Abuse, Neglect, and Violence Against Elderly Women in Ghana: Implications for Social Justice and Human Rights

Sex-related inequalities in crude and age-standardized suicide rates: trends in Ghana from 2000 to 2019

BACKGROUND

Suicide represents a major public health concern, affecting a significant portion of individuals. However, there remains a gap in understanding the age and sex disparities in the occurrence of suicide. Therefore, this study aimed to investigate the sex-related inequalities in suicide rates in Ghana from 2000 to 2019.

METHODS

We utilized data from the WHO Health Equity Assessment Toolkit (HEAT) online software. We analysed sex differences in both crude and age-standardized suicide rates in Ghana spanning from 2000 to 2019. Crude and age-adjusted suicide rates were calculated based on the International Classification of Diseases (ICD) definition and coding of suicide mortality. We measured inequality in terms of sex. Two inequality indicators were used to examine the suicide rates: the difference (D) and the ratio (R).

RESULTS

Age-standardized and crude suicide rates in Ghana were higher among men from 2000 to 2019. Between 2000 and 2007, the age-standardized suicide rate for women rose steadily and declined slightly between 2008 and 2019. Age-standardized suicide rates for men increased consistently from 2000 to 2010, then declined steadily from 2011 to 2019. The crude suicide rates among men and women followed similar patterns. The widest absolute inequality in crude suicide rates (D) was recorded in 2013 (D=-11.91), while the smallest difference was observed in 2000 (D=-7.16). We also found the greatest disparity in age-standardized rates in 2011 (D=-21.46) and the least in 2000 (D=-14.32). The crude suicide rates increased with age for both men and women aged 15-54 years and 55-85+ years respectively. However, the increased rate was higher in men than in women across all age groups surveyed. A similar pattern was observed for relative inequality in both crude and age-standardized rates of suicide.

CONCLUSION

The suicide rate in Ghana has declined over time. Suicide is more common among older men. Inequalities in suicide rates, in both absolute and relative terms, are similar. There is a need to monitor suicide trends in Ghana, especially among older men. Moreover, the findings could serve as a basis for future studies on suicide in Ghana.

Missing voices: older people's perspectives on being abused in Uganda

Abuse of older people is a major challenge for people who are aging. Studies into older people's perspectives on abuse focus mainly on developed countries, while the views of those in sub-Saharan Africa remain largely unheard in social research. To address this imbalance, we report a qualitative study using in-depth semi-structured interviews and focus group discussions to examine older people's perceptions of abuse in Uganda. Thirty-three participants were selected from four districts of Uganda to reflect different locations, levels of development, cultures, and contexts. Behaviors considered abusive were categorized into five themes: economic abuse, harassment and violence, disrespect, neglect and abandonment, and discrimination. Results showed that participants largely viewed their abuse from a cultural perspective, contrary to the West's perception based on a discourse of human rights. The findings show the need for a broader definition that includes the cultural dimensions of the abuse of older people in developing societies.

Prioritizing the National Aging Policy in Ghana: Critical Next Steps

Most developing nations are facing rapid population aging with limited economic and social resources. In Ghana, a National Aging Policy (NAP) was promulgated by the government in 2010 to ensure the well-being of older adults. Since its passage, the NAP has yet to be funded and implemented. In this paper we synthesize key information on policies and programs targeted at older adults in Ghana and identify the challenges that are adversely impacting their welfare, including the non-implementation of the National Aging Policy. To give the NAP needed attention and promote its implementation, a national coordinating body exclusively devoted to older adults is an essential first step. Critical next steps are offered to promote the effective implementation of the NAP and ensure the well-being of older adults in Ghana. With its current foundation of support programs for older adults, Ghana has the opportunity to be the lead nation in Sub-Saharan Africa to establish a national level office dedicated to promoting older adults' well-being and including them in the nation's development efforts.

"They Do Not Care about Us Anymore": Understanding the Situation of Older People in Ghana

While existing research acknowledges copious challenges faced by older adults (people aged 60 and over) in Ghana and most countries in sub-Saharan Africa, they fail to situate the lived experiences of this vulnerable group within the broader context of health geography and public health. This paper draws insights from ecological systems theory and the “geographies of older people” literature to examine the lived experiences of older people in Ghana. Data for the study were gathered using interviews (42) and sharing circles (10). Our findings reveal a complex mix of experiences consistent with the different levels of the environment. Dominant themes include access to social support, functional impairment and poor health status, social status, poor access to water and sanitation services, food insecurity, economic insecurity, and caregiving burden. These findings support the wide-held notion that the experiences of older people are complex and produced by the interplay of both individual and structural factors. Our findings demonstrate that sociocultural, economic, political, and climatic factors are important consideration in promoting elderly wellbeing and quality of life in Ghana.

Psychometric Properties of a New Scale Measuring Neglect and Abuse of Older Adults in the Community: Implications for Social Activity

Background

Neglect and abuse of older adults are still prevalent in communities of developing countries, a situation that could discourage active and healthy behaviors in community-dwelling older adults.

