Older people's challenges and expectations of healthcare in Ghana: A qualitative study

Barriers and Facilitators to Age-Friendly Health Care: A Scoping Review

AIMS

As the global population ages, older adults are increasingly experiencing more complex health problems, resulting in an increase in the prevalence of prolonged hospitalisation. This study aimed to explore the barriers and facilitators to age-friendly health care.

DESIGN

Scoping review.

DATA SOURCES

A systematic search was performed from 2004 to 2024 in the following eight electronic databases: PubMed, Cochrane Library, Web of Science, EBSCOhost, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, China Science and Technology Journal Database and WanFang. A manual search was conducted through the references of the included papers and related publications.

REVIEW METHODS

This review utilised the scoping review methodology framework proposed by Arksey and O'Malley. Studies were screened and extracted independently by two reviewers using a standardised form. Thematic synthesis was used to summarise data. The PRISMA-ScR Checklist was also used.

RESULTS

Thirty-seven studies were included. The following six themes were identified: (1) communication and services; (2) facilities and environment; (3) leadership and policy; (4) information management and investment; (5) education and training and (6) multidisciplinary resources.

CONCLUSION

Several barriers and facilitators to age-friendly health care have been reported. Communication and service issues are critical to age-friendly care both in developed and developing countries. Understanding modifiable barriers and facilitators is essential to addressing these factors and promoting evidence-based care for older individuals.

IMPACT

With the rapid growth of ageing populations worldwide, hospitals need to adapt to ensure age-friendly health care for older patients, and this review provides insights on barriers and facilitators to age-friendly health care. To this end, the review is designed to stimulate global discussions among hospital leaders, clinicians and staff; policymakers and researchers to improve care for patients as they age.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

A qualitative exploration of gaps in undergraduate gerontological nursing courses and recommendations for change

BACKGROUND

The present study intended to gain insight into curricula gaps and explore recommendations for change to improve undergraduate nursing students' knowledge, attitudes and skills in gerontological nursing in Ghana.

METHODS

A qualitative exploratory design was selected for this study. This study was conducted in two phases. In phase 1, semi-structured interviews were conducted with Ghanaian gerontological nursing experts to identify existing gaps in Ghanaian gerontological nursing courses. In phase 2, gerontological nursing experts in Ghana and Australia were interviewed to put forward recommendations to address the current gaps in Ghanaian gerontological nursing courses identified in phase 1. Data were recorded, transcribed verbatim and analysed using a content analysis process.

RESULTS

Five themes were generated from the data. Two of the themes represented gaps in Ghanaian gerontological nursing courses: (1) Gaps in Ghanaian gerontological nursing curriculum impact care of older adults. (2) Aspects of Ghanaian culture perpetuate misconceptions about ageing among undergraduate nursing students. Three themes represented recommendations to address gaps in Ghanaian gerontological nursing courses: (1) Specialised gerontology content is required to dispel myths about ageing. (2) Authentic learning can improve attitudes toward care of older adults. (3) Qualification and skills of preceptors influence knowledge and skills of undergraduate nursing students in gerontological nursing.

CONCLUSION

The inclusion of content such as spiritual needs and preventive healthcare services in undergraduate nursing curriculum is important in developing graduates that provide quality nursing care for older adults in Ghana. Additionally, the use of teaching approaches such as stand-alone courses, and clinical simulations can contribute significantly towards dispelling misconceptions about ageing and provide a deeper understanding of the care needs of older adults among nursing graduates in Ghana. It is anticipated that when these changes are made by the Nursing Registration Board and nursing schools in Ghana, it will lead to improvement in knowledge and skills specific to the care of older adults and ultimately enhance health outcomes of older adults in Ghana.

Barriers impeding research data sharing on chronic disease prevention among the older adults in low-and middle-income countries: a systematic review

Introduction

Chronic diseases, including cardiovascular disease, diabetes, cancer, and chronic respiratory diseases, are a growing public health concern in low-and middle-income countries (LMICs) among the older population. The current review aimed to identify the main barriers that impede researchers from sharing research data on the prevention of chronic diseases in older adults living in LMICs). The review included both older women and men from these countries.

Methods

Studies were selected from 11 databases, including Web of Science, Scopus, PubMed, Taylor and Francis, Biomedical Central, BioOne, CINAHL, EBSCOHost, ScienceDirect, Wiley Online, and Google Scholar, were then transferred to CADIMA, an online tool for screening purposes, and a total of 1,305,316 studies were identified through a robust search strategy. CADIMA also ensured the quality of all studies in this review. The sampling techniques were performed by selecting and screening studies per this review's eligibility criteria. Ultimately, 13 studies were found to meet these criteria. A PRISMA flow chart was used to map out the number of studies that were identified, included, and excluded.

