AN IN-DEPTH RESEARCH ON SOCIAL ISOLATION AND HEALTH-PROMOTING PRACTICES AMONG OLDER INDIVIDUALS LIVING WITH VARIOUS HEALTH STATUSES IN NIGERIA

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Social isolation, especially in the elderly population, is gaining acknowledgement as a critical public health concern with extensive consequences for health and overall well-being. Social isolation is frequently characterised by an absence of significant social interactions, restricted social networks, and rare participation in social activities (Fakoya et al., 2020). The impact of social isolation on older individuals, particularly those with diverse health conditions, can be significant. Research indicates that social isolation correlates with various adverse health effects, encompassing mental health issues, cognitive deterioration, and heightened rates of morbidity and mortality (Cotterell, Buffel & Phillipson, 2018; Zhang & Liu, 2016). In Nigeria, as traditional family structures and social networks evolve, older individuals may face heightened risks of social isolation, particularly as health issues and mobility limitations become more evident in their later years.

Nigeria, akin to numerous developing nations, is experiencing demographic transformations, characterised by a rising population of older adults as a result of advancements in healthcare and a reduction in birth rates. Nevertheless, with the rise in life expectancy, there is a corresponding increase in the probability of chronic illnesses, disabilities, and social isolation. The conventional family and community frameworks in Nigeria, characterised by the care of older adults by extended family members, are diminishing as a result of urbanisation, migration, and socio-economic challenges (Akinyemi et al., 2017). As a result, elderly individuals may find themselves devoid of the intimate support networks that were historically common in numerous Nigerian communities. The phenomenon of social isolation among older adults is frequently intensified by various health conditions, including mobility limitations, sensory impairments, and chronic diseases. The presence of these health conditions may diminish their capacity to engage in social activities, thereby exacerbating their isolation from family, friends, and the broader community (Courtin & Knapp, 2017). For example, elderly individuals coping with stroke, diabetes, or various chronic conditions may encounter both physical and emotional obstacles that hinder their ability to sustain social relationships, consequently heightening their feelings of isolation. The connection between isolation and adverse health outcomes (Breheny & Severinsen, 2018) underscores the importance of investigating strategies to mitigate this issue and enhance the well-being of older adults in Nigeria.

The connection between social isolation and health has been extensively explored in academic literature. Individuals who experience social isolation often exhibit elevated stress levels, compromised immune responses, and a heightened susceptibility to cardiovascular diseases, hypertension, and depression (Holt-Lunstad et al., 2017). In older adults, the risk becomes significantly heightened, as social isolation may result in declines in both physical and mental well-being. The impact of social isolation on mental health is significant. Individuals in advanced age who experience a deficiency in social support or engagement face an elevated risk of encountering depression and anxiety. Research indicates that loneliness, an element of social isolation, serves as a significant predictor of depression in later stages of life (Courtin & Knapp, 2017). Furthermore, cognitive decline presents a significant concern, as studies suggest that older adults who experience social isolation face a heightened risk of developing dementia and various forms of cognitive impairment (Shankar et al., 2018). This situation raises significant concerns in Nigeria, where mental health services frequently suffer from inadequate funding, and there exists a notable lack of awareness and access to support for older adults facing cognitive health challenges.

Practices that promote health, including consistent physical activity, nutritious eating, social involvement, and cognitive engagement, are crucial for sustaining health and well-being in later life (Boulos et al., 2017). These practices can alleviate the negative impacts of social isolation and assist older individuals in managing their health conditions with greater efficacy. For example, participation in physical activity has demonstrated benefits for cardiovascular health, mobility, and mental well-being (Taylor, 2018). Engagement in social activities, including involvement in community events, religious assemblies, or volunteer efforts, can alleviate feelings of loneliness and foster a sense of connection.

In Nigeria, the potential for older adults to participate in health-promoting practices is frequently constrained by various factors, such as inadequate infrastructure, the absence of age-friendly environments, and socio-economic challenges (Ajayi et al., 2020). Individuals in advanced age, grappling with a range of health conditions, often encounter heightened challenges, as their capacity to engage in social and physical activities may be limited by their health circumstances. Moreover, cultural obstacles may hinder the adoption of specific health-promoting practices, as longstanding beliefs regarding ageing and well-being might dissuade older individuals from engaging in physical activity or pursuing mental health assistance (Akanimohb et al., 2017).

