Longitudinal Studies of Aging in Sub-Saharan Africa: Review, Limitations, and Recommendations in Preparation of Projected Aging Population.

Background and Objectives: The United Nations has projected a 218% increase in older people in Sub-Saharan Africa (SSA) between 2019 and 2050, underscoring the need to explore changes that would occur over this time. Longitudinal studies are ideal for studying and proffering solutions to these changes. This review aims to understand the breadth and use of longitudinal studies on aging in the SSA regions, proffering recommendations in preparation for the projected aging population. Research Design and Methods: This paper is the third of a four-part series paper of a previous systematic mapping review of aging studies in SSA. We updated the search (between 2021 and 2023) and screened the titles/abstracts and full-text articles by a pair of independent reviewers. Data were extracted using a standardized data-charting form, identifying longitudinal studies in SSA. Results: We identified 193 studies leveraging 24 longitudinal study data sets conducted at 28 unique sites. The World Health Organization's Study on Global AGEing and Adult Health (WHO-SAGE) (n = 59, 30.5%) and Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) (n = 51, 26.4%) were the most used longitudinal data sets. Four studies used more than one longitudinal study data set. Eighteen of the longitudinal study data sets were used only in 1-4 studies. Most (n = 150, 77.7%) of the studies used a cross-sectional analytical approach. Discussion and Implications: Longitudinal studies on aging are sparingly being utilized in SSA. Most analyses conducted across the longitudinal data set were cross-sectional, which hindered the understanding of aging changes that occurred over time that could better inform aging policy and interventions. We call for funding bodies, such as WHO-SAGE, to develop funding competitions that focus on conducting longitudinal analyses, such as structural equation modeling, highlighting changes occurring among the aging population in SSA.

"You're Not Understood, and You're Isolated": A Narrative Account of Loneliness by Black Older Adults in Ontario, Canada.

Loneliness among older adults is a leading health and social concern globally and in Canada, including racialized and minoritized groups. Although previous studies have explored loneliness among ethnic minoritized groups in Canada, little is known about the constellating factors contributing to loneliness among native-born and immigrant Black older adults (BOAs) in Canada and their unique ways of dealing with the experience. Our study explores the constellating factors shaping loneliness experiences among BOAs living in Ontario. Using a narrative approach, we purposively selected and interviewed 13 BOAs. Time as a driver of change, a sense of belonging reinforced through place identity, and challenges of making a new home were dominant themes. Our finding highlights the need for increased cultural sensitivity at the micro and macro levels, which will improve a sense of belonging and reduce loneliness among racialized immigrant older adults.

Understanding Social and Emotional Loneliness among Black Older Adults: A Scoping Review.

Black older adults' (BOAs) experience of loneliness differs from other ethnic groups because of the disproportionate disadvantages faced across their life course. This scoping review aimed to describe the range of research on loneliness or subjective social isolation among BOAs, identifying the contributing factors to loneliness in this population, based on Weiss' Social provision Framework. Of the 15,345 initial retrieved citations from seven databases and corporate websites, we included 27 studies conducted in the USA, Nigeria, South Africa, Ghana, Canada, the United Kingdom, and Uganda. Studies reporting on BOAs' experience of loneliness focused on the influence of attachment, social integration, opportunity for nurturance, reassurance of worth, guidance, socio-economic factors, health-related factors and behaviors, and technology, media device possession and usage. There is a need for future studies to identify which social provisions (when targeted) could reduce loneliness, allowing clinicians to develop relevant interventions.

Setting priorities for ageing research in Africa: A systematic mapping review of 512 studies from sub-Saharan Africa.

