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Effect of Community-Based Elderly Care Services on Healthcare Utilization among Older Adults in Nigeria

Abstract

Population ageing is becoming an increasingly important public health and healthcare concern in Nigeria as improvements in survival and changing demographic patterns increase the number of older adults requiring health and social care services. Older adults may experience multiple chronic conditions, functional limitations, reduced mobility, social isolation, and increased healthcare needs. However, access to appropriate healthcare services may be limited by financial constraints, geographical barriers, transportation difficulties, inadequate geriatric services, dependence on family caregivers, and limited availability of community-based support. Community-based elderly care services provide an opportunity to deliver health and supportive services closer to older adults through home visits, community health assessments, health education, medication support, chronic disease monitoring, rehabilitation, referral services, social support, and assistance with accessing healthcare facilities. Such services may reduce barriers to healthcare access and encourage appropriate and timely utilization of healthcare services among older adults. Against this background, this study investigates the effect of community-based elderly care services on healthcare utilization among older adults in Nigeria. The study will be anchored on Andersen's Behavioral Model of Health Services Use, the Social Ecological Model, and the Donabedian Model of Healthcare Quality. Andersen's Behavioral Model explains healthcare utilization through predisposing, enabling, and need factors, with community-based elderly care services serving as an enabling factor that may improve access to healthcare. The Social Ecological Model emphasizes the influence of individual, family, community, healthcare-system, and environmental factors on healthcare access and utilization among older adults. The Donabedian Model explains healthcare quality through structure, process, and outcome, with community-based elderly care services representing an important service-delivery process and healthcare utilization serving as a measurable outcome. Collectively, these theoretical perspectives provide a suitable framework for explaining how community-based elderly care services may influence healthcare utilization among older adults in Nigeria. The study will adopt a quantitative quasi-experimental or analytical comparative research design. The study population will comprise adults aged 60 years and above residing in selected communities in Nigeria, as well as healthcare workers and community-based care providers involved in elderly care services. A multistage sampling technique will be used to select states, local government areas, communities, households, community-based elderly care programmes, and eligible older adults. Community-based elderly care services will be assessed using indicators such as frequency of home visits, community health assessments, chronic disease monitoring, medication support, health education, nutritional counselling, functional assessment, rehabilitation services, psychosocial support, caregiver education, referral assistance, appointment support, transportation assistance where available, follow-up activities, and accessibility of community care providers. Healthcare utilization will be assessed using indicators such as outpatient visits, primary healthcare attendance, hospital visits, preventive health service utilization, medication review, screening uptake, chronic disease follow-up, referral completion, emergency healthcare use, hospital admissions, and frequency of healthcare service utilization within a specified period. Data will be collected using structured questionnaires, healthcare facility records, community care registers, home-visit records, referral registers, medication records, and interviews with older adults and caregivers. Descriptive statistics will be used to summarize participants' demographic and health characteristics, exposure to community-based elderly care services, and healthcare utilization patterns. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of community-based elderly care services on healthcare utilization. Where a quasi-experimental design is adopted, healthcare utilization among older adults receiving structured community-based care may be compared with utilization among similar older adults without access to such services. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that community-based elderly care services have a significant positive effect on appropriate healthcare utilization among older adults in Nigeria. Older adults who receive regular and accessible community-based care are expected to demonstrate greater utilization of primary healthcare, preventive services, chronic disease monitoring, medication review, and other appropriate healthcare services than older adults without access to such services. Community-based care may reduce geographical and mobility barriers by bringing health support closer to older adults and assisting them in navigating available healthcare services. Regular monitoring may also facilitate early identification of health problems and encourage timely healthcare-seeking before conditions become severe. However, inadequate numbers of trained healthcare workers, limited funding, weak community health infrastructure, transportation challenges, low awareness of available services, caregiver limitations, and insufficient integration between community and facility-based healthcare may reduce programme effectiveness. The study therefore expects accessible, coordinated, adequately resourced, and age-responsive community-based elderly care services to contribute significantly to improved and appropriate healthcare utilization among older adults in Nigeria. The study is expected to contribute to the literature on community-based elderly care, healthcare utilization, older adult health, geriatric healthcare, primary healthcare, community health services, ageing and health, chronic disease management, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, local government health authorities, primary healthcare facilities, community health workers, geriatric healthcare providers, social care organizations, development partners, caregivers, and policymakers regarding strategies for strengthening community-based care for older adults. The study will also provide evidence-based recommendations for expanding community-based elderly care programmes, strengthening home-visit services, improving geriatric training for healthcare workers, integrating elderly care into primary healthcare, strengthening referral and follow-up systems, improving medication and chronic disease support, increasing community awareness, and developing sustainable community-based healthcare models that improve access to appropriate healthcare services for older adults across Nigeria.

Keywords: Community-based elderly care, healthcare utilization, older adults, geriatric healthcare, community health services, primary healthcare, ageing and health, chronic disease management, home-based care, Nigeria, public health.