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Original Contribution / Clinical Investigation

<-- Saudi Arabia-->
Pattern of current tobacco use among the Saudi adult population: results of the national Survey of Risk Factors of Non-Communicable Diseases
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Abdelshakour M. Abdalla, Lamiaa Z. Abuzaid, Waleed S. Al-Hussain, Nasser A. Al-Hamdan, Abdalla A. Saeed, Ahmed A. Bahnassy

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Concentrations of Azithromycin and Amoxicillin-Clavulanic acid in patients undergoing tonsillectomy
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Nidhal AK Mohammed Ali, Rasha G. Thanoon

International Health Affairs

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Influence of Elderly parent on family dynamics: results of a survey from Karachi, Pakistan
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Waris Qidwai, Imdad Ali Khushk, Sabrina Allauddin, Kashmira Nanji

Education and Training

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Leadership in Postgraduate Family Medicine Training Programs: A “Steps-Model” Implementation in Eastern Province-MOH, Saudi Arabia
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Abdullah Dukhail AL-Khathami

Case Study

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Evaluation of the Child with Short Stature
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Abdulrazak Abyad

Middle East Quality Improvement Program

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January 2017 - Volume 15, Issue 1

Influence of Elderly parent on family dynamics: results of a survey from Karachi, Pakistan

Waris Qidwai (1)
Imdad Ali Khushk
Sabrina Allauddin
Kashmira Nanji

(1) Dr Waris Qidwai
Professor and Chairman
Department of Family Medicine
The Aga Khan University
Karachi Pakistan

(2) Dr Imdad Ali Khushk
Pakistan Medical & Dental Council

(3) Sabrina Allauddin
Medical Student
Dow University of Health Sciences
Karachi Pakistan

(4) Kashmira Nanji
Aga Khan University, Karachi 74800, Pakistan

Dr. Waris Qidwai
The Tajuddin Chatoor
Professor and Chairman
Department of Family Medicine
Service Line Chief, Family Health
Aga Khan University, Karachi
Stadium Road, PO Box: 3500
Karachi-74800, Pakistan
Tel: 92-21-3486-4842 (Office) 92-3332317836 (Cell)
Fax: 92-21-3493-4294



Background: The current and projected increase of the elderly population has raised concerns about the financial, social, and emotional support for the elderly. The objective of this study was to explore the level(s) to which elderly individuals had an influence in important family matters and daily life activities.

Methods: A cross-sectional study was carried out in a tertiary care hospital of Karachi, Pakistan through convenience sampling during August to October 2014. The individuals who were > 35 years and had an elderly parent (> 65 years) were included. A pre-tested structured questionnaire was used for data collection. Analysis was done using SPSS 19.0. Logistic regression analysis was used to identify the reasons for appreciating elderly parent's influence in daily lives of study participants.

Results: A total of 200 study participants' information was included. About 35% of the participants were between 35 to 40 years of age and there was preponderance of females (68%) in the study. The majority (81%) of the participants responded that their parents have an influence on their family matters. Parents' experience (OR: 2.5; 95% CI: 1.1-5.4), wisdom (OR: 2.1; 95% CI: 0.9-4.6) and respect (OR: 1.2; 95% CI: 0.6-2.5) are some of the factors in which participant(s) are influenced by their elderly parents.

Conclusion: The study reveals that children respect their elders' decision(s) and appreciate their influence in family matters. The elders should let children take their own decisions and become autonomous. Children on the other hand should give respect to their elders and should involve them in family decisions.

Key words: elderly; geriatrics; family decisions; family matters; family system; family dynamics; social support


Family is a fundamental unit of any society. In recent times, this unit has adjusted itself to new challenges by changing its functions to cope with new realities. The emergence of the modern generation in a quickly changing world is an illustrative example of it (1). Besides, the advances in the field of medicine over the past 50 years have led to an increase in the average lifespan of the population and in the developing world; ageing issues have only recently begun to emerge as a cause of concern(2). World Health Organization reports that approximately six percent of the population was aged over 60 years in 1998, however, it will be almost doubled by 2025(3). This is because of the rise in the life expectancy; which has increased in the last three decades.(4).

