Associations of financial inclusion with physical activity participation in later life.

Background: Physical activity (PA) is a vital modifiable psychosocial intervention for promoting healthy longevity but problematically decreases with age. Innovative community-based strategies are recommended by the World Health Organization (WHO) to improve PA but prior research has seldom considered the interactive effect of financial inclusion, social networks, and sex differences on PA. In this study, we examine the role of sex differences and resourceful social networks in relation to the association of financial inclusion with PA among older Ghanaian people. Methods: The sample included 1201 adults aged ≥50 years who participated in the 2016-17 AgeHeaPsyWel-HeaSeeB study. We assessed financial inclusion with an eight-item Financial Instrument Questionnaire Scale and PA with the International Physical Activity Questionnaire Short Form (IPAQ-SF). Linear regressions and moderation analysis were used to test the hypothesized associations. Results: The mean financial inclusion and PA scores were 1.9(±1.8) and 9.0(±4.4) respectively. After full adjustment for potential confounders, a unit increase in financial inclusion was significantly and positively associated with increases in PA participation (ß = .308, p < .005) and also notable among those aged ≥65 years (ß = .413, p = .023). Crucially, the positive association between financial inclusion and PA was significantly modified by social networks (ß = .151, p < .001). However, the role of sex in this association was not robust. Conclusions: Findings emphasize the effect of financial inclusion on PA in old age, particularly when considering social networks. Programs to improve financial inclusion and social integration may benefit the acceptance and participation of PA among older adults.

COVID-19 crisis and increased risks of elder abuse in caregiving spaces.

This paper discusses the potential abuse and mistreatment against older adults by informal caregivers during the COVID-19 pandemic in Africa. The COVID-19 pandemic has distorted many informal caregivers' roles, which require serious adjustment for reducing caregiving stress and burden. Moreover, the COVID-19 pandemic has created challenging situations in caregiving spaces, which have the tendency to cause informal caregivers to abuse older adults. However, research on elder abuse and mistreatment, up to this point, remains underexplored in Africa. We, therefore, call for a deeper research and interrogation on the pathways and dynamics of violence and abuse against older adults in Africa. We also raise awareness of increased risks of domestic elder abuse and neglect during COVID-19 to stimulate the interest of social welfare institutions in understanding this phenomenon and its prevalence in Africa. We argue that the COVID-19 pandemic should serve as an avenue for governments, social welfare institutions, public health authorities, civil society and traditional leaders in African countries to develop a comprehensive programme and create public awareness to protect older adults against abuse, violence and neglect. The practical ways of minimising the effect of COVID-19 on domestic elder abuse in African settings are further discussed.

Financial inclusion and physical health functioning among aging adults in the sub-Saharan African context: Exploring social networks and gender roles.

BACKGROUND: It remains poorly understood how financial inclusion influences physical health functioning in later life in sub-Saharan African context and whether the association differs by gender and social relationships. We aim 1) to examine the associations of financial inclusion with functional impairment during older age in Ghana; and 2) to evaluate whether gender and social networks modify this association. METHODS: The cross-sectional analyses are based on a sample (N = 1,201) of study participants aged 50 years and over (M = 66.5 years, SD = 11.9, 63.3% female) deriving from the 2016-2017 AgeHeaPsyWel-HeaSeeB Study. Ordinary least squares (OLS) regression analyses with interactions were performed to estimate the link between financial inclusion and functional health and how the association is modified by gender and older age social networks. RESULTS: The mean financial inclusion score was 1.66 (SD = 1.74) in women and 2.33 (SD = 1.82) in men whilst mean activities of daily living (ADL) score was 13.03 (SD = 4.99) and 14.85 (SD = 5.06) in women and men respectively. We found that financial inclusion was associated with decreases in ADL (total sample: ß = -.548, p < .001; women: ß = -.582, p < .001; men: ß = -1.082 p < .001) and instrumental ADL (IADL) (total sample: ß = -.359, p = .034; women: ß = -.445, p = .026 but not in men). Social networks significantly moderated the association of financial inclusion with ADL such that the financially included who were embedded in a stronger constellation of social networks were 6% less likely to report ADL impairment compared to those with weaker social networks (ß = -.062, p = .025). CONCLUSIONS: The study provides empirical evidence for a better understanding of the association between financial inclusion and physical health functioning in the context of later life social networks. Interventions for functional health through financial inclusion in sub-Saharan Africa should include improving interpersonal and social networks for older adult and also through gender lenses.

