Introduction: Spaces and practices of care for older people in Sub-Saharan Africa

A cross-cultural investigation of the conceptualisation of frailty in northern Tanzania

“…In this rural subsistence-farming region of Tanzania, ‘real’ old age and frailty began when one stopped being able to work and produce meaningfully, and thus became financially reliant on family. This finding resonates with previous anthropological work, in that this period of frailty in old age was described as a return to a ‘childlike’ status (Cattell, 1990, 2002; Guillette, 1990; Freeman, 2018). This conceptualisation of frailty as a return to ‘childlike’ dependency, to many western perspectives, may seem to be a negative and infantilising stereotype.…”

“…Freeman describes how Malawians thought of body fluids as containing a ‘life force’ or energy, so that the body's energy may be referred to as ‘blood’. The lifecourse was explained as a ‘linear trajectory of diminishing blood (power/strength) until death’ (Freeman, 2018: 119). The same explanation for frailty was used by many in this study to explain the gender difference in frailty.…”

“…That is, care, through productive physical work for the subsistence of one's dependants, was what constituted a social ‘adult’. Differing from Cattell's findings, older people resisted returning to a ‘childlike’ identity by emphasising their bodies’ past productivity, and by doing as much as their bodies would allow them to do (Freeman, 2018). This finding echoes that of Becker (1994) in an investigation of older people with frailty in the United States of America, and is a common finding in HIC qualitative work, where the label of frailty is often rejected or resisted by older people (Grenier, 2006; Lloyd et al ., 2014; Warmoth et al ., 2016).…”

“…In a grounded theory study of older people in Malawi, hard physical work was necessary for subsistence and survival, and was again discussed as a means of attaining the status of a socially valid ‘adult’ (Freeman, 2018). Additionally, this work was conceptualised as a form of care, given that work was not only for the individual's subsistence, but an act of care-taking for the family and wider community (Freeman, 2018). That is, care, through productive physical work for the subsistence of one's dependants, was what constituted a social ‘adult’.…”

Family beliefs about care for older people in Central, East, Southern and West Africa and Latin America

“…Given the pervasiveness of familism and the UN Decade Call for Action, it is timely to explore and respond to notions of familism and its potential for impact on families. To date, there has been very little examination of the extent to which familism is embraced by family members themselves, or about how the concept of familism relates to contemporary contexts of care (Hoffman and Pype, 2016). In this article, we address the challenge of framing responsibility for care within familist discourses by undertaking a review of the state of knowledge of beliefs of family members about care for older people in CESW Africa and Latin America.…”