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Who cares? Implications of care-giving and -receiving by HIV-infected or -affected older people on functional disability and emotional wellbeing

  • M. NYIRENDA (a1) (a2), M. EVANDROU (a2), P. MUTEVEDZI (a1) (a3), V. HOSEGOOD (a1) (a2), J. FALKINGHAM (a2) and M.-L. NEWELL (a1) (a4)...


This paper examines how care-giving to adults and/or children and care-receiving is associated with the health and wellbeing of older people aged 50+ in rural South Africa. Data used are from a cross-sectional survey adapted from World Health Organization's Study on Global Ageing and Adult Health (SAGE) conducted in 2009/10 in rural South Africa. Bivariate statistics and multivariate logistical regression were used to assess the relationship between care-giving and/or care-receiving with functional disability, quality of life or emotional wellbeing, and self-rated health status, adjusted for socio-demographic factors. Sixty-three per cent of 422 older people were care-givers to at least one young adult or child; 27 per cent of older people were care-givers due to HIV-related reasons in young adults; 84 per cent of participants were care-recipients mainly from adult children, grandchildren and spouse. In logistic regressions adjusting for sex, age, marital status, education, receipt of grants, household headship, household wealth and HIV status, care-giving was statistically significantly associated with good functional ability as measured by ability to perform activities of daily living. This relationship was stronger for older people providing care-giving to adults than to children. In contrast, care-givers were less likely to report good emotional wellbeing; again the relationship was stronger for care-givers to adults than children. Simultaneous care-giving and -receiving was likewise associated with good functional ability, but about a 47 per cent lower chance of good emotional wellbeing. Participants who were HIV-infected were more likely to be in better health but less likely to be receiving care than those who were HIV-affected. Our findings suggest a strong relationship between care-giving and poor emotional wellbeing via an economic or psychological stressor pathway. Interventions that improve older people's socio-economic circumstances and reduce financial hardship as well as those that provide social support would go some way towards mitigating this relationship.

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The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution licence .

Corresponding author

Address for correspondence: Makandwe Nyirenda, Africa Centre for Health and Population Studies, R618 Enroute Somkhele, P.O. Box 198 Mtubatuba, 3935, KwaZulu-Natal, South Africa. E-mail:


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Abad-Corpa, E., Gonzalez-Gil, T., Martinez-Hernandez, A., Barderas-Manchado, A. M., De la Cuesta-Benjumea, C., Monistrol-Ruano, O. and Mahtani-Chugani, V. 2012. Caring to achieve the maximum independence possible: a synthesis of qualitative evidence on older adults’ adaptation to dependency. Journal of Clinical Nursing, 21, 21/22, 3153–69.
Aboderin, I. 2004. Decline in material family support for older people in urban Ghana, Africa: understanding processes and causes of change. Journals of Gerontology: Psychological Sciences and Social Sciences, 59B, 3, S128–37.
Aboderin, I. 2005. Changing family relationships in developing countries. In Johnson, M. L., Bengston, V. L., Coleman, P. G. and Kirkwood, T. B. L. (eds), Age and Ageing. Cambridge University Press, Cambridge, 469–75.
Agyarko, R. D., Kalache, A. and Kowal, P. 2000. Older people, children and the HIV/AIDS nexus. Paper presented at the XIII International AIDS Conference, 9–14 July, Durban, South Africa.
Agyarko, R. D., Madzingira, N., Mupedziswa, R., Mujuru, N., Kanyowa, L. and Matorofa, J. 2002. Impact of AIDS on Older People in Africa: Zimbabwe Case Study. World Health Organization, Geneva.
Antonucci, T. C., Birdtt, K. S., Sherman, C. W. and Trinh, S. 2011. Stability and change in the intergenerational family: a convoy approach. Ageing & Society, 31, 7, 1084–106.
Arber, S. and Cooper, H. 1999. Gender differences in health in later life: the new paradox? Social Science and Medicine, 48, 1, 6176.
Ardington, C., Case, A. and Hosegood, V. 2009. Labor supply responses to large social transfers: longitudinal evidence from South Africa. American Economic Journal: Applied Economics, 1, 1, 2248.
Ardington, C., Case, A., Islam, M., Lam, D., Leibbrandt, M., Menendez, A. and Olgiati, A. 2010. The impact of AIDS on intergenerational support in South Africa: evidence from the Cape Area Panel Study. Research on Aging, 32, 1, 97121.
