Promoting the Well-Being of Older People in Ethiopia: Lost Opportunities Due to the Poverty of Policy.

The world's population is aging with the fastest growth in the older population projected to take place in Africa. In this article, we present the challenges of the growing older population in Ethiopia, outline some key changes that are needed to address those challenges, and consider the opportunities that can come about when older adults' basic needs are met and they are supported in contributing to their communities. Older adults in Ethiopia are faced with multidimensional challenges that call for collaborative efforts from different stakeholders at local, regional, and national levels. However, some measures should be given the utmost priority: combating negative attitudes toward older people, strengthening geriatric/gerontology and social work education and research, and developing aging-specific policies and services. Although the challenges faced by older adults in Ethiopia seem like a problem of aging compounded by poverty, the root source of the problem is a poverty of policy fueled by ageism. If income support and appropriate health care was provided to older adults throughout Ethiopia, health and well-being in late life would improve, food and housing insecurity among older adults would lessen, and all Ethiopians could anticipate a dignified late life.

An application of the reasoned action approach to clinical students' intention toward a career in geriatrics.

Guided by the reasoned action approach, this study examined select individual, information, and social factors that influence intention toward pursuing a career in geriatrics among 314 clinical medical and nursing students in Ghana. A Poisson regression showed attitude toward older persons was a significant influencing factor of intention to choose a career in geriatrics for medical students (B = 0.015, SE = 0.0048, p = 0.002) but not nursing students (B = 0.009, SE = 0.0145, p = 0.512). Personal interest was, however, a significant influencing factor for both medical and nursing students (B = 0.462, SE = 0.0592, p = 0.000) and (B = 0.015, SE = 0.0048, p = 0.002), respectively. Nursing students with moderate to strong interest were 1.6 times more likely to express an intention to specialize in geriatrics, and medical students were 1.5 times more likely to express an intention to specialize in geriatrics. The results show that the most important factor influencing geriatric career intention is students' personal interest in the field. Evidence-based interventions such as early educational and practice exposure to the field and interactions with older adults are recommended.

The Impact of Online and Offline Social Support on the Mental Health of Carers of Persons with Cognitive Impairments.

The carers of persons with cognitive impairments, including Alzheimer's have migrated to online platforms to seek help, yet studies on the use of online social support within the context of caregiving are underdeveloped. Guided by the social support theory, we examined the association of online and offline social support with depression and anxiety in the United States. Using a subsample from the 2017 and 2018 Health Information National Trends Survey (n = 264), we conducted ordered logistic regression to test mediation and moderation effects, which revealed that only offline, not online social support had a direct association with carers' mental health. In the moderation model, online social support interacted with life stressors, while offline social support interacted with caregiving burden. Findings are supported using a hybrid model that combines online and offline social support to improve carers' mental health.

Barriers to Active Aging in Rural Ethiopia: A Call for a Paradigm Shift to a Rights-Based Approach.

Despite historical veneration of elders in many African nations, older adults are increasingly viewed as a burden. Using a hermeneutic phenomenological approach, in-depth interviews were conducted to explore the aging experiences of 20 adults aged 70 and older in rural Ethiopia. Themes that emerged from the interviews were analyzed in light of the three pillars of the World Health Organization's Active Aging Framework: health, security, and participation. Despite facing multiple barriers to active aging including lack of health care, financial hardship, ageism, and social exclusion, study participants were determined not to withdraw from activities in an effort to retain their autonomy, independence, and sense of dignity. Study findings point to the need for policymakers and other concerned bodies to develop supportive policies and programs to promote older adults' well-being. The study calls for a paradigm shift that involves adopting the WHO's Active Aging Framework, developing rights-based policies and programs, popularizing active aging, and revitalizing intergenerational solidarity.

'No Matter How Harsh, We Are Alive': Coping Strategies of Rural-Urban Migrant Homeless Older People in Ethiopia.

The prevalence of homelessness among older adults in Ethiopia is growing. While prior studies examined the push factors and challenges of homeless elders, little is known about how older people cope with homelessness in a context of limited ageing services. This study explored the coping strategies of homeless older people in Kobo Town, Ethiopia. Purposive sampling was used to identify 10 homeless older people and four key informants. Thematic analysis was used to analyse the data collected through in-depth interviews. To cope with the challenges faced on the street, homeless older people used various strategies including begging, holy water, drying leftover food, using river water for hygiene and sanitation, sleeping in church compounds, and creating their own social networks. Despite their best efforts, elders' coping strategies could not overcome the barriers imposed by their resource-poor environment. The findings call attention to the urgent need for a national response to elders' unmet needs including an income support programme and multifaceted support services for older adults in Ethiopia.

'Hunger would kill us instead of COVID-19': Elders' response to the pandemic in Debre Markos Town, Ethiopia.

