Building consensus on priority areas for Sub-Saharan Africa's ageing population research: An e-Delphi study protocol

BACKGROUND

Improvement in medico-social services has increased life expectancy and population ageing in Sub-Saharan Africa (SSA). It was estimated that about 163 million people aged 65 and older will be resident in SSA by 2050. There is inadequate ageing research capacity in SSA which necessitates this study to (a) identify a decade-long ageing research opportunities, challenges, and solutions, and (b) prioritize critical ageing research areas and methodologies relevant to the SSA.

METHODS

We designed an e-Delphi protocol following the Reporting Guideline for Priority Setting of Health Research with Stakeholder. The stakeholders will be researchers, practitioners, older adults, and caregivers purposively selected through snowballing quota sampling to complete three rounds of e-Delphi surveys. Round 1 will involve open-ended questions derived from the study objectives. Responses from round 1 will be prepared as a checklist for stakeholders to rate during rounds 2 & 3, using a 9-point scale: low priority (1-3), moderate priority (4-6), and high priority (7-9). The criterion for reaching a consensus will be ≥ 70% of stakeholders rating an item "high priority" and ≤ 15% as "low priority." Quantitative data will be analysed using descriptive statistics, Wilcoxon matched-pairs signed-rank test will be used to assess the stability of stakeholders' responses, and qualitative comments will be analysed using content analysis.

DISCUSSION AND IMPLICATIONS

Setting aging research/practice priorities will help maximize the benefits of research investment and provide valuable direction for allocating public and private research funds to areas of strategic importance.

Difficult but achievable: medical social workers' experiences transiting older adults from hospital care to nursing home in Nigeria

Very few literatures have focused on transition of older adults from hospitals to nursing homes in African region. As a first step, this study explored the experience of medical social worker when transiting older adult from the hospital to nursing home in southwestern region of Nigeria. A descriptive qualitative approach collected through a semi-structured interview among 16 medical social workers showed that there is limited availability of nursing home facilities in Nigeria. Additionally, bureaucratic and administrative hurdles often added to the complexities of facilitating seamless transitions into nursing care homes. Cultural beliefs and family dynamics exert a substantial influence on the decision-making process, making the task of medical social workers even more intricate. There is a need for a greater support from policymakers and healthcare authorities to address the challenges facing Nigerian medical social workers. Hence, to better understand and address these experiences, the healthcare system can better equip medical social workers to navigate the transitions effectively and ensure the well-being of older adults during this crucial phase of their lives is adequately supported.

Longitudinal Studies of Aging in Sub-Saharan Africa: Review, Limitations, and Recommendations in Preparation of Projected Aging Population

Background and Objectives

The United Nations has projected a 218% increase in older people in Sub-Saharan Africa (SSA) between 2019 and 2050, underscoring the need to explore changes that would occur over this time. Longitudinal studies are ideal for studying and proffering solutions to these changes. This review aims to understand the breadth and use of longitudinal studies on aging in the SSA regions, proffering recommendations in preparation for the projected aging population.

Research Design and Methods

This paper is the third of a four-part series paper of a previous systematic mapping review of aging studies in SSA. We updated the search (between 2021 and 2023) and screened the titles/abstracts and full-text articles by a pair of independent reviewers. Data were extracted using a standardized data-charting form, identifying longitudinal studies in SSA.

Results

We identified 193 studies leveraging 24 longitudinal study data sets conducted at 28 unique sites. The World Health Organization's Study on Global AGEing and Adult Health (WHO-SAGE) (n = 59, 30.5%) and Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) (n = 51, 26.4%) were the most used longitudinal data sets. Four studies used more than one longitudinal study data set. Eighteen of the longitudinal study data sets were used only in 1-4 studies. Most (n = 150, 77.7%) of the studies used a cross-sectional analytical approach.

Discussion and Implications

Longitudinal studies on aging are sparingly being utilized in SSA. Most analyses conducted across the longitudinal data set were cross-sectional, which hindered the understanding of aging changes that occurred over time that could better inform aging policy and interventions. We call for funding bodies, such as WHO-SAGE, to develop funding competitions that focus on conducting longitudinal analyses, such as structural equation modeling, highlighting changes occurring among the aging population in SSA.

