Demographic Characteristics Associated with the Likelihood to Use Paid Home Care for People with Dementia among South African Muslims

Abstract

Background: In societies where the value of filial piety is observed, a preference for caregiving to take place at home exists. In fact, institutional and paid home care for people with dementia (PWD) are still taboo in some Muslim societies. However, economic development and globalisation have resulted in intergenerational separation, thus impacting the ability by young adults to provide care for the elderly at home. Objective: We establish the demographic characteristics most likely to be associated with the use of paid home care -age, gender, education level, marital status, family structure, experience with dementia care in the family, and number of dependents -for PWD among South African Muslims. Methods: A survey, administered in the form of an online questionnaire, of Muslim families across each of the 9 provinces of South Africa was conducted. Multiple logistic regression was used to test the effects of the demographic variables on the type of care choice arrangement (family as primary caregiver vs. paid home caregiving). Results: 422 responses were analysed, 28% of which indicated the respondents' desire to use paid home caregivers. The multiple logistic regression results indicate that South African Muslim families are more likely to use paid home care if they are older (that is, over 40 years; OR = 1.972, 95% CI: 1.445-2.695), are female (OR = 1.637, 95% CI: 1.089-2.457), and have high levels of education (OR = 1.828, 95% CI: 1.070-3.125). Conclusion: Home-based care is touted as the next dementia care model. Given that intergenerational mobility is likely to increase as future generations continue to participate more in the labour market, minority groups with a disposition to the same familial social values will require appropriate support in order to cope with the demands of caring for PWD. Suitable interventions for Muslim families who are not open to using external assistance, as well as those who are, need to be administered to enable the caregiver and care recipient to thrive at home.

Dementia in Africa: Current evidence, knowledge gaps, and future directions

“…131 A study in South Africa showed that less than one third of respondents were willing to pay for formal home caregivers, with higher education, female sex, and older age associated with willingness to pay. 132 The challenges of formal care setting include the risk of delirium associated with dementia due to infective causes. 133,134…”

“…Negative attitudes to formal care exist among some family members and in some societies irrespective of economic status, with religious beliefs contributing to the perspective 131 . A study in South Africa showed that less than one third of respondents were willing to pay for formal home caregivers, with higher education, female sex, and older age associated with willingness to pay 132 . The challenges of formal care setting include the risk of delirium associated with dementia due to infective causes 133,134 .…”

Evolution of the Conceptualization of Filial Piety in the Global Context: From Skin to Skeleton

“…Similarly, studies of South African Muslims (Ramaboa and Fredericks, 2019) and Muslim immigrants to France from North Africa (Duguet et al, 2016) examined the filial obligation of adult children to provide support for their aging parents. Both studies cast filial piety as an integral aspect of Islam and found that greater endorsement of this filial obligation corresponded to the increased behavior of caring for an aging parent in the home.…”

Family care for older persons in South Africa: heterogeneity of the carer’s experience

“…In their study, Russell (2003) reported that 86 per cent of rural black South African participants, 60 per cent of urban black South African participants and 49 per cent of urban white South African participants disagreed with the idea of sending an older relative to an institution to be cared for. However, Ramaboa and Fredericks (2019) showed that among their Muslim sample, there was also support for paid care workers in the home, and in Hoffman's (2016) study, younger adults were more open to placement in aged-care homes as a way of balancing employment with care responsibilities. Research on care at home has mostly examined care for people living at home with dementia (Pretorius et al, 2009;Gurayah, 2015;Ramaboa and Fredericks, 2019;Smith et al, 2020;2022) and Alzheimer's disease (Hendricks-Lalla and Pretorius, 2020;Mahomed and Pretorius, 2021), and shows that family care is not only associated with increased support needs (Smith et al, 2020), but also linked to a negative impact on quality of life (Hendricks-Lalla and Pretorius, 2020) and family relations (Gurayah, 2015;Smith et al, 2020).…”

“…Decisions, and families' capacities, to care for an older person are shaped by many factors, including demographic change, migration and the impact of HIV in limiting the capacity of the middle generation to provide care to older persons (Schatz and Seeley, 2015;. The research that exists indicates variation in support for institutional eldercare (Russell, 2003;Ramaboa and Fredericks, 2019). In their study, Russell (2003) reported that 86 per cent of rural black South African participants, 60 per cent of urban black South African participants and 49 per cent of urban white South African participants disagreed with the idea of sending an older relative to an institution to be cared for.…”