Older Adults In Ghana Research Articles

The Relationship Between Social Capital and Sleep Duration Among Older Adults in Ghana: A Cross-Sectional Study.

Objective: This study aims to investigate the connection between social capital and sleep duration among older adults in Ghana, as limited research has been conducted to explore this relationship. Methods: This study utilized Wave 2 data from a sample of Ghanaian older adults from the World Health Organization Study on Global AGEing and Adult Health (SAGE). Self-reported data on social capital and sleep duration were compiled. Using ordered logistic regression, the relationship between social capital and sleep duration was examined. Results: Older adults who did not participate in social activities showed the strongest association with the risk of short sleep (p < 0.05). Our study found that older adults who sleep for shorter periods tend to report better sleep quality. There was no correlation between medium and long sleep durations and social capital. Conclusion: This study underscores the importance of more research to truly understand the complex connections between older adults' social participation, sleep, and health. It also has important implications for the promotion of good sleep in aging populations.

A Systematic review of macro - and meso - determinants of national health insurance enrolment among older adults in Ghana

A Systematic review of macro - and meso - determinants of national health insurance enrolment among older adults in Ghana

Healthcare seeking behaviour during illness among older adults in Ghana: does food security status matter?

BackgroundGhana’s growing older adult population raises critical questions regarding healthcare for these older adults. At the same time, food insecurity is high among older adults in Ghana. This underscores the need to investigate the issues of food security and healthcare seeking behaviour among older adults. However, research on the association between food security status and healthcare seeking behaviour among older adults is scant in the Ghanaian context. In this study, we advance the social gerontology literature by examining the association between food security status and healthcare seeking behaviors among older adults.MethodsUsing a multi-stage sampling framework, we collected data from a representative sample of older adults across three regions in Ghana. Data were analyzed using logistic regression technique. We determined the significance of the test at a probability value of 0.05 or less.ResultsOver two-thirds (69%) of respondents did not seek care during their last illness. Additionally, 36% of respondents were severely food insecure, 21% were moderately food insecure, 7% were mildly food insecure, and 36% were food secure. After controlling for theoretically relevant variables, our multivariable analysis revealed a statistically significant association between food security status and healthcare seeking behaviors with older people who are food secure (OR = 1.80, p < 0.01) and mildly food insecure (OR = 1.89, p < 0.05) being more likely to seek healthcare compared with their counterparts who are food insecure.ConclusionOur findings highlight the need for sustainable intervention programs to improve food access and health service use among older adults in Ghana and similar contexts.

Sleep and Happiness in Urban-Dwelling Older Adults in Ghana: A Serial Multiple Mediation Model of Generalized Anxiety and Depressive Symptoms

Sleep problems (SP) are highly prevalent and seriously affect health and well-being in old age. The aim of this study was to examine the association between SP and happiness in an urban-dwelling older sample. The authors further explore the effects of generalized anxiety and depressive symptoms in the SP-happiness link using serial mediating modeling. Data came from the 2016 to 2018 Aging, Health, Psychological Well-being, and Health-seeking Behavior Study in Ghana (n=661). The authors measured happiness with the cross-culturally validated item on a five-point scale. The GAD-7 and the CESD-8, respectively, assessed generalized anxiety and depressive symptoms. Participants reported nighttime and daytime SP in the last 30 days. The SPSS-based Hayes' PROCESS macro program (Model 6) was constructed to quantify the hypothesized mediation effect. The analysis included 661 adults aged greater than or equal to 50 years (mean age=65.53 [SD]=11.89 years; 65.20% women). After full adjustment, path models showed that SP was negatively associated with happiness (β=-0.1277, 95%CI=-0.15950 to -0.096). Bootstrapping estimates revealed that the SP-happiness link was serially mediated via generalized anxiety representing 8.77%, depressive symptoms yielding 18.95%, and anxiety symptoms→depressive symptoms accounting for 26.70% of the total effect. Generalized anxiety and depressive symptoms may explain the negative association between SP and happiness in urban-dwelling older adults in the sub-Saharan African (SSA) context. Interventions, social and clinical, to improve happiness through sleep quality should include ways to improve mental health. Longitudinal and cross-cultural data are warranted to assess the bi-directionality of this relationship.