As population ages there are many potential problems that can affect the mental status and overall health of the elderly(5). Although, health problems are considered to be the fundamental part of the aging process, the elderly face major challenges in social as well as economic aspects(5,6). The increase in world elderly population has raised concerns about the financial, social, and emotional support for the elderly(7). Since change occurs in the elderly's socio-economic status, the power to make decision(s) transfers from the parents to the younger generation(8,9). Due to this, the social position of elderly within the family is compromised(8). It is important to discuss the role of elderly population in this modified family system. Moreover, the level to which they would be involved in family matters in the future is also questionable.

Sociologists have been debating the role of elderly in the present society, wherein the family structure has changed from extended/joint to nuclear family system.(10) This change has led to a gap between the young generation and their grandparents; who had earlier played a distinctive role in traditional education of the children and decisions in family matters(11). Therefore, it is important to identify the factors and their extent for such changes.

Family systems in Asia vary considerably. However, this new framework is now applicable to both developed and developing countries(12). The objective of this study was to examine the extent to which seniors can influence the decisions made in the family. It is one of the indicators of assessing the social status of elderly. However, it is a very important aspect to discuss for the future role of elderly in families.


Study Setting and Participants:
A cross-sectional survey was conducted from August to October 2014 in a tertiary care hospital of Karachi, which is the largest, most populous and cosmopolitan city of Pakistan. Those individuals aged above 35 years and who had an elderly parent (> 65 years) were recruited for study through convenience sampling.

Written informed consent was taken from the study participants after the study protocol had been explained to them. Assurance with regards to confidentiality was provided to the participants. The study was reviewed and permitted by the departmental research committee of the Aga Khan University.

Questionnaire and Data Collection:
The interviews were questionnaire based. The initial questionnaire was developed in English which was later translated into Urdu, the national language, for clear understanding of the participants. The questionnaire was pre-tested on 10 individuals and it was revised based on the findings of the pre-test. The data collectors were trained before data collection to eliminate interviewer bias. The questionnaire comprised 2 sections beginning with the demographic details of the study participants. The second section of the questionnaire was about the extent of family matters influenced by elders; if it has a positive or a negative impact on the lives of the study participants. The extent of the influence of elderly was categorized into three levels i.e. low, medium and high.

Statistical Analysis:
Data was double entered and analyzed through SPSS 19.0. Proportions were calculated and chi-square test was used for assessing the different levels of influence. Logistic regression analysis was used to identify the reasons due to which the study participants were influenced by elderly parents. All the analysis was two-tailed and a p-value of 0.05 was considered statistically significant. Results are reported in the form of proportions, odds ratio and their corresponding 95% confidence intervals.


A total of 200 study participants' information was included in the final analysis. The baseline characteristics of the study participants are presented in Table 1. Over one-third of the participants (35%) were between 35 to 40 years of age and 45.5% were more than 45 years of age. There was a preponderance of females in the study sample (68%). About 70% of the participants had more than 12 years of education and three-quarters of the participants (75%) were employed. Approximately 77% of the participants had their parents living with them and 46% of the participants lived with both the parents. The majority (81%) of the participants responded that their parents have an influence on their family matters.

Table 1: Baseline characteristics of study participants (n=200)

Table 2 presents the level of parents' influence on different aspects of daily living. The participants responded that they felt the highest level of influence from parents in day to day activities of daily living (77.3%, P=0.001), followed by influence in household matters (76.1%, P=0.001). Likewise, regarding influence on religious beliefs and practices, 53.4% of the participants responded that their parents have high influence in religious issues. The lowest degree of influence by parents was felt on health related matters (31.5%).

Click here for Table 2: Level of parents' influence on different aspects of daily activities

The majority of the participants (87.7%) responded that the influence of elderly parents is favorable to them (Table 3). Moreover, 68.5% of the spouses considered the influence of elderly parents as positive. Approximately 81.5% of the parents are happy with the influence they have on their families while 80% of the participants mentioned that the reason for accepting parents influence on their lives is parents' experience. In addition, 50.6% of the participants accepted parents' influence because of the respect they have for their parents.

