Perceived basic needs and resources for the elderly in the peri-urban and rural communities in the Hhohho region in Swaziland

Curationis 33 (1): 23-32 The purpose of the study was to explore and describe the basic needs and resources for meeting the needs of the elderly in the peri-urban and rural communities in the Hhohho region in Swaziland. A qualitative, exploratory, descriptive and contextual research design was used. The study population consisted of the male and female elderly aged from 60 years old and above, and key informants (health motivator, community leaders and members from welfare organizations that serve as advocates for the elderly in Swaziland). Purposive sampling was utilized to select participants who met the inclusion criteria. Data were collected using focus groups and individual in-depth face-to-face interviews till data saturation was achieved as evidenced by repeating information. Tesch’s method of qualitative data analysis was utilised to identify themes. A total of 30 elderly persons and eight key informants participated in this research. From the study findings the researcher identified the following themes: need for resources because of poverty; need for support because of the burden of caring for others; need for health care because of health challenges; need for com­ pany because of loneliness, and need for protection because of abuse of elderly persons. Recommendations were made for community nursing practice, nursing education, nursing research and the Ministry of Health and Social Welfare. Correspondence address Prof Marie Poggenpoel, Department of Nursing Science, versity of Johannesburg, Box 524, Auckland Park, 2006 Tel: 011559 2860 Fax: 0115592257 E-mail: mariep@uj.ac.za Kev words Burnout, H om e-based caregivers, Stigma, Stress.


Background and rationale
Old age is defined by Stanhope and Lancaster (2004:546) as people who are 65 years old and above.The term eld erly in the context of this study will be used to describe those people who have reached the age o f 60 years and above.Kinsella (1997:1) and Charlton (2001:1) reported that the Southern Af rican region had the continent's high est percentage o f older inhabitants.In 1997 6.2 percent o f population was es timated to be 60 years o f age or older, slightly more than in the Northern Afri can region (Charlton, 2001: 1).In a speech Leete (2002:1) in the Valencia Forum stated that population ageing was occurring at a more rapid rate in developing countries.Swaziland as a developing country is no exception to this pattern of population growth, be cause according to the report on the Swaziland Population and Housing Census (Ministry o f Economic Plan ning and Development, 2000:8), 4.6 per cent of the total population were 60 years old and above.The total popula tion o f Swaziland in 1997 was 929 718 up from 681 059 in 1986 (Ministry of Economic Planning and Development,

2000:8).
The elderly thus constitute a signifi cant and growing population group in African countries and especially in Swaziland.They make up a group whose basic needs are not fully under stood, and community nurses have yet to offer the full complement of services which the elderly require and deserve.Population ageing is of considerable concern to public health authorities because ageing is associated with the increased prevalence, incidence, and severity o f chronic conditions.In this regard disease prevention and health promotion offer a potentially power fully response to this developing chal lenge.The challenge to community nurses is that they m ust study the needs o f this group and respond with appropriate and effective interventions (Spradley, 1990:597).
In Swaziland, traditionally all the needs of the family members including those of the elderly were taken care o f by the extended members o f the family.The extended family members had a respon sibility o f providing food, security, and also cared for the sick and the infirm.
But, with changing times more and more adults in the rural areas have migrated to the urban areas in search o f job op portunities and money (M inistry of Health, UNICEF, UNFPA and WHO Fi nal Report, 1995:9).
The traditional image and roles of the elderly are also changing.According to Banga (1994:68), various factors are playing a role in this regard.Education for instance has brought into conflict the traditional roles and authority of the elderly.Many old people have no access to their children and grandchil dren to impart their knowledge, experi ences and wisdom to the latter.Teach ers and other contemporary social lead ers are now counsellors from whom the young seek advice.The ideas acquired from schools are often inconsistent with traditional values and customs.Banga (1994:69) also stated at an Inter national Conference on Ageing in Af rica, that it was noted that because of the lack of education o f elderly people, they lose their powers and find them selves deprived o f their contribution in economic and judicial matters and of their role of transmission of knowledge.Banga (1994:70) concluded that "it seems it is more serious in rural areas where older person's authority is now questioned by the younger generation who want to implement the new tech niques they have learnt from school and from other contemporary leaders".But, despite the questioning o f the older person's authority, they are still expected to care for the very young children o f their sons and daughters who may have either left home to seek employment in the cities, or have died as a result o f a variety o f causes in cluding HIV/AIDS.