Risky health behaviours and chronic conditions among aged persons: analysis of SAGE selected countries

BackgroundIncreasing trends in risky health behaviours contribute to chronic health problems among the rapidly growing ageing population. Therefore, we examined the association between risky health behaviours and chronic health conditions among persons 50 years and older.MethodsThis study was a secondary analysis of longitudinal survey data from the 2007 Study on Global Ageing and Adult Health (SAGE Wave 1) conducted by the World Health Organization. Multilevel logistic regression techniques were used to examine high social cohesion among the aged. The output was reported as odds ratios (OR) and adjusted odds ratios (aOR).ResultsGenerally, the level of chronic conditions was 81.5% for all countries. Older adults in Ghana had the highest chronic conditions (94.0%) while the Russian Federation recorded the lowest (58.6%). The risk of chronic conditions was higher among the oldest-old (OR = 1.70, 95% CI = 1.29, 2.25), those who smoke tobacco (OR = 1.13, 95% CI = 1.01, 1.25) or drink alcohol (OR = 1.17, 95% CI = 1.06,1.29), and among those who live in rural areas (OR = 1.31, 95% CI = 1.16, 1.49). However, the odds were lower among females (OR = 0.88, 95% CI = 0.69,0.85), and those who were not working (OR = 0.52, 95% CI = 0.47, 0.58).ConclusionWe conclude that it is important to improve the health status of older people. To achieve this, there must be interventions and policies to facilitate the adoption of healthy or physically active lifestyles among older people. This could be achieved by strengthening advocacy and health education about the dangers of living a sedentary lifestyle, consuming alcohol and tobacco. Whatever behavioural change interventions, advocacy and health education must target high-risk sub-populations including the oldest-old, and those with low economic status. Given the regional disparities identified, it is necessary to prioritise older people residing in rural areas. The study underscores a need to provide more primary healthcare facilities in the rural areas of the countries included in this study. Such an initiative is likely to increase accessibility to healthcare services and information that would impact positively on the lifestyle behaviours of older people.

Physical activity and functional disability among older adults in Ghana: The moderating role of multi-morbidity.

Knowledge about how physical activity levels relate to functional disability is essential for health promotion and planning older adults' care or rehabilitation. The risk of living with one or more chronic health conditions increases with increasing age in lower and higher income countries-many of which are associated with physical inactivity. We conducted a cross-sectional study to examine the moderating role of multimorbidity on physical activity and its measures on functional disability among older adults in Ghana. Data from WHO's Study on global AGEing and adult health Ghana Wave 2 with a sample of 4,446 people aged 50+ years was used for this study. Functional disability was assessed using the 12-item WHO Disability Assessment Schedule 2.0. Three categories of physical activity levels were used: vigorous intensity, moderate intensity, and walking. Past month diagnosis by a doctor was used to assess the presence of a chronic condition, and the presence of two or more conditions was used to define multi-morbidity. Logistic regressions with a post hoc interactional tests were used to examine the associations. Overall, physical activity had a significant association with functional disability (OR = 0.25, 95%CI; 0.12, 0.32). A similar relationship was found for vigorous-intensity (OR = 0.19, 95%CI: 0.12, 0.29), moderate-intensity (OR = 0.19, 95%CI: 0.15, 0.25) and walking (OR = 0.41, 95%CI: 0.33, 0.51). Older adults living with one condition and physically active were 47% less likely to experience functional disability compared with the less active counterparts living with at least two chronic conditions. Among the three measures of physical activity, multimorbidity moderated the relationship between walking and functional disability. Future strategies for meeting the health and long-term care needs of older adults, particularly those living with only one chronic condition in Ghana should consider encouraging walking. Policies, financial assistance, family, and community level interventions aimed to promote and sustain physical activity among older adults should be a priority for stakeholders in Ghana.

Prevalence, patterns and associated factors of self-medication among older adults in Ghana

: Health literacy has pushed the frontiers of self-care in recent decades, particularly among older adults. However, not much is known about self-medication for minor ailments and chronic conditions among older adults in developing countries. This paper addresses this knowledge gap by examining the prevalence, patterns, and associated factors of self-medication among older adults (aged 50 years and more) in Ghana. The study employed a cross-sectional survey within four communities in the Bosomtwe District, Ghana. Using the purposive, snowballing, and convenient techniques, 384 older adults were involved in the study. Multivariate logistic regressions were used to estimate the factors associated with self-medication. Up to 54.4% of the respondents had self-medicated at least 3 months before the survey, while 60.2% self-medicated at least once every month. Open markets (43%) were the dominant drug sources, while quick relief (26.6%) and cheap cost (22.7%) were the reasons for self-medication. Females (AOR: 2.626, CI: 0.015–0.030, p = 0.022), tertiary graduates (AOR: 1.825, CI: 0.007–0.045, p = 0.045) and uninsured older adults (AOR: 3.293, CI: 0.015–0.026, p = 0.007) were more likely to self-medicate. Furthermore, those with no past illness (AOR: 0.036, CI: 0.007–0.033, p = 0.013) and without non-communicable disease (AOR: 0.008, CI: 0.001–0.012, p = 0.020) were less likely to self-medicate. Policy recommendations targeting the educated, uninsured, female older adults as well as stiffening the sale of medicines without prescription will be necessary for reducing the prevalence of self-medication among older adults.