Results

Five main barriers were consistently highlighted, including a lack of necessary resources (9, 69%), dealing with complex and sensitive research data (2,15%), lack of policies, procedures, guidelines (5,38%), medical big data processing and integration (2,15%), and inadequate ethical considerations, legal compliance, and privacy protection (6,46%). Discussion: By shedding light on these obstacles, researchers can develop strategies to overcome the identified barriers and address areas requiring further investigation. The registration details of this review can be found under PROSPERO 2023 CRD42023437385, underscoring the importance of this review in advancing our collective understanding of chronic disease prevention among older adults worldwide.

Systematic review registration

PROSPERO, identifier CRD42023437385, available at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023437385.

Exploring the association of self-rated oral health with self-rated general and mental health among older adults in a resource-poor context: Insights for advancing Sustainable Development Goal 3

INTRODUCTION

Older adults in Ghana have been disproportionately affected by oral health issues such as caries and periodontitis. This situation calls for comprehensive attention within health and healthcare policies, due to the established connections between oral health and other aspects of health and well-being in high-income countries, including physical and mental health. However, there is a significant gap in the literature when it comes to exploring the association of oral health with physical and mental health in resource-constrained settings like Ghana.

METHODS

To address this void, we collected a cross-sectional sample comprising older adults aged 60 and above (n = 1073) and analyzed self-rated health measures to investigate the relationship between oral health and general and mental health in Ghana.

RESULTS

The results of our logistic regression analysis revealed a significant association: older adults who reported poor oral health were more likely to rate their general (OR = 5.10; p < .001) and mental health (OR = 4.78, p < .001) as poor, compared to those with good oral health, even after accounting for demographic and socioeconomic variables.

CONCLUSIONS

Based on these findings, we discuss the policy implications of our findings, especially in the context of advancing Sustainable Development Goal 3 in Ghana and other resource-constrained settings.

Older people's challenges accessing health services in central Nepal: a qualitative study using the domain of access framework

BACKGROUND

Low- and middle-income countries face rapid population aging. However, the health system has remained largely unprepared to deliver health services to an aging population. As the population is rapidly aging in Nepal, their challenges and experience should be the focus for health care providers to address these issues. There is a paucity of evidence on barriers and facilitators to accessing health care services among older people in Nepal. The aim of this study was to investigate the challenges that older people experience while accessing health services in central Nepal.

METHODS

This qualitative study was conducted between April and June 2023. In-depth interviews were conducted among older people of a municipality in central Nepal, which were analysed thematically using a deductive-inductive approach based on the theory of access.

RESULTS

Hypertension and diabetes were the most common health problems among the participants. The affordability of health services was a major issue, although there is a health insurance scheme and a major focus on universal health coverage from the Government of Nepal. Other issues included poor acceptability, poor communication between older people and health staff, and poor accommodation due to a lack of elderly-friendly services, including long wait times in the clinic. Living with family was a major facilitator of access to health care services and was interrelated with multiple domains of access.

CONCLUSIONS

This study identified barriers to accessing health care services for older adults in Nepal. We found that the affordability of health services, poor acceptability, poor communication between older people and doctors, and a lack of elderly-friendly services are the key challenges experienced by older people. Older people felt that these barriers were easier to overcome when they had family support. Therefore, for those living with their children, family support was reported as the major facilitator.

Knowledge, Attitude, and Practice of Geriatric Care Among Health Care Professionals in Kumasi, Ghana

Background

The Ghanaian elderly population is increasing at the fastest rate and this has become a burden as the rate is not proportional to the investment in health to meet their deteriorating health needs. This creates discrepancies and inequalities in healthcare access and coupled with poor healthcare provider services, the inequalities widen. Poor care services are related to poor knowledge and bad attitudes of care providers hence this study seeks to explore the health practitioners' level of knowledge, attitude, and practice (KAP) toward geriatric care.

Methods

The study used a cross-sectional survey design with a simple stratified random technique to select study participants. Out of 257 participants who were sampled for the study, 215 responses were received, representing 83.6% response rate. However, 200 questionnaires were complete (93%) and valid for analysis, which consisted of 166 nurses, representing 83% valid responses, and 34 medical officers, physician assistants, and other allied health care providers, representing 17% valid responses from these professionals. A structured questionnaire was used to assess KAP using the knowledge about Older Patients Quiz (KOP-Q) and Kogan's Attitudes toward Old People Scale (KAOP). Using a mean score of 80%, knowledge, attitude, and practice were dichotomized into good or bad. The Kruskal-Wallis H test was used to compare mean rank across health professionals' knowledge, attitude, and practice of geriatric care.

