‘Gray Matter’: A book review

Our aged relatives need "assisted living" services to live happily since many more people are living for about 30 years past their compulsory retirement age, says a new book on Safeguarding.

The book titled: "Gray Matter: Why you must safeguard your aged relatives so that they can live happily after retirement for 30 years or more" is a guide that informs the reader about why and how you can safeguard your aged relatives to have a “happy” life after retirement.

It is authored by Isaac Ato Mensah, Florence Afful, Barbara Vannessa Sabbi, and Edem Ahiati with Isaac Ato Mensah and Florence Afful serving additionally as editors.

The book is an anthology comprising 20 chapters advocating “assisted living” services for persons aged 60 years and above.

According to the World Health Organisation, “Globally, life expectancy has increased by more than 6 years between 2000 and 2019 – from 66.8 years in 2000 to 73.4 years in 2019”.

This means there is a six-year increase in humanity’s average life expectancy in the last 20 to 25 years.

There is sufficient evidence that pension funds around the world are struggling to cope with the challenge.

For example, on 8 April 2024, the BBC provoked a discussion on this matter in an article by Chris Stokel-Walker which asked: “Is 75 the new 65?”

The book’s authors see such a question as global population health “gray matter”.

Barbara Sabbi is a practising Certified Nursing Assistant in the US while Florence Afful is a practising Registered Nurse in the United Kingdom.

The duo contribute material on how to do Safeguarding.

Isaac Ato Mensah and Edem Ahiati, on the other hand, being healthcare administrators focus on why we should safeguard our seniors.

Florence Afful and Isaac Ato Mensah also formulated a scale known as the “Florence-Ato Mensah Active Listening Score” to test active listening.

In many healthcare environments, a lack of active listening is causing avoidable problems.

The Florence-Ato-Mensah Active Listening Score is therefore a guide to help healthcare workers - and all and sundry - get the information needed from clients/their relatives in preparing a care plan.

In this book, Safeguarding is defined as: “protecting the aged, vulnerable children and people with learning disabilities from their exploiters, neighbours, family and even those that give them care/support in their daily living”.

It is a well-known fact that when people grow old and can no longer perform their usual “activities of daily living" (ADL), they tend to experience a lot of exploitation and abuse from others.

Safeguarding the aged is modeled on Jerome Bruner’s “Scaffolding” concept.

From Jerome Bruner’s Theory of Cognitive Development, we learn that scaffolding is the minimal support a facilitator gives children to help them learn effectively.

In the same vein, the assisted living programme mentioned in the book is a form of scaffolding the caregiver provides for the aged person.

The purpose of this is to support oldies as they go about performing their activities of daily living (ADL).

The caregiver is the scaffold that prevents falls, other domestic accidents, abuse, and other problems that our oldies suffer.

“Yet another indicator” the authors use to justify the reason for safeguarding the aged “is the national average household size”.

“This was 3.6 in 2021, but 4.5 in 2010”, according to the 2021 Ghana Population and Housing Census, suggesting that the number of people per household is reducing.

We can infer that this is due to rural-urban migration which leaves the elderly with no one to cater for them.

In the Savannah Region of Ghana, for example, the average household size was “7.1 in 2010 but reduced to 4.9 in 2021 (change; -2.2)” meaning at least two persons have left their households in the last 10 years.

The implications for our traditional/cultural practices of caring for the aged are obvious.

A 2014 publication by Patrick Enu titled “The effects of rural-urban migration in Ghana: Empirical evidence from the Okaishie community - Greater Accra Region” confirms that the majority of migrants from the rural areas to Ghana's capital city Accra were "able-bodied youth".

Added to that, the American Psychological Association in a 2019 article by Amy Novotney titled "The risks of social isolation” indicates that when “older adults” experience “loneliness” it increases their risk of “depression".

In Ghana especially, oldies who soil their bedsheets due to incontinence, for example, are often subjected to harsh treatment.

This can cause emotional and psychological trauma.

Safeguarding the aged is therefore necessary to ensure holistic care.

Some of the problems faced by the aged are hearing loss, diabetes, depression, dementia, delirium, falls, and incontinence.

The World Health Organisation in its "Ageing and Health" article published 1 October 2022 calls these comorbidities collectively as “geriatric syndromes”.

As a result of geriatric syndromes, many seniors forget basic self-care needs such as toileting and even drinking water, hence the need for scaffolding aka assisted living to help them learn, unlearn, and relearn.

As a solution, the book recommends the use of coercive and incentive policies - by District Assemblies in the case of Ghana - with the overarching aim of encouraging people to safeguard their seniors.

The book also provides a “prospectus” that District Assemblies could follow in establishing assisted living programmes.

This is because the authors are wary of everything becoming over-concentrated on the central government.

The book is available via Amazon.com in ebook, hardcover, and paperback formats.

Augustine Williams-Mensah is an undergraduate student at the Faculty of Applied Behavioural Sciences in Education of the University of Education, Winneba. He is also a staff at writersghana.com.