Hesitant or not: A cross-sectional study of socio-demographics, conspiracy theories, trust in public health information, social capital and vaccine hesitancy among older adults in Ghana

ABSTRACT Vaccination is an effective strategy to reduce the coronavirus disease 2019 (COVID-19) burden, but its effectiveness hinges on timely vaccine uptake. Addressing concerns among vaccine-hesitant individuals is critical to preventing the immunization program from failing. This study analyzes the determinants of vaccine hesitance among older adults (aged 50 years and older) in Ghana. We adopted a cross-sectional survey with a quantitative approach that accessed data from 400 older adults from the Accra and Kumasi metropolitan areas using purposive and snowball sampling techniques. Multivariate logistic regressions were used to estimate the socio-demographic, social capital, conspiracy theories about COVID-19, and public health information factors associated with vaccine hesitance within the sample. The study found that only minority (5%) of respondents had been vaccinated, with 79% indicating willingness to be vaccinated. The study found that females (AOR: 0.734, CI: 0.019–0.036, p = .027) and those who have retired (AOR: 0.861, CI: 0.003–0.028, p = .034) were significantly less likely to engage in COVID-19 vaccine hesitance. Furthermore, the study revealed that participants who trust public health information (AOR: 0.065, CI: 0.022–0.049, p = .031) and have social capital (AOR: 0.886, CI: 0.017–0.032, p = .001) were significantly less likely to present COVID-19 vaccine hesitance. Finally, participants who believe in conspiracy theories about COVID-19 and vaccines (AOR: 3.167, CI: 1.021–2.043, p = .004) were significantly more likely to engage in COVID-19 vaccine hesitance. Efforts to convey vaccination benefits and address issues through evidence-based information are needed to strengthen and preserve the public’s trust in vaccines in Ghana.

The Older Adult Migrant and Support Systems: A Focus on Haatso and Agbogbloshie Yam Markets’ Communities in Ghana

Social support is an important resource in old age. However, recent research shows that familial support, which used to be the primary source of care for older adults in Ghana has weakened. Using a qualitative descriptive approach and semistructured interviews, this study explored the nature and sources of social support available to 21 older adults who migrated from the northern part of Ghana to live in Haatso and Agbogbloshie Yam Markets. Findings show that the nature of familial support was mainly material and unstructured, irregular, inadequate, conditional, seasonal, and sometimes completely unavailable. External support systems from the community, religious organizations, nongovernmental organizations, and the government were unavailable, inadequate, or seasonal. The findings underscore the need for families to be educated about the needs of older adults and be empowered to help care for their older relatives.

The prevalence of hypertension and its associated risk factors among older adults in Ghana.

Hypertension is a worldwide health issue that primarily affects the elderly in our society. However, in comparison to the developed world, the prevalence of hypertension is higher in Sub-Saharan Africa. This paper examines the prevalence of hypertension and its associated risk factors among older adults in Ghana. Using the World Health Organization's study on global AGEing and adult health (WHO SAGE) Wave 1 cross-sectional data collected via in-person structured interviews; paper and pencil interviews (PAPI) from ten administrative regions of Ghana using stratified multistage cluster design from respondents aged 50+ grouped by decade, this study analyzed a nationally representative sub-sample of 3,997 respondents employing binary logistic regression. Odds ratios (OR) and 95% confidence intervals (95% CI) were used to estimate risk factors associated with hypertension (blood pressure ≥ 130/80 mm/Hg). There was a 53.72% hypertension prevalence rate among older adults. Hypertension prevalence tends to increase with increasing age. The prevalence of hypertension was associated with residency (B = -0.18, OR = 0.84, p < 0.017), with urban residents being more at risk of hypertension than rural residents. The prevalence of hypertension increased with overweight (B = 0.66, OR = 1.94, p < 0.001) and obesity (B = 0.82, OR = 2.28, p < 0.001). The amount of fruit and vegetable intake was insignificant but had an inverse relationship with hypertension prevalence. This study has shown that demographic and lifestyle factors significantly affect and explain the hypertension risk among older adults. Medical factors, such as chronic diseases, were largely insignificant and accounted for less hypertension prevalence. Therefore, when interpreting test findings in clinical practice, such as hypertension, it is essential to consider demographic and lifestyle factors. In addition, health policies and primary interventions that seek to improve the standard of living, lifestyle, and wellbeing of older adults need to be critically considered moving forward to lower hypertension prevalence among older adults in Ghana.

