Management and Coping with Care for Older Adults: Tales of Family Caregivers in Enugu State, Nigeria

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It then follows that the most essential line of action is caregiving. This paper examines how family caregivers manage and cope with the caregiving roles for older adults in south-east Nigeria. Method: We sought to adopt a qualitative research approach. Focus group discussions and in-depth interviews were utilized in collecting data from 54 participants aged 15-59 years who provide caregiving roles to older adults aged 60 years and above. Data were analyzed thematically. Results: We found that participants experience challenges managing care for older adults. This was owing to older adults' age, health status, attitude, financial incapacitation and educational status of the family caregivers. Most of the participants cope through human and non-human relationships. Findings show that communal relationships in rural communities is gradually declining. It was found that participants who cope through non-human relationships adopt strategies including maintaining a positive outlook of life, observing spiritual relationship with God and spending time playing games and music. Few participants narrated how they cope through adequate ageing nutrition and unsafe hygiene practices. We observed that family caregivers are in dire need of assistance in care management for older adults. Participants showed little knowledge of social work engagement in care management for older adults. Conclusion: We recommend that the Nigerian government should assist with health insurance schemes, security grants and payment to registered family caregivers. International organizations, indigenes in the diaspora and local humanitarian groups in collaboration with social workers can help develop care aid programs for older adults’ wellbeing in low-resource countries. coping strategies family members care management older adults social workers Introduction Globally, one significant trend is the rising ageing population. The United Nations (2019) reports that the world’s population of older persons aged 60 years and older is projected to triple over the next 30 years; with sub-Saharan Africa increasing from 31.9% in 2019 to 101.4% in 2050. Similarly, the United Nations Department of Economics and Social Affairs (UNDESA, 2019), Population Division estimated that Nigerians 65 years and older are expected to hit 16 million by 2050 and 74 million by 2100. The unprecedented rapid growth in ageing population could be associated with factors like improved living standards, advancement and breakthroughs in areas of medicine and technology (Omorogiuwa, 2016 ). The growth in the ageing population is a reflection that there will be a demand for the number of caregivers; consequent upon the fact that older adults as they age may require assistance with the necessities of life. Along with this, come the management and coping with care for older adults; which are sources of concern to family members. Across the globe, the pattern of ageing varies in different settings. While many High-Income Countries (HICs) adopt institutionalized care homes, most Low-Income Countries (LICs) still operate the filial care system (Ene at al., 2022a). This is based on the culturally homogenous society with the perspective that care for older adults is perceived as a significant traditional culture (Eze & Echeta, 2017 ). Thus, the filial care option is often provided by family members who might be spouses, children, nephews; among other younger family members (Ene at al., 2022b). According to the literature, family caregivers often participate in the exchange of patients’ information thereby necessitating their interaction with healthcare personnel (Ene &Nnama-Okechukwu, 2022 ; Wolf et al., 2020). Hence, providing care management for older adults includes coordinating care, managing medications, and meals, attending to medical encounters, finances, and mobility, among other activities of daily living. This assistance is expected to be friendly, helpful, available, and sensitive to the needs of the recipients. In Nigeria like other African countries, care for older adults has been an aged-long practice; aimed to ensure inclusiveness, healthy living and well-being for family members (Ene at al., 2022b). Achieving the healthy well-being of older adults entails adequate care management. Care management involves a patient-centered approach designed to assist patients and their support system (family members) in managing medical conditions more effectively (Agency for Healthcare Research and Quality, 2018 ). Given this precedent, care management for older adults has some positive and negative aspects including a feeling of affection, the extent of closeness, a sense of personal satisfaction and often overwhelming, constantly demanding and always challenging (Friedmann & Buckwalter, 2014; Litwan, Stoeckel & Roll, 2014 ). Sometimes, some of these challenges in care management can be highly rewarding such that the caregiver will learn patience, kindness, compassion, and above all will be justified; while the care recipient will be satisfied with the services rendered (Ene at al., 2024). It is perceived that family members who provide care for their older parents receive blessings from them while their children will also reciprocate similar gestures to them in their old age. Against this backdrop, scholars have reported that family members experience a burden in providing care management for Nigerian older adults (Ene &Nnama-Okechukwu, 2022 ; Faronbi & Olagun, 2017 ; Wojujutari, 2016 ). This comes with progression in the age of older adults, difficulty in mobility, decreased hunger, expanded delicacy, poor psychological capacity, decline in hearing, visual and dental status; among other challenges (Akinrolie et al., 2020 ; Ene at al., 2022b). Worrisome is that certain health outcome in ageing comes with a change in attitude (Ene at al., 2024). For instance, older adults suffering from dementia when they try to exhibit it may be perceived as witches and wizards from our African context. Caregivers with little knowledge of older adults' health status, may be unaware of this health problem and this may compound the burden experienced in care management (Cadmus et al., 2021 ). Additionally, concerns ranging from caregivers' ignorance, age, educational status, uncaring attitude, out-of-pocket payment for health services and lack of support have been reported in the literature (Adisa, 2019 ; Braham et al., 2019 , Ene at al., 2024). This implies that in the time to come, these challenges may pose a threat to care management for older adults. In this study therefore, an attempt is made to explore family members’ concerns about management and coping with care for older adults. This stems from the fact that coping with ageing is not done in isolation but may require the company of others who provide personal, emotional and healthcare assistance. For instance, while Leggett et al (2021), identified religion as a coping strategy, Beeber & Zimmerman ( 2013 ) reported communication and networking with family members. Again, Mah et al. ( 2021 ) suggested maintaining a positive outlook with adequate nutritional needs, whereas Wolff et al. ( 2020 ), recommends the use of health gadgets and apparatus. These include the use of walking aids, reading glasses, artificial teeth, hearing aid and minor health machines to monitor the overall wellbeing of older adults. Since care management for older adults is provided by family caregivers, it then becomes essential that they should be knowledgeable of these coping strategies. In this regard, the inability of family members to possess the essential knowledge required for coping with care management for older adults in Nigeria is problematic. They may not have substantial knowledge of health management, ageing nutrition and adequate hygiene practices. Similarly, most of these family members are also ageing, while majority have poor educational status, no training in geriatric care management and have no professional assistance. Providing inadequate coping strategies for older adults by their caregivers continues to cause life-threatening and challenging situations. For instance, it may lead to reduced physical ability, regular hospital visitation and loss of appetite which may all lead to developing illnesses associated with ageing including diabetes, osteoarthritis and chronic obstructive pulmonary diseases among others (Mcgregor et al., 2018 ). With these ageing-related illness, the implication is that family members may be unable to cope with the care management of older adults as it continues to cause life-threatening and challenging situations without professional assistance. Specific to this context, social workers are professionals who work directly with older adults to deal with the factors that exacerbate their wellbeing. They are expected to lobby, advocate and intensify education on geriatric care (Okoye et al., 2017 ). Sadly, geriatric social workers do not exist in Nigeria; with only a few medical social workers in health institutions. These professionals can organize counseling and provide discourse sessions to support a network of patients. They could also encourage the utilization of healthcare facilities, digital care systems, draw follow-up programs and could push for new narratives of ageing innovations in coping with care management for older adults (Ene & Ajibo, 2023 ; Nordesjö et al., 2021 ). In application, the profession adopts a multi-dimensional approach to evaluate the competencies of caregivers, their willingness to provide care and their acceptability of older adults particularly for those who are distraught as a result of an unwelcome health diagnosis (Okoye et al., 2017 ). In Furtherance, social workers can diffuse the incidences of crisis for family members by assisting in healthcare planning with health professionals like doctors and nurses. They render effective therapeutic and intervention services and coordinate follow-up care management to promote rapid recovery (Mcgregor et al., 2018 ). Again, they assist policymakers in proposing laws that will ensure healthy living for older adults and their families, particularly in LICs like Nigeria. Although the Nigerian system has been insensitive to older adults by giving them little attention yet, professionals and researchers are not relenting in their efforts to bring the needs of this group to the fore. Most of the studies and research done by Nigerian researchers concentrated on health challenges and caregiving stress experienced by family members (Adebowale, 2016 ; Akinrolie et al., 2020 ; Animasahun & Chapman 2017 ; Ene et al., 2024 ; Cadmus et al., 2021 ). Of all these studies, none has investigated the coping strategies family members adopt in the care management of older adults in Nigeria. More so, studies from a social work perspective are few. This study therefore becomes relevant for establishing empirical facts through adopting a qualitative research design. To bridge this knowledge gap, it is then imperative to research family members’ concerns about management and coping with care for older adults from the social work perspective in Enugu state, Nigeria Enugu state, Nigeria, becomes particularly important as a study area for our study for many reasons. First, there are some government missions and private-owned health facilities (hospitals) operating in the locality (Uzochukwu et al., 2014 ). Second, it is largely a religious homogeneous society with caring for the aged perceived as a filial responsibility (Akinrolie et al., 2020 ). Third, aside from the National Health Insurance Scheme (NHIS) provided only for public servants (Dokpesi, 2017 ), there is no existence of any organized association or group aimed at proffering management services and coping strategies for older adults and their family members (Ene at al., 2022a). This study therefore, advocates for government assistance, empowers family members, contributes to the existing literature, and ensures the integration of social workers in health institutions; all geared towards effective care management and coping with older adults in Enugu state, Nigeria. It is against this background that this study is posing the following research questions; (a) what are the concerns of family members in the care management of older adults in Nigeria (b) What coping strategies do family members adopt in the care management of older adults in Nigeria (c) What is the involvement of social workers in the coping with the care management of older adults? Theoretical framework We anchor our theoretical framework on the social learning theory propounded by Albert Bandura in 1977. The theory has been adopted by Bahn ( 2001 ) in the application of nurse education in care management of patients. The choice of this theory is that it emphasizes the importance of transferring learning through observation, imitation and education programs (Cherry, 2018 ). This could be associated with the fact that knowledge acquired through these actions serves as a guide for family members in care management for older adults. The key to this theory is that family members through direct practice, can acquire knowledge through learning by observation, training and teaching. They could also assimilate how roles and techniques in care management for older adults are performed and on later occasions, the coded data fills in as a guide for activity. In previous studies, many scholars advocated for wider use of social learning theory (McLeod, 2016 ; Zemlin, 2014 ). The explanation is ascribed to the view that what individuals do about their health is a higher priority than what they think about it (Parcel & Baronowski, 2013). As such, the central focus of numerous health education programs has been a change in knowledge through education, observation and training. Through these actions family members could get the chance to develop