How Far Is Inclusivity of Financial Services Associated With Food Insecurity in Later Life? Implications for Health Policy and Sustainable Development Goals.

This study investigates how financial services inclusion (FSI) may affect food insecurity among older Ghanaians and seeks to identify any modifying roles of age and gender in the associations. Data were analyzed for 1,200 adults aged 50+ years. Generalized linear models with a logit link function examined associations and interaction terms. Average FSI score was 1.9 (SD = 1.8), and the prevalence of hunger and breakfast skipping were 35.6% (95% confidence interval [CI]: [32.9%, 38.4%]) and 28.8% (95% CI: [26.3%, 31.5%]) respectively. After full adjustment for potential confounders, FSI was associated with 0.459 (95% CI: [0.334, 0.629]) and 0.599 (95% CI: [0.434, 0.827]) times lower odds for hunger and breakfast skipping respectively. However, the corresponding interactions were statistically insignificant. The findings indicate the potentially important role of FSI in reducing food insecurity in later life. Development of policies to empower older people economically through increased financial literacy and easier access to financial services may help actualize the Sustainable Development Goal 2.

Does financial inclusion predict a lower risk of loneliness in later life? Evidence from the AgeHeaPsyWel-HeaSeeB study 2016-2017.

OBJECTIVE: For many older people, loneliness represents a common source of impaired quality of life particularly in the context of poor access to financial services. This article examines the association between financial inclusion and loneliness in older adults and explores the moderating effects of gender and physical activity in this association. METHODS: One thousand two-hundred participants completed the Short Form Revised UCLA Loneliness Scale assessing loneliness during 2016-2017 Aging, Health, Psychological Well-being and Health-seeking Behavior (AgeHeaPsyWel-HeaSeeB) Study. Financial inclusion was assessed using an 8-item Financial Instrument Scale. RESULTS: Multiple ordinary least squares (OLS) regressions showed that increases in financial inclusion were associated with decreases in loneliness in the total sample (ß = -0.679, p < 0.001) and in women (ß = -0.787, p < 0.001) but not in men (ß = -0.594, p = 0.084). The negative effect of financial inclusion on loneliness was pronounced among those who engaged in physical activity (ß = -0.646, p < 0.042). CONCLUSIONS: Findings underscore the importance of financial inclusion for loneliness in later life particularly among older women and those who engage in physical activity. Encouraging and strengthening financial inclusion may crucially improve psychological health and emotional well-being among aging adults.

How do lifestyle choices affect the link between living alone and psychological distress in older age? Results from the AgeHeaPsyWel-HeaSeeB study.

BACKGROUND: Social isolation is widespread and strongly associated with worsening health-related outcomes across the life-course. Despite this broad base of knowledge, there is a paucity of research on the interactive effect of lifestyle choices and living arrangements on later life psychological state particularly in low- and middle-income settings. The aim of this study is to examine the influence of living alone on psychological distress in older people and to explore the protective roles of social participation and physical activity participation. METHODS: We used cross-sectional data from the 2016-17 Aging, Health, Psychological Well-being and Health-seeking Behavior Study (AgeHeaPsyWel-HeaSeeB) involving a representative sample of 1200 adults aged 50+ years in Ghana. The study focused on a latent measure of Kessler Psychological Distress Scale (K10) and on the General Practice Physical Activity Questionnaire (GPPAQ). Ordinary Least Squares (OLS) regression models evaluated the interactive effects of living arrangements and lifestyle choices on the K10 score. RESULTS: Living alone was independent predictor of psychological distress in the overall sample, among females, urban dwellers and all age groups. However, lifestyle choices of physical activity and social participation significantly moderated these associations. Moreover, in the stratified analysis, physical activity moderated the association for males, rural-dwellers and those 65+ years whilst social participation moderated the association for females, urban-dwellers and those 50-64 years. CONCLUSIONS: Lifestyle choices i.e. social participation and physical activity, and demographic factors i.e. age, gender, and residential status strongly attenuate the positive association of living alone with the risk of psychological distress in older age. These findings may inform intervention initiatives targeted at improving mental health of chronically detached and isolated older people.