A MIXED METHOD APPROACH TO UNDERSTANDING NURSING STUDENTS' SELF-EFFICACY TO CARE FOR OLDER ADULTS IN GHANA

Abstract To identify students’ motivation, gaps, and opportunities to design effective teaching strategies, it is necessary to examine nursing students' understanding of their self-efficacy to care for persons 60+ years. A mixed-method approach was employed. In phase 1, 170 second-and third-year nursing students from two public Nursing Colleges in Ghana were recruited. A cross-sectional survey included the General Self-efficacy to Care for Older Adults’ scale (GSE-COA), the Kogan’s Attitudes towards Old Peoples scale, and the Knowledge about Older Patients Quiz. Data were analyzed using descriptive statistics in SPSS IBM 26. The results of phase 1, informed the selection of students for phase 2. In phase 2, 17 students were purposefully selected for in-depth semi-interviews. Qualitative data were analyzed using thematic analysis. Both results were then integrated, interpreted, and presented jointly. Students’ mean age was 21yrs (SD=3.73), with 91 (54%) females. Most students 140 (71.0%) had lived with/were currently living with an older adult. The majority 164 (97%), had higher scores for GSE-COA (mean= 107, SD=14.29), indicating high self-efficacy. Qualitative results showed that students’ high self-efficacy was due to their familiarity with older adults at home and their perceived competence in routine nursing care. Students who demonstrated a high sense of self-efficacy were confident and perceived caring for older adults as a duty and responsibility, had experience/exposure to and were comfortable working with older adults. The findings demonstrate an opportunity to design effective teaching strategies to develop and sustain students’ interest and motivation in the care for older adults in Ghana.

Housing conditions and long-term care needs of older adults in Ghana: Evidence from the WHO SAGE Ghana Wave 1.

The present study examined the association between housing conditions and long-term care needs of older adults in Ghana. We used data from 4,920 adults aged ≥50 years that participated in the World Health Organisation's (WHO) Study on adult health and AGEing Ghana Wave 1. Housing conditions were assessed with drinking water, sanitation, cooking conditions and building materials, and long-term care needs were based on WHO Disability Assessment Schedule 2.0. Multivariable logistic regressions modelled the effect of housing conditions on long-term care needs. After full adjustment for all available potential confounders, older adults living in households with unimproved cooking conditions had higher odds of reporting long-term care needs (OR = 6.87, 95%CI: 5.04-9.37) compared to those in improved cooking condition households. Moreover, those in households with unimproved housing materials (OR = 1.27, 95%CI: 1.01-1.72) and those in unimproved sanitation households (OR = 1.26, 95%CI: 1.05-1.54) were more likely to experience long-term care needs after respectively controlling for demographic and health-related covariates. Poor housing conditions are risk factors of long-term care needs in Ghana. Efforts to improve housing conditions may benefit older age functional abilities and unmet long-term care needs.

Characterization of functional disability among older adults in Ghana: A multi-level analysis of the study on global ageing and adult health (SAGE) Wave II

Functional disability is a common public health problem that affects the health and quality of life of older adults. This causes them to be highly dependent on other members of their family, receive home care, or to be institutionalized. Although functional disability has been widely studied in developed country settings, very limited studies have focused on age-related functional disability in sub-Saharan Africa, and in particular Ghana. The purpose of this study is to assess various factors associated with the difficulties in performing basic and instrumental activities of daily living among older adults in Ghana. This cross-sectional study used data on 1610 older adults aged 50 years and above from the Study on Global Ageing and Adult Health (SAGE) survey Wave II conducted in Ghana. Nine standard functioning difficulty tools of WHODAS II was used for the analysis. The WHODAS II offers continuous summary scores with higher scores showing higher disability, and vice versa. A multi-level regression model was used to identify individual and household level risk factors linked to the functional disability of older adults. Female older adults (53.7%) reported having functional disability. The mean functional disability among older adults aged 50 years and above was 5.2 (± 5.9). Results indicated that older adults who are females, aged 70 years and above, and had three or more chronic conditions had a higher functional disability. Also, older adults who have adequate fruit intake and belong to wealthier households were found to have a lower functional disability. The study reveals that functional disability among older adults is frequent in Ghana and is associated with having three or more chronic conditions and being overweight/obese. Prevention of functional disability in old age in Ghana is therefore a matter of great social and economic concern, which calls for coordinate efforts across the board to mitigate this public health challenge.