directly more certain actions and more positive attitudes towards themselves and their older adults; given the culture of filial care in the conventional Nigerian society. Methods Study design The study adopted descriptive and phenomenological research design. Descriptive research design is a comprehensive summarization, in everyday terms of specific events experienced by individuals or groups of individuals (Lambert &Lambert, 2013). Furthermore, it is a research design that aims to obtain information to systematically describe a phenomenon, situation, or population (Voxco, 2021 ). Employing descriptive research design, the researchers narrated in detail the tales of family members. On the other hand, phenomenological research design is concerned with the study of the lived experiences of individuals (Crossman, 2020). This research design was specifically utilized to display the concerns of family members on management and coping with care for older adults in Enugu state, Nigeria. Study area The study was conducted in Enugu-North senatorial district of Enugu state. The State is one of the 36 states in the South-East geopolitical zone in Nigeria. Reports from the National Bureau of Statistics ( 2018 ) assert that the State has a population figure of about 4.1 million. The state has three senatorial zones one of which is Enugu-North. This senatorial zone comprised six Local Government Areas (LGAs) including Nsukka. Nsukka town was purposively selected for this study out of the 18 local communities that constitute Nsukka LGA. Based on the last census held by the National Population Commission (NPC, 2006), Nsukka had a population of 309,448 comprising 149,418 males and 160,030 females aged 15–59 years. Following the projected population formula at a growth rate of 2.9%, a total of 507494.7 comprising 245045.5 males and 262449.2 females respectively was derived for 2023. For this study, Nsukka LGA was purposively selected because it operates a three-level healthcare sector including primary (Nsukka Primary Healthcare Center), secondary (Nsukka General Hospital) and tertiary (University of Nigeria Medical Center) health facilities. Again, the town is a semi-urban locality where most rural indigenes owing to proximity migrate to the locality for healthcare services. Population and sampling In this locality, there are about ten healthcare facilities (Federal Ministry of Health, 2021 ). The study employed first a purposive sampling procedure in selecting three healthcare institutions. These institutions were selected based on their category. Hence, one primary, secondary and tertiary healthcare institution was employed for the study. The names of these institutions are withheld for confidentiality. A total of 54 participants comprising 18 participants(nine males and females) from each institution were selected from each health institution. The age distribution of participants was 15–59 years. The justification was that they were perceived to be the productive population. Also, at 15 years one can provide care management services whereas, in the most public sector, retirement commences at the age of 60 years. Second, we utilized the snowball sampling techniques to contact other respondents. The reason is that the family caregivers we met also know others in the same health institutions who provide care management services for their older adults. Third, the study employed availability sampling to ensure that only available and willing family caregivers would be recruited for this study. In Nigeria and Enugu state, in particular, no available data exists on health and social services used by older adults. The only available service for them is the relationship with family members and feeling connected to them which contribute to their wellbeing and independence. Data collection The authors employed the qualitative research method in generating data for this study. In research, this approach is concerned with perspectives and interpretations of people based on the care management experiences of their older adults, as it seeks to gain further insights into the thinking and behavior of people (Phillips et al., 2016). Focus Group Discussions (FGDs) served as the main source of data collection because of the numerous ideas, issues sub-topics and even solutions to a problem that can be generated as cited in qualitative studies (Creswell & Creswell, 2018 ). The rationale for the choice of this study was to gain an in-depth understanding of a situation to gather information on a particular research issue, from a maximum of eight participants for each session with persons of the same characteristics and gender (Nyumba et al., 2018 ). As social workers and researchers, we were also concerned with exploring and understanding the concerns of family caregivers in the care management of older adults in Nigeria (Carey, 2017 ). With the assistance of healthcare workers in the inpatient care (IPC) in the selected health institution between October and December 2023, family caregivers aged 15–59 years who provided care management for older adults aged 60 years and older were selected. We chose central locations, scheduled dates and time to ease their movements and reaffirmed them that the conversations would be short so that they could attend to their private affairs. The researchers with two research assistants collectively developed the focus group discussion and in-depth interview guides. They were made up of semi-structured questions and probes. According to Nyumba (2018), probes help in a deeper understanding of context through narratives that describe the concerns of family caregivers in the care management of older adults rather than a rudimentary guide. In all, six focus group discussions comprising eight participants for each session and six in-depth interviews comprising six participants (three males and females, such that one male and female is selected from each health institution) were employed in the data collection process. The interviews for each health institution were held at the end of each FGD. To prevent fatigue and considering the demanding assistance the participants rendered to their care recipients, the FGDs and IDIs lasted not more than 60 minutes. In the FGDs, the data collection process started with some introductory activities. This allowed for the two researcher assistants who served as the note-taker and voice recorder to meet with the research participants informally so that they became more comfortable during the data collection process. Data analysis The data analysis technique began with note-taking and careful audio recording of all the discussions. Data were analyzed after transcription in the English language. The researchers who did the transcription are grounded in the Igbo language, even though just a few participants expressed themselves in Igbo. After transcription, we compared the contents of the transcripts with the field notes to ensure coherence. Data immersion was implored by repeatedly hearing the audio and reading the transcribed discussion and field notes for familiarization and to gain some sense of the participant’s experiences on management and coping with care for older adults. The data analysis procedure for this study was based on an interpretative phenomenological approach having followed the qualitative analysis procedure of data reduction, data display and conclusion (Marvasti, 2004 ). The interpretative phenomenological approach to qualitative analysis aims to describe the lived experiences of family caregivers from their viewpoint and to understand how they cope with their experiences. This approach follows an inductive process (Kalof et al., 2008 ). To proceed with our data analysis for the study, the translated data was open-coded and started immediately after the translation of the data to avoid memory loss. The data was further coded, grouped and categorized. This is to ensure that codes with similar characteristics are grouped thematically. The thematic clusters to understand and communicate qualitative data are rooted in phenomenology (Creswell &Creswell, 2018 ). Our research notes which were our memo helped us to review and re-focus during the research process as we tried to understand the meaning of the coding categories and themes. Kalof et al. ( 2008 ) explained that a memo helps researchers write out their ideas and thoughts throughout the research process as codes, themes and theoretical concepts are developed, identified, reviewed and reworked. To add more rigor to data analysis, the analysis with relevant discussions was handed to two peers for further examination. Their insights contributed to the final checks on the analysis. These exercises corroborate with peer debriefing in qualitative research (Padgett, 2008 ). Lastly, special connotations were noted and pulled out as illustrative quotes from the thematic cluster. We then presented narratives account of structure in the result finding section by presenting quotes that matter to the participants as well as areas of disagreement and data that did not fit the prevailing patterns. After the rigors were followed, the data were categorized into three major themes, which include (a) concerns of family caregivers in care management for older adults (b) strategies family caregivers adopt in care management for older adults and (c) assessment on the knowledge of social workers’ involvement in care management for older adults. Ethical consideration Ethical clearance for the study was sought from the institutional review board of the Strategic Contacts Ethics Publications (STRACEP) of the University of Nigeria, Nsukka campus, Enugu state before the data collection commenced. All methods of data collected were carried out by relevant institutional guidelines and regulations. The need for written informed consent was waived by the institutional review board (IRB) of the Strategic Contacts Ethics Publications (STRACEP) of the University of Nigeria, Nsukka campus, Enugu state. The justification for the waived informed consent was that it was deemed unnecessary as family members volunteered to participate in the study. The participants were informed of their freedom to withdraw during the study. Also, anonymity and confidentiality were assured to all study participants before the discussions. The Strategic Contacts Ethics and Publications (STRACEP) of the University of Nigeria, Nsukka Campus, Enugu State granted the ethical approval with the clearance code: UNNEC/05/002/Ph.D./SW/10-ST08/0024. Results Demographic characteristics of participants Table 1 Percentage distribution of the socio-demographic characteristics of participants Socio-demographic features Frequency (n = 54) Percentage (%) Gender Male 27 50 Female 27 50 Marital status Married 32 59.3 Not married 22 40.7 Educational attainment Secondary school and below 29 53.7 Tertiary school 25 42.3 Income > ₦50,000 33 61.1 ≤ ₦50,000 21 38.9 Age > 30 years 31 57.4 ≤ 30 years 23 42.6 Religion Christian 42 77.8 Non-Christian 12 22.2 Source : Fieldwork survey, 2024 Table 1 presents a snapshot of the socio-demographic details of the participants. One can observe that all the participants lived with older adults at the time of the study. They all provide care management for older adults aged 60 and older. Equal consideration was given to gender to prevent gender domination. There were more married participants (59.3%) and a higher percentage of the participants (53.7%) had secondary school certificates and below. A good percentage of the participants (61.1%) earned less than ₦50,000 ( $ 2 estimate) monthly. We had more participants (57.4%) aged less than 30 years and most (77.8) of the participants are Christians. For the in-depth interview, the six participants comprising three males and females were married. Although only two had tertiary certificates, four had secondary school certificates. Hence majority earned more than ≤ ₦50,000 and are aged above (≤ 30 years). They are predominately Christians. Family caregivers’ concerns in care management for older adults In this theme, we present family members' concerns in care management for older adults. The participants highlighted various concerns. We categorized their views into the following sub-themes including changing contemporary society, income level, health status and older adults' attitudes. Changing contemporary society From the narratives, the changing contemporary Nigerian society was an important concern in care management for older adults. On this issue, some participants attributed the change to the place of residence, quest for education, search for greener pastures, and adoption of the Western lifestyle. In the various FGD sessions, landmark quotes from groups were extracted and they read: I brought my mother to live with me in the city. Life here is ‘mind your own’. One can rarely tell when one’s neighbor is at home, what more informing the person to assist in providing care management for an older adult [Female, FGD, 35 years]. In this current society, life has changed. This is due to modernization. Everyone wants to go to school, get a job and live in the cities. This makes it difficult for older adults to receive adequate care management because no one wants to be left behind [Male, FGD, 35 years]. You see, life is filled with numerous difficulties which must be satisfied. In this society, family members no longer perceive care management for older adults as an obligation to be performed by the extended family. In this view, older adults are left in their homes in the villages with paid assistants to provide care management. This enabled other family members to perform certain responsibilities [Male, FGD, 42 years]. In the conventional society, care management for older adults was a collective activity. This is often done in a familiar environment. Recently, people have adopted the Western lifestyle of the nuclear family system with fewer family members. While the extended family system is gradually fading, concentration is