DETERMINATION OF NEEDS OF BLACK AGED PERSONS IN PORT ELIZABETH : DIRECTION FOR FUTURE INTERVENTIONS

Social, econommic and health care needs o f elderly black persons in Port Elizabeth and areas in its immediate vicinity are investigated. Conclusions are drawn from a sample study o f 301 elderly people^ The investigation reveals that the majority o f pensioners are -women, their educational standard is below standard 10, and they have little vocational or specialized training. A high proportion (86%) o f them are breadwinners and therefore they are unwilling to reside in institutions. Recreational facilities are inadequate. Pension payout points are overcrowded and disorganized. Also health care services are inaccessible to most elderly people. In view o f these findings, a community-based approach to care for the elderly is recommended. The approach should promote social interaction among elderly through establishment o f luncheon clubs and service centres and well-being ofall elderly through geriatric clinics as well as home care services for the infirm. This entails an intersectorial collaboration, with the elderly being fully involved and participating. Considering the exponential growth ofthe elderly population in South Africa, it is imperative that the government and other organizations should take cognizance o f studies o f this nature when making future decisions as regards the care o f this group.


INTRODUCTION
In 1980, elderly persons (men and women older than 65 and 60 years, respectively) comprised approximately 3.78% of South Africa's population (Van Rensburg, 1984) It has been projected that by the year 2015, this proportion will uKrease to over 5% of which about two thirds will be black (black is defined here in terms of the South African Population Registration Act of 1950 (Act No 30) A recent report of the Central Statistical Services (1991) mdicated that the elderly population (60+ years old) compnse 4.3% of the total South Afncan population.Of these, 55.4% are black s (T able 1).The p o p ulation is " increasing exponentially with tim e" (Hofmeyr and Mostert, 1989).Proposed improvements in standard of living and lifestyle, modem medicine and improved health care facilities will further contribute to a higher proportion of elderly people m society (W .H .0.,1974H .0., & Holmes, 1983).These factors point to an inevitable situation in the near future that a larger elderly population may become dependent upon a smaller proportion of breadwinners.The problem is compounded by the fact that, in the past, the South African government did not cater for the needs of the black elderly.Black people were regarded as temporary sojourners for the purpose of employment after which they would return to the rural areas to retire.
The breakdown of the extended family system as well as the traditional rriral lifestyle, due to modernization and rural to urban migration, have compelled most of the elderly to reside permanently in urban areas (Holmes, 1983, Hildebrandt, 1992, Ferreira et al, 1993& Wessels, 1984).This has created an extra burden on the governm ent and other organizations with regard to provision of essential services which include housing, sanitation and recreational facilities as well as health care.
For these provisions to be efTectively planned and provided, it is necessary to detmnine the needs of the elderly and ensure that they are involved and are fully participating in existing and future community-based developmental projects.In this way, the elderly population will become part and parcel of the community, rather than a burden Consequently they will be empowered to be active participants.This tq)proach will dispel the prevalent notion that elderly people are passive and frail (O'Brien &Gillis, 1993).
This study aims to address the above concerns and was inspired by an exploratory survey conducted m Port Elizabeth in April to May 1988 by the researcher.An interview and a questionnaire mvolvmg a small sample of elderly persons indicated social and economic hardships they encountered which resulted in ill health S u b ^u en tly , m July to August 1990 a more comprehensive research project was conducted Port E lizabeth was again chosen The town is one of many urban areas m South Afnca with a significant proportion of black elderly in its population.The objectives of the study were to: • determme the social, economic and health care needs of the black aged persons in Port Ehzabeth  & Gillis (1993) highlight the need for the government to see the elderly as a major source \v1iich could play a significant role in meetmg some of the human resource needs of this country.These recommendaticms could prove invaluable to decision makers in policy formulation and urt)an plaiming.