The COVID-19 pandemic has posed unpredictable challenges globally. Older adults are among the population groups most vulnerable to COVID-19. Poor urban elders in Ethiopia struggle to meet their basic needs due to waning traditional familial norms of providing care for elders as a result of urbanisation, poverty and migration. The aim of this study was to give voice to vulnerable elders during the COVID-19 lockdown in Ethiopia and to reveal their sources of support. Using a qualitative case study design, data were collected from 27 elders aged 60 and above in Debre Markos Town, Ethiopia via in-depth interviews conducted from March-May 2020. To determine the nature of support provided for destitute elders, data were also gathered from two local officials. Narrative data were analysed using thematic analysis. Four prominent themes were identified: 'Hunger would kill us instead of COVID-19,' 'Feeling hopeless and begging to die,' 'We prefer social support rather than food donations' and 'Gratitude.' Elders considered the practice of social distancing to fight COVID-19 as an unwelcome luxury for people whose livelihood depends on begging and petty trade. The physical distancing programme put elders in isolation, diminishing their capacity to maintain their livelihood. Due to the increasing disrespectful attitudes towards aged people, elders felt even less valued than usual. Interactions were described as undermining, embarrassing and abusive. A special emergency fund and organised social supports are needed to minimise the effect of the pandemic on vulnerable groups like destitute elders in Ethiopia. Moreover, an institutional welfare response is needed to ensure elders can live a dignified life.

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.

Challenges and Assets of Older Adults in Sub-Saharan Africa: Perspectives of Gerontology Scholars.

Life expectancy is increasing globally, with the biggest gains expected in sub-Saharan Africa. Using an online survey, we investigated the perspectives of gerontology scholars on the challenges of aging in sub-Saharan Africa as well as the assets of older adults. Respondents (n = 72) from 17 countries, primarily in Africa, and representing 16 disciplines, identified the top issues facing African older adults as: poverty, lack of trained geriatric professionals, food insecurity, disability/health issues, and long-term care. Older adults' unique strengths were noted as indigenous knowledge systems, being holders of cultural heritage, and their contributions to development. Respondents' biggest concerns about older adults in sub-Saharan Africa were the lack of government attention to aging issues (63%) and a lack of social services targeted to older adults' needs (57%). Government funding (77.8%) and international partnerships (38.9%) were noted as resources needed to support aging research in sub-Saharan Africa. The response or non-response of governments in sub-Saharan Africa will determine whether the growing number of older adults will increasingly experience unmet needs and whether their assets will be considered in development efforts. Establishing professional networks of gerontology scholars in the region will help to document the challenges faced by older adults, to plan for the coming demographic shift, and to empower older adults to thrive as valued community members.

Alzheimer's Caregivers' Experience With and Perceptions of the Affordable Care Act: Thematic Analysis of Online Discussion Forums.

The objective of this study was to analyze caregivers' authentic perceptions of and experiences with the Affordable Care Act (ACA). This mixed-methods study identified and analyzed caregivers' unsolicited posts on a national online forum. Data posted in 2011 to 2017 were collected. The text-mining thematic analysis method was used to code and analyze 514 caregiver posts. Although many caregiver posts about the ACA had a negative tone, perceptions became more positive over time. Three overall themes emerged: (a) concern about cost implications of placement decisions for care recipients, (b) skepticism about government and health care system support of their caregiving roles, and (c) caregivers' own well-being and concerns about health insurance. Clear and effective communication between policymakers, health professionals, and caregivers is needed to enhance health system literacy. Policymakers, as well as health and social care professionals working with Alzheimer's patients and their families, should be empowered to develop and support a family-centered service system.

"Homelessness and Health Problems Are Not Distinct:" the Challenges of Rural-Urban Migrant Homeless Older People in Ethiopia.

Compared with western countries, research on homelessness among older people in developing nations is minimal. Unlike in Global North nations that offer income security in late-life, in areas like Sub-Saharan Africa abject poverty contributes to older adults migrating from rural areas to urban centers in search of a means of livelihood. The aim of this study was to explore the challenges faced by homeless older rural-urban migrants in Kobo Town, Ethiopia. This cross-sectional study employed a qualitative descriptive case study. Purposive sampling was used to identify ten older adult migrants who had been homeless for more than a year. Data from in-depth interviews was supplemented with key informant interviews, observation, and document review. The narrative data was analyzed using thematic analysis. Study results revealed that homeless elders faced multiple challenges including lack of necessities such as food, shelter, and water, mobility issues, lack of employment access, social exclusion, and psychological struggles. The findings call attention to the need for practical access to social and economic empowerment responses to prevent and curb homelessness among older adults in developing nations.

"The Ugly Face of Old Age": Elders' Unmet Expectations for Care and Support in Rural Ethiopia.