Food Insecurity and Functional Disability Among Older Adults in Ghana: The Role of Sex and Physical Activity.

We examined the associations between food insecurity and functional disability among older adults in Ghana and, the roles of sex and physical activity on the relationship. A cross-sectional study design was employed. A total of 4446 older adults (50+ years of age) from the Study on Global Aging and Adult Health Ghana Wave 2, a countrywide study, was completed in2015. Logistic regression models were used to examine the associations between measures of food insecurity and functional disability using data from Study on Global Aging and Adult Health Ghana Wave 2. Functional disability was assessed using World Health Organization Disability Assessment Schedule 2.0 composed of 12 items in 6 domains of cognition, mobility, self-care, getting along, life activities, and participation in society. Food insecurity was assessed from 12-month food sufficiency and experience of hunger over the last 12months. Approximately 11% were identified as having functional disability. The prevalence of food insecurity was 23.8% for insufficient food intake and 18.3% for hunger. Adjusting for all variables, older adults who reported consuming insufficient food (OR 2.27; 95% CI 1.57, 3.28), and those who experienced hunger (OR 2.35; 95% CI 1.59, 3.46) had higher odds of functional disability, compared with those not reporting these issues. Sex differences modified the association between hunger and functional disability. Physical activity served as a protective factor (OR 0.60; 95% CI 0.38, 0.95) on the association implying that older adults who engaged in physical activity were 40% less likely to experience food insecurity-induced functional disability. Food insecurity is associated with functional disability among older adults. Results highlight the usefulness of tackling the social determinants of health and promoting financial/social security in older age in a changing Ghanaian society.

An integrative review on individual determinants of enrolment in National Health Insurance Scheme among older adults in Ghana

BackgroundWe conducted an integrative review in an attempt to methodically and systematically understand the individual (personal factors) that influence National Health Insurance Scheme [NHIS] enrolment among older adults aged 50 years and above. The study was premised on evidence pointing to a state of little or no change in the enrolment rates [especially among older adults], which contrasts with the initial euphoria that greeted the launch of the scheme - which culminated in high enrolment rates.MethodsThe integrative literature review was conducted to synthesise the available evidence on individual determinants of NHIS among older adults. The methodological approach of the integrative literature review follows a five-stage interdependent and interconnected procedure of problem identification, literature search, data evaluation, data analysis and results presentation. Studies that met the inclusion criteria were peer-reviewed articles published in the English Language, from January 2010 to July 2020 and have Ghana as its setting or study area. The Andersen's Behavioural Model was used to categorize the predictor variables.ResultsPredisposing factors [gender, age, level of education and marital status], enabling factors [income] and need factors [health conditions or health attributes of older adults] were identified as individual predictors of NHIS enrolment among older adults. The findings support argument of Andersen's Behavioural Model [where predisposing, enabling and need factors are considered as individual determinants of health behaviour].ConclusionsThe findings call for policy reforms that take into account the aforementioned individual predictors of NHIS enrolment, especially among the aged.

Effect of financial services access on health services utilisation among rural older adults in Ghana

AbstractThis study explored the effect of access to financial services on rural older adults' health services utilisation. A cross‐sectional survey design was adopted to gather data (N = 310; mean age = 66.13 years and standard deviation [SD] = 24.72) in selected rural communities in Ghana. We applied endogenous treatment Poisson regression (ETPR), an econometrics model that accounts for self‐selection bias, to estimate the association between access to financial services and the use of health services. Findings revealed that education, internet use, club membership, employment status, proximity to financial institution (FI) and regional location were associated with access to financial services. Importantly, access to financial services was associated with increased health services use. The study results suggest that access to financial services may help increase the use of health services among rural older adults in Ghana.

Predictors of Healthcare Utilization Among Older Adults with Moderate to Severe Cognitive Limitations in Ghana: A Cross-Sectional Analysis of the WHO Study on Global Ageing and Adult Health (SAGE) Wave 1.