Problem statement
The elderly population is increasing, as indicated by the 1997 Census that 4.6 percen t o f the p o p u latio n in Swaziland was 60 years old and above.Many of them live in poverty and un der very difficult circumstances.There are many ageing people for whose care society has not been able to make pro vision, and indeed about whose needs society is largely ignorant due to the lack o f substantive research informa tion on their needs.Urbanisation and the disintegration o f the extended fam ily continue to threaten the security of the elderly.With the social changes that are occurring, a new image o f the elderly is also emerging and with it, new dimensions regarding the care and wel fare of the elderly are also emerging.These new dimensions regarding their care pose a challenge and burden upon communities in which they live, and also to the community nurses and the Ministry o f Health and Social Welfare (2003:42).The elderly continue to ex perience difficulty in accessing serv ices due to lack o f transport and, with the current emphasis of health care pro grammes being on maternal and child health, there is serious concern that resources are being shifted away from needed geriatric care at a time when growth in the older population is ac celerating (Ministry o f Health, 1983:8;Ministry of Health and Social Welfare, 2006: 1 & 13;Mabuza, 2008: 10 & 11).The research question that arose was: What are the perceptions o f the eld erly and key informants ( health moti vator, community leaders and members of welfare organizations who serve as advocates for the elderly in Swaziland) about the basic needs and the re sources for the elderly in the Hhohho region?

Research objective
The research objective for this study was to explore and describe the per ceptions of the elderly and key inform ants about the basic needs and re sources for elderly persons in the peri urban and rural communities in the Hhohho region in Swaziland (Mabuza, 2008:12).

Definition of key concepts
Perception: The term perception refers to the experience of sensing, interpret ing, and comprehending the world in which one lives.This makes percep tion a highly personal and internal act (Kneisl, Wilson & Trigoboff, 2004:143).In this research perception refers to eld erly and key informants perceptions about the basic needs and resources for elderly persons in the peri-urban and rural communities in the Hhohho region in Swaziland.
Basic needs: The elderly, like any age group, have physiological, safety, love and belonging, self-esteem, and selfactualisation needs.Their physical, emotional, and social needs are com plex and interrelated (Spradley 1990, 604-607).
Resources: Resources in the elderly person's environment include any as sets or means of facilitation in the the promotion o f health (University of Jo hannesburg, 2010:7).

Elderly person:
The elderly person is an individual from sixty years and older (Central Statistics Office, 1997:3).
Community: A community is an identi fiable group o f persons who share a common interactive pattern and/or geo graphical location (University of Johan nesburg,2010:5).In this research com munity referred to the elderly living in the peri-urban and rural communities o f the Hhohho region in Swaziland.

Research design and method
The research design and method will be described below.

Research design
A qualitative, explorative, descriptive and contextual research design was followed in this study ( Mabuza, 2008: 26-28 ).A qualitative design was cho sen in order to explore the field.The qualitative research method is largely an investigative process where the re searcher makes sense o f a social phe nomenon by contrasting, comparing, cataloguing and classifying the object o f the study (M iles & Huberm an, 1994:104).An exploratory and descrip tive design was used, where qualita tive research methods were followed to explore and describe the perceptions about the basic needs o f the elderly and the resources for meeting these needs (Brink & Wood 1994:119).The context o f the research was the peri urban and rural communities in the Hhohho region where the elderly were found.The elderly were from a low socio-economic status with only pri mary school education.Although these elderly were part o f extended families they did not receive any financial or social support from their adult children and other relatives.