As migration, urbanization, and aging accelerate in developing nations, traditional family supports for elders are diminishing. With these trends in mind, hermeneutic phenomenology was used to examine the experiences of 10 rural Ethiopian elders of age 70 and older. Narrative data from in-depth interviews revealed three prominent themes: the "good old days," drained happiness, worry and pessimism. Elders felt devalued by their children, grandchildren, and youth in general. Compared to how they treated their own parents, elders believed that their children's sense of filial obligation was weak and unreliable. Interactions were described as undermining, embarrassing, and abusive. Elders were pessimistic about the prospect of reliable caregivers, even expressing a wish to die before they become dependent on others for care. Despite such challenges, participants viewed aging as a privilege. New cooperative models of community-based care are needed to ensure that elders in developing nations can expect adequate care throughout their lives.

Integration as a Tool for Interprofessional Work: A Synthesis of the Literature Regarding How to Use Integrative Strategies to Address Complex Public Health Problems.

BACKGROUND AND PURPOSE: There has been limited success addressing complex public health problems using "siloed" approaches. A next important step in addressing persistent public health problems is adopting an "integrative" approach-intentional collaboration across the domains of research, clinical practice, community, and policy. This synthesis of the literature aggregates and synthesizes the diffuse and multi-disciplinary integration literature base to describe key concepts, aspects of praxis, and challenges and successes to help guide interprofessional practice. METHODS: A three-step approach was used: 1) a wide-ranging search for articles on integration theory/praxis; 2) a more focused search in the health literature bases; 3) a snowball strategy to identify additional studies. DISCUSSION/CONCLUSIONS: Identified themes included elements of successful integration; characteristics of an effective integrator; and dynamics between stakeholders in integration praxis. Results of this synthesis of the integration literature provide a deeper understanding of integration and points to clear and exciting next steps for integration praxis and inquiry.

The Mastery Matrix for Integration Praxis: The development of a rubric for integration practice in addressing weight-related public health problems.

In response to the limitations of siloed weight-related intervention approaches, scholars have called for greater integration that is intentional, strategic, and thoughtful between researchers, health care clinicians, community members, and policy makers as a way to more effectively address weight and weight-related (e.g., obesity, diabetes, cardiovascular disease, cancer) public health problems. The Mastery Matrix for Integration Praxis was developed by the Healthy Eating and Activity across the Lifespan (HEAL) team in 2017 to advance the science and praxis of integration across the domains of research, clinical practice, community, and policy to address weight-related public health problems. Integrator functions were identified and developmental stages were created to generate a rubric for measuring mastery of integration. Creating a means to systematically define and evaluate integration praxis and expertise will allow for more individuals and teams to master integration in order to work towards promoting a culture of health.

Death Attitudes Among Middle-Aged Koreans: Role of End-of-Life Care Planning and Death Experiences.

The purpose of this study was to examine factors affecting death attitudes among middle-aged Koreans. In addition, the study explored the interaction effect between knowledge about end-of-life care planning and the experience of death of family or friends on death attitudes. The sample was obtained from a national survey with middle-aged adults in South Korea ( n = 2,026). Multivariate regression analysis revealed significant main effects and an interaction effect between knowledge about end-of-life care planning and the experience of death on death attitudes. Greater knowledge of end-of-life care planning was associated with more positive attitudes toward death; however, the effect was stronger for those who had not experienced the death of family or friends. Being older and having greater life satisfaction were also associated with more positive attitudes toward death. This study suggests that end-of-life education can help middle-aged adults embrace the final stage of life and prepare for their own death.

Facilitators and Barriers for Advance Care Planning Among Ethnic and Racial Minorities in the U.S.: A Systematic Review of the Current Literature.

Growing evidence suggests a low engagement in advance care planning (ACP) among ethnic minorities in the U.S. The purpose of this study was to synthesize findings from prior research about ACP among ethnic minorities. An extensive literature search was conducted using multiple electronic databases. After applying inclusion criteria, 26 studies were included. Four categories of facilitators and barriers to ACP were identified: (1) Socio-demographic factors, (2) health status, literacy and experiences, (3) cultural values, and (4) spirituality. Socio-demographic factors showed inconsistent findings regarding their association with ACP engagement. Worse health status and knowledge about ACP are common facilitators across ethnic minority groups, whereas mistrust toward the health care system was a barrier only for Blacks. Collectivistic cultural values influenced ACP engagement among Latinos and Asian Americans; however, spirituality/religion played an important role among Blacks. The implications for culturally competent approaches to promote ACP and future research directions are discussed.

Women's social networks and use of facility delivery services for uncomplicated births in North West Ethiopia: a community-based case-control study.