Methods

This study used the cross-sectional and correlational approaches to construct a scale measuring neglect and abuse in older adults living in the community. The study population was all (3,211) older adults who were resident in Accra and were part of the database of the Social Security and National Insurance Trust. Participants were 515 individuals who met some inclusion criteria. Three steps were followed to determine an initial set of 11 items, and principal component analysis with varimax rotation and confirmatory factor analysis were used to select relevant items and assess the psychometric properties of the final scale.

Results

Principal component analysis with varimax rotation yielded a two-factor solution on all 11 items. The first factor extracted was “discrimination and exploitation,” which accounted for a variance of 53.9% out of total variance of 70.8%. The scale had a good internal consistency (Cronbach’s α = .90, factor loading ≥0.50). Confirmatory factor analysis confirmed the two-factor solution and produced satisfactory convergent and discriminant validity.

Conclusion

It is concluded that 11 items that make up 2 factors are potential indicators of neglect and abuse of older adults at the community level. Finally, neglect and abuse of older people in the community can contribute to an increase or decrease in social activity.

Grannicides in Ghana: a study of lethal violence by grandchildren against grandmothers

The current article presents the results of an exploratory research that examined 16 homicides perpetrated by grandchildren against their own grandmothers in Ghana, West Africa. The term grannicide was coined by the present author and employed in the current analysis to denote the slaying of a grandmother by her grandchildren. Data for the present study were extracted from various Ghanaian print and electronic media. Results from the analysis of data show that grannicide is gendered, with all 16 identified grannicides perpetrated by grandsons against grandmothers. Offenders typically were young and of low socioeconomic background. Victims were of advanced age, poor, and at least partially dependent on their children and grandchildren for economic, physical and social support. All the homicides occurred in the rural areas of the country, and the victims commonly shared a residence with the assailant. Witchcraft accusations were the predominant motive in grandchild-to-grandmother slayings. The killings were overwhelmingly brutal, exhibiting characteristics that criminologists call overkill. Recommendations for reducing this type of crime are offered.

Explanations around physical abuse, neglect and preventive strategies among older Yoruba people (60+) in urban Ibadan Southwest Nigeria: A qualitative study

Older people's views, experiences and explanations on abuse and neglect in later life is marginal in the literature. With more cases of physical abuse and neglect in old age in sub-Saharan Africa, this study explored the views and positions of older people and community stakeholders like religious leaders on why physical elder abuse and neglect and preventive measures within community settings in Nigeria. An exploratory research design that consisted of two focus group discussions with older Yoruba men and women (60+) and six semi-structured interviews with religious leaders (Christianity, Islam, and Traditional) guided the study. Based on thematic analysis, the findings revealed that older persons and religious leaders have multiple interpretations of physical elder abuse and neglect. Social ills, poor economic situation, evil machinations, and stereotypes and misconceptions of old age and spirituality are possible explanations for physical abuse and neglect. The intersecting nature of the factors promoting vulnerability to physical abuse and neglect in later life also emerged in the preventive measures suggested by older persons and community members. As such, the participants affirmed that most older persons are becoming conscious of vulnerability to abuse and do contest actions, relationships, and contexts that can reduce their vulnerability and earn more social acceptance. Nonetheless, the participants expressed worries over the absence of policies and legal frameworks that can protect older people against physical abuse and neglect. More worrisome was the growing spread of social ills, stereotypes around old age, poverty in old age, witchcraft accusations and ageism. These developments are compounding ageing experiences, including physical abuse and neglect in urban spaces in Nigeria.

Does insurance enrolment increase healthcare utilisation among rural-dwelling older adults? Evidence from the National Health Insurance Scheme in Ghana

INTRODUCTION

This paper examines the relationship between national health insurance enrolment and the utilisation of inpatient and outpatient healthcare for older adults in rural areas in Ghana. The Ghanaian National Health Insurance Scheme (NHIS) aims to improve affordability and increase the utilisation of healthcare. However, the system has been criticised for not being responsive to the needs of older adults. The majority of older adults in Ghana live in rural areas with poor accessibility to healthcare. With an ageing population, a specific assessment of whether the scheme has benefitted older adults, and also if the benefit is equitable, is needed.

METHODS

Using the Ghanaian Living Standards Survey from 2012 to 2013, this paper uses propensity score matching to estimate the effect of enrolment within the NHIS on the utilisation of inpatient and outpatient care among older people aged 50 and over.

RESULTS

The raw results show higher utilisation of healthcare among NHIS members, which persists after matching. NHIS members were 6% and 9% more likely to use inpatient and outpatient care, respectively, than non-members. When these increases were disaggregated for outpatient care, the non-poor and females were seen to benefit more than their poor and male counterparts. For inpatient care, the benefits of enrolment were equal by poverty status and sex. However, overall, poor older adults use health services much less than the non-poor older adults even when enrolled.

CONCLUSION

The results indicate that NHIS coverage does increase healthcare utilisation among rural older adults but that inequalities remain. The poor are still at a great disadvantage in their use of health services overall and benefit less from enrolment for outpatient care. The receipt of healthcare is significantly influenced by a set of auxiliary barriers to access to healthcare even where insurance should remove the financial burden of ad hoc out of pocket payments.