on the nuclear family [Female, FGD, 36 years]. Family caregivers’ financial status An important concern for participants was the increasing economic challenges in the country. This identified challenge transcends to increasing responsibility for family caregivers to provide the needs of older adults and their own needs. We observed that most participants had low education, irregular jobs, and poor enumeration. These demographic attributes of participants affect the quality of care management given to older adults. Caregivers' financial status was stressed in this point: In this country, money is difficult to come by. As a public worker, I am saddled with the responsibility of providing for my children since my husband is late. Again, I am expected to care for my aged mother. Yet, I have no regular job to cope with these responsibilities [Female, IDI, 40 years]. While lamenting economic concerns, most of the participants considered the use of non-institutional health facilities so that they do not go into debt. See a typical quote below: Yes, I encourage my parents to consider the use of traditional medicine. I tell them to use local medicine within the community because it is cheaper. This was used by our forefathers. Thank God, alternative medicine doctors are increasing daily in our communities [Male, IDI, 35 years]. Health status of older adults According to the participants’ narratives, the effect of older adults’ health status remains a major concern in care management. Responses from the participants indicated that peoples’ increase in age, translates to increased healthcare responsibility. This was evident from the various FGD sessions when in one of the sessions a participant had this to say: Mama keeps complaining of various illnesses. If it is not knee pain, it will be waist pain. I often ignore her and her excessive complaints, my siblings are the ones to explain to her the problems she is going through. I will not kill myself providing care management for her when she cannot stop complaining of various health problems [Female, FGD, 40 years]. Older adults’ attitude Narratives illustrated that older adults' attitudes are important concerns for participants. It was observed that often this comes with progression in age. The participants wished that their older parents would understand their predicament regarding the impact care recipients' attitudes may have on providing care management. See illustrative quotes below: Lately, I have been living a life filled with quarrels. Today, my mother will accuse my brother's wife of shouting at her and I will reprimand my brother's wife. Tomorrow she will accuse my sister of starving her to death and I will quarrel with my sister. Do you know that recently my mother accused me of slapping her in my house? Angrily my husband and I vowed that she would never visit us again. My sibling said that Mama had turned into a witch, my brother reported that she hallucinates, but a friend told me that it is dementia. Honestly, I am tired of her [Female, IDI, 45 years]. A male participant who was extremely vocal in one of the FGD sessions frightened us by saying: There are times when Papa will not wake up fast. One has to beat him hard to wake him. When he is awake, he often laments seeing familiar persons and relatives who are deceased. There are times when he speaks to himself and talks of abstract things that do not make sense. We often ignore him when he behaves like this [Male, FGD, 42 years]. Coping strategies family members adopt in care management of older adults The participants gave various strategies they adopt in care management for older adults. They mentioned strategies including staying close to family members, maintaining a positive outlook in life, social networking with friends and groups, and ensuring adequate spiritual relationships with God. In this study, the coping strategies adopted by family members in the care management of older adults were categorized into two sub-themes including adopting "human relationship" and "non-human relationship". In this regard, responses on staying close to family members, social networking with friends and religious groups were categorized as "human relationship". Responses on maintaining a positive outlook, maintaining a spiritual relationship with God and other specific views not related to human relationships like spending time with pets or playing music and games were categorized as "non-human relationships". Coping through human relationship In our discussion, it was revealed that communal living and relationships are gradually dwindling in our society. The participants explained that coping is not done in isolation but in the company of others. We are listing some typical quotes below: You see communal living in rural communities is gradually declining in our society. On a good day, we take Papa to the clubhouse where he sits, drinks and discusses with other cohorts. He feels happy and excited when he returns and will want to revisit the club area on another occasion [Male, IDI, 51 years]. My religious group often pays a visit to Mama's House. They provide her with gifts and foodstuffs. Also, they pray for her and give her good wishes. They provide counseling for her and everyone present at home. This gives us consolation in care management [Female, IDI, 39 years]. Papa is a member of the Order of Noble Knights in the church. Owing to this position, sometimes the Priest pays visits. He prays and provides consolation words for us all. If need be, he presents Papa's condition to the congregation for collective prayers [Male, IDI, 40 years]. Coping through non-human relationship We observed that participants adopt coping strategies that are not related to individuals. In this category, participants narrated that they maintain a positive outlook on life, maintain a spiritual relationship with God, and spend time playing games and music. Few participants narrated how they cope with adopting ageing nutrition, and safe hygiene practices. Below are illustrative quotes from IDI participants and two FGD participants who summarized their group's standpoint: No one will live young forever. Ageing is inevitable and this is the only means to attain heaven or hell. So, we must accept our fate and provide care management for older adults. In return, we will obtain a huge blessing that older adults are known to give [Female, IDI, 49 years]. You see, I attain mass every day. I know that God will assist me till the end. His words from the Bible verse give me the courage to continue to strive till the end. I know His Grace is sufficient for us [Female, IDI, 54 years]. Oftentimes when the burden becomes excessive, I use to listen to my spiritual music. I also cope with indoor games like 'Chess games' when the care recipient is asleep. These strategies serve as consolation to cope with the situation in care management for my aged mother [Male, IDI, 29 years]. You see to prepare food for older adults is not easy because their food is often bitter. There are times when you have to place them on a diet considering their health status like Mama who is diabetic. For me, I provide adequate fruits and vegetables for her. On occasions when I do not have the strength to cook, I simply provide her with what I have available at home [Female, FGD, 29 years]. Bedwetting often occurs for my Papa. I cannot cope with providing pampers for him. So, we use old wrappers as improvised pampers for him. When going to bed, we will paddy him up like a baby. In the morning we will wash the cloth, but if he wet himself on the ground, we will clean it up using a rag. This is difficult, but we have to do it for him [Female, FGD, 39 years]. Still, on coping through non-human relationships, only two participants mentioned that one coping strategy they adopt is keeping mute. Below is the response by one of the participants: I endure the situation in my heart. I do not want people to say that I have abandoned my parents. This is why despite the stress and difficulties I experience in care management I adopt silence as a coping strategy [Female, IDI, 27 years]. Assessment of family members’ knowledge of the involvement of social workers in care management of older adults In this regard, the resounding view was that there is little or no knowledge about social workers' involvement in the care management of older adults. We observed that most study participants do not know who social workers are and what they do. As narrated by this participant " I don’t know them and who they are” . Few participants in the tertiary health institution reported knowing about them but did not understand their roles in the health setting. For instance, a participant said: ...if there is any way they can assist and help us in providing care management for our older parents, I would love to engage them. I need professional assistance in the care management of my father who has been diagnosed with chronic ill-health. Discussion Across the globe, management for the vulnerable is a priority. While high-income countries provide alternate care management for older adults, low-income countries still adopt the filial care system. This stems from the fact that healthy lives and well-being are essential for all at all ages (UNDESA, 2016). Given that with an increasingly ageing population (UN, 2019 ), and with older adults' vulnerability to illnesses (Mcgregor et al., 2018 ), their health and well-being are of utmost importance. It then becomes essential to manage and adopt strategies to cope with care for older adults in Enugu state, Nigeria. According to the findings of this study, family members' major concerns in care management for older adults were on changing contemporary society, income level, health status and older adults' attitude. First, changing contemporary society was a concern owing to the place of residence of the family member, the quest for education, the search for greener pastures, and the adoption of a Western lifestyle. It was reported that life in the city poses difficulty in care for older adults, unlike communal living in the rural localities. Women who are known to provide care, seek to be educated to secure jobs to make a living whereas the extended family system is going extinct. Second, in our conversations, we observed that concerns on income level transcend from increasing family responsibility to providing for the needs of older adults. this emanates from low education, poor income and high inflation in the country. This concern allows the utilization of non-institutional health facilities. The issue of the health status of older adults was the third concern. We discovered in this study that an increase in the age of older adults translates to increased health demands. Fourth, the attitude of older adults was the last mentioned concern of family members. It was found that family caregivers lack the knowledge of some health challenges that may affect the social networking of older adults. Hence, when some older adults display certain ageing health challenges like dementia, they may be perceived as witches and wizards in our African context. Alternatively, some older adults are often ignored by their family caregivers owing to their unintentional attitude. This negative perception of older adults has been reported by scholars including Cadmus et al. ( 2021 ) and Mah et al. ( 2021 ). A novel finding in this study is that family caregivers cope with the management of older adults through human and non-human networking. It was revealed that coping through human networking was done through interacting with cohorts at clubhouses, visits from religious groups, and friends. While some present gifts, others provide prayer sessions and counseling services. It was also discovered that family members cope with care management of older adults through various ways including maintaining a positive outlook on life, spiritual relationship with God and spending time playing games and music. In furtherance, a few participants narrated how they cope with adequate ageing nutrition and unsafe hygiene practices. It is imperative to note that family caregivers are very much aware of certain unsafe hygiene practices they adopt in coping with care for older adults. However, despite this knowledge, they accept to adopt such strategies since they have no alternative. More so, we observed that few participants adopted silence as a coping strategy. This stems from the fact that care management challenges for older adults are not reported by family caregivers but are endured. But we are worried for those who might not have the desire to endure. We see in developed countries, various alternatives provided for family caregivers to cope with care management for older adults. For instance, the availability of long and short-term care homes, paid formal caregivers, social media interactive platforms, government-approved health insurance, security grants, and mainstreaming of older adults’ care management in the educational curriculum. These among other age-friendly strategies, would ensure adequate avenues to provide and develop the knowledge needed for healthy ageing. Another unique finding in this study that is not common in other studies is the knowledge of the involvement of social workers in the care of older adults in Nigeria. Quite disturbing is the finding that the participants had little or no knowledge about social workers' involvement in the care management of older adults. This could be associated with the fact that formal social work practice is relatively new and emerging in Nigeria (Okoye et al., 2017 ). Social work proficient contribution fills in as a mediation measure for management and coping with care for older adults. One of the particular ways social work professionals guarantee sufficient survival techniques is through the idea of 'self-improvement' development in old age. Through this concept, older adults can be urged to take on a 'strength-based approach' that demonstrates a conviction that