COVID-19: Experiences of Social Workers Supporting Older Adults With Dementia in Nigeria

Amidst the COVID-19 pandemic, numerous public health protocols were instituted by government agencies to safeguard individuals with dementia, their family caregivers, and formal care providers. While these preventive measures were implemented with good intentions, they inadvertently imposed significant challenges on medical social workers in Nigeria. This paper explored the experiences of medical social workers caring for people with dementia during the COVID-19 pandemic in Nigeria. Twenty-six medical social workers from 6 government hospitals in Southwestern Nigeria participated in an in-depth interview. The research reveals 3 pivotal aspects: Firstly, the escalating demands within the work environment, where medical social workers grapple with the intricate task of conveying sensitive information about dementia diagnosis and COVID-19 prevention protocol, managing expectations regarding dementia diagnoses, and navigating resource constraints for individuals with dementia during the pandemic. Secondly, discernible impacts on the work climate and interprofessional relationships shed light on the challenges these professionals face in collaborating with other healthcare providers. Lastly, the reverberations on social workers' personal lives underscore the pandemic's toll on their well-being. Thus, the findings underscore the need for proactive measures to equip medical social workers to face the distinctive challenges in dementia care during future pandemics. Recognizing the potential resurgence of global health crises, the research highlights the need for strategic preparedness to mitigate the impact of future pandemics on the well-being of individuals with dementia and the professionals dedicated to their care.

COVID-19 Vaccine Hesitancy Among Older Adults in a Geriatric Centre in Nigeria

Introduction Despite the proven efficacy of COVID-19 vaccines, there is a significant level of hesitancy, particularly among the elderly population in Nigeria. The research investigates factors associated with COVID-19 vaccine hesitancy among older persons attending Geriatric Centers in southwestern Nigeria. Methods This was a cross-sectional study of 332 older adults (≥60 years). Sociodemographic characteristics, attitudes, beliefs, psychological antecedents, sources of information, and perceived sensitivity to the COVID-19 vaccine were explored. Bivariate and multivariate analyses were performed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 27.0, Armonk, NY) at a 0.05 significance level. Results The mean age of the respondents was 71.8±7.3 years. The prevalence of COVID-19 vaccine hesitancy was 43.1%. Predictors of COVID-19 hesitancy were not knowing where to get vaccination OR=7.058 (1.745-28.542), did not think vaccines are safe OR=8.767 (2.250-34.159), worries about unforeseen future effects OR=1.111 (1.004-1.227), preference for natural immunity OR=1.170 (1.036-1.321). Discussion COVID-19 vaccine hesitancy was high in our study. Our study underscores the importance of community engagement, education, and communication strategies tailored to the needs and perceptions of the older population in Nigeria.

"He [the doctor] said I should go and wait for my death:" Dualities in care and support access among female cancer survivors

INTRODUCTION

While some countries have positive outlooks and technology at their disposals to detect and treat cancer in its earliest stages, other countries frequently demonstrate trends of late-stage presentation and treatment hesitancy. Nigeria is a nation that has a high cancer burden, with poorer outcomes than higher income countries (HICs). To add to the body of cancer knowledge in global health, and inform relevant policies to improve cancer survivorship, our study offers insight on cancer survivors' experiences in accessing care and support in Nigeria.

METHODS

The study employed a qualitative descriptive method. Semi-structured interviews were conducted with a purposive sample of 30 female breast cancer survivors in Nigeria (Mage = 42 years). Their responses were transcribed, coded, and analyzed for themes.

RESULTS

The four major themes identified were: 1) views about chemotherapy and treatments; 2) support from families and others; 3) support from health care providers; and 4) religion and coping. Each of these themes include sub-themes that offer insights on the dualities of cancer survivorship.

DISCUSSION

The high cancer death rate in Nigeria may be masking the growing number of cancer survivors, especially women diagnosed with breast cancer. It is important to design interventions that not only target cancer prevention but improving the health and quality of life of those affected by cancer in Nigeria until end of life. The findings highlight a critical need for more attention on cancer survivorship in Nigeria.

Relationship between family dynamics, spirituality, quality of life and happiness among older adults in Nigeria

Happiness of older adults in rarely studied in the global south like Nigeria compared with the global north. This study assessed the relationship between family dynamics, spirituality, quality of life and happiness among older adults in Nigeria. Cross-sectional study of 378 older adults (≥60 years) were selected. Oxford Happiness questionnaire, the family dynamics, spirituality, and quality of life (QoL) were determined with the Family Relationship Index, spiritual Index of Well-being scale and Quality-of-Life Brief questionnaire respectively. Descriptive and inferential statistics were carried out at α0,05. The mean age was 72,8±7,1 years and 255 (67,5%) were females. Majority 313 (82,8%) were assessed to be happy. Overall, family dynamics, spirituality, and health related QoL were significantly determinants of happiness (p<0,05). Among the women, there was good cohesion in the family dynamics (p=0,031), good health related QoL in the physical domain (p<0,001) and satisfaction with health (p=0,036) were the predictors of happiness. Having higher self-efficacy (p=0,018) and life scheme spirituality (p=0,050) were the predictors of happiness among the men. The present findings showed that most of the older adults were happy. Routine assessment and interventions could increase the feeling of happiness among older adults in the global south.

