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Prevalence and correlates of disability among older Ugandans: evidence from the Uganda National Household Survey

Taylor & Francis
Global Health Action
Authors:
Stephen Ojiambo Wandera at Makerere University
Stephen Ojiambo Wandera
James Ntozi
James Ntozi
James Ntozi
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Betty Kwagala
Betty Kwagala
Betty Kwagala
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Abstract and Figures

Nationally representative evidence on the burden and determinants of disability among older people in sub-Saharan Africa in general, and Uganda in particular, is limited. The aim of this study was to estimate the prevalence and investigate the correlates of disability among older people in Uganda. We conducted secondary analysis of data from a sample of 2,382 older persons from the Uganda National Household Survey. Disability was operationalized as either: 1) having a lot of difficulty on any one question; 2) being unable to perform on any one question; or, 3) having some difficulty with two of the six domains. We used frequency distributions for description, chi-square tests for initial associations, and multivariable logistic regressions to assess the associations. A third of the older population was disabled. Among all older persons, disability was associated with advancement in age (OR=4.91, 95% CI: 3.38-7.13), rural residence (0.56, 0.37-0.85), living alone (1.56, 1.07-2.27), separated or divorced (1.96, 1.31-2.94) or widowed (1.86, 1.32-2.61) marital status, households' dependence on remittances (1.48, 1.10-1.98), ill health (2.48, 1.95-3.15), and non-communicable diseases (NCDs) (1.81, 0.80-2.33). Gender was not associated with disability among older persons. Disability was associated with advancement in age, rural residence, living alone, divorced/separated/widowed marital status, dependence on remittances, ill health, and NCDs. Interventions to improve health and functioning of older people need to focus on addressing social inequalities and on the early preventive interventions and management of NCDs in old age in Uganda.
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Prevalence and correlates of disability among older Ugandans: evidence from the Uganda National Household Surv
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Prevalence and correlates of disability
among older Ugandans: Evidence from a
national household survey
Stephen Ojiambo Wandera, James Ntozi &
Betty Kwagala
Department of Population Studies,
Makerere University,
Kampala, Uganda
Outline of presentation
• Introduction
• Objectives
• Data & methods
• Results
• Discussion
• Conclusions
• Recommendations
Introduction
• Older persons in Uganda increased from 1.1
million in 2002 to 1.3 million in 2010
• The number is expected to increase to 5.5
million by 2050
• About 1 billion people are disabled - 15% of
global population (GBD, 2010; WHO, 2013)
• In Uganda, the 2011 DHS, estimated disability
at 19%.
Problem statement
• Limited research on disability of older persons in
Africa in general, and Uganda in particular.
• Data on prevalence and correlates of disability
are not systemic in many SSA countries
• Available data from either WHO Study on global
AGEing and adult health (SAGE) & IN-DEPTH
network sites (Nyirenda et al., 2013).
Objective of the paper
To determine the prevalence and
correlates of disabilities in the older
population in Uganda, using a
nationally representative sample
Data & methods
• 2010 UNHS data - 6,800 households interviewed
• Unweighted sample of 2,628 older persons = age 50 &
older were selected. Weighted sample = 2,382 older
persons was used
• Disability measured by 6 domains of functioning
limitations in regard to:
o Seeing even when wearing glasses,
o Hearing even when using hearing aid,
o Walking or climbing steps
o Personal care (bathing, toileting, feeding etc)
o Remembering or concentrating
o Communicating or understanding
Outcome variable – being disabled
• These six questions were originally recoded into
five categories
1. No, no difficulty,
2. Yes - some difficulty,
3. Yes - a lot of difficulty,
4. Can not perform at all
5. Don’t know
• An older person was disabled if he / she had:
• A lot of difficulty or could not perform at all on any
of the six questions or
• Some difficulty on at least two questions
Statistical analyses
• Descriptive statistics – frequency
distribution
• Chi-square test for associations
• Binary logistic regression to determine
correlates of disability among older
persons in Uganda
Results – Table 1
Variables
Percent (%)
Frequency
Gender
Female
52.3
1246
Male
47.7
1136
Age group
50
-59