they can adapt to the real factors and requests of life related to ageing process (Portraj, 2016). This should be possible through the support of a difference in disposition that dodges correlation with different ages, demoralization of negative explanations about self and usage of self-strength. It becomes essential to foster great relational abilities and all that can empower one to remain socially connected and associated with family members (Olason, 2012). In the families, social workers work with older adults and their caregivers. They provide person-centered, integrated care to deal with possible care management challenges that may compound problems in caregiving. The professionals adopt a multi-dimensional approach to evaluate the competencies of caregivers, their willingness to provide care, and their acceptability of older adults, particularly those who are distraught as a result of an unwelcome health diagnosis (Wolf et al., 2020). Social workers can diffuse the sense of crisis for caregivers by assisting in planning with other health professionals, rendering effective therapeutic services, and providing follow-up programs. Although Nigerian society does not support institutionalized homes for older adults (Adisa, 2019 ), short-term care homes can utilize the services of social workers. They could supervise services provided by various care agencies, serve as a platform for recommending competent careers, and help them in providing appropriate healthcare management techniques and services for older adults. It is envisaged that international organizations, local humanitarian groups and Nigerians in the diaspora, with the collaboration of social workers could help develop a care aid programme for all older adults in Nigeria. Strength and limitations First, the researchers encountered difficulties in recruiting participants who would volunteer to answer the questionnaires. Second the recruited participants were drawn from a particular state. These limitations notwithstanding, we believe that the findings of this study remain valid. Conclusion To ensure healthy living and well-being, care must be given to older adults. Hence, it is essential to manage and adopt strategies to cope with care for older adults in Enugu state, Nigeria. This study then revealed that; First, family members’ major concerns in care management for older adults were on changing contemporary society, income level, health status and older adults’ attitude. These concerns affect the management and strategies adopted in coping with care for older adults. Second, it was observed that a major coping strategy by family caregivers was carried out through human and non-human networking. Through social networking older adults and their family members receive various gifts, counseling, and prayers and maintain a positive outlook on life. This indicates the role of social networking in care management for coping with healthy ageing. Third, the social work proficient contribution fills in as a mediation measure for management and coping with care for older adults. Their presence becomes essential to foster stronger relational abilities and all that could empower one to remain socially connected and associated with family members. Social workers by assisting in planning with other health professionals, could also participate in rendering effective therapeutic services, and develop effective care management services for older adults in Nigeria. Declarations Acknowledgment The researchers acknowledged that this work is original and has not been published elsewhere, nor is it currently under consideration for publication elsewhere. Declaration of interest statement We the authors hereby declare that there is no conflict of interest concerning this study. Ethics approval The Strategic Contacts Ethics and Publications (STRACEP) of the University of Nigeria, Nsukka Campus, Enugu State granted the ethical approval with the clearance code: UNNEC/05/002/Ph.D./SW/10-ST08/0024.All methods of data collected were carried out in accordance with relevant institutional guidelines and regulations. The need for written informed consent was waived by the institutional review board of the Strategic Contacts Ethics Publications(STRACEP) of the University of Nigeria, Nsukka Campus, Enugu State. The justification for the waived informed consent was because it was deemed unnecessary as the family caregivers volunteered to participate in the study. Clinical Trial Number Not applicable. Funding The study received no funding nor grant from any group, organization, or agency in the public or commercial sectors. Consent to participants The authors affirm that the research participants provided verbal informed consent for the publication of the data in this research paper. The participants were informed of their freedom to withdraw at any time in the course of the study. Also, anonymity and confidentiality was assured to all study participants before the discussions. Consent for publication We the authors hereby declare that the manuscript should be published in the sent journal. Authors’ contributions Jacinta Chibuzor Ene: was involved in the conceptualization of the research topic, methodology, funding, investigation, project administration, writing original draft, writing review and editing of the manuscript. Nkechinyere Patricia Onyishi: participated in writing review and editing of the original manuscript. Tanyi Lum: participated in data management, design, formal analysis interpretation, writing review and editing of original manuscript. Data availability Data is stored in coded materials and databases without personal data, and authors have policies in place to manage and keep data secure. All datasets generated and/or analyzed during the current study are not publicly available due to the principle of confidentiality assured to the participants and mode of storage (tape recording device), but are available from the corresponding author on reasonable request. References Agency for Healthcare Research and Quality. (2018). Care management: Implications for medical practice, health policy and health services research https://www.ahrq.gov/ncepcr/care/coordination/mgmt.html. Adebowale, S. (2016, March 8). Nigeria’s population elderly to constitute 20% in 2016. The Eagle. https://theeagleonline.com.ng/nigerias-population-elderly-to-constitute-20-in-2016-cmd/ Adisa, O. (2019). Why are some older persons economically vulnerable and others not? 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The influence of caregivers’ burden on the quality of life of caregivers of older adults in Nigeria. International Psychogeriatric Journal , 29 (7), 1085–1093. https://doi.org/10.1017/S1041610216002295. Federal Ministry of Health (2021). Hospitals and Clinics . https://www.hfr.health.gov.ng/facilities/hospitals. Friedemann, M., L. & Buckwalter, K., C. (2014). Family caregivers’ role and burden related to gender and family relationship. Journal of the American Geriatric Society, 58 (1) 937-943. Kalof, L., Dan, A., & Dietz, T. (2008). Essential of social research . Open University press. Leggetti, A., Bugajski, B., Gitlin, L., &Kales, H. (2021). Characterizing dementia caregivers style in managing care challenges: Cognitive behavioral components. PubMed Central, 20 (6), 2188-2204. https://doi.org/10.1177/1471301220988233. Litwan, H., Stoeckel, K.J & Roll, A (2014). Relationship status and depressive systems among older co-resident caregivers. Aging and mental health, 18 (1) , 225-231.https://doi.org/10.1080113607863.2013.837148 Mah, J.C., Stevens, S.J. Keefe, J.M. (2021). Social factors influencing utilization of home care in community-dwelling older adults: a scoping review. BMC Geriatric, 21 , 145. https://doi.org/10.1186/s12877-021-02069-1. Marvasti, A. B. (2004). Qualitative research in sociology . Sage Publication. Mcgregor, J., Mercer, S. W., & Harris, F. M. (2018). Healthcare benefits of primary care social work for adults with complex health and social needs: A systematic review. Health and Social Care in Community, 26 (1), 1–13. https://doi.org/10.1111/hsc.12337. McLeod, S., A. (2016). Bandura-social learning theory . Retrieved from https;//www.simplypsychology.org/bandura.html. National Bureau of Statistics (2018). Demographic statistics bulletin (2017). https://nigerianstat.gov.ng/elibrary/read/775. National Population Commission (NPC,2006). Population statistics, maps and charts of the federal republic of Nigeria : Preliminary report. Abuja: Federal Republic of Nigeria. Retrieved from https://www.citypopulation.de/php/nigeria. Nordesjö, K., Scaramuzzino, G., Ulmestig, R. (2021). The social worker-client relationship in the digital era: a configurative literature review. European. Journal of Social Work. https://doi.org/10.1080/13691457.2021.1964445. Nyumba, T.O, Wilson, K. Derrick, C. J., & Mukherjee, N. (2018). The use of focus group discussion methodology: Insights from two decades of application in conservation. Methods in Ecology and Evolution, 9 (1), 20–32.https://doi.org/10.1111/2041-210X.12860. Omorogiuwa, T.A (2016). The psychosocial problems of the elderly: Implications for social work practice . Journal of Nursing, Social Studies, Public Health and Rehabilitation , 3 (4), 111-118. Okoye, U.O., Ebimgbo, S., &Ene, J. (2017). Social work with older adults. In Okoye, U., Chukwu, N., Agwu, P. (Eds.). Social Work in Nigeria: Book of Readings (pp172-183). Nsukka, Enugu state: University of Nigeria Press Limited. Padgett, D. K. (2008). Qualitative methods in social work research (2nd edn) ed.). SAGE Publishers. Parcel, G. & Baranowski, T. (2013). Social learning theory and health education. Journal of Health Education , 12 (3), 14-18. Phillips, M.B.; Foley, A.L.; Barnard, R.; Isenring, E. A. & Miller, M., D. (2010). Nutritional screening in community dwelling older adults: A systematic literature review. Nutrition Clinic Journal, Asia Pacific, 19(3), 440-449. UN (2019). Aging. https://www.un.org/en/sections/issues-depth/ageing/. United Nations Department of Economics and Social Affairs. (UNDESA, 2019). World population prospects 2019 . https://population.un.org/wpp/. Uzochukwu, B.S.C., Onwujekwe, O.E., Soludo, E., Nkoli, E. & Uguru, N.P. (2014). The district health system in Enugu State, Nigeria: An analysis of policy development and implementation. Research paper of the consortium for research on equitable health systems , pp1-28. DOI:10.35202/AJHE.2014.3203. Voxco, D. (2021, September 29) Descriptive Research Design. https://www.voxco.com/blog/descrpitive-research-design/. Wolff, J. L., Freedman, V. A., Mulcahy, J. F., & Kasper, J. D. (2020). Family caregivers’ experiences with health care workers in the care of older adults with activity limitations. JAMA Network Open, 3 (1), Article e1919866. https://doi.org/10.1001/jamanetworkopen.2019.19866. Wojujutari, A. (2016). Effect of caregiving burden and life satisfaction on older adults’ care providers’ psychological well-being in Ondo State. Research on Humanities and Social Sciences,6 (17), 224-266. Retrieved from https://pdfs.semanticschloar.org/.../93d3df10e4e8244f782918bc37f400627389.pdf. Zemlin, C. (2014). Transfer and implementation of knowledge and attitude: A particularchallenge for caregivers in dementia care. Journal of Nursing Education and Practice , 4 (1), 81-88. https://dx.doi.org/10.5430/jnep.v4n1p81. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 26 Jun, 2024 Editor assigned by journal 21 Jun, 2024 Submission checks completed at journal 21 Jun, 2024 First submitted to journal 17 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4593553","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":319461628,"identity":"c21c2fd3-4be3-4a92-80ab-b21091194020","order_by":0,"name":"Jacinta Ene","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIiWNgGAWjYBACxgYGhgMw9gMInUCMFogiZgOitCArYpMgSgtz++GHhwt/2DHwSzcfq+bdcYeBnz3HgLngFx6H9aQZHJ6RkMwgOedY2m3eM88YJHveGDDP7MOjpSGH4TBPAjODwY0cs9u8bYdBDANm3h48WvrfgLTUM9jfyP9WDNJiT1DLDLAtQMMlctiYwbZIALXw/MCn5ZnBYZ604zwSN9KMJee2HeaROPOs4DBvA24thv3Jjz/z2FTL8c9IfvjhbdthOf725I2Pef7g0QI1jgcmAGYcYGzDrUUehzgeW0bBKBgFo2DEAQDGnk4NhAX53AAAAABJRU5ErkJggg==","orcid":"","institution":"University of Nigeria, Nsukka Campus Enugu State","correspondingAuthor":true,"prefix":"","firstName":"Jacinta","middleName":"","lastName":"Ene","suffix":""},{"id":319461629,"identity":"33968e8b-7463-465a-ae5e-0df2ff348f37","order_by":1,"name":"Nkechinyere Onyishi","email":"","orcid":"","institution":"University of Nigeria, Nsukka Campus Enugu State","correspondingAuthor":false,"prefix":"","firstName":"Nkechinyere","middleName":"","lastName":"Onyishi","suffix":""},{"id":319461630,"identity":"cbe043b3-9e41-48e8-8eed-54ba4ea7e5f0","order_by":2,"name":"Tanyi Lum","email":"","orcid":"","institution":"University of Nigeria, Nsukka Campus Enugu State","correspondingAuthor":false,"prefix":"","firstName":"Tanyi","middleName":"","lastName":"Lum","suffix":""}],"badges":[],"createdAt":"2024-06-17 10:33:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4593553/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4593553/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60151711,"identity":"7a33d2ea-5c48-442e-ae54-adb358ffe558","added_by":"auto","created_at":"2024-07-12 11:06:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":602700,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4593553/v1/bdda3a8e-1ffa-47c2-a8aa-81cfa21e47f7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Management and Coping with Care for Older Adults: Tales of Family Caregivers in Enugu State, Nigeria","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGlobally, one significant trend is the rising ageing population. The United Nations (2019) reports that the world\u0026rsquo;s population of older persons aged 60 years and older is projected to triple over the next 30 years; with sub-Saharan Africa increasing from 31.9% in 2019 to 101.4% in 2050. Similarly, the United Nations Department of Economics and Social Affairs (UNDESA, 2019), Population Division estimated that Nigerians 65 years and older are expected to hit 16\u0026nbsp;million by 2050 and 74\u0026nbsp;million by 2100. The unprecedented rapid growth in ageing population could be associated with factors like improved living standards, advancement and breakthroughs in areas of medicine and technology (Omorogiuwa, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). The growth in the ageing population is a reflection that there will be a demand for the number of caregivers; consequent upon the fact that older adults as they age may require assistance with the necessities of life. Along with this, come the management and coping with care for older adults; which are sources of concern to family members.