Understanding the impact of digital technology on the well-being of older immigrants and refugees: A scoping review

Background

The fast-paced development of digital technologies in the areas of social media, pet robots, smart homes, and artificial intelligence, among others, profoundly influence the daily lives of older adults. Digital technology can improve the well-being and quality of life of older adults, older immigrants and refugees who suffer migration-associated stress, loneliness, health and psychosocial challenges.

Aims

The aim of this scoping review is to map out extant empirical literature that has examined the implication of digital technology among older refugees and immigrants.

Methods

Using a1 five-stage framework, we conducted a scoping review of peer-reviewed empirical studies published in English with no time restrictions. We searched nine databases for the reviews, and abstracts were reviewed using Rayyan QCRi(c) before the full-text review. The comprehensive database search yielded 4134 articles, of which 15 met the inclusion criteria.

Results

The results of the review suggest that digital technology is essential to the well-being, quality of life of older immigrants and refugees, especially for maintaining and building new social support networks, navigating opportunities, coping with migration-induced stress through e-leisure, and staying connected to their culture. The literature also revealed poor utilisation of digital technologies amongst older immigrants and refugees, suggesting barriers to access.

Conclusion

The study concluded by highlighting the need for more research and interventions that focus on multiple strategies, including education for increased access to and utilisation of digital technology to ensure that more older migrants can benefit from the advantages of digital technology in a safe way.

A Triple Jeopardy: Inadequate Knowledge about COVID-19 among Older Persons with Psychiatric Diagnosis attending a Geriatric Centre in Southwest Nigeria

BACKGROUND

Older persons with mental illnesses have been affected by COVID-19 because of reduced access to routine health care, the adverse social impacts of preventive strategies and inadequate knowledge of the COVID-19 pandemic. Adequate knowledge is crucial to ensuring adherence to the right preventive practices.

OBJECTIVES

This study evaluates the knowledge gaps about COVID-19 and preventive practices among older persons with psychiatric diagnoses (PD) in comparison with older persons with non-psychiatric diagnosis (nPD).

METHODS

A hospital-based comparative study was conducted among older persons attending the sycho-geriatric and Healthy Ageing clinics of the Geriatric Centre, University College Hospital, Ibadan, Nigeria. Data were gathered with a semi-structured interviewer-administered questionnaire, and SPSS version 23 was used to analyse the data. Level of significance was set at 5%.

RESULTS

390 respondents aged 60 and above were sampled in the two groups: 195 with PD and 195 with nPD. Their mean age was PD:72.2 (±7.4) years and nPD:71.0 (±8.0) years. Majority were aware of the ongoing pandemic (PD:95.9%; nPD:96.4%). The use of facemask (PD:89.7%; nPD:86.7%) was the commonest preventive practice. Male gender (OR: 2.09, CI ;1.14-3.86, p = 0.018) and education (OR: 5.10, CI; 1.15-22.67, p=0.032) were predictors of knowledge among PD and nPD respectively.

CONCLUSION

Older persons with psychiatric diagnoses have more gaps in their knowledge of COVID-19. Inadequate knowledge about COVID-19 could further put them in jeopardy of contracting the virus with its associated morbidity and mortality, in addition to the risk that old age and mental illness contribute. Health education programs about COVID-19 targeting the older population with mental illnesses would be beneficial.

TRIPLE MALADY: OLDER PERSONS WITH MENTAL ILLNESSES AND COVID- 19: INSIGHTS FROM A PSYCHOGERIATRIC CLINIC IN NIGERIA

Background

Older persons with mental illnesses have been differentially affected by COVID-19 because of reduced access to routine health care, the adverse social impacts of the preventive strategies, and inadequate knowledge of the ongoing COVID -19 pandemic.Adequate knowledge is crucial to ensuring adherence to the right preventive practices among older persons.

Methods

A hospital-based comparative study was conducted among older persons attending the Psychogeriatric and Healthy Ageing clinics of the Geriatric Centre, University College Hospital, Ibadan. Data were gathered with a semi-structured interviewer administered questionnaire and SPSS version 23 was used to analyze the data. The level of significance was set at 5%.