The Role of a Health Protection Scheme in Health Services Utilization Among Community-Dwelling Older Persons in Ghana.

OBJECTIVES: This study examines the relationships between National Health Insurance Scheme (NHIS) enrollment and the frequency and "timing" of health services utilization among community-dwelling older Ghanaians. It also investigates whether the NHIS policy has improved equity in access to health care in later life. METHODS: Cross-sectional data were derived from an Ageing, Health, Psychological Wellbeing and Health-seeking Behavior Study collected between August 2016 and January 2017 (N = 1,200). Descriptive and bivariate analyses described the sample. Generalized Poisson and logit regression models, respectively estimated the predictors of frequency of health services utilization and time from onset of illness to health facility use and during last illness episode. RESULTS: Older persons with active NHIS membership frequently used health facilities (ß = 0.237, standard error [SE] = 0.0957, p ˂ .005), but the association was largely a function of health-related factors. The NHIS enrollees were more likely to attend health facility earlier (ß = 1.347, SE = 0.3437, p ˂ .001) compared with nonenrollees, after adjusting for theoretically relevant covariates. Moreover, given the NHIS enrollment, the rich (eß = 2.149, SE = 0.240, p ˂ .005), social support recipients (eß = 1.366, SE = 0.162, p ˂ .05) and those living with relevant others (eß = 2.699, SE = 0.175, p ˂ .001) were more likely to consume health services. DISCUSSION: Ghana's NHIS policy generally increases health services utilization but at present lacks the capability to improve equitable access to health care, especially between poor and nonpoor older adults. This may hamper the progress toward universal health coverage (UHC), indicating the need for further refinements in the policy including ways to improve the health status of older persons.

Multidimensional Social Support and Health Services Utilization Among Noninstitutionalized Older Persons in Ghana.

Objectives: This study examines multidimensional social supports as predictors of health services utilization among community-dwelling older Ghanaians. Method: Using data from a 2016/2017 Aging, Health, Psychological Wellbeing and Health-Seeking Behavior Study (N = 1,200), Poisson regression models estimated the associations of aspects of informal social support and health facility utilization among older people. Results: Findings suggest that regular contacts with family/close friends (odds ratio [OR] = 1.299; 95% confidence interval [CI] = [1.111, 1.519]), social participation (OR = 1.021; 95% CI = [1.140, 1.910]), and remittances from adult children (OR = 1.091; 95%CI = [1.086, 1.207]) were associated with increased health services utilization with some gender variations. Having caregivers increased health care use generally (OR = 1.108; 95% CI = [1.016, 1.209]) and among men (OR = 1.181; 95% CI = [1.015, 1.373]). However, we found decrease in health care use among those who received pecuniary assistance (OR = 0.893; 95% CI = [0.805, 0.990]). Discussion: Perceived structural and functional social support domains appear influential in health care utilization among older adults in Ghana. The findings underscore the need for intervention programs and social policies targeted at both micro-factors and wider social factors, including the novel area of remittances to older adults.

Aging and the Rising Burden of Noncommunicable Diseases in Sub-Saharan Africa and other Low- and Middle-Income Countries: A Call for Holistic Action.