Boon, H., James, S., Ruiter, R. A. C., van den Borne, B., Williams, E. and Reddy, P. 2010. Explaining perceived ability among older people to provide care as a result of HIV and AIDS in South Africa. Aids Care – Psychological and Socio-medical Aspects of AIDS/HIV, 22, 4, 399408.
Boon, H., Ruiter, R. A., James, S., Van Den Borne, B., Williams, E. and Reddy, P. 2009. The impact of a community-based pilot health education intervention for older people as caregivers of orphaned and sick children as a result of HIV and AIDS in South Africa. Journal of Cross-cultural Gerontology, 24, 4, 373–89.
Booysen, F. 2004. Social grants as safety net for HIV/AIDS-affected households in South Africa. SAHARA J: Journal of Social Aspects of HIV/AIDS Research Alliance, 1, 1, 4556.
Bor, J., Tanser, F., Newell, M. L. and Barnighausen, T. 2012. In a study of a population cohort in South Africa, HIV patients on antiretrovirals had nearly full recovery of employment. Health Affairs, 31, 7, 1459–69.
Bowling, A. 2005. Just one question: if one question works, why ask several? Journal of Epidemiology and Community Health, 59, 5, 342–5.
Burns, J., Keswell, M. and Leibbrandt, M. 2005. Social assistance, gender and the aged in South Africa. Feminist Economics, 11, 2, 103–15.
Capistrant, B. D., Moon, J. R., Berkman, L. F. and Glymour, M. M. 2012. Current and long-term spousal caregiving and onset of cardiovascular disease. Journal of Epidemiology and Community Health, 66, 10, 951–6.
Case, A. and Paxson, C. 2005. Sex differences in morbidity and mortality. Demography, 42, 2, 189214.
Chepngeno-Langat, G., Madise, N., Evandrou, M. and Falkingham, J. 2011. Gender differentials on the health consequences of care-giving to people with AIDS-related illness among older informal carers in two slums in Nairobi, Kenya. AIDS Care, 23, 12, 1586–94.
Christensen, K. 2008. Human biodemography: some challenges and possibilities for aging research. Demographic Research, 19, 43, 1575–86.
Cooperman, N. A., Arnsten, J. H. and Klein, R. S. 2007. Current sexual activity and risky sexual behavior in older men with or at risk for HIV infection. AIDS Education and Prevention, 19, 4, 321–33.
Curtis, B., Bradshaw, D. and Nojilana, B. 2002. Socio-demographic Profile of the Magisterial District of Hlabisa – 1996 Census. South African Medical Research Council, Durban, South Africa. Available at:
Dayton, J. and Ainsworth, M. 2004. The elderly and AIDS: coping with the impact of adult death in Tanzania. Social Science and Medicine, 59, 10, 2161–72.
Debpuur, C., Welaga, P., Wak, G. and Hodgson, A. 2010. Self-reported health and functional limitations among older people in the Kassena-Nankana District, Ghana. Global Health Action, 3, supplement 2, 5463.
Dougan, S., Payne, L. J., Brown, A. E., Evans, B. G. and Gill, O. N. 2004. Past it? HIV and older people in England, Wales and Northern Ireland. Epidemiology and Infection, 132, 6, 1151–60.
Fayers, P. M. and Sprangers, M. A. G. 2002. Understanding self-rated health. The Lancet, 359, 9302, 187–8.
Funk, L. M. 2012. ‘Returning the love’, not ‘balancing the books’: talk about delayed reciprocity in supporting ageing parents. Ageing & Society, 32, 4, 634–54.
Goode, W. J. 1960. A theory of role strain. American Sociological Review, 25, 4, 483–96.
Govender, K., Penning, S., George, G. and Quinlan, T. 2012. Weighing up the burden of care on caregivers of orphan children: the Amajuba District Child Health and Wellbeing Project, South Africa. AIDS Care, 24, 6, 712–21.
Hill, C., Hosegood, V. and Newell, M.-L. 2008. Children's care and living arrangements in a high HIV prevalence area in rural South Africa. Vulnerable Children and Youth Studies, 3, 1, 6577.
Hosegood, V., Benzler, J. and Solarsh, G. C. 2006. Population mobility and household dynamics in rural South Africa: implications for demographic and health research. Southern African Journal of Demography, 10, 1/2, 4367.
Hosegood, V., Preston-Whyte, E., Busza, J., Moitse, S. and Timaeus, I. M. 2007. Revealing the full extent of households’ experiences of HIV and AIDS in rural South Africa. Social Science and Medicine, 65, 6, 1249–59.
