Long-term Care for Older Adults in Africa: Whither Now?

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.

China's Ambitious Policy Experiment with Social Long-Term Care Insurance: Promises, Challenges, and Prospects

In 2016, China launched long-term care insurance (LTCI) pilot programs in 15 cities across the country. In this Commentary, we provide an overview of these pilots regarding the target insured population, sources of financing, beneficiary eligibility criteria, and benefit design. We offer perspectives on the strengths and limitations, implementation challenges, and future prospects of these ongoing pilots. Also, we highlight the needs for addressing several key policy issues and challenges before further expanding these programs toward national implementation. These include solidifying the LTCI financing pool for independence and self-sustainability, balancing national priorities and local needs in LTCI design, reducing coverage gaps and disparities, ensuring quality of care through pay-for-performance and regulatory oversight, and strengthening independent evaluation of LTCI implementation and impacts.

Behavioral and psycho-social impairments among people living with dementia and their management by caregivers in South-Western Uganda: a qualitative study

OBJECTIVES

This study aimed to explore the behavioral and social impairments among people living with dementia (PLWD) in rural southwestern Uganda. It also explored the burden of caregivers for people living with dementia.

METHODS

This was a qualitative study among people living with dementia and their caregivers. We consecutively enrolled 30 people living with dementia with their caregivers from their homes. We conducted in-depth interviews using a semi-structured interview guide. We did a thematic content analysis.

RESULTS

The themes under-reported behavioral impairment were; difficulty in personal care, physical inactivity, and impaired judgment. Under the social and cognitive impairment theme, there was the failure to be in social gatherings like church, community groups, and markets. Under the caregivers' role, their burden included managing behavioral, social, and cognitive impairments of PLWD. Although caregivers were committed to caring for PLWDs, this required sacrificing time at the expense of income-generating activities.

CONCLUSIONS

Dementia hinders the behavioral and social aspects of the affected people. Caregivers are highly burdened to care for PLWD. Strategies to minimize caregivers' burden while caring for people living with dementia are recommended.

Prevalence and determinants of care needs among older people in Ghana

Introduction

Given the longevity noticed among older people in Ghana, and the potential occurrence of functional disability in later years of life, it has become essential to understand their care needs. This study examined the care needs in daily tasks and associated factors in Ghana, following the World Health Organisation International Classification of Functioning, Disability and Health framework.

Materials and methods

A cross-sectional survey was conducted among a sample of 400 older people from Komfo Anokye Teaching Hospital in Southern Ghana. Care need was assessed by one question; “Do you regularly need help with daily tasks because of long-term illness, disability, or frailty?” Multivariate logistic regression was used to test the association between care need and independent variables based on the WHO-ICF conceptual framework.

Results

Majority of the sample (81%), particularly women (54%) reported needing care in daily tasks. Per the WHO-ICF conceptual framework, functional disability—activity variable, (OR = 1.07 95%CI: 1.05–1.09, p<0.001), and absence of government support—an environmental factor, (OR = 3.96 95%CI: 1.90–8.25, p<0.001) were associated with care need.

Conclusions

The high prevalence of care needs among older people may offer an indication that majority of older people in Ghana could benefit from long-term care services. Functional disability and the absence of government support are the major issues that need to be prioritised in addressing the increased demand for care related to performing daily tasks among older people in Ghana.

Public and health policy for the aged in Africa to the South of Saara

OBJECTIVE

to know the social and health responses for the elderly in sub-Saharan Africa.

METHODS

An integrative literature review.

RESULTS

There is a lack of specialized health care to meet the real needs of the elderly, and the shortage of health professionals does not contribute favorably to this situation. There is a small number of facilities for the elderly and most of them are inadequate. Although there are models of care as well as social and health support policies for the elderly, there are still inequities/inequalities in access to these policies, especially for the most disadvantaged populations.

CONCLUSION

Social and health policies for the elderly in Sub-Saharan Africa are below standard and appropriate economic, political and social intervention is required.

Family medicine residency training in Ghana after 20 years: resident attitudes about their education

Objective

In addition to assessing educational needs of family medicine trainees in Ghana, we sought to assess whether those entering the training programme aimed to pursue an academic career.

Design

A case study using an anonymous cross-sectional survey through collaboration between faculty members from the family medicine departments of Ghana and the University of Michigan.

Setting

The family medicine postgraduate trainees and the most recent graduates in the three training sites, Accra, Kumasi and Mampong, as well as modular residents in Ghana served as the targeted participants during data collection between October and November of 2018.

Participants

Second and third year family medicine residents, fellows (known as senior residents in Ghana) and recent graduates were invited to participate in this study. Thirty-five of 77 eligible subjects provided responses (46% response rate), but five records were eliminated due to incomplete data to yield a survey completion rate of 39% (30/77).

Result

Participants were mostly men (n=19), and the average age of respondents was 37 years old. The participants indicated the residency programmes needed more faculty 97% (n=29), supervision during outpatient care 87% (n=26) and lectures 83% (n=25). The main reason provided by respondents for entering residency programme in family medicine, which is currently not required for practising primary care in Ghana, was to obtain more education 93% (n=28). Participants who had completed the residency programme were much more likely to be interested in becoming faculty compared with those still in residency (p <0.001).

Conclusion

The research confirms the need for more faculty and the importance of investing in faculty development resources for ensuring a robust programme. These findings provide constructive feedback that could improve residency curricula of the local and regional family medicine training programmes and supports investing in trainees and new graduates as future faculty candidates.

Establishing the First Geriatric Medicine Fellowship Program in Ghana

As life expectancy in Ghana improves, a large and growing population of older adults require healthcare. Despite governmental support for the care of older adults, there have been no geriatricians and no in-country educational path for those desiring to become specialists in this field. In fact, 23 of 54 countries in sub-Saharan Africa (SSA) lack even a single geriatrician. We describe a novel and collaborative approach used to develop the first geriatric training fellowship in Ghana. Faculty from the Ghana College of Physicians and Surgeons and the University of Michigan worked together to develop a rigorous and evidence-based geriatrics curriculum, based on US standards but adapted to be appropriate for the cultural, economic, educational, and social norms in Ghana. This approach led to a strong training model for care of older adults while also strengthening the ongoing collaboration between the two partner universities in Ghana and the United States. The fellowship has been inaugurated in Ghana and can serve as a concrete educational model for other countries in SSA. J Am Geriatr Soc 67:1718-1723, 2019.