Determinants of health care utilisation among the elderly population in rural Ghana

Exavery, Amon
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Introduction: As people age, they become more vulnerable to ill‐health from acute and increasingly chronic diseases. This has elevated health care demand and utilisation in the elderly especially in the developed countries. In developing countries, ageing so far has not been a serious public health concern because of smaller number of older people in these countries. Recently however, the number of older adults in Sub‐Saharan Africa has increased rapidly, projected to stand at 130 million by 2050 from 30 million in 2000. This increase mirrors health related problems and has obvious public health implications. Thus, there is an urgent need to recognise and respond to health needs of the ageing populations in Africa. Objectives: To describe health care utilisation, health status and compare the proportions of adults aged 50+ years with moderate and poor health status to those with good health status. Another objective was to identify factors associated with health care utilisation among the elderly population in Kassena‐Nankana district, Ghana in 2007. Methods: Secondary analysis was performed on a cross‐sectional dataset collected between February and July 2007 through face‐to‐face interviews within the settings of the Navrongo DSS in Ghana. A total of 594 adults aged 50+ years participated in this study. The outcome variable was health care utilisation occurring in the last three years. Explanatory variables were grouped as predisposing, enabling and need‐related factors according to the behavioural model of health services utilisation. The predisposing variables were age, sex, marital status, ethnic background, education and smoking or use of smokeless tobacco. Occupation and financial position were included as enabling factors. Medical history of chronic conditions, self‐reported health status, difficulty with self‐care (e.g. bathing, washing, dressing etc), difficulty with picking up things in the last 30 days and cognitive impairment were grouped as need‐related factors. Logistic 382128 v univariate and multivariate regression analyses were conducted. STATA 10 statistical software was used to carry out this process. Results: The proportion of study participants reporting poor, moderate and good health status were 14.2%, 43.3% and 42.5% respectively. About one‐third (31%) of the study participants reported to have utilised health care services in the last 3 years. The following factors were identified as determinants of health care utilisation among the elderly rural Ghanaians: a medical history of at least one chronic condition (OR = 2.36; 95% CI = [1.49 – 3.75]; p < 0.001), self‐perceived health (OR = 2.00; 95% CI = [1.11 ‐ 3.59]; p = 0.021), age group (OR = 1.68; 95% CI = [1.07 ‐ 2.64]; p = 0.025), cognitive impairment (OR = 1.26; 95% CI = [1.02 – 1.56]; p = 0.032) and difficulty with picking up things in the last 30 days (OR = 0.76; 95% CI = [0.61 ‐ 0.96]; p = 0.021). Conclusion: Medical history of at least one chronic condition and poor perceived health status were the most pervasive determinants of health care utilisation. In addition, age group (60‐69 years), severe cognitive impairment and severe difficulty with picking up things in the last 30 days presented a significant influence on health care utilisation among the elderly population in rural Ghana. Recommendations: Provision of home‐based health care services could facilitate their accessibility for the elderly especially those with various difficulties. These factors could help health policy makers and health service providers identify and understand the situation of the elderly rural Ghanaians and consequently create conducive environment for providing appropriate health care services.
MSc (Med), Population-Based Field Epidemiology, Faculty of Health Sciences, University of the Witwatersrand
elderly, health care utilisation, determinants, rural Ghana