Results

It shows that the majority (94%) of participants have low levels of knowledge in geriatric care. The majority (84%) of participants do not practice good geriatric care. Differences in knowledge exist among health providers and were statistically significant (P = .045). Doctors had the lowest mean knowledge score (78.61). Nurses (100.27) and physician assistants (106.15) had moderate mean knowledge score ranks. Although not statistically significant, the rank order for practice scores from highest to lowest was: physician assistants (112.95), nurses (99.19), and doctors (79.21). There were however no statistically significant differences between professions in practice scores (P = .067), or attitude scores (P = .097).

Conclusion

Health care providers have low knowledge and, bad attitude toward aged care and this may be related to their service delivery which may affect the aged patronage of healthcare services. This is a wake-up call for authorities to organize continuous professional development to enable care providers to improve their service delivery.

Health care service utilization among elderly in rural setting of Gandaki province, Nepal: a mixed method study

Introduction

Globally, one in every six people will be elderly by 2030. In Nepal, there has been a notable rise in the aging and elderly. Addressing the healthcare needs of them is crucial. Despite the different efforts to advocate for healthy aging, various factors continue to limit this process. This paper aims to explore the utilization of healthcare services among the elderly population and uncover influences on the ability to access these services.

Method

A mixed-method community-based study was conducted in Bihadi Rural Municipality of Parbat, Nepal. The quantitative segment involved interviews with 355 individuals aged ≥60 years, while 18 respondents were enlisted for in-depth interviews. We used descriptive statistics, chi-square test, and logistic regression in quantitative analysis. Similarly, content and thematic analysis were performed in the qualitative component.

Results

This study reported that health service utilization among the respondents was 65.4%. Among the factors ethnicity (OR 3.728, 95% CI 1.062-15.887), not good health status (OR 2.943, 95% CI 1.15-8.046), bus as means of transportation (OR 8.397, 95% CI 1.587-55.091) had higher odds whereas government hospital (OR 0.046, 95% CI 0.009-0.193), not always available health staffs (OR 0.375, 95% CI 0.147-0.931), not sufficient medicine (OR 0.372, 95% CI 0.143-0.924), not available medicine (OR 0.014, 95% CI 0.002-0.068) had lower odds for health service utilization. Other factors identified from qualitative components include long waiting times, insufficient medicine, lack of trained health personnel, financial capacity, low utilization of health insurance, distance, and support from family members.

Conclusions

Nonetheless, a portion of the elderly remained excluded from mainstream of healthcare services. A combination of social, healthcare-related, and individual factors influences the utilization of healthcare services. To ensure elderly-friendly services, prioritize geriatric care training, secure medication availability, and establish a dedicated health insurance program for them. In the current federal context, localizing evidence-based, innovative strategies to address the healthcare needs of the elderly is crucial.

Dimensions of patient-centred care from the perspective of patients and healthcare workers in hospital settings in sub-Saharan Africa: A qualitative evidence synthesis

INTRODUCTION

The United States Institute of Medicine defines patient centred care (PCC), a core element of healthcare quality, as care that is holistic and responsive to individual needs. PCC is associated with better patient satisfaction and improved clinical outcomes. Current conceptualizations of PCC are mainly from Europe and North America. This systematic review summarises the perceived dimensions of PCC among patients and healthcare workers within hospitals in sub-Saharan Africa (SSA).

METHODS

Without date restrictions, searches were done on databases of the Web of Science, Cochrane Library, PubMed, Embase, Global Health, and grey literature, from their inception up to 11th August 2022. Only qualitative studies exploring dimensions or perceptions of PCC among patients, doctors and/or nurses in hospitals in (SSA) were included. Review articles and editorials were excluded. Two independent reviewers screened titles and abstracts, and conducted full-text reviews with conflicts resolved by a third reviewer. The CASP (critical appraisal skills program) checklist was utilised to assess the quality of included studies. The framework synthesis method was employed for data synthesis.