METHODOLOGY
The study was conducted in ten urban and peri-urban townships o f Port Elizabeth.
Random sampling was carried out at pension pay points w hich included Santa and E m pilw eni h o sp itals, N ew B righton, Kwazakhele, Zwide and farms (Walmer/ Seaview and Greenbudies).Evoy tenth black eldedy peraon wfao complied with the critehon of 60 years and above for females and 65 years for nudes was selected at the pension pay points.Sampling was carried out during the sixteen days ttie pension was paid out Twenty (20) subjects were chosen each day.The total was 320 subjects.Of these, nirKleen subjects were lost during interviews due to reasons stated in a subsequent paragraph.The remaining 301 constituted the sample.Five trained home nursing auxiliaries assisted the re se a rc h e r to c o lle c t th e data.The questionnaires were ddivered to those elderly people wfao could write and read English, and w ere collected after com pletion.The interview schedule was used to collect data from the elderly people who could neither read nor write English.
The study had limitations in that there were no separate registers for pensioners.It was difficult at times to detennine exact ages.It was also problematic to distinguish, anxxig the total percentage of the aged population receiving pension, those who were bedridden, or disabled and those receiving pension through the bank.In addition, the survey was carried out just after the period of severe unrest in Port Elizabeth.At that time, house numbers were erased and the elderly people were unsympathetic and unco-operative to anybody coming "from the regime" to ask them questions.Consequently, some elderly people were unwilling to give responses on some aspects with which they felt uncomfortable.Nonetheless, 301 of them responded.

Marital S u tu i, Sex and Age Distribution
Of respondents 48 over (Figure 1).In addition to the above, 78.9% were female, showing a tendency of women to outlive m ea

Education and Skills
Figure 2 highlights the educational standard among the respondents and shows that a majority of the sample were poorly educated with only 1.3% having attained the level of Standard 10.Only 10.4% ofthem had received some form o f specialist training in their occupation Thus, their skills they had were centred around wwk experience.

Housing and Economic Dependency
The majority (85.9%) o f the elderly were heads of their households.This is higher than the 75% observed by Aquilino (1990) Of the respondents 90% preferred to hve mdependently but within their communities (Table 3).They identified themselves as an integral part of the communities they lived in and they did not want to be separated from their families After all, the majority of them were the breadwinners When asked whether they would like to live in mstitutions, only 30 responded positively and the rest w a e against the idea The banks were even more distant for 86.4%.Just under half (46.5%) rqwrted they were within easy reach of their pension pay points (Table 4) IncomcAPension Pay-out Ifystem The pension was paid at intervals of two months.The study showed that 93.8% of the elderly preferred to receive their pension monthly.
Health C are Needs The study showed that 442% of the elderiy felt that their health was ranging between poor to very poor (Figure 3).Chronic diseases like hypertension, arthritis, heart conditions, diabetes melUtus and lung conditions were common.It is of utmost importance to note the 4% of the elderiy who needed constant help with activities of daily living (Table 5).
Services to cater for the needs of the frail aged should be planned and estabUshed within an acc ep ted and affo rd a b le com m unity framewoik.The elderly voiced a need for home visiting services either by a nurse or a community worker.