Hosegood, V. and Timæus, I. M. 2005. Household composition and dynamics in KwaZulu Natal, South Africa: mirroring social reality in longitudinal data collection. In van der Walle, E. (ed.), African Households. Census Data. M. E. Sharpe, New York, 5877.
Hosegood, V. and Timæus, I. M. 2006. HIV/AIDS and older people in South Africa. In Cohen, B. and Menken, J. (eds), Aging in Sub-Saharan Africa: Recommendations for Furthering Research. National Academies Press, Washington DC, 250–75.
Houlihan, C. F., Bland, R. M., Mutevedzi, P. C., Lessells, R. J., Ndirangu, J., Thulare, H. and Newell, M. L. 2011. Cohort profile: Hlabisa HIV treatment and care programme. International Journal of Epidemiology, 40, 2, 318–26.
Ice, G. H., Yogo, J., Heh, V. and Juma, E. 2010. The impact of caregiving on the health and well-being of Kenyan Luo grandparents. Research on Aging, 32, 1, 4066.
Idler, E. L. and Benyamini, Y. 1997. Self-rated health and mortality: a review of twenty-seven community studies. Journal of Health and Social Behavior, 38, 1, 2137.
Joint United Nations Programme on HIV/AIDS (UNAIDS) 2011. World AIDS Report 2011. UNAIDS, Geneva.
Justice, A. C. 2010. HIV and aging: time for a new paradigm. Current HIV/AIDS Report, 7, 2, 6976.
Kimuna, S. R. and Makiwane, M. 2007. Older people as resources in South Africa: Mpumalanga households. Journal of Aging and Social Policy, 19, 1, 97114.
Knight, L., Hosegood, V. and Timæus, I. M. 2013. The South African disability grant: influence on HIV treatment outcomes and household well-being in KwaZulu-Natal. Development Southern Africa, 30, 1, 135–47.
Kowal, P., Kahn, K., Ng, N., Naidoo, N., Abdullah, S., Bawah, A., Binka, F., Chuc, N. T., Debpuur, C., Ezeh, A., Xavier Gomez-Olive, F., Hakimi, M., Hirve, S., Hodgson, A., Juvekar, S., Kyobutungi, C., Menken, J., Van Minh, H., Mwanyangala, M. A., Razzaque, A., Sankoh, O., Kim Streatfield, P., Wall, S., Wilopo, S., Byass, P., Chatterji, S. and Tollman, S. M. 2010. Ageing and adult health status in eight lower-income countries: the INDEPTH WHO–SAGE collaboration. Global Health Action, 3, supplement 2, 1122.
Leibbrandt, M., Finn, A. and Woolard, I. 2012. Describing and decomposing post-apartheid income inequality in South Africa. Development Southern Africa, 29, 1, 1934.
Lloyd-Sherlock, P., Barrientos, A., Moller, V. and Saboia, J. 2012 a. Pensions, poverty and wellbeing in later life: comparative research from South Africa and Brazil. Journal of Aging Studies, 26, 3, 243–52.
Lloyd-Sherlock, P., Minicuci, N., Beard, J. and Chatterji, S. 2012 b. Social protection and preventing illness in developing countries: establishing the health effects of pensions and health insurance. International Social Security Review, 65, 4, 5168.
Lloyd-Sherlock, P., Saboia, J. and Ramírez-Rodríguez, B. 2012. Cash transfers and the well-being of older people in Brazil. Development and Change, 43, 5, 1049–72.
Lowenstein, A. 2005. Global ageing and challenges to families. In Johnson, M. L., Bengston, V. L., Coleman, P. G. and Kirkwood, T. B. L. (eds), Age and Ageing. Cambridge University Press, Cambridge, 403–12.
McEwen, B. S. 2001. From molecules to mind. Stress, individual differences, and the social environment. Annals of the New York Academy of Sciences, 935, 1, 42–9.
Men, C., Meessen, B., van Pelt, M., Van Damme, W. and Lucas, H. 2012. ‘I wish I had AIDS’: a qualitative study on access to health care services for HIV/AIDS and diabetic patients in Cambodia. Health, Culture and Society, 2, 1, 2339.
Minkler, M. and Fuller-Thomson, E. 1999. The health of grandparents raising grandchildren: results of a national study. American Journal of Public Health, 89, 9, 1384–9.
