Do factors across the World Health Organisation's International Classification of Functioning, Disability and Health framework relate to caregiver availability for community-dwelling older adults in Ghana?

Family Support, Perceived Physical Activeness and Chronic Non-Communicable Diseases as Determinants of Formal Healthcare Utilization Among Older Adults with Low Income and Health Insurance Subscription in Ghana

Evidence suggests that enrollment in a health insurance scheme is associated with higher levels of formal healthcare utilization among older adults, especially those with low income in sub-Saharan Africa (SSA), including Ghana. This study examines the prevalence of formal healthcare utilization and associated factors among older adults with low income and health insurance subscription enrolled in a social intervention program (known as the Livelihood Empowerment Against Poverty [LEAP] program) in Ghana. Cross-sectional data were obtained from an Aging, Health, Lifestyle and Health Services Survey conducted in 2018 among 200 older adults aged 65 years and above enrolled in the LEAP program. The results showed that almost 9 in 10 (87%) older adults utilized formal healthcare services for their health problems. Older adults who received family support, rated themselves to be physically active and had non-communicable diseases (NCDs) were more significantly likely to utilise formal health care services than their counter parts. We recommend that health policies and programs for older adults with low income and health insurance subscription under the LEAP program should consider the roles of family support, physical activeness and NCDs in influencing their use of formal healthcare services.

Why do spouses provide personal care? A study among care-receiving Dutch community-dwelling older adults

This study investigates under what conditions older spouses receive personal care from their spouse. Whether spousal care is provided is determined by individual and societal factors related to informal and formal care provision. Individual factors concern the need for care (the care recipient's health status), the spouse's ability to provide care (the spouse's health status) and the quality of the marital bond. Societal factors reflect changing policies on long-term care (indicated by the year in which care started) and gender role socialisation (gender). From the Longitudinal Aging Study Amsterdam, which completed eight observations between 1996 and 2016, we selected 221 independently living married respondents, aged 59-93, who received personal care for the first time and had at least one previous measurement without care use. The results show that if an older adult received personal care, the likelihood of receiving that care from the spouse decreased over the years: from 80% in 1996 to 50% in 2016. A husband or wife was less likely to receive spousal care when the spouse was unable to provide care or the quality of the relationship was low. No gender differences were found in either the prevalence of spousal care use or in the factors associated with that use. Thus, individual factors and the societal context seem to determine whether one receives personal care from their spouse. The decline in the likelihood of personal care provision from a spouse over the years may indicate a crumbling of family solidarity, an unmeasured and growing inability of the older spouse to provide care or an increasing complexity of care needs that requires the use of formal care. As care-giving can be a chronic stressor and most spouses provide care without assistance from others, attention from policy makers is needed to sustain the well-being of older couples.

Using ethics of care as the theoretical lens to understand lived experiences of caregivers of older adults experiencing functional difficulties

The lived experiences of caregivers of older adults in Ghana are not well understood. The purpose of this study was to explore and discuss the lived experiences of these caregivers using the Ethics of Care as a theoretical lens and Interpretative phenomenological analysis as the methodological approach. Ten caregivers in receipt of social welfare services on behalf of older adults were recruited from the Social Welfare Unit at the Komfo Anokye Teaching Hospital (KATH) in southern Ghana. The analysis identified five interrelated themes: 1) committing the Self to caregiving; 2) caregiving impacting the Self; 3) motivating factors to caregiving; 4) caregiving burdens, and 5) thinking about personal affairs. Their experiences demonstrate that caregivers value the caregiving relationship, as posited by Ethics of Care, and tend to care for their health and well-being. Caregivers’ expression of commitment to caring for older adults is mainly influenced by reciprocity, despite internal and external stressors, and desire to fulfil unmet personal needs. Ethics of care offers an understanding of the lived experiences of caregivers of older adults in Ghana. The findings draw attention to the state to develop specific programs to ensure the health, social and financial well-being of older adults’ caregivers.