\u003c/p\u003e \u003cp\u003eAcross the globe, the pattern of ageing varies in different settings. While many High-Income Countries (HICs) adopt institutionalized care homes, most Low-Income Countries (LICs) still operate the filial care system (Ene at al., 2022a). This is based on the culturally homogenous society with the perspective that care for older adults is perceived as a significant traditional culture (Eze \u0026amp; Echeta, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Thus, the filial care option is often provided by family members who might be spouses, children, nephews; among other younger family members (Ene at al., 2022b). According to the literature, family caregivers often participate in the exchange of patients\u0026rsquo; information thereby necessitating their interaction with healthcare personnel (Ene \u0026amp;Nnama-Okechukwu, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Wolf et al., 2020). Hence, providing care management for older adults includes coordinating care, managing medications, and meals, attending to medical encounters, finances, and mobility, among other activities of daily living. This assistance is expected to be friendly, helpful, available, and sensitive to the needs of the recipients.\u003c/p\u003e \u003cp\u003eIn Nigeria like other African countries, care for older adults has been an aged-long practice; aimed to ensure inclusiveness, healthy living and well-being for family members (Ene at al., 2022b). Achieving the healthy well-being of older adults entails adequate care management. Care management involves a patient-centered approach designed to assist patients and their support system (family members) in managing medical conditions more effectively (Agency for Healthcare Research and Quality, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Given this precedent, care management for older adults has some positive and negative aspects including a feeling of affection, the extent of closeness, a sense of personal satisfaction and often overwhelming, constantly demanding and always challenging (Friedmann \u0026amp; Buckwalter, 2014; Litwan, Stoeckel \u0026amp; Roll, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Sometimes, some of these challenges in care management can be highly rewarding such that the caregiver will learn patience, kindness, compassion, and above all will be justified; while the care recipient will be satisfied with the services rendered (Ene at al., 2024). It is perceived that family members who provide care for their older parents receive blessings from them while their children will also reciprocate similar gestures to them in their old age.\u003c/p\u003e \u003cp\u003eAgainst this backdrop, scholars have reported that family members experience a burden in providing care management for Nigerian older adults (Ene \u0026amp;Nnama-Okechukwu, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Faronbi \u0026amp; Olagun, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Wojujutari, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). This comes with progression in the age of older adults, difficulty in mobility, decreased hunger, expanded delicacy, poor psychological capacity, decline in hearing, visual and dental status; among other challenges (Akinrolie et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Ene at al., 2022b). Worrisome is that certain health outcome in ageing comes with a change in attitude (Ene at al., 2024). For instance, older adults suffering from dementia when they try to exhibit it may be perceived as witches and wizards from our African context. Caregivers with little knowledge of older adults' health status, may be unaware of this health problem and this may compound the burden experienced in care management (Cadmus et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Additionally, concerns ranging from caregivers' ignorance, age, educational status, uncaring attitude, out-of-pocket payment for health services and lack of support have been reported in the literature (Adisa, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Braham et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2019\u003c/span\u003e, Ene at al., 2024). This implies that in the time to come, these challenges may pose a threat to care management for older adults.\u003c/p\u003e \u003cp\u003eIn this study therefore, an attempt is made to explore family members\u0026rsquo; concerns about management and coping with care for older adults. This stems from the fact that coping with ageing is not done in isolation but may require the company of others who provide personal, emotional and healthcare assistance. For instance, while Leggett et al (2021), identified religion as a coping strategy, Beeber \u0026amp; Zimmerman (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) reported communication and networking with family members. Again, Mah et al. (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) suggested maintaining a positive outlook with adequate nutritional needs, whereas Wolff et al. (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), recommends the use of health gadgets and apparatus. These include the use of walking aids, reading glasses, artificial teeth, hearing aid and minor health machines to monitor the overall wellbeing of older adults. Since care management for older adults is provided by family caregivers, it then becomes essential that they should be knowledgeable of these coping strategies.\u003c/p\u003e \u003cp\u003eIn this regard, the inability of family members to possess the essential knowledge required for coping with care management for older adults in Nigeria is problematic. They may not have substantial knowledge of health management, ageing nutrition and adequate hygiene practices. Similarly, most of these family members are also ageing, while majority have poor educational status, no training in geriatric care management and have no professional assistance. Providing inadequate coping strategies for older adults by their caregivers continues to cause life-threatening and challenging situations. For instance, it may lead to reduced physical ability, regular hospital visitation and loss of appetite which may all lead to developing illnesses associated with ageing including diabetes, osteoarthritis and chronic obstructive pulmonary diseases among others (Mcgregor et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). With these ageing-related illness, the implication is that family members may be unable to cope with the care management of older adults as it continues to cause life-threatening and challenging situations without professional assistance.\u003c/p\u003e \u003cp\u003eSpecific to this context, social workers are professionals who work directly with older adults to deal with the factors that exacerbate their wellbeing. They are expected to lobby, advocate and intensify education on geriatric care (Okoye et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Sadly, geriatric social workers do not exist in Nigeria; with only a few medical social workers in health institutions. These professionals can organize counseling and provide discourse sessions to support a network of patients. They could also encourage the utilization of healthcare facilities, digital care systems, draw follow-up programs and could push for new narratives of ageing innovations in coping with care management for older adults (Ene \u0026amp; Ajibo, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Nordesj\u0026ouml; et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). In application, the profession adopts a multi-dimensional approach to evaluate the competencies of caregivers, their willingness to provide care and their acceptability of older adults particularly for those who are distraught as a result of an unwelcome health diagnosis (Okoye et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). In Furtherance, social workers can diffuse the incidences of crisis for family members by assisting in healthcare planning with health professionals like doctors and nurses. They render effective therapeutic and intervention services and coordinate follow-up care management to promote rapid recovery (Mcgregor et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Again, they assist policymakers in proposing laws that will ensure healthy living for older adults and their families, particularly in LICs like Nigeria.\u003c/p\u003e \u003cp\u003eAlthough the Nigerian system has been insensitive to older adults by giving them little attention yet, professionals and researchers are not relenting in their efforts to bring the needs of this group to the fore. Most of the studies and research done by Nigerian researchers concentrated on health challenges and caregiving stress experienced by family members (Adebowale, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Akinrolie et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Animasahun \u0026amp; Chapman \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Ene et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Cadmus et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Of all these studies, none has investigated the coping strategies family members adopt in the care management of older adults in Nigeria. More so, studies from a social work perspective are few. This study therefore becomes relevant for establishing empirical facts through adopting a qualitative research design. To bridge this knowledge gap, it is then imperative to research family members\u0026rsquo; concerns about management and coping with care for older adults from the social work perspective in Enugu state, Nigeria\u003c/p\u003e \u003cp\u003eEnugu state, Nigeria, becomes particularly important as a study area for our study for many reasons. First, there are some government missions and private-owned health facilities (hospitals) operating in the locality (Uzochukwu et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Second, it is largely a religious homogeneous society with caring for the aged perceived as a filial responsibility (Akinrolie et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Third, aside from the National Health Insurance Scheme (NHIS) provided only for public servants (Dokpesi, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), there is no existence of any organized association or group aimed at proffering management services and coping strategies for older adults and their family members (Ene at al., 2022a). This study therefore, advocates for government assistance, empowers family members, contributes to the existing literature, and ensures the integration of social workers in health institutions; all geared towards effective care management and coping with older adults in Enugu state, Nigeria. It is against this background that this study is posing the following research questions; (a) what are the concerns of family members in the care management of older adults in Nigeria (b) What coping strategies do family members adopt in the care management of older adults in Nigeria (c) What is the involvement of social workers in the coping with the care management of older adults?\u003c/p\u003e\n\u003ch3\u003eTheoretical framework\u003c/h3\u003e\n\u003cp\u003eWe anchor our theoretical framework on the social learning theory propounded by Albert Bandura in 1977. The theory has been adopted by Bahn (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2001\u003c/span\u003e) in the application of nurse education in care management of patients. The choice of this theory is that it emphasizes the importance of transferring learning through observation, imitation and education programs (Cherry, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). This could be associated with the fact that knowledge acquired through these actions serves as a guide for family members in care management for older adults. The key to this theory is that family members through direct practice, can acquire knowledge through learning by observation, training and teaching. They could also assimilate how roles and techniques in care management for older adults are performed and on later occasions, the coded data fills in as a guide for activity.\u003c/p\u003e \u003cp\u003eIn previous studies, many scholars advocated for wider use of social learning theory (McLeod, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Zemlin, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). The explanation is ascribed to the view that what individuals do about their health is a higher priority than what they think about it (Parcel \u0026amp; Baronowski, 2013). As such, the central focus of numerous health education programs has been a change in knowledge through education, observation and training. Through these actions family members could get the chance to develop directly more certain actions and more positive attitudes towards themselves and their older adults; given the culture of filial care in the conventional Nigerian society.