Research method
Sampling, data collection, data analy sis, literature control, measures to en sure trustworthiness, and the ethical principles adhered to in this study are discussed.

Population and Sampling
The population for this research in cluded elderly and key informants.Purposive sampling meaning a con scious and intentional selection, was utilised to ensure that the elderly mem bers and key informants who partici pated in the interviews were the ones who met the sampling criteria (Bums & Grove, 1993:246;Tesch in Creswell, 1994:148).Criteria for the purposive sampling o f the elderly included that they were 60 years and above, lived in the peri-urban and rural communities of the Hhohho region in Swaziland, and that they were from a low socio-economic status.Criteria for the purposive sampling of the key informants included that they were knowledgeable about the needs and resources o f the elderly in the peri-urban and rural communi ties in the Hhohho region of Swaziland (Mbuza, 2008:30).

Sample realization
Included in the sample were 30 elderly persons, eight males and 22 females, from the ages o f 60 years and above, and eight key informants, including the rural health motivator, the key leader in one o f the peri-urban communities and also a councillor, social welfare offic ers, members o f the Philani Maswati Charity Organisation and Umftunti Association who act as advocates for the elderly in Swaziland (Mabuza, 2008: 57-59).

Sample size
Since this research was qualitative in nature, the researcher was committed to obtaining a clear and in-depth un derstanding o f the perceptions about the basic needs and the resources for meeting these needs from the partici pants' perspectives through data satu ration.Hence, the size of the sample was determined by the principle of satu ration (Morse, 1994:104;Streubert & Carpenter, 1999:25).Interviews were conducted till there was a repetition of information regarding the needs and resources of the elderly (Mabuza, 2008: 31).

Data collection
Eight individual in-depth face-to-face interviews were conducted (De Vos, Strydom , F ouche, Poggenpoel & Schurink, 1998:126;DeVos, Strydom, Fouche & Delport, 2002:297) with the key informants in order to understand their perceptions regarding the basic needs and resources o f the elderly in the H hohho region in S w aziland (Mabuza, 2008: 37-39).The question that was asked o f the key informants in Siswati was: "What are your percep tions about the basic needs o f the eld erly, and the resources for meeting these needs in the peri-urban and rural communities in which elderly live in the Hhohho region?"Three focus group interviews (Krueger, 1994:75-80) were conducted with the elderly to achieve an in-depth exploration of the phenom enon in question (Service, 1989:4;Mabuza, 2008:31-37).The same ques tion asked o f the key informants was posed to the elderly.All the interviews were audio-taped and transcribed by the researcher (Mabuza, 2008: 39).A pilot study was conducted as a pre paratory undertaking for the main re search project.One focus group was conducted with the elderly and one indepth interview was conducted with a key informant, as part of the pilot study, to assess if the research question elic ited the information on perceptions about basic needs and resources for elderly.These interviews were included in the data analysis o f all interviews as the research question did elicit appro priate information for the research.During the process of data collection, the researcher assumed a neutral posi tion (intuition); preconceived ideas were bracketed in an effort to avoid bias in the research (B urns & G rove, 1993:80).Field notes o f the observa tions in the study were kept by the re searcher (Mabuza, 2008:39).

Data analysis
All the transcriptions o f the interviews and field notes were analysed.Tesch's m ethod o f open coding (Cresw ell 1994:155) was utilised in analysing data in this research.The researcher identi fied themes and supporting categories pertaining to the perceptions o f the basic needs o f the elderly and the re sources for meeting these needs in the data.Raw data were also sent to an in dependent coder together with a letter explaining the Tesch's method of data analysis that should be used for the analysis o f data After the analysis of the data, the researcher and independ ent coder met for a consensus discus sion on the themes and supporting cat egories (Mabuza, 2008: 39-42).The re sults were then translated into English.

Literature control
The results were discussed in the light of relevant literature and similar stud ies to verify the results, namely, to place them in the context o f what is already known (Streubert & Capenter, 1999:20;Mabuza, 2008:42).

