: 6-11.
34. Robinson J (2000) Phases of the qualitative interview with institutionalized elderly individuals. J Gerontol Nurs 26: 17-23.
35. Davis L (2005) Educating individuals with dementia: Perspectives for rehabilitation professionals. Topics in Geriatric Rehabilitation 21: 304-314.
36. Charness N (2008) Aging and human performance. Human Factors 50: 548-555.
37. Coser J, Rosa BC, Hansen D, Bianchi DP, Krug M, et al. (2017) Malnutrition risk and hospitalization in elderly assisted primary care. Genc. Suade Colevita 22: 2.
38. Samelson EJ, Kelsey JL, Kiel DP, Roman AM, Cupples A, et al. (2008) Issues in Conducting Epidemiologic Research Among Elders: Lessons From The MOBILIZE Boston Study 168: 1
39. Laird M, Conn V (1996) Nursing challenge: Conducting research with older adults. J Nursing Sci 1: 5-6.
40. Jackson J, Mandel D, Blanchard J, Carlson M, Cherry B, et al. (2009) Confronting challenges in intervention research with ethnically diverse older adults: the USC Well Elderly II Trial. Clinical Trials 6: 90-101.
41. Lachs M, Pillemer K (2004) Elder abuse. The Lancet 364: 1263-1272.
42. National Center on Elder Abuse. Prepared for the Administration for Children and Families and the Administration on Aging in the U.S. Department of Health and Human Services. (1998) The national elder abuse incidence study. 1998.
43. Chouliara Z, Kearney N, Worth A, Stott D (2004) Challenges in conducting research with hospitalized older people with cancer: drawing from the experience of an ongoing interview-based project. European J Cancer Care 13: 409-415.