Results

A total of 390 respondents aged 60 and above were sampled in the two groups: 195 with a psychiatric diagnosis (PD) and 195 with a non-psychiatric diagnosis (nPD). Their mean age was PD: 72.2 (±7.4) years and nPD: 71.0 (±8.0) years. About 14.9% had dementia and mild cognitive impairment; 14.6% psychotic disorders; 13.8% mood disorders and 6.6% anxiety and somatoform disorders. The majority were aware of the ongoing pandemic (PD: 95.9%; nPD: 96.4%). The use of facemask (PD: 89.7%; nPD: 86.7%) was the commonest preventive practice. Male gender (OR:2.09, CI; 1.14-3.86, p= 0.018) and education (OR: 5.10, CI; 1.15-22.67, p= 0.032) were predictors among PD and nPD respectively.

Conclusion

Older persons with psychiatric diagnoses have gaps in their knowledge of COVID-19 compared to those without symptoms. Health education about the ongoing pandemic and prevention programs targeting the older population with mental illnesses would be beneficial.

Understanding Social and Emotional Loneliness among Black Older Adults: A Scoping Review

Black older adults’ (BOAs) experience of loneliness differs from other ethnic groups because of the disproportionate disadvantages faced across their life course. This scoping review aimed to describe the range of research on loneliness or subjective social isolation among BOAs, identifying the contributing factors to loneliness in this population, based on Weiss’ Social provision Framework. Of the 15,345 initial retrieved citations from seven databases and corporate websites, we included 27 studies conducted in the USA, Nigeria, South Africa, Ghana, Canada, the United Kingdom, and Uganda. Studies reporting on BOAs’ experience of loneliness focused on the influence of attachment, social integration, opportunity for nurturance, reassurance of worth, guidance, socio-economic factors, health-related factors and behaviors, and technology, media device possession and usage. There is a need for future studies to identify which social provisions (when targeted) could reduce loneliness, allowing clinicians to develop relevant interventions.

A Mapping Review on the Uptake of the COVID-19 Vaccine among Adults in Africa Using the 5A's Vaccine Taxonomy

Uptake of a vaccine is complete if individuals are aware of the associated risks of the vaccine, accept the vaccine, and respond positively to the nudges (activation) to increase the uptake, and respond when the vaccine is made accessible and affordable. We mapped systematically the existing literature concerning the 5As-acceptability, accessibility, affordability, awareness, and activation-of COVID-19 vaccination among adults and, specifically, older adults (55 years and older) in Africa. We searched multiple databases from 2020 to December 2021. Using predefined inclusion and exclusion criteria, two reviewers screened citations, conducted title and abstract screening, and extracted data independently. We included 68 articles conducted in 33 African countries, primarily cross-sectional studies (n = 49, 72%). None of the articles focused on older adults only, but 22 articles (32%) included at least one older adult (55 years and older) in their sample size. Acceptance (n = 58, 85%) was the most commonly researched aspect of vaccine uptake, followed by accessibility (n = 17, 25%), awareness (n = 13, 19%), and affordability (n = 5, 7.0%). We found only one report on activation. Factors affecting acceptance of the COVID-19 vaccine in Africa were grouped into sociodemographic factors; knowledge-, attitude-, and belief-related factors; a COVID-19 vaccine efficacy and safety concern factor; and trust in government and public health authorities. The governments of African nations should focus on strategies to influence the modifiable factors identified in this review. More studies are needed to evaluate the impact of nudges (activation) to improve COVID-19 vaccine uptake in African nations.

Older persons’ perceptions about advanced directives and end of life issues in a geriatric care setting in Southwestern Nigeria

Introduction

Advanced directives enable the planning of care and support services independent of the older person’s ability to make the decision. There is a paucity of information regarding the views and preferences regarding advanced directives and other end of life issues among older persons in low and middle-income countries such as Nigeria. The study aimed to explore the knowledge, attitude and belief of older persons regarding decision making surrounding end of life and advance directives

Methods

Data were collected through focus group discussions at a monthly social gathering of outpatients in a geriatric center in Oyo State, Nigeria. Discussions were audiotaped, transcribed and analyzed manually using a thematic approach.

Results

Respondents’ knowledge about the end of life care and advanced directives as prescribed in high income settings were sparse and did not include choices about treatment options or any medical directives. The predominant perceptions among the participants bordered mainly on the arrangements for place of death, burial and property sharing. Participants listed in order of preference the major decision makers in the advanced directive process mainly, the oldest male child, religious leaders and legal practitioners.

Conclusion

Our findings imply the need for improving knowledge and awareness about the benefits of advanced directives among older persons with a focus on opportunities for their active participation.