The healthcare system in Nigeria encounters considerable obstacles in delivering sufficient care for the elderly population. The constraints of limited resources, insufficient staffing, and the absence of specialised services for the elderly have significantly impeded the healthcare system's capacity to address the increasing demands of the ageing demographic (Ogunniyi & Baiyewu, 2018). The challenge of social isolation exacerbates this issue, as older adults who find themselves isolated tend to have reduced access to healthcare services, potentially leading to delays in the treatment of health conditions. In rural regions, where the healthcare infrastructure is notably constrained, elderly individuals may encounter considerable obstacles in obtaining care, further intensifying their isolation and health difficulties (Fakoya et al., 2020).

In light of these challenges, the implementation of health-promoting practices is essential for enhancing the quality of life among older adults, particularly those experiencing social isolation. Strategies that foster community engagement, enhance healthcare accessibility, and support both physical and mental health can effectively alleviate the adverse impacts of social isolation. In Nigeria, there is an increasing acknowledgement of the necessity to tackle the health and social care requirements of older adults, especially as the population ages and the prevalence of chronic diseases rises. Thus, the necessity for this investigation.

1.2 Statement of the Problem

The phenomenon of social isolation is increasingly recognised as a pressing issue among the elderly population, especially in developing nations such as Nigeria, where cultural and socioeconomic dynamics play a crucial role in influencing the welfare of older adults. With the ageing population, there is a rising occurrence of health conditions in older adults, resulting in varying levels of health status that may influence their social engagement and overall quality of life (Abdulraheem et al., 2020). Despite the established consequences of social isolation on mental and physical well-being, such as increased susceptibility to depression, anxiety, and chronic illnesses, there exists a significant deficiency in comprehending how these elements interact within the Nigerian framework.

In Nigeria, older adults frequently encounter various obstacles to social engagement, such as physical disabilities, insufficient transportation options, and the erosion of social networks resulting from the loss of peers or family members (Adebayo et al., 2021). Moreover, the cultural norms that have historically prioritised familial support are increasingly being undermined by urbanisation and migration, resulting in a heightened vulnerability to loneliness and isolation among many elderly individuals. The lack of social connection can worsen pre-existing health conditions and impede the pursuit of health-enhancing practices, which are vital for sustaining both physical and mental health (Ene-Obong, 2019).

Practices that promote health include various activities designed to improve well-being, such as consistent physical exercise, balanced nutrition, and active social participation. Nevertheless, the degree to which older individuals participate in these activities can be profoundly affected by their health condition. For instance, individuals with chronic illnesses might encounter difficulties in engaging with community activities or may lack sufficient support from carers to uphold an active lifestyle (Odukoya et al., 2022). This scenario establishes a detrimental loop in which compromised health results in social isolation, thereby exacerbating health and overall well-being.

Although there is a growing recognition of the impact of social isolation on older adults, research specifically examining the connection between social isolation and health-promoting behaviours among older individuals in Nigeria remains scarce. Grasping this relationship is essential for formulating precise interventions that can adeptly cater to the distinct requirements of older populations. An urgent inquiry is required to explore the impact of diverse health conditions on the ability and motivation of older adults to participate in health-enhancing behaviours, alongside the influence of social networks in either supporting or obstructing these endeavours. Furthermore, the current healthcare framework in Nigeria frequently does not adopt a comprehensive strategy for geriatric care, neglecting to consider the complex dimensions of ageing. A significant number of healthcare providers lack sufficient training in gerontology, which constrains their capacity to effectively address the social and health requirements of older adults (Oladapo et al., 2021). This deficiency in care intensifies the issue of social isolation, as elderly individuals may lack the confidence to pursue assistance or engage in community health efforts. This research aims to assess the relationship between social isolation and health-promoting behaviours among elderly individuals with diverse health conditions in Nigeria.

1.3 Objectives of the study

The primary objective of this study is to critically evaluate social isolation and health promoting practices among older individuals living with various health statuses in Nigeria. Specific objectives of this study are to:

1. To investigate the relationship between social isolation and health-promoting practices among older individuals living with various health statuses in Nigeria

2. To evaluate the factors that lead to social isolation among older individuals living with various health statuses in Nigeria.

3. To explore the health-promoting practices engaged in by older individuals living with various health statuses in Nigeria

4. To provide recommendations aimed at improving social connections and promoting health among older individuals living with various health statuses in Nigeria

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

1. 1. 1. What is the relationship between social isolation and health-promoting practices among older individuals living with various health statuses in Nigeria?

      2. What are the factors that lead to social isolation among older individuals living with various health statuses in Nigeria?

      3. What are the health-promoting practices engaged in by older individuals living with various health statuses in Nigeria?

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: There is no significant relationship between social isolation and health-promoting practices among older individuals living with various health statuses in Nigeria.

Ha: There is a significant relationship between social isolation and health-promoting practices among older individuals living with various health statuses in Nigeria.