Noncommunicable diseases (NCDs) are a prevalent and growing burden among older cohorts in sub-Saharan Africa and other low- and middle-income countries (LMICs) as in many wealthier parts of the world. This stems from the combined effects of factors such as demographic aging, behavioral transitions, and developmental origins of health and disease. A crucial characteristic of many NCDs is that their personal and family impacts and costs are not accurately reflected in mortality data. Their effects are often chronic and long-term and can cause morbidity, loss of work ability, and impaired quality of life over a prolonged period. Unless addressed seriously, the continuing increase of NCDs and their burden in sub-Saharan African countries and other LMICs will almost certainly undermine progress toward achieving the target of reducing by 25% premature mortality from NCDs in these countries by 2025 and also one-third reduction of NCDs target by 2030. To have any chance of meeting or even getting near to these targets, this article calls for action by national and regional governments to strengthen universal health coverage (UHC), economic empowerment of vulnerable groups, public-private partnerships, effective fiscal regulation, and public education on NCDs, their risk factors and impacts in sub-Saharan Africa in particular and most LMICs globally.

Financial Inclusion, Health-Seeking Behavior, and Health Outcomes Among Older Adults in Ghana.

PURPOSE: This study examines the associations between financial inclusion, health-seeking behavior, and health-related outcomes in older persons in Ghana. METHOD: Employing data from a 2016/2017 Aging, Health, Psychological Well-Being and Health-Seeking Behavior Study (N = 1,200; mean age = 66.2 years [standard deviation = 11.9], we estimated regression models of self-rated health (SRH), psychological distress (PD), and health-care use (HCU) on a variable representing compositional characteristics of financial inclusion. RESULTS: Multivariate logistic and generalized Poisson models showed that financial inclusion is positively associated with SRH (ß = .104, standard error [SE] = .033, p < .001) but inversely related to both PD (ß = .038, SE = .032, p < .005) and HCU (ß = -.006, SE = .009, p < .05) independent of other factors. However, after adjusting for socioeconomic and health-related factors, the associations were tempered and the effect of SRH decreased by 0.094 and PD increased by 0.065 points but HCU became statistically insignificant (ß = -.020, SE = .0114, p > .05). CONCLUSIONS: Financial services inclusion profoundly appears to buffer against and retard health-related challenges in later life. Social and health policies targeted at improving the health outcomes of older people should include and build on the growing recognition of the importance of inclusive financial services and strategies.

Explaining the gender gap in health services use among Ghanaian community-dwelling older cohorts.

Although gender differences in use of health services have been documented, little is known about whether such disparities vary by marital and socioeconomic status in later life, especially in low- and middle-income countries. We examined the relation of gender to use of health care among community-dwelling older Ghanaians (N = â€¯1200) and whether marital status and income moderated this relationship using data from the Aging, Health, Psychological Wellbeing and Health-seeking Behavior Study conducted in 2016/2017. Multivariate logistic regression modeling showed no significant gender disparities in use of health care, adjusting for covariates. However, married women were less likely to use health care than married men (adjusted Odds Ratio [aOR] = 0.324, 95% confidence interval [CI]: 0.146-0.718). Further, while married older people with higher incomes had lower odds of using health care (aOR = 0.355, 95% CI: 0.137-0.924), use of health services was greater in married women with higher incomes compared with their male counterparts (aOR = 8.695 (95% CI: 1.233-61.296). The modifying effects of marital status and income appeared substantial in explaining gender differences in use of health services in later life. These findings have implications for health policy, health promotion and quality of life of older people.

Market vegetable hygiene practices and health risk perceptions of vegetable sellers in urban Ghana.

The paper examines the hygiene practices and health risk perception of vegetable sellers in urban Ghana. Based on a qualitative in-depth study of vegetable sellers drawn from five purposively sampled markets in Kumasi Metropolis, the study found that the vegetable sellers have generally low risk perception. Consequently, the vegetable handling practices by these market women remain largely unsafe presenting potential health risks to consumers. Regular monitoring by relevant agencies and sustained public education are therefore key for reducing market contamination which is critical for maintaining a healthy population.