DISCUSSION
The fmdings of the Port Elizabeth survey, like similar research elsewhere in South Africa, illustrate the obstacles identified by the elderiy population in an urban setting which should be addressed by the government through RDP.
The following is a summary o f the P.E.investigation: Most tjTthe elderiy persons preferred to stay within the communities in which they belonged.Institutions for the eld eriy are not favoured by the majority of the black community who regard the concept as contradictory to tradition.In addition, 90% of the elderiy preferred to Uve independently within the community (T«ble 3).They did not vvant to be separated fh>m th e ir fam ilies.S hangase (1 9 9 1 ) also emphasized the fact that it is important for the eldffly to remain in the community safely, usefully and actively for as long as possible.Bryrone (1986) andFerreira et al. (1993) co ncur w ith th e above fin d in g s and recommend that housing poUcies ^u l d aim at assisting and enabling the elderly to fmd affordable accom m odation w ithin the community.
South A frica has a long h isto ry o f experiencing a severe housing shortage which has aiTected a vast section of the population, especially blacks (Bell, 1993).In view of the rqwrted overcrowding, accommodation for the elderly should receive prompt attention.
Welfare organizations, the business sector and the local authority should work out a co-ordinated strategy to meet this enormous problem (Ntshona 1991, Ferreua & Lamont 1990).
The church meets the spiritual, social and recreational needs of most elderly blacks.It is recommended that service centres and luncheon clubs be established ui order to meet some other needs of the elderly people e g social interaction with peers, occupational therapy and the enjoyment of a balanced meal ui congenial suiroundings It is noted that the government has met the proposed recommendation of providing uicome to black seniors on the same criteria as other population groups and pensions arc now paid out monthly.What still remains diflicult IS the congestion and disorganization at pension pay pouits Repeated efTorts by the South Afncan Council for the Aged (SACA) to have a humane system implemented have resulted m a commission of enqtiiry, and it is hoped that the situation will be rectified soon (Eckley, 1993) It is recommended that the commimity should be involved in helping the elderly to raise funds to meet some of their needs. Hildebrandt (1992) proposed self-help projects in which the elderly could participate and Eckley (1993) mentioned that business could could be undertaken from home.
Self-help schemes like the teaching o f handwork, gardening, etc., running a busmess from home, involvement in educare and the eklerly initiating social chibs with peers arc suggested Molkr (1990) in her study on the role of black seniors in educare discussed the involvement of the eklerly in the educare system, which coiUd meet some financial, social and psychological needs Creation of job opportunities for those from all age groups and are ehgible and healthy is encouraged.Small entrepreneurship and educational opportunities based on need could have social, economic and psychological benefits to the individual ( N t^n a , 1991).
Community geriatric clinics to help momtor and mamtain the health of the elderly are needed as invariably the elderly sufTo from chronic conditions significant percentage of the eldaly was ftail and there is a need to plan and establish a frail care service, for example a home care service to support the family frail care mstitution is only recommended for the frail and destitiUe elderly or when the family can no longer cope alone Hales (1980) proposed that district geriatnc clinics for preventive care be esUblished in black townships Hildebrandt (1992) concurs with this suggestion Knowledge about self-care could empower elderly people to make appropnate choices in their daily lives to m am um their health and to respond to treatment A fu rth e r recom m endation is that pre-retirem ent program m es should be designed and implemented five to ten years before retinng.Employers should try to be mvolved in the preparauon for retirement of th e ir em ployees especially the nonprofessional and the poorly educated groups The preparation ensures that they will not depend on the state pension only and that the necessary psycho-social ac^ustments are made.

CONCLUSION
Itcan be concluded from this investigation that a community based qjproach to the care of the elderiy shoukl form the central pillar around which programmes for this group of people ^u l d revolveiiowever, the government has a role in constructing a clear framewoik for addressing the needs of the elderly J t should be noted that some of the recommendations made here are being addressed currently by the community, the South African Council for the Aged and the govensnenLlt is imperative that the rem aining needs be addressed.A n endeavour to involve the elderly people actively in (danning for their care can only serve to empower them, an investment that can pay dividends on &e long term.
As most tteeds of the elderly are interwoven and interrelated with those of the o th a age groups, it is recomntended that appropriate community organizations or interest groups shoukl address the needs of the other age groups also e.g.creating employment opportunities for the young adults.Problems of the eklerly can be compounded by the frustrated aspirations of t h ^ children and grandchiklren.

T
a b le 4 : A c o e s s ib llity o f s o c ia l s e rv ic e s o f th e b la c k a g e d p e ra

SoufocCMHral Staitliela S«fviOM. Port Elitabath, 1991 Coloureds
investigation, are applicable elsewhere m South AlhcaVilakazi (1994)notes that more than 80% of the eldaly live in tmpovcnshed circumstances, where illiteracy is high and lack of pension and access to health care is prevalent It is noted that in meeting the basic needs, the g overnm ent p ro p o ses that partnership be developed with community-baaed stmctuies (ANC, 1994) while O'Brien