Gauteng's elderly in the context of COVID-19
The elderly are more vulnerable to developing severe symptoms if they contract COVID-19, and face an increased risk of dying from the virus. This increased vulnerability stems from greater frailty and general weakening of the immune system, often exacerbated by existing chronic conditions such as heart disease or high blood pressure. In light of the disproportionate impact of COVID-19 on the elderly, the GCRO has used data from our Quality of Life V survey (2017/18) to better understand the lives of the elderly in Gauteng province. In particular, we look at how the elderly form parts of families and households, and fulfill key caregiving and economic roles in the province. South Africa’s apartheid history has left Gauteng, and South Africa, with substantially different population-age structures for different population groups. As household structure and the distribution of care-giving roles also vary by population group, we present separate data for African elders, for whom we have the largest sample size.
Globally, COVID-19 mortality increases most sharply for those aged 70 or higher - but, this data comes primarily from high income countries with strong health care systems. In less developed countries, which have shorter life expectancies, high levels of pre-existing conditions known to worsen outcomes, and generally weaker health systems, mortality is likely to rise earlier. Consequently, we have focused our analysis on those aged 60 and above. Like South Africa as a whole, Gauteng has high levels of conditions believed to worsen COVID-19 outcomes, such as high blood pressure, diabetes, heart disease, TB and untreated HIV/AIDS, and life expectancy is already low (63,8 years for males and 69,2 years for females).
Key results of our analysis can be explored in our interactive visualisation below. Overall, some 13% of Quality of Life V respondents in Gauteng are aged 60 years and older (n=3350; total sample=24 889). While 26% of the elderly live alone, most (74%) live in households with two or more people. A total of 16% of the elderly live only with their spouse - which is just over half of those living in a two-person household. Most elderly people (59%) live with family members other than their spouse, and 42% live in households with children under 18 years. Levels of embeddedness within a multigenerational household are highest for African elderly, with 54% living in households with children under 18 years of age.
Not only do the elderly often live with children, but they frequently also support children financially, including their own adult children. Some 65% of elderly respondents reported having at least one dependent child, and those with dependent children had an average of three. These children include both minors and adults, for whom they are caring for on a daily basis, providing food and shelter or perhaps just supporting financially. The figure for respondents in the African population group is even higher with 74% of African elderly with at least one dependent child.
Of elderly respondents who report having dependent children, 87% fulfil the role of primary carer - that makes up 56% of all elders. Furthermore, just over 20% of older respondents live with their own children who are younger than 18 years, while 32% live with their children who are older than 18 years. In addition, many elderly (26%) are living with their grandchildren, with 53% of this group in ‘skip generation’ households and 47% in multi-generation households. These figures clearly demonstrate that many of Gauteng’s elderly are playing a significant role with regards to the care and support of children, both minors and adults.
Households headed by the elderly are likely to be particularly vulnerable in the context of the COVID-19 pandemic, whether through poverty or through potential loss of income through the illness or death of the household head. In addition to age and relationship status, being the head of the household is often associated with higher income (Posel, 2001). As many as 85% of elderly respondents identify themselves as the head of their household, and consequently likely make financial contributions to their household, even if it is through their pension or social grant. Additionally, 48% of these household heads are male. Current evidence suggests that men are more vulnerable to serious illness and death from COVID-19 infection, meaning that these households headed by elderly males may be more vulnerable from the loss of income from serious illness or death.
With South Africa now under lockdown, the social and economic implications of the pandemic, and efforts to contain it, are becoming increasingly clear. Evidence of growing levels of hunger and income insecurity raises concerns about spiralling poverty, social unrest and economic collapse as a result of long term shutdowns. This has led some commentators to suggest that in countries like South Africa, there is a choice to be made between policies of lockdown, with wide economic and social impacts, and simply allowing the disease to run its course, thereby restricting negative impacts to an increase in deaths amongst the elderly. Others have convincingly highlighted the flaws in this argument, in particular that they ignore the social and economic costs of an overwhelmed health system and large numbers of deaths in a concentrated period. While our relatively youthful population (South Africa’s median age is 25 and Gauteng’s is 29) may provide some protection against the impact of COVID-19, our elderly do not exist in isolation from the rest of the population. Our analysis (consistent with national-level data) suggests that without intervention, this pandemic will have significant implications for many households that include or rely on support from elderly household members.
Even with intervention, the risks are substantial. South Africa’s current lockdown will inevitably need to be eased in coming weeks, and measures to protect the elderly and other at-risk groups, for example through ‘shielding’, must be considered. Understanding the location of the elderly - both physically, and within families, households and communities - will be critical to establishing how to do this in the most viable way. Household structure, along with population age distribution, has been recognised in understanding variable risk of transmission, and consequently must be considered as part of any shielding strategy - particularly given evidence that a large proportion of infections occur within households. Our analysis highlights some of the difficulties of isolating the elderly from other less vulnerable members of the population in the South African context. Additionally, it demonstrates the need for policies which take into account the financial and social support that the elderly provide, and accommodate varied living situations and household structure across the country.
The lives of Gauteng’s elderly are almost certainly intertwined with those of younger residents in numerous other ways beyond those presented here. Along with the pandemic’s economic and social costs, the human and emotional impacts of allowing COVID-19 to disrupt large numbers of intergenerational relationships in a short period of time will be substantial, and devastating.
A number of recommendations which would support the elderly, and the families and households dependent on them, have been made by South African academics and activists. These include extensive and cross-cutting interventions to support households, workers, businesses and the economy, a temporary increase in the value of child support grants, continuing to pay out old age grants for six months after a beneficiary passes away, and careful, data-driven and localised analysis of challenges and potential solutions. The importance of protecting and supporting Gauteng’s elderly is clear.
Reviewed by Christina Culwick.