Trustworthiness
The model o f Guba and Lincoln (1985: 295-331) for trustworthiness in qualita tive research was used.The model of Guba and Lincoln (1985:295-331) was used because it is comparatively well developed conceptually and has been used by qualitative researchers, par ticularly nurses and educators, for a number o f years (Krefting, 1991:215).Within this study (Mabuza, 2008: 46-55) the following four criteria to ensure trustworthiness o f this research are truth-value, applicability, consistency and neutrality.Applying strategies of credibility ensured truth-value.The re searcher spend several years working with elderly in the Hhohho region.She kept a reflexive journal when she inter viewed the participants; used different methods of data collection (focusgroup interviews, in-depth individual inter views, observation and field notes); used more than one data source (eld erly and key informants); had peer re views from supervisors; checked the themes and categories with the partici pants, and focused on the perceptions o f the basic needs and resources for elderly.Applying strategies of trans ferability ensured applicability.The re searcher provideda clear description of the demographics of the participants, and gave a dense description o f the results with supporting direct quota tions o f the participants.Similarly ap plying strategies o f dependability en sured consistency.A dense description was given of the research methodol ogy used in this study.Neutrality was ensured by confirmability.A chain of evidence of the whole research proc ess was provided (Lincoln & Guba 1985:290).

Ethical principles
Ethical principles were applied accord ing to the guidelines of the Democratic Nursing Organization for South Africa (1998:3-6).The principles of ethical re search that were adhered to in order to ensure the quality o f research included confidentiality and anonymity, privacy, consent, beneficence, and feedback (Mabuza, 2008: 43-45).These ethical principles were applied in the follow ing manner.During the whole research process the participants were not iden tified.They were interviewed in ven ues o f their own choice where they felt comfortable.All participants gave writ ten consent after the research was ex plained to them.The participants could withdraw at any time without penalty.The participants benefited through this research because they were enabled to express their perceptions on the needs and resources for the elderly in peri urban and rural communities.The De partment of Health officials have taken cognizance o f the results o f this re search and have made policy changes to ensure that the needs o f the elderly are catered for.All the participants re ceived feedback on the research re sults.

Research findings
Five themes were identified during data analysis in which Tesch's descriptive method o f analysis (Creswell, 1994: 155) was utilised.The themes are: need for resources because of poverty; need for support because o f the burden of caring for grandchildren and others; need for health care because o f health challenges; need for company because of loneliness; and need for protection because of abuse.