Understanding older adults' functioning and health-seeking behaviour during the COVID-19 pandemic in Ghana: A descriptive qualitative study

Little research has been conducted to explore the functional status of community-dwelling older adults in sub-Saharan Africa, including Ghana, especially during the COVID-19 pandemic. This study investigated the functional status and the health-seeking behaviour of older adults during the COVID-19 pandemic in Ghana. Utilising a descriptive qualitative approach, semi-structured interviews were used to collect data from 12 eligible older adults from southern Ghana. With the use of NVivo (v12), descriptive and focused coding techniques were employed to analyse the data. The following five themes were identified after the data analysis: (a) older adults' health status during COVID-19 pandemic, (b) feeling limited, (c) feeling of unhappiness for being inactive, (d) striving to be active and (e) seeking healthcare during COVID-19 pandemic. This study revealed the unique health and social-related needs of Ghanaian older adults during the COVID-19 pandemic. This study's findings draw attention to the urgent need for the state to devise practical health and social-related initiatives to support older adults during and after the COVID-19 pandemic.

Prevalence and determinants of care needs among older people in Ghana

Introduction

Given the longevity noticed among older people in Ghana, and the potential occurrence of functional disability in later years of life, it has become essential to understand their care needs. This study examined the care needs in daily tasks and associated factors in Ghana, following the World Health Organisation International Classification of Functioning, Disability and Health framework.

Materials and methods

A cross-sectional survey was conducted among a sample of 400 older people from Komfo Anokye Teaching Hospital in Southern Ghana. Care need was assessed by one question; “Do you regularly need help with daily tasks because of long-term illness, disability, or frailty?” Multivariate logistic regression was used to test the association between care need and independent variables based on the WHO-ICF conceptual framework.

Results

Majority of the sample (81%), particularly women (54%) reported needing care in daily tasks. Per the WHO-ICF conceptual framework, functional disability—activity variable, (OR = 1.07 95%CI: 1.05–1.09, p<0.001), and absence of government support—an environmental factor, (OR = 3.96 95%CI: 1.90–8.25, p<0.001) were associated with care need.

Conclusions

The high prevalence of care needs among older people may offer an indication that majority of older people in Ghana could benefit from long-term care services. Functional disability and the absence of government support are the major issues that need to be prioritised in addressing the increased demand for care related to performing daily tasks among older people in Ghana.

Social Networks in Limbo. The Experiences of Older Adults During COVID-19 in Ghana

While studies exploring COVID-19 and its global influence have begun, social networks and support among older adults in low-and middle-income countries, such as Ghana have been inadequate despite its enormous relevance. Thus, the study presents the voices of older adults in Jamestown, Accra and their social networks during the COVID-19 pandemic in Ghana. Using a phenomenological approach, data were collected from 15 older adults through in-depth interviews on older adults' social network experiences during COVID-19 pandemic situation. Older adults generally struggled to maintain connections with their family members, friends, neighbors, and the community, especially during the lockdown. They ascribed their limited interaction to COVID-19 preventive measures, such as social distancing and the limitation of face-to-face meetings imposed by the government. Loneliness, stress, and depression are also linked to the breakdown of social networks. The findings provide a deeper understanding of the impact of COVID-19 on older adults' quality of life. It emerged that the Ghanaian society could reconsider the professional services of gerontologists, social workers, community outreach workers, and philanthropists in mitigating loneliness, stress, and depression among older adults in current and future pandemics.

The roles and capacities of social workers in the lives of older adults seeking healthcare and their caregivers in Ghana

As Ghana's older population increases in number and proportion, the social and healthcare needs of older adults and their caregivers become more critical highlighting the relevance of social workers' contribution in assisting older adults and their caregivers. The purpose of this study was to explore social workers' contributions, discussed against the International Federation of Social Workers (IFSW) Policy on Ageing and Older Person framework. The study employed a descriptive qualitative approach making use of semi-structured interviews to collect information from eight social workers at the Social Welfare Unit in Komfo Anokye Teaching Hospital in Ghana. Themes and codes were developed from the interviews using thematic analysis, employing In-vivo and descriptive coding, and N-Vivo v12 as a management tool. Analysis of interviews revealed three interrelated themes; (a) "We provide it accordingly": Talking about their contributions as systematic, (b) "I think we can do more": Talking about their contributions as insufficient, and (c) "Our efforts are being hampered": Complaints of inadequate resources for working with older adults and their caregivers. The study offers areas of opportunities for social workers per the IFSW policy framework to reflect and examine their current knowledge and skill to address the challenges population ageing presents in Ghana. While social workers contribute towards helping older adults seeking healthcare and their caregivers, their needs cannot be ignored. The findings draw attention to effective policies and programs that can provide social workers with the needed resources to be independent and be able to devise novel approaches unique to older adults and their caregivers.

