Study on global AGEing and adult health (SAGE) | 1 |1 | Health of older Ghanaians: Health Risks and...

Study on global AGEing and adult health (SAGE) |1 |

Health of older Ghanaians: Health Risks and Chronic Non-communicable

Diseases

Dr Alfred E Yawson


Introduction

Globally, low fertility and mortality rates are contributing to rapid increase in older populations

Ghana is also experiencing progressive increases in the percentage of the older population

o The population of those aged 60 years and above in Ghana is projected to increase from 6.5% in 2010 to 11.9% in 2050

o In low and middle income countries there is a double burden of disease (high levels of both communicable and non-communicable diseases)


IntroductionSocio-demographic characteristics of Ghana show

fertility rates and mortality rates to be falling gradually over the years : implication is the upward movement of the percentage of older population

There is a need for information to address policy

The goal of SAGE survey is generally to strengthen, gather, process and manage data on older persons and to respond to health needs


Methodology The multi-country Study on global AGEing and adult health (SAGE)

Wave 1 (China, Ghana, India, Mexico, Russia, and South Africa)

Interviewed a nationally representative sample of adults aged 50 years and older, with a smaller comparison group of adults aged 18-49 years.

Health, disability, subjective well-being, quality of life, social cohesion, risk factors, performance tests, anthropometric measurements and biomarkers.

Data were collected in 2007-08.


Assessment tools


Enumeration Areas Visited


Health Risks: older adults and health risk identify health risks

focus on interventions that improve health

through effective health promotion

in a supportive health and social policy environment


Health Risks: five major risk factors Tobacco use,

alcohol consumption,

intake of fruit and vegetables,

physical activity levels and

environmental risk factors

Morbidity and Interventions


Tobacco useThe prevalence

was higher among males,

those with no education,

the currently married

rural residents and the poorest income quintile group

Overall prevalence of current daily smokers among older adults in Ghana was 7.6%. Men were three times as likely as women to be current tobacco users


Alcohol Use

Generally, alcohol use declined with increasing age

frequent heavy drinkers were highest among those who had completed Secondary and High school

Life time abstention from alcohol increased as income quintiles increased (Q1=48.2% and Q5=61.4%)

Proportion of older persons who reported heavy alcohol use was 3%


Nutrition: intake of fruits and vegetables Over two-thirds of older adults (males and females)

had insufficient intake of fruits and vegetables in their diet

Insufficient dietary intake was worse for:

o Those 70 years or more . It worsened with increasing age!

o Rural residents

o Lowest income group . It worsened with decreasing income!

o Those with little or no education. Relatively better for those with higher educational levels.


Levels of Physical ActivityHigh level of physical activity decreased with

increasing age, (70% in 50-59yrs vs. 46.5% in 80+ age group)

High level physical activities was more common amongst

o Males ; Rural residents and the currently married (compared to the widowed and divorced/separated )

o Lowest income quintiles (75%) than the higher income groups (Q5= 49%)

o and those with little or no education (level of physical activity decreased as educational level increased)


Obesity and overweight The overall prevalence of obesity was 30%

More common among :

o Females (35% vs. 25% in males)

o separated/divorced or widowed

o Urban residents

o Older persons with higher education and

o Those in highest income group


Access to improved water sources and sanitation

Urban household had improved sources of domestic water and sanitation, (95% and 19%) than Rural households (75% and 11%).

Highest income quintile households had the highest improved water and sanitation and easier access to drinking water

A fifth of all rural households spends more than 30 minutes to get to source of drinking water (10% for urban households)


Indoor air pollution:cooking fuel used by Households(HH)Huge difference existed in type of cooking fuel by

urban and rural HH (17% of urban HH used clean fuel; <1% by rural HH)

Almost all the rural households (98.9%) used solid fuel.

Use of clean fuel increased with increasing income quintile.


Health State: self-reported health Respondents were asked to rate their

“overall health today” and

level of difficulty with “household and work activities over the last 30 days”.

Rating of health states worsened with increasing age

Women always rated their health worse than men


Health State: Mean health scoresMean health score generally showed higher values

for

males than females

urban residents than rural residents

In addition mean health score

decreased as age increased and

decreased as income levels decreased.


Frailty by country-SAGE Wave 1

50 55 60 65 70 75 80 85 900

0.05

0.1

0.15

0.2

0.25

0.3

0.35

0.4

0.45

0.5

ChinaIndiaMexicoRussiaSouth AfriGhanaM

ean

frai

lty in

dex


Frailty by sex in Ghana

50 55 60 65 70 75 80 85 900

0.05

0.1

0.15

0.2

0.25

0.3

0.35

0.4

0.45

MaleFemale

Frai

lty in

dex


Morbidity and Intervention

In most countries, as in Ghana, the contribution from chronic conditions to overall burden of disease is increasing.

More older persons self-reported chronic non-communicable diseases compared to acute conditions, (21.8% vs. 11.6%).


Chronic non-communicable diseases

Arthriti

sStr

oke

Angina

Diabetes

Chronic L

ung Dise

ase

Asthma

Depression

Hyperte

nsion

Cataracts

Endentulism

0

2

4

6

8

10

12

14

16

Prevalence (%) of Chronic conditions in the 50+ group


Chronic non-communicable diseases: high prevalence groups

Prevalence of chronic diseases was higher among:

o Females

o urban residents

o separated/divorced and the widowed

o the highest income quintile.

Clear sex and rural-urban differences existed: Women (≥50 years) and Urban residents had higher self-reporting of the chronic diseases.


Chronic diseases- Example sex, rural-urban difference

Chronic condition

Prevalence (%) P- value Female: Male ratio

Urban Rural

Hypertension 22.8 7.3 0.001 1.8

Diabetes 6.4 2.2 0.001 1.3

Stroke 4.0 1.7 0.004 1.2


Health care responsiveness: Health Care Received in last 12 months

Overall 97% of older persons said they needed health care in last 12 months and only 71% actually received care

Quality of care: older persons rated responsiveness of inpatient care as 73% and out patient care as 63%


Health care responsiveness: health services coverage

Inpatient care was lowest among:

o females

o > 60 years (Retired)

o lowest income quintile

o rural residents

o the widowed

These are vulnerable groups among the older population


Health care responsiveness: preventive health care

Two indicators were used : Breast cancer screening and Cervical cancer screening

only 3% of women > 50 yrs had access to breast cancer screening through mammography

only 3% of women > 50 yrs had access to cervical cancer screening through Pap smear


Policy implicationHealth risks and chronic non-communicable

diseases are prevalent among older persons in Ghana

Health services do not seem responsive to the health care needs of vulnerable groups among the older adult population

These issues clearly deserve special attention as Ghana implements the 2010 National ageing Policy


Take Home Message: As we grow old

We slow down – become obese, less mobileWe lose income – less able to afford We lose our partners – issues with widows We become frail- unable to support our selvesWe lose some functions_ sight, teeth, hearingUnable to access healthUnable to fight infections,Susceptible to all kinds of afflictions


For more information

http://apps.who.int/healthinfo/systems/surveydata/index.php/catalog/6/study-description

www.who.int/healthinfo/sage

Thank you very much



http://www.who.int/healthinfo/sage

Study on global AGEing and adult health (SAGE) | 1 |1 | Health of older Ghanaians: Health Risks and...

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