A quarter of a century ago, the proportion of older people living in institutions in developed countries had reached an estimated 9% (22). Since that time, there has been a shift in emphasis towards care in the community and the use of less restrictive residential settings. Current rates of use of nursing homes are in the range of 4–7% in countries such as Canada (), Israel (), South Africa () and the United States (4%). In most African countries, older people can be found in long-stay hospital wards, homes for the destitute and disabled, and – in some sub-Saharan countries – in witches’ camps. Social, economic and cultural changes taking place in some.