1.6 Significance of the study

The importance of this study reaches far beyond mere academic understanding, influencing a range of stakeholders who are crucial in improving the lives of older individuals. This research will examine the issues surrounding social isolation and advocate for health-oriented practices, with the potential outcomes contributing significantly to the enhancement of the well-being of the elderly demographic in Nigeria. The research presents important consequences for various parties involved, such as healthcare professionals, policymakers, community groups, carers, and the elderly individuals in question.

The older demographic will be the main recipients of the findings from this study. A deeper comprehension of the impacts of social isolation on health can facilitate the development of initiatives aimed at improving quality of life. Heightened awareness and focused interventions can alleviate the adverse effects of isolation, fostering both mental and physical health. When older individuals are enabled to participate in health-enhancing activities and receive social support, they are inclined to achieve better health outcomes and greater overall life satisfaction.

This study will provide healthcare providers with essential insights, allowing for a deeper understanding of the intricate relationship between social isolation and health outcomes in older adults. An understanding of the ways in which various health conditions affect social participation and health-enhancing activities will guide the creation of comprehensive care strategies. Such insights can assist providers in customising interventions that address not only physical health requirements but also take into account the social factors that profoundly influence overall well-being. Heightened recognition of social isolation may foster more proactive strategies aimed at advancing mental and emotional well-being in elderly patients.

The findings will serve as a valuable resource for policymakers, emphasising the urgent necessity for policies that tackle the distinct challenges encountered by older individuals in Nigeria. Comprehending the intricacies of social isolation can guide efforts to enhance community involvement and establish support systems for the elderly. Policymakers have the opportunity to leverage the data to champion funding and resources aimed at initiatives that foster social engagement and health education, thereby improving the overall quality of life for older adults.

This research will be invaluable for community organisations in crafting impactful outreach initiatives. Recognising the obstacles to health-enhancing behaviours and social involvement will empower these organisations to develop focused strategies that align with the requirements of older adults. Engaging with local organisations can improve access to resources, promote involvement in community activities, and create opportunities for health education, ultimately cultivating a more nurturing atmosphere for older adults.

This study will provide essential insights for carers, encompassing both family members and professional carers. Comprehending the implications of social isolation on health can enable carers to adopt proactive measures that ensure older adults stay involved in their communities and uphold healthy lifestyles. Training programs can be designed utilising the research findings to provide carers with essential tools for effectively addressing social isolation and promoting health-enhancing practices.

Moreover, this research will enhance the wider conversation surrounding ageing and health in Nigeria. By illuminating the essential matters of social isolation and health-enhancing practices, the research will provoke thoughtful discourse among scholars, health practitioners, and the broader community regarding the significance of aiding older adults. This may result in heightened support for the rights and requirements of the elderly, promoting a more inclusive community.

1.7 Scope of the study

Broadly, this study focus is to critically evaluate social isolation and health promoting practices among older individuals living with various health statuses in Nigeria. Empirically, the study will discuss the relationship between social isolation and health-promoting practices among older individuals living with various health statuses in Nigeria, the factors that lead to social isolation among older individuals living with various health statuses in Nigeria and the health-promoting practices engaged in by older individuals living with various health statuses in Nigeria.

Geographically, the study will be carried out in National Hospital, Abuja.

1.8 Limitations of the study

Throughout the investigation, the investigators meticulously examined the intrinsic limitations that exist within all human behaviours. A significant obstacle encountered was the insufficient depth of academic inquiry into the topic. An important aspect that influenced the situation was the scarcity of data concerning an in-depth research on social isolation and health promoting practices among older individuals living with various health statuses in Nigeria. In light of the undertaking, it proved to be quite challenging to locate the necessary materials, texts, or information and to systematically arrange the data, necessitating a considerable allocation of time and effort.

Furthermore, the conclusions drawn from the study may be limited by the relatively small sample size and the narrow focus of the research, which predominantly centres on National Hospital, Abuja. Consequently, the results of the study possess restricted practical significance, underscoring the necessity for additional investigation.

Furthermore, the individual faced considerable limitations stemming from financial restrictions. As an individual pursuing academic excellence with constrained financial means, they had to meticulously manage these limitations during their educational journey. The high transportation costs at the research site presented a considerable obstacle in fulfilling the financial commitments associated with travel expenses.

Furthermore, the individual had a busy agenda due to their academic commitments, which included attending lectures and engaging in various educational activities.

1.9 Definition of terms

Social isolation: Social isolation is a state in which the individual lacks a sense of belonging socially, lacks engagement with others, has a minimal number of social contacts, and they are deficient in fulfilling and quality relationships.

Health status: Health status is a measure of how people perceive their health—rating it as excellent, very good, good, fair, or poor.

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