Abstract
BackgroundHealth systems in low and lower-middle income countries, particularly in sub-Sahara Africa, often lack the specialized personnel and infrastructure to provide comprehensive care for elderly/ageing populations. Close-to-client community-based approaches are a low-cost way of providing basic care and social support for elderly populations in such resource-constrained settings and family caregivers play a crucial role in that regard. However, family caregiving duties are often unremunerated and their care-related economic burden is often overlooked though this knowledge is important in designing or scaling up effective interventions. The objective of this study, therefore, was to estimate the economic burden of family caregiving for the elderly in southern Ghana.MethodsThe study was a retrospective cross-sectional cost-of-care study conducted in 2015 among family caregivers for elderly registered for a support group in a peri-urban district in southern Ghana. A simple random sample of 98 respondents representative of the support group members completed an interviewer-administered questionnaire. Costs were assessed over a 1-month period. Direct costs of caregiving (including out-of-pocket costs incurred on health care) as well as productivity losses (i.e. indirect cost) to caregivers were analysed. Intangible costs were assessed using the 12-item Zarit burden interview (ZBI) tool and the financial cost dimension of the cost of care index.ResultsThe estimated average cost of caregiving per month was US$186.18, 66% of which was direct cost. About 78% of the family caregivers in the study reported a high level of caregiving burden (as measured with the ZBI) with females reporting a relatively higher level than males. Further, about 87% of the family caregivers reported a high level of financial stress as a result of caregiving for their elderly relative.ConclusionThe study shows that support/caregiving for elderly populations imposes economic burden on families, potentially influencing the economic position of families with attendant implications for equity and future family support for such vulnerable populations.
Highlights
Health systems in low and lower-middle income countries, in sub-Sahara Africa, often lack the specialized personnel and infrastructure to provide comprehensive care for elderly/ageing populations
The family caregivers recruited for the study were caregivers of elderly persons recruited from the Akrowa Aged Life Foundation (AALF) register
62% of the caregivers indicated that their finances have gotten worse as a result of caregiving for their elderly relative
Summary
Health systems in low and lower-middle income countries, in sub-Sahara Africa, often lack the specialized personnel and infrastructure to provide comprehensive care for elderly/ageing populations. The proportion of elderly ( referred to as ageing) populations is increasing globally; it is estimated that by 2050, around two billion persons in the world will be aged 60 years and over, with 400 million aged 80 years and over [1] Of this population, 80% will live in low and middle income countries (LMICs). In Europe, the Nortey et al International Journal for Equity in Health (2017) 16:16 population ageing Such overwhelming interest has been driven, in part, by the notion that costs to society in general, and to families in particular, will escalate with the increasing population of dependent elderly people [2]. This caregiving arrangement, is currently undergoing extensive changes due to several factors including: a weaker extended family system; a rural-urban within country migration and outmigration from Ghana, often leaving the elderly with limited support; general difficulties in global economic conditions with families (especially younger people) becoming busier and making little time for the elderly
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