Discussion of findings Theme 1: Need for resources because of poverty
The study highlighted the needs of the elderly and a lack o f resources includ ing food security, housing, clothing, water supply and basic sanitation, elec tricity supply and financial resources (Mabuza, 2008:59-79).
All the participants reported that: "K udla akweneli.S itfo la sinkhw a kanye ngeliviki ngabo Lwesibili e-Salvation Army.Letinnye tinhlobo tekudla letenta emaseko lamatsatfu asititfoli".(Food is not enough.They only get bread once a week on Tues days only at the Salvation Army Cen tre.They do not get food that contains the three food groups).Masango (2005:11) reported that: "A poor 70-year-old man o f Macambeni in Piggs Peak lives with his nine year old granddaughter.The ageing man was left to look after his daughter af ter the demise o f his wife and son.He and his granddaughter had been scav enging fo r fo o d from bins an d take away outlets in Piggs Peak".
One of the key informants from the in dividual interview s stressed that: "There is needfor clothing fo r the eld erly, because nowadays you only have to wear your clothes two or three times and they need to be washed.You need soap to wash these clothes.Then this question is answered by the financial capacity or economic status o f this person ".
The same key informant further stated that the elderly found themselves hav ing to distribute the little money they had to all the basic needs that arose each day: "Hence, there was dire need to get a sizeable income so as to be able to purchase the necessary cloth ing, especially winter clothing".
When asked to explain what he meant by being poor, he said: "N gisho kokw em batsa.N g ite tim p h a h la tekuvunula tekumbatsa p h ela ". (He does not have Swazi attire to put around his waistline.)One of the key informants said: " The elderly people have to provide fo o d and clothing and even i f school fees are free they have to pay levies and buy uniforms ".
When discussing the problem of poor housing, the participants in the focus groups rep o rted that: "S ila la ngaphandle ". (They are sleeping out side.)One of the key informants also con firmed that: Destitute elderly slept out side in a shack made o f sacks The structures were falling apart; they were in a dilapidated state; others did not have houses of their own.One of the eld erly said: "E... n g ite in d vod za n a len g a gakhela indlu yokulala".(She has no son who can build her a house).
The focus group participants in the peri-urban communities unanimously reported that: "Letindlu lesihlala kuto tiyadzilika (The houses they are liv ing in are in a terrible state some of the participants complain that the rooms they are allocated to are collapsing).
A key inform ant said: "Tidzingo tabogogo b a sica lly badzinga emakhaya ekiM ala.Some o f them lapha bahlala khona are shambles kiite lobanakekelako".(They do not have decent clothing due to poverty.The Roman Catholic Mission provides them with blankets only).Kaseke (1998:3) is of the opinion that it is not surprising that poverty has become a serious problem in Swaziland.Many people did not benefit from the economic growth achieved in the 1970's and 80's.In addition the problem was also exacerbated by the lack of a com prehensive social security system in Swaziland (Magagula, 2004:7).Seventy percent o f Swaziland's population live in poverty, and a quarter rely on food aid for survival, of which the elderly are also part.High unemployment in the formal economy and the social im pact of HIV/AIDS have pushed 69 nine percent of the population into poverty (Ngidi, 2004:3).
Theme 2: Need for support because of the burden of caring for grandchildren and others The burden of caring for grandchildren who were orphans due to HIV/AIDS related illnesses and others; chronic ill nesses were also reported."L a b a n im n g i betfu asinakw a b a n tfw a n a betfu.Solo sibhekeke kokutsi sinakekele tihlobo kakhulu batukulu betfu ". (Most o f them are neglected by their own children, but they are still expected to take care of other relatives, especially children and grand children).
Most participants in focus group in terviews, especially the peri-urban eld erly, reported the problem o f normal services provision when they said: "S ite em anti lam aning lahlobile.Kubita kutsi siye emfuleni lose dvute siyowasha loko lokungcolile.Site gesi nem ithoyi lebesinayo seyidzlikile".(They have no water supply and there fore have to fetch water from the nearby streams and rivers for cooking and laun dry.They also do not have electricity supply.The toilets that they have were destroyed).
Noumbissi (2004:1) reported that more than 40% o f the elderly population re sided in the poorest environments, while about 30% o f adults were in the same situation.Noumbissi (2004:1)  The elderly shoulder many caring re sponsibilities, yet there are very little support given to them; they are caring for their disabled children.Most of them receive help, if any, from outside the family circles and neighbours; as elderly women they have more caring responsibilities for their children and grandchildren; they care for the sick at home who have HIV/AIDS and other related illnesses, which pose a great deal of psychological and emotional strain on them, hence, they are de pressed.
Nhongo (2002:1-2) noted that older people were shouldering immense re sponsibility in the face o f food short ages and they faced a multiplicity of problems.It was not uncommon to find older people looking after up to seven teen children.The elderly had to start afresh as breadwinners to look after those children.(They experience many caring respon sibilities, yet there is very little support given to them; they are caring for their disabled children.Most of them receive help, if any, from outside the family cir cles and neighbours; as elderly women they have more caring responsibilities for their children and grandchildren; they care for the sick at home who have HIV/AIDS and other related illnesses which pose a lot of psychological and emotional strain on them) Another elderly participant from the peri-urban focus group interview s stresses that the elderly get no assist ance when they are bereaved, so much so, that: "Ingatsti umuntfu angaze atibulale ". (One feels like committing suicide).They all describe ill-treatment by the hospital staff when the elderly are ad mitted to hospital.
A key informant said that one o f the problems the elderly faced was: "Poor access to medical and other health care facilities since there is no provision fo r specialized care de signed fo r the elderly coupled with the negative attitudes o f the health work ers particularly nurses who can not even offer spiritual care and lack o f transport amenities due to unfriendly public bus conductors are an issue".
The elderly participants reported that: "Abasinaki; abasamkeli ngendlela lefanele; siyakubhadalela lokwelashwa; bonesi abasphi kudla noma sow u d zin g a k u fu n tw a ; seb a te nomusa.Abasibhandishi ngesineke; ab a siyisi n a sem th o yi nalapho kugezelw a khona; kute nanem itsi etibhedlela takahulumende".(Serv ices are unfriendly; there is poor recep tion at clinics; we are made to pay for the treatment; nurses do not feed us and they are no longer friendly.They do not do wound dressings gentle; they do not take us to the bathroom; there is no medication in the govern ment hospitals.They express a lot of unhappiness when they have to go to the government health facilities).
The same negative attitudes from health care workers towards the eld erly have been reported in Great Brit ain (Laurent, 1993:20).The elderly were regarded as stupid, decrepit, feeble, or unusually eccentric, wise or sweet natured, and in any event to be patron ised.These attitudes pervaded the health services and meant that serv ices were based on deep-seated stere otypes o f what old people were like, rather than what they needed.The negative attitude towards the elderly in an article by Pick'n Pay (2003: 2) pointed out that in an increasing youthorientated society, older persons were o ften m ade to feel w orthless, disrespected and redundant in any sense of the word.