Functional difficulties and toileting among older adults in Ghana: evidence from the World Health Organization Study on global AGEing and adult health (SAGE) Ghana Wave 1

Ghana's older population is projected to increase in coming decades and as a result will see increasing care needs. Understanding the functional difficulties older adults experience, and the associated factors, will help identify relevant intervention to assist older adults in meeting their care needs. This study aimed to analyse the prevalence of functional difficulties among older adults in Ghana, and examine how the World Health Organization International Classification of Functioning, Disability and Health (WHO-ICF) conceptual framework can relate to toileting difficulty to understand the factors that increase older adults’ care needs. Data were for 5,096 adults aged ⩾50 years from the WHO Study on global AGEing and adult health (SAGE) Ghana Wave 1. Difficulties were assessed using self-reported difficulty on 22 functional items, including toileting. Multivariate logistic regression tested associations between toileting and other factors as related to the WHO-ICF conceptual framework. Older adults reported climbing one flight of stairs without resting as a common functional difficulty. Difficulty eating was the item least identified. Toileting difficulty was ranked second among five total activities of daily living difficulties. Age, marital status, self-reported health, memory, bodily pain, short- and far-distance vision, obesity, stroke, chronic lung disease, trust at individual and neighbourhood level, toilet facility type, socialising with co-workers, and public and religious meeting attendance were statistically significantly associated with toileting difficulty in the final parsimonious model. Post-hoc analysis testing interaction revealed that interaction existed between female sex and never married marital status (p = 0.04), and obesity and widowed marital status (p = 0.01), with toileting as the outcome. A significant level of functional difficulty existed among Ghanaian older adults in this sample. Toileting difficulty was associated with factors across different components in the WHO-ICF, emphasising functional, social and environmental factors related to this fundamental human activity.

"Who doesn't Have Challenges? I Have a Lot of Challenges": Exploring the Challenges and Coping Strategies of Neglected Older Adults in Ghana

The purpose of this study was to explore the challenges neglected older adults experience and the strategies they employ to cope. A Phenomenological qualitative approach was adopted. Employing criterion purposive sampling, 12 older adults were recruited from a community in Winneba in Ghana. A semi-structured interview guide following focus group discussion was used to explore the challenges and the coping strategies of older adults. Thematic data analysis making use of descriptive coding was employed. The study revealed that neglected older adults experience financial challenges, health issues, and social isolations. They lacked decent accommodation, nutritional food and were prevented from determining the kind of food they want to eat. These neglected older adults survived by adopting internal and external coping strategies. This study offers a better understanding of the needs of neglected older adults and the nature of their coping strategies. It is recommended that financial and social care should be available for older adults.

Correlates of older adult inpatients' personal care provision to people with functional difficulties in Ghana

Introduction

Most research depicts older adults as needing personal care, with limited research on older adults’ contributions in the lives of others in developing countries like Ghana. The purpose of the study was to examine the personal care provision and socio-demographic correlates of personal care provision by older adult inpatients in Ghana.

Materials and methods

A hospital-based survey was conducted among 400 consecutively surveyed older adult inpatients at Komfo Anokye Teaching Hospital in southern Ghana. Stata 15 was used to analyse the data. The relationship between personal care and older adult inpatients’ socio-demographic characteristics were analysed using the chi-square test. Multivariate logistic regression analysis was employed.

Results

Overall, 28% of older adult inpatients provided personal care. Participants were mostly females, married or cohabiting, completed at most junior high school, Christians, urban residents, not working and living with their immediate family. Primarily, most participants provided personal care to one person, once a week, and one-hour duration. Nearly three-quarters of participants provided personal care to someone who lives with them. After adjustment, male older adults were 50% less likely to and urban residents were 83% more likely to provide personal care. Being single, separated or divorced was statistically significantly associated with personal care provision, however, were not statistically significant after adjusting for sex and residence. A post hoc analysis testing for interaction revealed no relationship existing between sex and marital status concerning personal care provision (p = 0.106).

Conclusion

Female and urban resident older adult inpatients in Ghana are not just passive receivers of care but also provide personal care to others with functional difficulties, independent on age. It further draws attention to the need for policies and programs that can support older adults, particularly females and urban residents, to be productive in the later life.