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThe study adopted descriptive and phenomenological research design. Descriptive research design is a comprehensive summarization, in everyday terms of specific events experienced by individuals or groups of individuals (Lambert \u0026amp;Lambert, 2013). Furthermore, it is a research design that aims to obtain information to systematically describe a phenomenon, situation, or population (Voxco, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Employing descriptive research design, the researchers narrated in detail the tales of family members. On the other hand, phenomenological research design is concerned with the study of the lived experiences of individuals (Crossman, 2020). This research design was specifically utilized to display the concerns of family members on management and coping with care for older adults in Enugu state, Nigeria.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy area\u003c/h2\u003e \u003cp\u003eThe study was conducted in Enugu-North senatorial district of Enugu state. The State is one of the 36 states in the South-East geopolitical zone in Nigeria. Reports from the National Bureau of Statistics (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) assert that the State has a population figure of about 4.1\u0026nbsp;million. The state has three senatorial zones one of which is Enugu-North. This senatorial zone comprised six Local Government Areas (LGAs) including Nsukka. Nsukka town was purposively selected for this study out of the 18 local communities that constitute Nsukka LGA. Based on the last census held by the National Population Commission (NPC, 2006), Nsukka had a population of 309,448 comprising 149,418 males and 160,030 females aged 15\u0026ndash;59 years. Following the projected population formula at a growth rate of 2.9%, a total of 507494.7 comprising 245045.5 males and 262449.2 females respectively was derived for 2023. For this study, Nsukka LGA was purposively selected because it operates a three-level healthcare sector including primary (Nsukka Primary Healthcare Center), secondary (Nsukka General Hospital) and tertiary (University of Nigeria Medical Center) health facilities. Again, the town is a semi-urban locality where most rural indigenes owing to proximity migrate to the locality for healthcare services.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePopulation and sampling\u003c/h2\u003e \u003cp\u003eIn this locality, there are about ten healthcare facilities (Federal Ministry of Health, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The study employed first a purposive sampling procedure in selecting three healthcare institutions. These institutions were selected based on their category. Hence, one primary, secondary and tertiary healthcare institution was employed for the study. The names of these institutions are withheld for confidentiality. A total of 54 participants comprising 18 participants(nine males and females) from each institution were selected from each health institution. The age distribution of participants was 15\u0026ndash;59 years. The justification was that they were perceived to be the productive population. Also, at 15 years one can provide care management services whereas, in the most public sector, retirement commences at the age of 60 years. Second, we utilized the snowball sampling techniques to contact other respondents. The reason is that the family caregivers we met also know others in the same health institutions who provide care management services for their older adults. Third, the study employed availability sampling to ensure that only available and willing family caregivers would be recruited for this study. In Nigeria and Enugu state, in particular, no available data exists on health and social services used by older adults. The only available service for them is the relationship with family members and feeling connected to them which contribute to their wellbeing and independence.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eThe authors employed the qualitative research method in generating data for this study. In research, this approach is concerned with perspectives and interpretations of people based on the care management experiences of their older adults, as it seeks to gain further insights into the thinking and behavior of people (Phillips et al., 2016). Focus Group Discussions (FGDs) served as the main source of data collection because of the numerous ideas, issues sub-topics and even solutions to a problem that can be generated as cited in qualitative studies (Creswell \u0026amp; Creswell, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The rationale for the choice of this study was to gain an in-depth understanding of a situation to gather information on a particular research issue, from a maximum of eight participants for each session with persons of the same characteristics and gender (Nyumba et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). As social workers and researchers, we were also concerned with exploring and understanding the concerns of family caregivers in the care management of older adults in Nigeria (Carey, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). With the assistance of healthcare workers in the inpatient care (IPC) in the selected health institution between October and December 2023, family caregivers aged 15\u0026ndash;59 years who provided care management for older adults aged 60 years and older were selected. We chose central locations, scheduled dates and time to ease their movements and reaffirmed them that the conversations would be short so that they could attend to their private affairs.\u003c/p\u003e \u003cp\u003eThe researchers with two research assistants collectively developed the focus group discussion and in-depth interview guides. They were made up of semi-structured questions and probes. According to Nyumba (2018), probes help in a deeper understanding of context through narratives that describe the concerns of family caregivers in the care management of older adults rather than a rudimentary guide. In all, six focus group discussions comprising eight participants for each session and six in-depth interviews comprising six participants (three males and females, such that one male and female is selected from each health institution) were employed in the data collection process. The interviews for each health institution were held at the end of each FGD. To prevent fatigue and considering the demanding assistance the participants rendered to their care recipients, the FGDs and IDIs lasted not more than 60 minutes. In the FGDs, the data collection process started with some introductory activities. This allowed for the two researcher assistants who served as the note-taker and voice recorder to meet with the research participants informally so that they became more comfortable during the data collection process.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003e The data analysis technique began with note-taking and careful audio recording of all the discussions. Data were analyzed after transcription in the English language. The researchers who did the transcription are grounded in the Igbo language, even though just a few participants expressed themselves in Igbo. After transcription, we compared the contents of the transcripts with the field notes to ensure coherence. Data immersion was implored by repeatedly hearing the audio and reading the transcribed discussion and field notes for familiarization and to gain some sense of the participant\u0026rsquo;s experiences on management and coping with care for older adults.\u003c/p\u003e \u003cp\u003eThe data analysis procedure for this study was based on an interpretative phenomenological approach having followed the qualitative analysis procedure of data reduction, data display and conclusion (Marvasti, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). The interpretative phenomenological approach to qualitative analysis aims to describe the lived experiences of family caregivers from their viewpoint and to understand how they cope with their experiences. This approach follows an inductive process (Kalof et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). To proceed with our data analysis for the study, the translated data was open-coded and started immediately after the translation of the data to avoid memory loss. The data was further coded, grouped and categorized. This is to ensure that codes with similar characteristics are grouped thematically. The thematic clusters to understand and communicate qualitative data are rooted in phenomenology (Creswell \u0026amp;Creswell, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur research notes which were our memo helped us to review and re-focus during the research process as we tried to understand the meaning of the coding categories and themes. Kalof et al. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2008\u003c/span\u003e) explained that a memo helps researchers write out their ideas and thoughts throughout the research process as codes, themes and theoretical concepts are developed, identified, reviewed and reworked. To add more rigor to data analysis, the analysis with relevant discussions was handed to two peers for further examination. Their insights contributed to the final checks on the analysis. These exercises corroborate with peer debriefing in qualitative research (Padgett, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Lastly, special connotations were noted and pulled out as illustrative quotes from the thematic cluster. We then presented narratives account of structure in the result finding section by presenting quotes that matter to the participants as well as areas of disagreement and data that did not fit the prevailing patterns. After the rigors were followed, the data were categorized into three major themes, which include (a) concerns of family caregivers in care management for older adults (b) strategies family caregivers adopt in care management for older adults and (c) assessment on the knowledge of social workers\u0026rsquo; involvement in care management for older adults.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eEthical consideration\u003c/h2\u003e \u003cp\u003e Ethical clearance for the study was sought from the institutional review board of the Strategic Contacts Ethics Publications (STRACEP) of the University of Nigeria, Nsukka campus, Enugu state before the data collection commenced. All methods of data collected were carried out by relevant institutional guidelines and regulations. The need for written informed consent was waived by the institutional review board (IRB) of the Strategic Contacts Ethics Publications (STRACEP) of the University of Nigeria, Nsukka campus, Enugu state. The justification for the waived informed consent was that it was deemed unnecessary as family members volunteered to participate in the study. The participants were informed of their freedom to withdraw during the study. Also, anonymity and confidentiality were assured to all study participants before the discussions. The Strategic Contacts Ethics and Publications (STRACEP) of the University of Nigeria, Nsukka Campus, Enugu State granted the ethical approval with the clearance code: UNNEC/05/002/Ph.D./SW/10-ST08/0024.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDemographic characteristics of participants\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003ePercentage distribution of the socio-demographic characteristics of participants\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocio-demographic features\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n\u0026thinsp;=\u0026thinsp;54)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational attainment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary school and below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIncome\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt; ₦50,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le; ₦50,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;30 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;30 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChristian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Christian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cb\u003eSource\u003c/b\u003e: Fieldwork survey, 2024\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents a snapshot of the socio-demographic details of the participants. One can observe that all the participants lived with older adults at the time of the study. They all provide care management for older adults aged 60 and older. Equal consideration was given to gender to prevent gender domination. There were more married participants (59.3%) and a higher percentage of the participants (53.7%) had secondary school certificates and below. A good percentage of the participants (61.1%) earned less than ₦50,000 (\u003cspan\u003e$\u003c/span\u003e2 estimate) monthly. We had more participants (57.4%) aged less than 30 years and most (77.8) of the participants are Christians.\u003c/p\u003e \u003cp\u003eFor the in-depth interview, the six participants comprising three males and females were married. Although only two had tertiary certificates, four had secondary school certificates. Hence majority earned more than \u0026le; ₦50,000 and are aged above (\u0026le;\u0026thinsp;30 years). They are predominately Christians.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eFamily caregivers\u0026rsquo; concerns in care management for older adults\u003c/h2\u003e \u003cp\u003e In this theme, we present family members' concerns in care management for older adults. The participants highlighted various concerns. We categorized their views into the following sub-themes including changing contemporary society, income level, health status and older adults' attitudes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eChanging contemporary society\u003c/h2\u003e \u003cp\u003eFrom the narratives, the changing contemporary Nigerian society was an important concern in care management for older adults. On this issue, some participants attributed the change to the place of residence, quest for education, search for greener pastures, and adoption of the Western lifestyle. In the various FGD sessions, landmark quotes from groups were extracted and they read:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI brought my mother to live with me in the city. Life here is \u0026lsquo;mind your own\u0026rsquo;. One can rarely tell when one\u0026rsquo;s neighbor is at home, what more informing the person to assist in providing care management for an older adult [Female, FGD, 35 years].