Ng, N., Kowal, P., Kahn, K., Naidoo, N., Abdullah, S., Bawah, A., Binka, F., Chuc, N. T., Debpuur, C., Egondi, T., Xavier Gomez-Olive, F., Hakimi, M., Hirve, S., Hodgson, A., Juvekar, S., Kyobutungi, C., Van Minh, H., Mwanyangala, M. A., Nathan, R., Razzaque, A., Sankoh, O., Kim Streatfield, P., Thorogood, M., Wall, S., Wilopo, S., Byass, P., Tollman, S. M. and Chatterji, S. 2010. Health inequalities among older men and women in Africa and Asia: evidence from eight Health and Demographic Surveillance System sites in the INDEPTH WHO–SAGE Study. Global Health Action, 3, supplement 2, 96107.
Nguyen, N. and Holodniy, M. 2008. HIV infection in the elderly. Clinical Interventions in Aging, 3, 3, 453–72.
Nyambedha, E. O., Wandibba, S. and Aagaard-Hansen, J. 2003. ‘Retirement lost’ – the new role of the elderly as caretakers for orphans in Western Kenya. Journal of Cross-cultural Gerontology, 18, 1, 3352.
Nyirenda, M., Chatterji, S., Falkingham, J., Mutevedzi, P., Hosegood, V., Evandrou, M., Kowal, P. and Newell, M.-L. 2012. An investigation of factors associated with the health and well-being of HIV-infected or HIV-affected older people in rural South Africa. BMC Public Health, 12, 1, 259.
Nyirenda, M. and Newell, M.-L. 2010. Orphanhood and HIV risk in rural KwaZulu-Natal. In Nzimande, N. B. (ed.), State of the Population of KwaZulu-Natal: Demographic Profile and Development Indicators. Department of Social Development/UNFPA, Durban, South Africa, 159–86.
Ogunmefun, C., Gilbert, L. and Schatz, E. 2011. Older female caregivers and HIV/AIDS-related secondary stigma in rural South Africa. Journal of Cross-cultural Gerontology, 26, 1, 85102.
Pearlin, L. I., Mullan, J. T., Semple, S. J. and Skaff, M. M. 1990. Caregiving and the stress process: an overview of concepts and their measures. The Gerontologist, 30, 5, 583–94.
Petersen, I., Baillie, K. and Bhana, A. 2012. Understanding the benefits and challenges of community engagement in the development of community mental health services for common mental disorders: lessons from a case study in a rural South African subdistrict site. Transcultural Psychiatry, 49, 3/4, 418–37.
Petersen, I., Bhana, A., Campbell-Hall, V., Mjadu, S., Lund, C., Kleintjies, S., Hosegood, V. and Flisher, A. J. 2009. Planning for district mental health services in South Africa: a situational analysis of a rural district site. Health Policy Plan, 24, 2, 140–50.
Pirkis, J., Burgess, P., Hardy, J., Harris, M., Slade, T. and Johnston, A. 2010. Who cares? A profile of people who care for relatives with a mental disorder. Australian and New Zealand Journal of Psychiatry, 44, 10, 929–37.
Plagerson, S., Patel, V., Harpham, T., Kielmann, K. and Mathee, A. 2010. Does money matter for mental health? Evidence from the Child Support Grants in Johannesburg, South Africa. Global Public Health, 6, 7, 760–76.
Ratcliffe, J., Lester, L. H., Couzner, L. and Crotty, M. 2013. An assessment of the relationship between informal caring and quality of life in older community-dwelling adults – more positives than negatives? Health and Social Care in the Community, 21, 1, 3546.
Reid, J. and Hardy, M. 1999. Multiple roles and well-being among midlife women: testing role strain and role enhancement theories. Journals of Gerontology: Psychological Sciences and Social Sciences, 54B, 6, S329–38.
Rieker, P. P. and Bird, C. E. 2005. Rethinking gender differences in health: why we need to integrate social and biological perspectives. Journals of Gerontology: Psychological Sciences and Social Sciences, 60B, special number 2, 40–7.
Rozario, P. A., Morrow-Howell, N. and Hinterlong, J. E. 2004. Role enhancement or role strain. Research on Aging, 26, 4, 413–28.
Salomon, J. A., Nordhagen, S., Oza, S. and Murray, C. J. 2009. Are Americans feeling less healthy? The puzzle of trends in self-rated health. American Journal of Epidemiology, 170, 3, 343–51.
Sapolsky, R. M. 1996. Why stress is bad for your brain. Science, 273, 5276, 749–50.
Sapolsky, R. M. 1999. Glucocorticoids, stress, and their adverse neurological effects: relevance to aging. Experimental Gerontology, 34, 6, 721–32.
