Intrinsic and extrinsic motives drive family caregivers to provide care to older adults in urban poor Accra, Ghana

“Now that my mother is old, it’s my responsibility to take care of her so that one day my children can also do the same for me.”

The world’s population is growing old. According to the Population Reference Bureau, 10% of the world’s population are aged 65 years and older as of 2021. It is well documented that growing old contributes to an increased risk of disability. Therefore, older adults may need assistance to participate in society actively.  

Older adults, especially in sub-Saharan Africa, are often poor, and they tend to rely on the benevolence of their children for their daily maintenance. The family often provides care and support to older adults. Families spend time with older persons, accompany them to the hospital and assist them with daily tasks in and around the home to enhance their wellbeing.

Family caregivers are motivated by varied reasons to care for their older care recipients. Family caregivers’ motivation for providing care can affect their caregiving roles, behaviour, outcomes, and wellbeing, consequently impacting the quality of care they provide to older care recipients. We interviewed thirty-one family caregivers in November 2016 to explore their motives for providing care to their older care recipients in James Town and Ussher Town in Accra, Ghana. In terms of socio-demographic characteristics, care recipients were aged 64-95, and a higher proportion were females, widowed, and living with non-communicable diseases such as hypertension and diabetes. Regarding family caregivers, they were aged 21-74, and a higher proportion were females, worked at home/nearby home, adult children of care recipients, and lived with care recipients in the same house.

Our analysis showed that caregivers were motivated to care in two ways: intrinsically (empathy and affection) and extrinsically (personal obligation and reciprocity).

Intrinsic motivations

Family caregivers were motivated by concern for the wellbeing of older adults to provide care. Family caregivers recognised older adults’ financial, health, and practical needs, which inspired them to provide care. Family caregivers cooked, performed laundry and ran errands to meet the practical needs of their older care recipients. They also accompanied their older care recipients to hospitals and provided them loans to supplement their working capital.

Affection for parents also motivates children to provide care to their parents. For example, one family caregiver reported that:

“The love for my mother motivated me to provide care to her.”

Studies in Botswana, Ghana and Ireland found that family caregivers were motivated by affection and responsibility to care for their older adults.

Extrinsic motivations

Family caregivers were motivated by normative expectations for adult children to care for their aged parents and principles of reciprocity to care for their care recipients. Older adults being parents and relatives made family caregivers felt obliged to care for them.

“Now that she is old, it’s my responsibility to take care of her [mother] so that one day my children can also do the same for me.”

Also, some family caregivers felt obliged to provide care because providing care to older recipients denotes respect. Older persons are respected because they serve as a repertoire of wisdom. Family caregivers reported that the desire to pay back past deeds of older adults also motivated them to provide care:

“She [grandmother] has done a lot for me. During my childhood, even though my mother was there, she had been the closest person I have ever known. She has done a lot for me, so I feel in my small way even though I don’t have money, I massage her knees because she complains a lot of knee pains … and I make sure I check her blood pressure regularly any time I’m home. Those are the only things I can do in paying her back.”

Research has established that reciprocity motivates family caregivers to care for older adults. In Ghana, a study revealed that past deeds motivated family caregivers to care for their older care recipients. Similarly, family caregivers in Osun State and Kwara State in Nigeria, and India reported that reciprocity motivated them to care for older adults.

Going forward

Research suggests that family caregivers motivated by intrinsic motives provide adequate care to their care recipients than those motivated by extrinsic reasons. An explanation is that persons motivated by intrinsic motives are more autonomous than those motivated by extrinsic motives. Our study found that while some family caregivers were motivated by intrinsic motives to care for older adults, others were motivated by extrinsic motives. This finding highlights the need for social workers to target and provide tailor-made support to assist family caregivers motivated by extrinsic reasons since they are more likely to provide inadequate care. Possible interventions can include collaborations between social workers and   certified counselling and clinical psychologists who can use psychotherapy to enhance the quality of care provided by family caregivers with extrinsic motives.

Keywords: Family caregivers, older adults, intrinsic motivation, extrinsic motivation, urban poor, Ghana

This blog post was prepared for Chronicity Care Africa by the authors.

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