BACKGROUND: In 2040, the older population's growth rate in sub-Saharan Africa (SSA) will be faster than those experienced by developed nations since 1950. In preparation for this growth, the National Institute on Aging commissioned the National Academies' Committee on Population to organize a workshop on advancing aging research in Africa. This meeting provided a platform for discussing some areas requiring improvement in aging research in SSA regions. We believed that conducting a systematic review of peer-reviewed articles to set priorities for aging research in SSA is warranted. Therefore, this article is the first in a Four-Part series that summaries the types and trends of peer-reviewed studies in SSA. METHODS: This systematic mapping review followed the Search-Appraisal-Synthesis-Analysis Framework. We systematically searched multiple databases from inception till February 2021 and included peer-reviewed articles conducted with/for older adults residing in SSA. Conventional content analysis was employed to categorize studies into subject-related areas. RESULTS: We included 512 studies (quantitative = 426, qualitative = 71 and mixed-method = 15). Studies were conducted in 32 countries. Quantitative studies included were observational studies: cross-sectional (n = 250, 59%), longitudinal (n = 126, 30%), and case-control (n = 12, 3%); and experimental studies: pre-post design (n = 4, 1%), randomized control trial (RCT, n = 12, 3%); and not reported (n = 21, 5%). Fifteen qualitative studies did not state their study design; where stated, study design ranged from descriptive (n = 14, 20%), ethnography (n = 12, 17%), grounded theory (n = 7, 10%), narrative (n = 5, 7%), phenomenology (n = 10, 14%), interpretative exploratory (n = 4, 6%), case studies (n = 4, 6%). Of the 15 mixed-method studies, seven did not state their mixed-method design. Where stated, design includes concurrent (n = 1), convergent (n = 1), cross-sectional (n = 3), informative (n = 1), sequential exploratory (n = 1) and retrospective (n = 2). Studies were classified into 30 (for quantitative studies) and seven (for qualitative and mixed-method) subject-related areas. HIV/AIDs-related and non-communicable diseases-related studies were the most predominant subject-related areas. No studies explored the transdisciplinary co-production of interventions. CONCLUSIONS: There are glaring gaps in ageing research in SSA, especially mixed-methods and RCTs. A large number of studies focused on HIV/AIDs and non-communicable disease-related studies. National and international funding agencies should set up priority funding competitions for transdisciplinary collaborations in ageing research.

The clinical experiences of Nigerian physiotherapists in managing environmental and socioeconomic determinants of mobility for older adults.

Study Aim: To describe how physiotherapists in northern Nigeria managed the environmental and socioeconomic determinants of mobility for older adults.Methods: We adopted a qualitative description approach, purposely selected and conducted telephone interviews with 20 physiotherapists from Abuja [the Federal Capital Territory], four of the six states in North-central, and one state in the North-west regions of Nigeria. Data were analyzed using qualitative content and constant comparative analyses.Result: The physiotherapists had between 5 and 11 years practice experience in managing older adults with mobility limitations. Three iterative stages of identification, intervention, and documentation emerged as clinical experiences of Nigerian physiotherapists in managing environmental and socioeconomic determinants of mobility for older adults. Identification stages included determining older adults with mobility limitation through patients'/physiotherapists' reports and identifying the environmental (e.g. staircase location, floor types, furniture, and the urban built environment) and socioeconomic (e.g. education, income, and occupation) factors. The clinical decision of the "best" individualized approach to intervention, providing reassurance and education during and after the intervention were sub-stages for the intervention stage. There is a potential gap in the documentation process of these stages as most of the physiotherapists (n = 15; 75%) reported not doing so.Conclusion: This study suggested three iterative stages of identification, intervention, and documentation of the environmental and socioeconomic determinants of mobility for older adults. While there was a potential gap in regard to documentation of these stages in patients' case notes, physiotherapists especially in North-central Nigeria believed that co-developing a pragmatic set of clinical questions focusing on these determinants of mobility could encourage physiotherapists to explicitly document them. As the approach used in our research is purely descriptive, a grounded theory approach would potentially provide more detailed sub-stages that could be a more effective guide for physiotherapists to use during clinical practice.

Describing reasons for loneliness among older people in Nigeria.

The rural-urban migration of family members often leads to a higher probability of older people living alone, and minimizes family/social networks, which increases old age loneliness. In this study, we describe the existence of loneliness among older adults in Nigeria and its factors, aiming to inform the development of interventions for reducing old age loneliness. We adopted a descriptive phenomenological approach to the qualitative design, purposefully selecting and conducting face-to-face interviews with 12 older adults aged 58-88. We analyzed the data using a Thematic Analysis. Results of the analysis revealed three major themes: perception and existence of loneliness, factors for loneliness, and context-dependent coping strategies. We described results based on the theory of interactionist perspectives of loneliness and drew policy implications from this. Participants drew interesting associations between loneliness, decreasing family/social networks, recent family ties structures, disability-associated ageing, and lack of social programs, and suggested context-dependent coping strategies to reduce loneliness.