Table 3: Parental influence and factors considered favorably by study participants (n=200)

The majority of the participants (84.6%) responded that they take parents' advice on family matters and 70% of their decisions are in accordance with the modern times. The participants also mentioned that they along with their spouses cannot take better decisions without input from the elderly parents. Figure 1 depicts the reasons for accepting elderly parents influence in daily lives. The study participants responded that parents' experience (OR: 2.5; 95% CI: 1.1-5.4), parents' wisdom (OR: 2.1; 95% CI: 0.9-4.6), parents' respect (OR: 1.2; 95% CI: 0.6-2.5) and at times parents' financial position (OR: 1.9; 95% CI: 0.4-8.9) are some of the factors by which they are influenced by their elderly parents.

Figure 1: Reasons for appreciating elderly parents' influence in daily lives


The joint family is an ancient institution of the sub-continent. Several generations living together is the ideal living arrangement where elders are being taken care of and their opinion is sought for every decision in family related matters, but it has undergone some changes in the late twentieth century.

The prominent feature of the joint family system was that the elderly person in the family was recognized by their leader who has been considered as someone having a firm grip keeping the entire family together with a strong foundation of morals and values. In addition to holding a sole authoritative place in the decision regarding major and minor family matters, their advice and guidance was also considered irreplaceable. The continuous and growing impact of urbanization, secularization, and Westernization, has however, made a significant impact on the family systems, both in terms of structure as well as decision-making. The societies and families in Pakistan have been distinguished for their cultural values and lifestyles since centuries(10). In the current study, 46% of the participants had both of their parents living with them.

This study assessed the level of the impact elders have on family. It has been documented that in a joint family, the family has been more dependent on the decision-making powers of the elderly members of the family as compared to the ones who are living separate from their parents and almost all the areas of their lives have been contributed to by them(4,5). Though in an opinion of a minor group, the contribution given by the elderly members of the family is appreciated, the younger group of the family ends up in difference of opinions and perceptions(13,14).

People's perception of the aging process varies from culture to culture, for instance, aging can be regarded as an unwanted phenomenon in one culture; and in another it can be a mark for wisdom, survival, and eminence (15,16). In this study, upon enquiring about reasons for favoring the influence of elders in family matters, a vast majority of the subjects pointed out that the elders have more experience in dealing with daily life issues (OR: 2.5; 95% CI: 1.1-5.4), and better ways of solving problems (OR: 2.1; 95% CI: 0.9-4.6).

The study participants also responded that respect of the elderly is another factor for accepting the parents' influence. A considerable proportion of the families considered that the elderly affected their lives in a good way and they have a better approach to the issues regarding family matters. In Asian families, elderly are considered to be a source of inspiration and are looked upon as a primary source of guidance(17,18). After retirement, there is a drastic change in the lifestyle of an elderly characterized by sudden loss of income, which leads to an abrupt transition from head of the family to an inactive member in decision-making, and consequently leads to low self-image and depression (17,19,20). On the contrary, in this study, the majority of the participants responded that not only they but their spouse also respects the decision of the elderly family member. However, we could not cross-validate the findings with the elderly family member(s).

In this study, 76.1% of the participants responded that they feel high severe influence of their parents in the actions of daily living. This can be disturbing on part of the children as in today's world male and females both are working to make their ends meet and they need to make certain decisions that they are capable of doing because of the changes in life style and other norms of the society(7,21,22). A relatively smaller group of the participants pointed out that their lives have been less influenced by the elders and they are of the opinion that family matters are handled in a better way by their own decision-making powers for their family(21, 23). Therefore, the elderly parents should allow a certain degree of freedom to their children to take decisions at least regarding activities of daily living (1,8,24).

This study had certain limitations. Firstly, the data was collected from a tertiary care hospital and so the results might not apply to the general population. Moreover, in the study, we inquired about parents influence from their children but we did not include parents' perspective. Therefore, future studies on this issue are warranted to include perspective of participants from different parts of Pakistan and also the population living in rural areas, so as to further understand and obtain views of both i.e. children and their parents.