RESULTS

5507 articles were retrieved. Thirty-eight studies met the inclusion criteria, of which 17 were in the specialty of obstetrics, while the rest were spread across different fields. The perceived dimensions reported in the studies included privacy and confidentiality, communication, shared decision making, dignity and respect, continuity of care, access to care, adequate infrastructure and empowerment. Separate analysis of patients' and providers' perspective revealed a difference in the practical understanding of shared-decision making. These dimensions were summarised into a framework consisting of patient-as-person, access to care, and integrated care.

CONCLUSION

The conceptualization of PCC within SSA was largely similar to findings from other parts of the world, although with a stronger emphasis on access to care. In SSA, both relational and structural aspects of care were significant elements of PCC. Healthcare providers mostly perceived structural aspects such as infrastructure as key dimensions of PCC.

TRIAL REGISTRATION

PROSPERO Registration number CRD42021238411.

Study on the time and scale of mutual aid for aging care under the background of active aging

Background

China has entered an aging society and will likely become the fastest-aging country in the world. The demand for aging care services has greatly increased. In recent years, the model of mutual aid for aging care has met the needs of older adults, especially those in rural areas. In this case, how much time should be spent on mutual aid for the older adult in terms of time and how much influence the size of the group has in terms of space are two very important questions when studying mutual aid for aging care.

Methods

An overlapping generations model is built in this article, which includes representative agents, representative enterprises, the endowment insurance system constructed by the government, and the behavior of representative agents in mutual aid for aging care under the background of active aging.

Results

In the base case, the optimal proportion of time to participate in the mutual aid group is 9.31%, and the optimal proportion of time is influenced by the benchmark time of care and the size of the care group. With the increase in the benchmark time of care, the optimal proportion of time increases correspondingly, but the increase is decreasing. With the increase in the size of the care group, the optimal proportion of time decreases, but after the size reaches 4 or 5, the impact becomes very small. When parents' psychological preference coefficient changes from 0.1 to 0.9, that is, when parents change from introverted to extroverted personalities, the optimal proportion of time and parents' utility will also change.

Conclusion

For children who usually take care of their parents for a long benchmark time, the optimal time to participate in the mutual aid group based on personal utility maximization is also long. Second, as the size of the group increases, the time for representative agents to participate in the mutual aid group gradually decreases. In addition, the model of mutual aid for aging care is highly correlated with parents' personalities, and extrovert parents benefit more from this model.

Self-reported dignity and factors that influence dignity in hospitalised older adults: A cross-sectional survey

OBJECTIVE

This study examined levels of self-reported dignity and explored factors expected to influence dignity experienced by older adults during acute hospitalisation in Ghana.

BACKGROUND

Dignified care has been recognised as inseparable from quality nursing care and maintaining patients' dignity has been highlighted in professional codes of conduct for nurses. However, there is a lack of research on self-reported dignity and the factors that influence the dignity of older adults during acute hospitalisation in Africa.

SETTING

A large teaching hospital in the northern region of Ghana.

PARTICIPANTS

Hospitalised older adults.

METHODS

A cross-sectional survey was used to gather data from a convenience sample of 270 older inpatients, using the Hospitalized Older Adults' Dignity Scale. Data were analysed using descriptive statistics and stepwise ordinal logistic regression to investigate stratified dignity outcomes. The study was reported following the STROBE checklist.

RESULTS

More than half of the older adults surveyed reported low to moderate levels of dignity. Demographic characteristics such as age, marital status, religious status, occupation, level of education and type of hospital ward did not show any significant associations with dignity levels. However, there was a significant association found between dignity levels and sex and the number of hospitalisations.

CONCLUSION

Most older adults in a Ghanian hospital experienced loss of dignity during their acute hospitalisation. Male older adults reported higher dignity levels during acute hospitalisation than their female counterparts. Further, older adults who were admitted to hospital for the second time reported less dignity compared to those admitted three or more times.

RELEVANCE TO CLINICAL PRACTICE

The results emphasise the importance of healthcare professionals having the necessary knowledge and skills to provide gender-sensitive care, which ultimately promotes the dignity of all patients. Additionally, the results underscore the urgency of implementing measures that guarantee patients' dignity during all hospital admissions.

PATIENT OR PUBLIC CONTRIBUTION

Survey questionnaires were completed by hospitalised older adults at the study setting.

Family caregivers' experience of care with a child with cerebral palsy: the lived experiences and challenges of caregivers in a resource-limited setting in northern Ghana

INTRODUCTION

Caring for a child with cerebral palsy may be more emotionally and physically exhausting than caring for a typical growing child. The family caregivers' perspective of this phenomenon needs exploring to facilitate the development of services. Our study explored the challenges family caregivers face with children with cerebral palsy in a resource-limited context in northern Ghana.