As the number of older adults in Ghana keeps increasing, so does the prevalence of aging-related diseases and conditions that tend to lead to cognitive decline. However, knowledge on the predicting factors of healthcare utilization among older adults with cognitive limitations is still scarce. This study examines the predictive factors of healthcare-seeking behavior among older adults with moderate-to-severe cognitive limitations in Ghana. Based on Andersen's behavioral model of health service utilization, the study analyzed data from 3106 older adults with moderate to severe cognitive limitations in Ghana aged 50+ using Bivariate Probit Regression and the Heckman Selection Model. Results showed that individuals who were aged 75+, living in urban settlements, educated, higher income levels and parents who had some level of education, pension benefits, and both mandatory and voluntary health insurance were more likely to seek inpatient care. Enabling resources such as the national health insurance scheme and other types of medical insurance, household income, pension benefits, and predisposition factors like education influenced outpatient and inpatient healthcare consumption for older adults with moderate to severe cognitive limitations but had little influence on the choice of healthcare facility except for health insurance. Since the healthcare-seeking behavior of older adults with moderate-to-severe cognitive limitations is driven by an amalgamation of several internal and external factors, there is a need for policy change to understand and cautiously incorporate these factors into the decision to improve equitable access to healthcare services for these individuals, as not all sizes fit all in providing quality care for them.

The effect-modification of physical activity on the association of pain with impaired physical function in aging adults.

Pain is prevalent among older adults and may result in impairment in physical function. However, little is known about the effect-modification of this relationship by physical activity (PA) participation. This large and representative study sought to estimate the effect of pain on physical function among older adults in Ghana and evaluate whether PA modifies this association. Data came from 1201 adults aged ≥50years participating in the AgeHeaPsyWel-HeaSeeB Study in Ghana. Pain constructs were defined using the Medical Outcomes Study Short Form-36 (MOS SF-36). PA was assessed using the International Physical Activity Questionnaire short form (IPAQ-SF) and physical function impairment was measured by seven-item domains based on the activities of daily living (ADL) and instrumental ADL (IADL). Adjusted hierarchical OLS regressions were fitted to estimate the direct and moderating relationships between pain facets, PA, and impaired physical function. The relationships of pain severity (β=0.348, p<.001), and pain interference (β=0.424, p<.001) with impaired physical function were robust after full adjustment for confounding variables. Persons with pain experiences had significantly increased impaired physical function risks. PA significantly modified the association between pain severity (β = -0.232, p<.001) and pain interference (β = -0.143, p<.001) with impaired physical function. Our data indicate that the relationships of pain with physical function impairment are modified by PA intensity. Future studies are warranted to understand the indirect effect of pain on functional limitations and how PA promotion could manage pain and improve functional ability in aging adults.

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.

Food insecurity and geriatric functional limitations: Observational analysis from the AgeHeaPsyWel-HeaSeeB Survey.

International literature suggests that food insecurity is linked with increased risks of functional impairment. However, data on the mediational mechanisms underlying this association are largely lacking. This study investigates the indirect relationship (via mental distress) between food insecurity and functional limitations among older adults in Ghana and evaluates the moderating effect of age, sex, and physical activity in this association. The analytic sample comprised 1201 adults aged ≥50years from the AgeHeaPsyWel-HeaSeeB study 2016-2017. We assessed food insecurity using hunger and skipped breakfast-related items. Seven mobility and activities of daily living-related difficulties assessed functional limitations. We used a moderated mediation analysis with the Hayes'PROCESS Macro v3.5 to model the hypothesized associations. About 36% of the sample were functionally limited, and 44% and 9% revealed moderate and severe food insecurity respectively. Food insecurity was associated with increased odds of having functional limitations after full adjustment for potential confounders (OR=1.25, 95% CI: 1.05-1.50). However, this association was buffered by physical activity; those who engaged in physical activity were 23% less likely to suffer food insecurity-induced functional limitations compared to physically inactive (OR=0.77, 95% CI: 0.67-0.88). Mental distress significantly mediated the food insecurity-functional limitations association and explained 86.9% of the association (total effect: OR=2.85; 95% CI: 1.42-2.71; direct effect: OR = 1.05; 95% CI: 1.21-1.87; indirect effect: OR = 1.34; 95% CI: 1.36-2.24). Food insecurity is a risk factor for functional limitations in old age. Interventions to address food insecurity may benefit functional abilities via regular physical activity and improved mental health outcomes.