The study reveals that children respect their elders' decisions and appreciate their influence in family matters. In addition, they look up to their elders because of their experience and better approach in solving problems. However, it is essential to achieve a balance for harmony in families, both from elderly parents and their children. Both the groups should realize their boundaries and limitations. The elders should give space and freedom to their children so that they can be autonomous and are prepared for the future. Children on the other hand should give proper care, respect to their elders and should involve them in family decisions so that they do not feel worthless.


1. Li H, Ji Y, Chen T. The roles of different sources of social support on emotional well-being among Chinese elderly. PloS one. 2014;9(3):e90051.
2. Bowling A, Browne PD. Social networks, health, and emotional well-being among the oldest old in London. Journal of gerontology. 1991;46(1):S20-S32.
3. Cantor MH. Family and community: Changing roles in an aging society. The gerontologist. 1991;31(3):337-46.
4. Prince MJ, Harwood RH, Blizard R, Thomas A, Mann AH. Social support deficits, loneliness and life events as risk factors for depression in old age. The Gospel Oak Project VI. Psychological medicine. 1997;27(02):323-32.
5. Siu O-L, Phillips DR. A study of family support, friendship, and psychological well-being among older women in Hong Kong. The International Journal of Aging and Human Development. 2002;55(4):299-319.
6. Thompson MG, Heller K. Facets of support related to well-being: quantitative social isolation and perceived family support in a sample of elderly women. Psychology and aging. 1990;5(4):535.
7. Kendig HL, Coles R, Pittelkow Y, Wilson S. Confidants and family structure in old age. Journal of gerontology. 1988;43(2):S31-S40.
8. Pinquart M, Sörensen S. Influences of socioeconomic status, social network, and competence on subjective well-being in later life: a meta-analysis. Psychology and aging. 2000;15(2):187.
9. Zarit SH, Reever KE, Bach-Peterson J. Relatives of the impaired elderly: correlates of feelings of burden. The gerontologist. 1980;20(6):649-55.
10. Taqui AM, Itrat A, Qidwai W, Qadri Z. Depression in the elderly: Does family system play a role? A cross-sectional study. BMC psychiatry. 2007;7(1):57.
11. Rubenstein RL. The role of grandparents in the psychological development of children: a cross-cultural study 2015. Doctoral Dissertation.
12. Lu L. Social Support, Reciprocity, and Well-Being. The Journal of social psychology. 1997;137(5):618-28.
13. Mullins LC, Mushel M. The Existence and Emotional Closeness of Relationships with Children, Friends, and Spouses The Effect on Loneliness among Older Persons. Research on Aging. 1992;14(4):448-70.
14. Antonucci TC, Birditt KS, Sherman CW, Trinh S. Stability and change in the intergenerational family: A convoy approach. Ageing and Society. 2011;31(07):1084-106.
15. Yi Z, Wang Z. Dynamics of family and elderly living arrangements in China: New lessons learned from the 2000 census. China Review. 2003:95-119.
16. Wellman B, Wortley S. Brothers' keepers: Situating kinship relations in broader networks of social support. Sociological perspectives. 1989;32(3):273-306.
17. Chou K-L, Chi I. Reciprocal relationship between social support and depressive symptoms among Chinese elderly. Aging & Mental Health. 2003;7(3):224-31.
18. Adams RG, Blieszner R. Aging well with friends and family. American Behavioural Scientist. 1995;39:209-24.
19. Shanas E. The family as a social support system in old age. The gerontologist. 1979;19(2):169-74.
20. Agneessens F, Waege H, Lievens J. Diversity in social support by role relations: A typology. Social networks. 2006;28(4):427-41.
21. Ducharme F, Couture M, Lamontagne J. Decision-making process of family caregivers regarding placement of a cognitively impaired elderly relative. Home health care services quarterly. 2012;31(3):197-218.
22. Colombo F, Aroldi P, Carlo S. "Stay Tuned": The Role of ICTs in Elderly Life. Health Technology And Informatics 203. 2014:145.
23. Mullins LC, Johnson DP, Andersson L. Loneliness of the elderly: The impact of family and friends. Journal of Social Behavior & Personality. 1987.
24. Litwin H. Social network type and morale in old age. The gerontologist. 2001;41(4):516-24.