One of the key informants said: "Kute i-organizational structure ngekweku tsi nangabe um untfu lom dzala angaya ku p h i esib h ed le la nom a unayo noma ute imali kute nje because labanye bakh o n a baham ba kalukhuni ngalo kw ekutsi labanye sebachwalile nemadvolo akasavumi ukhanzda kutsi seba stark lemakhaya kute lolobanakekelako kahle". Kute lo sin a kekela ko m ayelana nekusimikisa ema-clinic ngani ngoba n eb a n tfw a b etfu b aya sib u kelela kantsi site nalem ali yokubhadala esibhedlela".
(There is no organisa tional structure to look at the elderly persons' medical needs and there is no difference between those in the rural and in peri-urban communities in this regard.They also face transport prob lems).
One of elderly participants in the fo cus group interviews in the rural set ting complains that no one is willing to take them to the clinics, and they do not have money to pay the hospital or health centre as they are neglected by their own children.
The issue o f neglect was also dis cussed by one of the key informants w hen she ex p lain ed : "L abanye basenabo b antfw ana kodvw a seb a fa n a n ek u tsi seb a fa ngoba abatihluphi ngekunakekela batali babo.In kin g a ku tsi a b a b a siti ngalutfo batali babo kantsi umtali wa spender yonkhe imadlana labekadze anayo amfundzisa khona phela naye atomsita nase aphelelwe ngemandla" (Much as it is true that some o f the elderly people have lost their children others still have children.The problem is they do not provide for their parents, yet the parents had spent the little re sources giving them education with the hope that they will return the same kind ness in the future).