Sapolsky, R., Armanini, M., Packan, D. and Tombaugh, G. 1987. Stress and glucocorticoids in aging. Endocrinology and Metabolism Clinics of North America, 16, 4, 965–80.
Schatz, E. J. 2007. ‘Taking care of my own blood’: older women's relationships to their households in rural South Africa. Scandinavian Journal of Public Health, 69, supplement, 147–54.
Schatz, E. and Gilbert, L. 2012. ‘My heart is very painful’: physical, mental and social wellbeing of older women at the times of HIV/AIDS in rural South Africa. Journal of Aging Studies, 26, 1, 1625.
Schatz, E. and Ogunmefun, C. 2007. Caring and contributing: the role of older women in rural South African multi-generational households in the HIV/AIDS era. World Development, 35, 8, 1390–403.
Scholten, F., Mugisha, J., Seeley, J., Kinyanda, E., Nakubulwa, S., Kowal, P., Naidoo, N., Boerma, T., Chatterji, S. and Grosskurth, H. 2011. Health and functional status among older people with HIV/AIDS in Uganda. BMC Public Health, 11, 1, 886.
Schröder-Butterfill, E. and Fithry, T. S. 2012. Care dependence in old age: preferences, practices and implications in two Indonesian communities. Ageing & Society. doi:10.1017/S0144686X12001006.
Shisana, O., Rehle, T., Simbayi, L. C., Zuma, K., Jooste, S., Pillay-van-Wyk, V., -Mbelle, N., Zyl, J. V., Parker, W., Zungu, N. P., Pezi, S. and the SABSSM III Implementation Team. 2009. South African National HIV Prevalence, Incidence, Behaviour and Communication Survey 2008: A Turning Tide Among Teenagers? HSRC Press, Cape Town, South Africa.
Sokolovsky, J. 2001. Living arrangements of older persons and family support in Less Developed Countries. In Population Bulletin of the United Nations Special Issue on Ageing and living arrangements of older persons: critical issues and policy responses, 42/43, 162–69. United Nations, New York.
Ssengonzi, R. 2007. The plight of older persons as caregivers to people infected/affected by HIV/AIDS: evidence from Uganda. Journal of Cross-cultural Gerontology, 22, 4, 339–53.
Ssengonzi, R. 2009. The impact of HIV/AIDS on the living arrangements and well-being of elderly caregivers in rural Uganda. AIDS Care, 21, 3, 309–14.
StataCorp 2009. Stata: Release 11. Statistical Software. StataCorp LP, College Station, Texas.
Tanser, F., Hosegood, V., Bärnighausen, T., Herbst, K., Nyirenda, M., Muhwava, W., Newell, C., Viljoen, J., Mutevedzi, T. and Newell, M.-L. 2008. Cohort Profile: Africa Centre Demographic Information System (ACDIS) and Population-Based HIV Survey. International Journal of Epidemiology, 37, 5, 956–62.
Wallrauch, C., Bärnighausen, T. and Newell, M.-L. 2010. HIV prevalence and incidence in people 50 years and older in rural South Africa. South African Medical Journal, 100, 12, 812–4.
Wang, R., Wu, C., Zhao, Y., Yan, X., Ma, X., Wu, M., Liu, W., Gu, Z., Zhao, J. and He, J. 2008. Health related quality of life measured by SF-36: a population-based study in Shanghai, China. BMC Public Health, 8, 1, 292.
WHOQoL Group 1993. Study protocol for the World Health Organization project to develop a Quality of Life assessment instrument (WHOQoL). Quality of Life Research, 2, 2, 153–9.
Wilson, A. O., Adamchak, D. J., Nyanguru, A. C. and Hampson, J. 1991. A study of well-being of elderly people in three communities in Zimbabwe. Age and Ageing, 20, 4, 275–9.
WHO 2010. Measuring Health and Disability: Manual for Who Disability Assessment Schedule (Whodas 2.0). In Üstün, T. B., Kostanjsek, N., Chatterji, S. and Rehm, J. (eds). World Health Organization, Geneva
WHO 2011. WHO Study on global AGEing and adult health (SAGE); Available from
Xavier Gomez-Olive, F., Thorogood, M., Clark, B. D., Kahn, K. and Tollman, S. M. 2010. Assessing health and well-being among older people in rural South Africa. Global Health Action, 3, supplement 2, 2335.
Yount, K. M. and Agree, E. M. 2005. Differences in disability among older women and men in Egypt and Tunisia. Demography, 42, 1, 169–87.
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