\u003c/p\u003e\u003cp\u003eIn this current society, life has changed. This is due to modernization. Everyone wants to go to school, get a job and live in the cities. This makes it difficult for older adults to receive adequate care management because no one wants to be left behind [Male, FGD, 35 years].\u003c/p\u003e\u003cp\u003eYou see, life is filled with numerous difficulties which must be satisfied. In this society, family members no longer perceive care management for older adults as an obligation to be performed by the extended family. In this view, older adults are left in their homes in the villages with paid assistants to provide care management. This enabled other family members to perform certain responsibilities [Male, FGD, 42 years].\u003c/p\u003e\u003cp\u003eIn the conventional society, care management for older adults was a collective activity. This is often done in a familiar environment. Recently, people have adopted the Western lifestyle of the nuclear family system with fewer family members. While the extended family system is gradually fading, concentration is on the nuclear family [Female, FGD, 36 years].\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eFamily caregivers\u0026rsquo; financial status\u003c/h2\u003e \u003cp\u003eAn important concern for participants was the increasing economic challenges in the country. This identified challenge transcends to increasing responsibility for family caregivers to provide the needs of older adults and their own needs. We observed that most participants had low education, irregular jobs, and poor enumeration. These demographic attributes of participants affect the quality of care management given to older adults. Caregivers' financial status was stressed in this point:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIn this country, money is difficult to come by. As a public worker, I am saddled with the responsibility of providing for my children since my husband is late. Again, I am expected to care for my aged mother. Yet, I have no regular job to cope with these responsibilities [Female, IDI, 40 years].\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eWhile lamenting economic concerns, most of the participants considered the use of non-institutional health facilities so that they do not go into debt. See a typical quote below:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eYes, I encourage my parents to consider the use of traditional medicine. I tell them to use local medicine within the community because it is cheaper. This was used by our forefathers. Thank God, alternative medicine doctors are increasing daily in our communities [Male, IDI, 35 years].\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eHealth status of older adults\u003c/h2\u003e \u003cp\u003eAccording to the participants\u0026rsquo; narratives, the effect of older adults\u0026rsquo; health status remains a major concern in care management. Responses from the participants indicated that peoples\u0026rsquo; increase in age, translates to increased healthcare responsibility. This was evident from the various FGD sessions when in one of the sessions a participant had this to say:\u003c/p\u003e \u003cp\u003eMama keeps complaining of various illnesses. If it is not knee pain, it will be waist pain. I often ignore her and her excessive complaints, my siblings are the ones to explain to her the problems she is going through. I will not kill myself providing care management for her when she cannot stop complaining of various health problems [Female, FGD, 40 years].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eOlder adults\u0026rsquo; attitude\u003c/h2\u003e \u003cp\u003eNarratives illustrated that older adults' attitudes are important concerns for participants. It was observed that often this comes with progression in age. The participants wished that their older parents would understand their predicament regarding the impact care recipients' attitudes may have on providing care management. See illustrative quotes below:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eLately, I have been living a life filled with quarrels. Today, my mother will accuse my brother's wife of shouting at her and I will reprimand my brother's wife. Tomorrow she will accuse my sister of starving her to death and I will quarrel with my sister. Do you know that recently my mother accused me of slapping her in my house? Angrily my husband and I vowed that she would never visit us again. My sibling said that Mama had turned into a witch, my brother reported that she hallucinates, but a friend told me that it is dementia. Honestly, I am tired of her [Female, IDI, 45 years].\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eA male participant who was extremely vocal in one of the FGD sessions frightened us by saying:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThere are times when Papa will not wake up fast. One has to beat him hard to wake him. When he is awake, he often laments seeing familiar persons and relatives who are deceased. There are times when he speaks to himself and talks of abstract things that do not make sense. We often ignore him when he behaves like this [Male, FGD, 42 years].\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eCoping strategies family members adopt in care management of older adults\u003c/h2\u003e \u003cp\u003eThe participants gave various strategies they adopt in care management for older adults. They mentioned strategies including staying close to family members, maintaining a positive outlook in life, social networking with friends and groups, and ensuring adequate spiritual relationships with God. In this study, the coping strategies adopted by family members in the care management of older adults were categorized into two sub-themes including adopting \"human relationship\" and \"non-human relationship\". In this regard, responses on staying close to family members, social networking with friends and religious groups were categorized as \"human relationship\". Responses on maintaining a positive outlook, maintaining a spiritual relationship with God and other specific views not related to human relationships like spending time with pets or playing music and games were categorized as \"non-human relationships\".\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eCoping through human relationship\u003c/h2\u003e \u003cp\u003eIn our discussion, it was revealed that communal living and relationships are gradually dwindling in our society. The participants explained that coping is not done in isolation but in the company of others. We are listing some typical quotes below:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eYou see communal living in rural communities is gradually declining in our society. On a good day, we take Papa to the clubhouse where he sits, drinks and discusses with other cohorts. He feels happy and excited when he returns and will want to revisit the club area on another occasion [Male, IDI, 51 years].\u003c/p\u003e\u003cp\u003eMy religious group often pays a visit to Mama's House. They provide her with gifts and foodstuffs. Also, they pray for her and give her good wishes. They provide counseling for her and everyone present at home. This gives us consolation in care management [Female, IDI, 39 years].\u003c/p\u003e\u003cp\u003ePapa is a member of the Order of Noble Knights in the church. Owing to this position, sometimes the Priest pays visits. He prays and provides consolation words for us all. If need be, he presents Papa's condition to the congregation for collective prayers [Male, IDI, 40 years].\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eCoping through non-human relationship\u003c/h2\u003e \u003cp\u003eWe observed that participants adopt coping strategies that are not related to individuals. In this category, participants narrated that they maintain a positive outlook on life, maintain a spiritual relationship with God, and spend time playing games and music. Few participants narrated how they cope with adopting ageing nutrition, and safe hygiene practices. Below are illustrative quotes from IDI participants and two FGD participants who summarized their group's standpoint:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eNo one will live young forever. Ageing is inevitable and this is the only means to attain heaven or hell. So, we must accept our fate and provide care management for older adults. In return, we will obtain a huge blessing that older adults are known to give [Female, IDI, 49 years].\u003c/p\u003e\u003cp\u003eYou see, I attain mass every day. I know that God will assist me till the end. His words from the Bible verse give me the courage to continue to strive till the end. I know His Grace is sufficient for us [Female, IDI, 54 years].\u003c/p\u003e\u003cp\u003eOftentimes when the burden becomes excessive, I use to listen to my spiritual music. I also cope with indoor games like 'Chess games' when the care recipient is asleep. These strategies serve as consolation to cope with the situation in care management for my aged mother [Male, IDI, 29 years].\u003c/p\u003e\u003cp\u003eYou see to prepare food for older adults is not easy because their food is often bitter. There are times when you have to place them on a diet considering their health status like Mama who is diabetic. For me, I provide adequate fruits and vegetables for her. On occasions when I do not have the strength to cook, I simply provide her with what I have available at home [Female, FGD, 29 years].\u003c/p\u003e\u003cp\u003eBedwetting often occurs for my Papa. I cannot cope with providing pampers for him. So, we use old wrappers as improvised pampers for him. When going to bed, we will paddy him up like a baby. In the morning we will wash the cloth, but if he wet himself on the ground, we will clean it up using a rag. This is difficult, but we have to do it for him [Female, FGD, 39 years].\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e Still, on coping through non-human relationships, only two participants mentioned that one coping strategy they adopt is keeping mute. Below is the response by one of the participants:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI endure the situation in my heart. I do not want people to say that I have abandoned my parents. This is why despite the stress and difficulties I experience in care management I adopt silence as a coping strategy [Female, IDI, 27 years].\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eAssessment of family members\u0026rsquo; knowledge of the involvement of social workers in care management of older adults\u003c/em\u003e \u003c/p\u003e \u003cp\u003eIn this regard, the resounding view was that there is little or no knowledge about social workers' involvement in the care management of older adults. We observed that most study participants do not know who social workers are and what they do. As narrated by this participant \"\u003cem\u003eI don\u0026rsquo;t know them and who they are\u0026rdquo;\u003c/em\u003e. Few participants in the tertiary health institution reported knowing about them but did not understand their roles in the health setting. For instance, a participant said:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e...if there is any way they can assist and help us in providing care management for our older parents, I would love to engage them. I need professional assistance in the care management of my father who has been diagnosed with chronic ill-health.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAcross the globe, management for the vulnerable is a priority. While high-income countries provide alternate care management for older adults, low-income countries still adopt the filial care system. This stems from the fact that healthy lives and well-being are essential for all at all ages (UNDESA, 2016). Given that with an increasingly ageing population (UN, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), and with older adults' vulnerability to illnesses (Mcgregor et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), their health and well-being are of utmost importance. It then becomes essential to manage and adopt strategies to cope with care for older adults in Enugu state, Nigeria.