One o f the key informants expressed concern: "Sisahamba singuPhilani MaSwati silitfolile litfuba lokubuketa letindzawo both emakhaya nakhona lapha em a d o lb h en i sib u ka yona inhlala kahle yebantfu labadzala. Sibonileke lapho kutsi baphatsekile bagula kakhulu. K u b a n etifo nje tekutsi umuntfu sowukhulile. Bakhala nje ngem advolo; bakhala ngaboshukela bayabahlupha kakhulu; bo BP nalokunye kephabayephuta kuya esibhedlela. Tizatfu tiningi kungaba ku tsi kute im ali n ek u tsi bangap h a ts e k i kahle n a se b e fik ile emtfola m p h ilo bese loko ku benta
banconote kufela emakhaya ". (When they go to the communities, rural and peri-urban, as members o f the Philani MaSwati Charity Organization, the eld erly that they meet complains o f diabe tes, arthritis and hypertension but de lay in seeking treatment. Reasons for the delay can vary from lack o f financial resources to inacces sibility o f health facilities in terms of the negative attitudes o f health work ers hence; they prefer to die at home.) "kunokutsi siphatseke kabi singamane sifele emakhaya " .(Rather than be humiliated, they would rather die at home).
They unanim ously reported that: "Lusito Iwetemphilo silutfola e Salva tion Army Clinic nase Lotna kuphela (The only available assistance they re ceive at least once a week is from the Salvation Army Centre and the Roman Catholic Church based in Mbabane.)Theme 4: Need for company because of loneliness Emotionally, a considerable number of participants in the focus group inter views expressed a sense o f despond ency.
They in d icated that: "S esip h ila ngekutsi siye em asontfw eni ngoba sengilapho sitid v u d vu ta k h o n a ".(Nothing bring them happiness and they only rekindle their hope by going to church.Church is a place where eld erly get spiritual comfort for everyday problems).Leete (2004:5) stated that recent inves tigation showed that an increasing number of old people wished to die at home.Most elderly persons in the fo cus group interviews confirmed this as one of the key informants said: "I f no body pays attention to them, by ju st conducting a church service with them they end up getting hurt as she or he lacks strength to even afford to go to the nearest church centre ".This finding is in line with the re sponses o f nurse participants in the research on the spiritual needs o f older people (N arayanasam y, C lisset, Perumal, Annasamy & Edge, 2004:13) who have concluded the need for com fort and reassurance was significant.
In all the focus group interviews par ticipants reported: "Labanye betfu bate bantfwana; bate emadvozda afa; bantfwabetfu babatsetse bantfwana babo kitsi bahamba nabo; bantfwana betfu bem antfom batana baham ba bayokw endza; bashiyw a ngem advodza nebafati babo bemuka; liningi letfu sesite batali; labanye betfu a siza n g e sendze; n o kutsike ku te idzawo yokuchitsa situnge".(Some o f them are childless; being widowed; the children have been taken away from them by their parents; husbands died; jilted by their spouses; their children married and left; most o f them have no parents; a few of them never married and there are no recreational facilities for the elderly).
Participants reported that they were liv ing alone because of the death of their spouses or neglect by their own family members.They were left alone to care for the grandchildren because their C urationis M arch 2010 parents had died.The burden of bury ing their children was highlighted in almost all the responses.Also high lighted by the study was the indica tion of the need for company, element of abuse and neglect by relatives in cluding their own children needing so cial support.
Theme 5: Need for protection because of abuse The concern on abuse was emphasised by one o f the key informants, when he mentioned that the grandmothers were raped, sometimes by their grandchil dren and beaten using all sorts o f weap ons.
One elderly woman in a focus group cried and said: we are abused But I am not able to explain because o f the presence o f these men in this group This was supported by several reports in the local newspapers as described below.As confirmation that the element o f abuse was prevalent, the local news papers also cited some incidences of abuse in different com m unities o f Swaziland.For instance, Makhubu (2005:9) reported in the local newspa per that an elderly widow, of 60, from Elangeni, was indecently assaulted by her 23-year old neighbour who fondled her private parts and tried to rape her while she was sleeping in her house.Makhanya (2005:5) reported that an eld erly widow of the Engculwini area stared death in the face on Monday when she was almost stabbed by her enraged son.Dlamini (2005:1) reported in the local newspaper that a 75-year old bed ridden grandmother deteriorated be cause she was haunted by the criminal act o f her granddaughter who had ab ducted an 18 m onths old child at Nkoyoyo, Mbabane.She lamented by exclaiming: "Please don' t kill me

Limitations
The focus o f the study was on the per ception of needs and resources of the elderly in peri-urban and rural commu nities in the Hhohho region.This re search was contextual in nature and can not be generalized to all the elderly in Swaziland.It would be helpful to also try to get a description of how the eld erly in other regions in Swaziland would perceive their needs and resources.