BACKGROUND: High maternal mortality has remained an unmet public health challenge in the developing world. Maternal mortality in Ethiopia is among the highest in the world. Since most maternal deaths occur during labor, delivery, and the immediate postpartum period, facility delivery with skilled birth attendants is recommended to reduce maternal mortality. Nonetheless, the majority of women in Ethiopia give birth at home. Individual attributes and availability and accessibility of services deter service utilization. The role of social networks that may facilitate or constrain service use is not well studied. METHODS: Community-based case-control study was conducted between February and March 2014 in Jabi Tehinan District, North West Ethiopia. Retrospective data were collected from 134 women who had uncomplicated births at health facilities and 140 women who had uncomplicated births at home within a year preceding the survey. Interviews were held with eight women who had uncomplicated births at health facilities and 11 who had uncomplicated births at home. The quantitative data were entered and analyzed using SPSS for Windows versions 16.0 and hierarchical logistic regression model was used for analysis. The qualitative data were transcribed verbatim and data were used to substantiate the quantitative data. RESULTS: The results indicated that social network variables were significantly associated with the use of health facilities for delivery. Taking social networks into account improved the explanation of facility use for delivery services over women's individual attributes. Women embedded within homogeneous network members (Adjusted OR 2.53; 95% CI: 1.26-5.06) and embedded within high SBA endorsement networks (Adjusted OR 7.97; 95% CI: 4.07-12.16) were more likely to deliver at health facilities than their counterparts. Women living in urban areas (Adjusted OR 3.32; 95% CI: 1.37-8.05) and had better knowledge of obstetric complications (Adjusted OR 3.01; 95% CI: 1.46-6.18) were more likely to deliver at health facilities. CONCLUSION: Social networks facilitate SBA utilization by serving as a reference for the behavior to deliver at health facilities. These findings inform health professionals and other stakeholders regarding the importance of considering women's social networks in designing intervention to increase the proportion of women who deliver at health facilities.

Healthy Eating and Activity Across the Lifespan (HEAL): A call to action to integrate research, clinical practice, policy, and community resources to address weight-related health disparities.

Despite intense nationwide efforts to improve healthy eating and physical activity across the lifespan, progress has plateaued. Moreover, health inequities remain. Frameworks that integrate research, clinical practice, policy, and community resources to address weight-related behaviors are needed. Implementation and evaluation of integration efforts also remain a challenge. The purpose of this paper is to: (1) Describe the planning and development process of an integrator entity, HEAL (Healthy Eating and Activity across the Lifespan); (2) present outcomes of the HEAL development process including the HEAL vision, mission, and values statements; (3) define the planned integrator functions of HEAL; and (4) describe the ongoing evaluation of the integration process. HEAL team members used a theoretically-driven, evidence-based, systemic, twelve-month planning process to guide the development of HEAL and to lay the foundation for short- and long-term integration initiatives. Key development activities included a review of the literature and case studies, identifying guiding principles and infrastructure needs, conducting stakeholder/key informant interviews, and continuous capacity building among team members. Outcomes/deliverables of the first year of HEAL included a mission, vision, and values statements; definitions of integration and integrator functions and roles; a set of long-range plans; and an integration evaluation plan. Application of the HEAL integration model is currently underway through community solicited initiatives. Overall, HEAL aims to lead real world integrative work that coalesce across research, clinical practice, and policy with community resources to inspire a culture of health equity aimed at improving healthy eating and physical activity across the lifespan.

Civic Engagement of Older Adults in Mainland China.

Due to great challenges resulting from China's rapid population aging, Chinese elders are mobilized to address problems caused by this demographic trend through civic engagement. Based on an integrative review of policy, research, and practice, this article reveals that today's Chinese elders have a higher level and wider scope of civic engagement than previous cohorts. A set of factors contributing to such improvement are further identified, including the reform of the national economy, transformation of governmental functions, and the use of effective strategies applied to concrete programs. However, several constraints limiting Chinese elders' equal, active engagement in civic life remain, including the social stratification of older adults, preferential selection of participants due to the nation's socioeconomic development strategy, and family care work competing with other types of civic activities. Finally, future directions for policy, research, and practice are proposed in order to increase Chinese elders' civic engagement.

"Death Is Better Than Misery": Elders' Accounts of Abuse and Neglect in Ethiopia.

As the proportion of elders in developing nations increases and the ability of families to meet their needs is stretched thin, the risk of elder abuse will grow. This study examined the types and nature of abuse and neglect from the perspective of elders in Ethiopia who experienced abuse in noninstitutional settings. A qualitative design guided by hermeneutic phenomenology was used to explore the lived experiences of abuse and neglect of 15 Ethiopian elders. Nine women and six men ranging in age from 64 to 93 years were interviewed. Most were victims of multiple forms of abuse, especially financial exploitation, emotional abuse, and neglect. Economic vulnerability was a clear underlying factor contributing to elders' risk for encountering abuse. Effective prevention efforts must address the societal level factors that ultimately contribute to elder abuse while also holding individuals responsible for their harmful behaviors against elders.