METHODS

We conducted a qualitative study underpinned by phenomenological principles where it is believed that the reality of a phenomenon is tied to caregivers' perspectives of their own experiences. In this study, we unearthed caregivers' experiences/challenges from their own perspectives. The method of data analysis used was to allow the issues to emerge from the data (inductive process) using the content analysis approach. We recruited 13 caregivers of children with cerebral palsy from the physiotherapy unit at Tamale Teaching Hospital, and conducted individual in-depth interviews supported by an open-ended topic guide. Interviews were audio recorded, transcribed, and translated and coded inductively before conducting a content analysis of the data when grouped into themes.

RESULTS

We have identified barriers to managing a child with cerebral palsy, including sociocultural barriers (values, attitudes and belief systems within society), economic challenges and immediate physical care burdens. Specific barriers included discrimination and isolation, lack of family and societal support, with poor access to health information and formal education. Others were lack of information on the cause and course of cerebral palsy, caregivers' loss of jobs, increased healthcare expenditure and struggles in lifting and moving children, which resonate with evidence-based multidimensional model of caregiving process and caregiver burden.

CONCLUSION

Caregivers have the arduous task of caring for a child with cerebral palsy. Social support interventions and policy initiatives that seek to ameliorate caregivers' finances and make formal education accessible to this marginalised child population may be beneficial in this context.

Gerontological nursing in Ghana: Preferences and perceptions of nursing students

Undergraduate nursing students in developed countries are reported to have poor perceptions and low preference for gerontological nursing. However, perceptions and preferences of undergraduate nursing students toward gerontological nursing in low-income countries have not been well explored. This study explored the perceptions and preferences of undergraduate nurses in Ghana toward gerontological nursing. A mixed method study design was used to explore Ghanaian undergraduate nursing students' perceptions and preferences for caring for older people. One hundred and seventy-four nursing students were surveyed and 30 of them were interviewed. Quantitative data were analyzed descriptively using SPSS version 27. Content analysis was used to analyze qualitative data to generate themes. Response rate in the study was 73%. The majority of participants (95.4%) were below the age of 29. Gerontological nursing was ranked as the least preferred nursing specialty among graduating undergraduate nurses. Poor perceptions and inadequate knowledge about the care of older people were largely responsible for the lack of preference for gerontological nursing. Improving undergraduate nursing students' knowledge about gerontological nursing is critical in correcting poor perceptions about gerontological nursing.

Availability and Affordability of Primary Health Care Among Vulnerable Populations in Urban Kumasi Metropolis: Family Health Perspective

Purpose

Health-related expenditures pose a significant burden on vulnerable populations. This study assessed the availability and affordability of primary health care among disadvantaged populations in urban Kumasi Metropolis, Ghana.

Methods

This study was a descriptive cross-sectional study conducted among multi-level participants of vulnerable populations ≥18 years of age (n=710) constituting the older adults/aged, pregnant women, head porters, sex workers, and other vulnerable groups (people with disabilities and the homeless). Data were collected using a semistructured questionnaire. Poisson regression with robust variance was used to assess the association between vulnerability and access to health care.

Results

There were significant differences in the availability and adequacy of health care among the vulnerable groups studied. Distance to the source of care was >5 km for majority of the vulnerable groups and the average expenditure on a visit to the health facility was GH¢ 27.04 (∼US$ 5.55 as at January 2019). Challenges to health care among the vulnerable groups included monetary (37.9%), stigmatization (18.6%), and staff attitude (25.9%). Head porters and other vulnerable groups were less likely to view health care as affordable compared with older adults. The difference in the perception of health care affordability was, however, explained by sociodemographic characteristic and health care-related factors.

Conclusion

Despite the introduction of a National Health Insurance Scheme in Ghana, this study highlights challenges in health care access among vulnerable populations independent of the type of vulnerability. This suggests the need for stakeholders to adopt other innovative care strategies that may have broader applicability for all populations.

Nurses’ attitudes towards hospitalized older adults in a tertiary care setting in Ghana

Introduction

The increasing population of older adults and rapid increases in co‐morbidities globally has necessitated the need for a healthcare delivery system that meets the multifaceted needs of the growing population of older adults. Concurrent with these rising complex health needs is the importance of positive, non‐judgmental attitudes of health services providers towards older adults. Moreover, this is particularly important in the nursing profession, given nurses' significant and crucial roles in healthcare settings.