\u003c/p\u003e \u003cp\u003eAccording to the findings of this study, family members' major concerns in care management for older adults were on changing contemporary society, income level, health status and older adults' attitude. First, changing contemporary society was a concern owing to the place of residence of the family member, the quest for education, the search for greener pastures, and the adoption of a Western lifestyle. It was reported that life in the city poses difficulty in care for older adults, unlike communal living in the rural localities. Women who are known to provide care, seek to be educated to secure jobs to make a living whereas the extended family system is going extinct. Second, in our conversations, we observed that concerns on income level transcend from increasing family responsibility to providing for the needs of older adults. this emanates from low education, poor income and high inflation in the country. This concern allows the utilization of non-institutional health facilities. The issue of the health status of older adults was the third concern. We discovered in this study that an increase in the age of older adults translates to increased health demands. Fourth, the attitude of older adults was the last mentioned concern of family members. It was found that family caregivers lack the knowledge of some health challenges that may affect the social networking of older adults. Hence, when some older adults display certain ageing health challenges like dementia, they may be perceived as witches and wizards in our African context. Alternatively, some older adults are often ignored by their family caregivers owing to their unintentional attitude. This negative perception of older adults has been reported by scholars including Cadmus et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) and Mah et al. (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA novel finding in this study is that family caregivers cope with the management of older adults through human and non-human networking. It was revealed that coping through human networking was done through interacting with cohorts at clubhouses, visits from religious groups, and friends. While some present gifts, others provide prayer sessions and counseling services. It was also discovered that family members cope with care management of older adults through various ways including maintaining a positive outlook on life, spiritual relationship with God and spending time playing games and music. In furtherance, a few participants narrated how they cope with adequate ageing nutrition and unsafe hygiene practices. It is imperative to note that family caregivers are very much aware of certain unsafe hygiene practices they adopt in coping with care for older adults. However, despite this knowledge, they accept to adopt such strategies since they have no alternative. More so, we observed that few participants adopted silence as a coping strategy. This stems from the fact that care management challenges for older adults are not reported by family caregivers but are endured. But we are worried for those who might not have the desire to endure. We see in developed countries, various alternatives provided for family caregivers to cope with care management for older adults. For instance, the availability of long and short-term care homes, paid formal caregivers, social media interactive platforms, government-approved health insurance, security grants, and mainstreaming of older adults\u0026rsquo; care management in the educational curriculum. These among other age-friendly strategies, would ensure adequate avenues to provide and develop the knowledge needed for healthy ageing.\u003c/p\u003e \u003cp\u003eAnother unique finding in this study that is not common in other studies is the knowledge of the involvement of social workers in the care of older adults in Nigeria. Quite disturbing is the finding that the participants had little or no knowledge about social workers' involvement in the care management of older adults. This could be associated with the fact that formal social work practice is relatively new and emerging in Nigeria (Okoye et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Social work proficient contribution fills in as a mediation measure for management and coping with care for older adults. One of the particular ways social work professionals guarantee sufficient survival techniques is through the idea of 'self-improvement' development in old age. Through this concept, older adults can be urged to take on a 'strength-based approach' that demonstrates a conviction that they can adapt to the real factors and requests of life related to ageing process (Portraj, 2016). This should be possible through the support of a difference in disposition that dodges correlation with different ages, demoralization of negative explanations about self and usage of self-strength. It becomes essential to foster great relational abilities and all that can empower one to remain socially connected and associated with family members (Olason, 2012).\u003c/p\u003e \u003cp\u003e In the families, social workers work with older adults and their caregivers. They provide person-centered, integrated care to deal with possible care management challenges that may compound problems in caregiving. The professionals adopt a multi-dimensional approach to evaluate the competencies of caregivers, their willingness to provide care, and their acceptability of older adults, particularly those who are distraught as a result of an unwelcome health diagnosis (Wolf et al., 2020). Social workers can diffuse the sense of crisis for caregivers by assisting in planning with other health professionals, rendering effective therapeutic services, and providing follow-up programs. Although Nigerian society does not support institutionalized homes for older adults (Adisa, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), short-term care homes can utilize the services of social workers. They could supervise services provided by various care agencies, serve as a platform for recommending competent careers, and help them in providing appropriate healthcare management techniques and services for older adults. It is envisaged that international organizations, local humanitarian groups and Nigerians in the diaspora, with the collaboration of social workers could help develop a care aid programme for all older adults in Nigeria.\u003c/p\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eStrength and limitations\u003c/h2\u003e \u003cp\u003eFirst, the researchers encountered difficulties in recruiting participants who would volunteer to answer the questionnaires. Second the recruited participants were drawn from a particular state. These limitations notwithstanding, we believe that the findings of this study remain valid.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eTo ensure healthy living and well-being, care must be given to older adults. Hence, it is essential to manage and adopt strategies to cope with care for older adults in Enugu state, Nigeria. This study then revealed that; First, family members\u0026rsquo; major concerns in care management for older adults were on changing contemporary society, income level, health status and older adults\u0026rsquo; attitude. These concerns affect the management and strategies adopted in coping with care for older adults. Second, it was observed that a major coping strategy by family caregivers was carried out through human and non-human networking. Through social networking older adults and their family members receive various gifts, counseling, and prayers and maintain a positive outlook on life. This indicates the role of social networking in care management for coping with healthy ageing. Third, the social work proficient contribution fills in as a mediation measure for management and coping with care for older adults. Their presence becomes essential to foster stronger relational abilities and all that could empower one to remain socially connected and associated with family members. Social workers by assisting in planning with other health professionals, could also participate in rendering effective therapeutic services, and develop effective care management services for older adults in Nigeria.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researchers acknowledged that this work is original and has not been published elsewhere, nor is it currently under consideration for publication elsewhere.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of interest statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe the authors hereby declare that there is no conflict of interest concerning this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Strategic Contacts Ethics and Publications (STRACEP) of the University of Nigeria, Nsukka Campus, Enugu State granted the ethical approval with the clearance code: UNNEC/05/002/Ph.D./SW/10-ST08/0024.All methods of data collected were carried out in accordance with relevant institutional guidelines and regulations. The need for written informed consent was waived by the institutional review board of the Strategic Contacts Ethics Publications(STRACEP) of the University of Nigeria, Nsukka Campus, Enugu State. The justification for the waived informed consent was because it was deemed unnecessary as the family caregivers volunteered to participate in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received no funding nor grant from any group, organization, or agency in the public or commercial sectors. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors affirm that the research participants provided verbal informed consent for the publication of the data in this research paper. The participants were informed of their freedom to withdraw at any time in the course of the study. Also, anonymity and confidentiality was assured to all study participants before the discussions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe the authors hereby declare that the manuscript should be published in the sent journal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJacinta Chibuzor Ene:\u0026nbsp;\u003c/strong\u003ewas involved in the conceptualization of the research topic, methodology, funding, investigation, project administration, writing original draft, writing review and editing of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNkechinyere Patricia Onyishi:\u003c/strong\u003e participated in writing review and editing of the original manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTanyi Lum:\u003c/strong\u003e participated in data management, design, formal analysis interpretation, writing review and editing of original manuscript. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData is stored in coded materials and databases without personal data, and authors have policies in place to manage and keep data secure. All datasets generated and/or analyzed during the current study are not publicly available due to the principle of confidentiality assured to the participants and mode of storage (tape recording device), but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAgency for Healthcare Research and Quality. (2018). \u003cem\u003eCare management: Implications for medical practice, health policy and health services research \u003c/em\u003ehttps://www.ahrq.gov/ncepcr/care/coordination/mgmt.html.\u003c/li\u003e\n\u003cli\u003eAdebowale, S. (2016, March 8). Nigeria\u0026rsquo;s population elderly to constitute 20% in 2016. \u003cem\u003eThe Eagle.\u003c/em\u003ehttps://theeagleonline.com.ng/nigerias-population-elderly-to-constitute-20-in-2016-cmd/\u003c/li\u003e\n\u003cli\u003eAdisa, O. (2019). Why are some older persons economically vulnerable and others not? 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Transfer and implementation of knowledge and attitude: A particularchallenge for caregivers in dementia care. \u003cem\u003eJournal of Nursing Education and Practice\u003c/em\u003e, \u003cem\u003e4\u003c/em\u003e(1), 81-88. https://dx.doi.org/10.5430/jnep.v4n1p81.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"coping strategies, family members, care management, older adults, social workers","lastPublishedDoi":"10.21203/rs.3.rs-4593553/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4593553/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Often, ageing is associated with a decline in health conditions and changes in the dietary needs of older adults. It then follows that the most essential line of action is caregiving. This paper examines how family caregivers manage and cope with the caregiving roles for older adults in south-east Nigeria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eWe sought to adopt a qualitative research approach. Focus group discussions and in-depth interviews were utilized in collecting data from 54 participants aged 15-59 years who provide caregiving roles to older adults aged 60 years and above. Data were analyzed thematically.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eWe found that participants experience challenges managing care for older adults. This was owing to older adults' age, health status, attitude, financial incapacitation and educational status of the family caregivers. Most of the participants cope through human and non-human relationships. Findings show that communal relationships in rural communities is gradually declining. It was found that participants who cope through non-human relationships adopt strategies including maintaining a positive outlook of life, observing spiritual relationship with God and spending time playing games and music. Few participants narrated how they cope through adequate ageing nutrition and unsafe hygiene practices. We observed that family caregivers are in dire need of assistance in care management for older adults. Participants showed little knowledge of social work engagement in care management for older adults.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eWe recommend that the Nigerian government should assist with health insurance schemes, security grants and payment to registered family caregivers. International organizations, indigenes in the diaspora and local humanitarian groups in collaboration with social workers can help develop care aid programs for older adults’ wellbeing in low-resource countries.\u003c/p\u003e","manuscriptTitle":"Management and Coping with Care for Older Adults: Tales of Family Caregivers in Enugu State, Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-12 10:58:00","doi":"10.21203/rs.3.rs-4593553/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-06-26T18:10:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-21T10:43:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-21T10:43:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2024-06-17T10:31:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a9f05605-ee1a-46f5-856f-1d69f95c2cf1","owner":[],"postedDate":"July 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-23T03:54:02+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-12 10:58:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4593553","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4593553","identity":"rs-4593553","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}