Recommendations
Recommendations were made in refer ence to community nursing practice, nursing education, nursing research and the Ministry of Health and Social Welfare discussed below:

Community Nursing Practice
The com m unity nursing fraternity should develop a long-term, multifac eted approach towards improving the health and quality o f life of the ne glected group o f elderly people.Re spect and cultural values should be included in the general school curricu-lum.The aim should be to develop geri atric services (Lipschitz, 2004:608).To address the concern of the spirituality of the elderly could be to engage the services of a chaplain, spiritual coun sellor or some other person specialis ing in the spiritual care of the ill and the dying (McSherry & Ross, 2002:483).To prevent abuse, com m unity nurses should work with agencies and organi sations such as the Swaziland Action Group Against Abuse (2004-2005:7) that recognizes the importance o f gen der and power relations and seeks to influence those who make decisions at policy-making and political levels.More information is needed on the causes and consequences o f elder abuse, drawing data provided by elderly peo ple them selves (Sw aziland Action Group Against Abuse, 2004Abuse, -2005:7):7).Optimisation o f contacts with friends and relatives should be stressed so as to avoid loneliness and depression.The importance o f measures to enable the elderly to continue to attend the church of their choice where they are likely to meet old friends and possibly m ake new ones is also stressed (Gillespie, 1994:6).If the family refuses placement somewhere else of elderly vulnerable to abuse, legal alternatives for the protection of this elderly should be considered when such negotiations fail (Griffith, 2004: 324-345).There should be provision of health educa tion and case management services to help those elderly persons remain in their homes and empower them to as sume an active role in promoting their own health (Wiek, 2000:1).

Nursing education
The issue o f professional education for the care o f older people is emphasised in Joy, Carter andSmith (2000:1043) when they state that it is important to include gerontology within pre-registration, higher education diploma and post-registration courses.Nurse prac titioners in adult health and gerontol ogy must expand their repertoire of health promotion and health mainte nance strategies to meet the needs of this special population (Swenson, 1992).Modules that focus on ageing well including health promotion, dis ease prevention, maintaining cognitive functioning, social support, and active involvement with life are recommended because they encourage strategies to maximize the potential of ageing well (H all-L ong, P lo w field & H ayes, 2004:535).

Nursing research
Research into the relationship between social activity and life satisfaction amongst the rapidly growing popula tion o f the elderly is recommended (Gillespie, 1994:6).Community nurses must take the lead in incorporating the findings of research about health pro m otion into clin ical practice and protocols and into the community part nerships and programmes so as to ben efit efforts for meeting the basic needs of the elderly (Pender, 2003:4).A col laborative project o f research in spir itual and spiritual care in nursing from a Christian World View is crucial to pro vide nurses w ith eviden ce-b ased knowledge to guide their giving of spir itual care, an essential aspect o f w holistic health care (Van Dover, 2002:2).Twigg (2004:1) 1998:20).Providers of palliative care are needed, and that different diseases re quire diverse parameters for the plan ning of rational palliative care treatment and team organisation.In addition of to the legislative incorporation o f the palliative care a long-term strategy at the national and local level is needed, with defined palliative care services and providers (Stambuk, 2004: 2).Health and medical services should be free of charge and nurses should be gentle and friendly to the elderly.Doctors must not only treat the elderly but must make the access to medical treatment as easy as possible (Bloom, 2005:12)

Conclusion
The research objective of this study was to explore and describe the basic needs for the elderly and resources to meet these needs in the peri-urban and rural communities in the Hhohho region in Swaziland.Qualitative in-depth in terviews were conducted with elderly participants and key informants.Rich data were obtained from these inter views.It was clear from the results that the elderly in Swaziland are a neglected population.The elderly and key inform ants expressed concerns about pov erty, lack o f access to health services, the burden o f caring for others, loneli ness and abuse.

Theme 3 :
Need for health care because of challengesThe participants described different challenges in their pursuit of health care including unkind treatment by health staff, lack o f resources and a lack of understanding o f the needs o f the eld erly.
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