Aim

The study aimed to evaluate nurses’ attitudes towards older adults in a tertiary hospital in Ghana.

Design

It employed a descriptive cross‐sectional quantitative design.

Method

Data were collected from 160 registered adult medical and surgical ward nurses using the Ageism Attitude Scale (AAS).

Results

Findings indicated that more than half of the participants had a diploma in general nursing. None of the nurses surveyed specialized in the care of older adults, and the mean age of participants was 30.14 (3.75) (minimum 24 and maximum 42 years). Female nurses had more positive attitudes than their male counterparts. Although the surveyed nurses reported a somewhat positive attitude towards older adults, there was no correlation between nurses' education levels and positive attitudes.

Knowledge of Ghanaian Graduating Undergraduate Nurses About Ageing

Introduction

Knowledge on ageing has an impact on the quality of care provided to older people. Although older Ghanaians provide various forms of support to family and communities, many of them experience poor nursing care in the Ghanaian health system. There is, however, dearth of evidence regarding knowledge of ageing among Ghanaian nurses.

Objective

This study therefore used a descriptive survey approach to investigate knowledge of graduating undergraduate nurses on physiological, and psychosocial changes in ageing.

Methods

Seventy graduating undergraduate nurses were surveyed to identify their knowledge on physiological and psychosocial changes leading to care needs of older people in Ghana. Three undergraduate nursing programs with gerontological nursing courses were purposively selected for the study. Descriptive statistics were used to analyze the data in order to present quantitative descriptions of variables in this study.

Results

The response rate in the study was 42%. Findings of the study show graduating undergraduate nursing students have inadequate knowledge on ageing. Several gaps in knowledge regarding ageing were identified. Although undergraduate nursing schools had gerontological nursing courses in their programs, over 90% of participating graduating nursing students indicated pain, anxiety and depression are normal aspects in the ageing process.

Conclusion

It is imperative to improve the current curricula content on gerontological nursing in Ghanaian nursing schools to equip nurses with knowledge and skills needed to provide quality healthcare to older people in Ghana. Improving knowledge on ageing through evidence-informed gerontological nursing curricula content will lead to better nursing care of older Ghanaians. Providing educational opportunities for improved quality nursing care of older Ghanaians is in line with the United Nations (UN) Sustainable Development Goal 3, which aims at providing equal and quality healthcare to all age groups by 2030.

Prioritizing the National Aging Policy in Ghana: Critical Next Steps

Most developing nations are facing rapid population aging with limited economic and social resources. In Ghana, a National Aging Policy (NAP) was promulgated by the government in 2010 to ensure the well-being of older adults. Since its passage, the NAP has yet to be funded and implemented. In this paper we synthesize key information on policies and programs targeted at older adults in Ghana and identify the challenges that are adversely impacting their welfare, including the non-implementation of the National Aging Policy. To give the NAP needed attention and promote its implementation, a national coordinating body exclusively devoted to older adults is an essential first step. Critical next steps are offered to promote the effective implementation of the NAP and ensure the well-being of older adults in Ghana. With its current foundation of support programs for older adults, Ghana has the opportunity to be the lead nation in Sub-Saharan Africa to establish a national level office dedicated to promoting older adults' well-being and including them in the nation's development efforts.

Unmet Needs of Healthcare Services and Associated Factors among a Cohort of Ghanaian Adults: A Nationally Stratified Cross-Sectional Study Design

We estimated the prevalence of unmet needs of healthcare services (UNHS) and its associated factors among a cohort of older Ghanaian adults. World Health Organization (WHO) Study on Global AGEing and Adult Health for Ghana was used with a total of 4735 participants. Logistics regression analysis was performed using Stata 16 to assess associated factors. The overall UNHS was 3.7% (95% CI = 2.7-4.8) and the prevalence was significantly high amongst older adults aged 60 to 69 years (5.9%). Could not afford the healthcare (56.4%) was the main contender for UNHS. UNHS was influenced by; those aged 60 to 69 years [OR (95% CI) = 1.86 (1.19-2.91)]; no formal educational [aOR (95% CI) = 4.71 (1.27-17.38)], and no NHIS [OR (95% CI) = 1.78 (1.03-3.09)]. Participants needed care for joint pain (25.4%), and communicable diseases (19.1%). The inability to access healthcare was relatively higher for older adults more advanced in age, with low education, and for those without health insurance. Health system strengthening including financial protection by expanding the National Health Insurance Scheme to all Ghanaians in line with Ghana's Universal Health Coverage Roadmap would reduce the unmet healthcare needs of older adults.