44.7
1066
60
-69
28.1
670
70
-79
18.2
433
80+
9.0
213
Region
Central
24.7
589
Eastern
30.6
728
Northern
19.7
470
Western
25.0
595
Place of residence
Rural
90.8
2162
Urban
9.2
220
Table 1 cont’d
Variable
Percent (%)
Frequency
Living alone
No
91.0
2167
Yes
9.0
215
Relationship to household head
Head
69.9
1664
Spouse
19.2
458
Relative
10.9
260
Marital status
Married
58.6
1396
Divorced/separated
10.1
240
Widow/widower
31.2
744
Never married
0.1
2
Education level
None
68.1
1621
Primary
24.8
589
Secondary +
7.1
169
Table 1 cont’d
Variable Percent (%) Frequency
Was sick in past 30 days
No 38.0 904
Yes 62.0 1478
Self-reported NCDs
No 76.7 1828
Yes 23.3 554
Disabled
No 67.2 1600
Yes 32.8 782
Total 100.0 2382
Nature and severity of disability
31.4
13.4
19.6
12.1
4.8
3.3
8.7
2.2
8.8
3.1
1.9
0.9
59.9
84.4
71.6
84.8
93.3
95.8
0
20
40
60
80
100
120
Sight Hearing Walking Remembering Self-care Communication
Percentage (%)
Nature of disability
Some
difficulty
A lot / Can not
at all
No difficulty
Chi-square test
• Factors associated with disability were:
– Gender
– Age group
– Residence
– Living alone
– Relationship to household head
– Marital status
– Household poverty
– Household major source of earnings
– Technical skill
– Bicycle ownership
– Ill health
– Self-reported NCDs
Table 3 – Regression results
Variables OR Std errors p-value [95% CI]
Age group
50-59* 1.000
60-69 1.527 0.193 0.001 1.192 1.956
70-79 2.648 0.374 0.000 2.007 3.493
80+ 4.802 0.903 0.000 3.321 6.942
Residence
Rural* 1.000
Urban 0.556 0.117 0.005 0.368 0.840
Living alone
No* 1.000
Yes 1.637 0.313 0.010 1.126 2.381
Marital status
Married* 1.000
Div / separated 2.017 0.421 0.001 1.339 3.038
Widowed 1.841 0.322 0.000 1.307 2.594
Table 3 cont’d
Variables OR Std errors p-value [95% CI]
Household poor
No* 1.000
Yes 1.358 0.162 0.010 1.075 1.716
Household major earnings
Farming* 1.000
Wages 0.802 0.111 0.113 0.611 1.053
Remittances 1.466 0.221 0.011 1.091 1.970
Has technical skill
No* 1.000
Yes 1.284 0.159 0.045 1.006 1.638
Sick in past 30 days
No* 1.000
Yes 2.479 0.293 0.000 1.966 3.127
Reported an NCD
No* 1.000
Yes 1.844 0.241 0.000 1.427 2.382
Discussion
• Advancement in age associated with increased
disability, due to onset of NCDs e.g. in Ghana
(Debpuur et al., 2010)
• Living alone deprives one of “direct health
promotional effect of marriage & social support”
(Wang et al., 2013).
• Divorced / separated older persons at high risk of
disability – due to loneliness & depression,
associated with disability (Berlau et al., 2012)
Discussion cont’d
• Consistent evidence that disability is associated with
ill health & NCDs (Nyirenda et al., 2012; Scholten et
al., 2011; Strobl et al., 2013)
• Some limitations included:
– Self-reported NCDs & disability might be lower
– Cant distinguish between disability from birth &
that by age or occupational hazards
Conclusions
• Disability was associated with:
– advancement in age,
– rural residence,
– living alone,
– separated / divorced or widowed marital status,
– household poverty,
– dependence on remittances,
– possessing a technical skill,
– sickness and
– self-reported NCDs.
• Socio-economic vulnerabilities are associated
with disability among older persons in Uganda
Recommendations
1. Interventions to improve the health of older
persons through early prevention and
management of non-communicable diseases
2. Reduce socio-economic inequalities and
poverty among older persons in Uganda – target
lonely older persons
3. Further research on health of older people in
Uganda

Supplementary resource (1)

Prevalence and correlates of disability among older Ugandans: Evidence from the Uganda National Household Survey
Data
April 2015
Stephen Ojiambo Wandera · James Ntozi · Betty Kwagala
... Globally, studies have found associations between socio-demographic factors (e.g., age, sex, place of residence, marital status, and wealth status), health factors (self-reported health and chronic conditions) and disability in older adults. For example, with regard to age, studies have linked increasing age with a higher risk of disability [2,6,15,16] since the process of ageing is associated with functional decline and sensory loss [17]. Biritwum et al. 's [18] study among older adults in six countries (Ghana, South Africa, China, India, Russia and Mexico) found that the prevalence of disability increased with age. ...
... Regarding place of residence, the findings are mixed. In some studies, the prevalence of disability was higher in older adults residing in rural areas [15,23], while it was higher in older adults residing in urban areas in other studies [24,25]. ...
... Studies have documented a lower prevalence of disability in married older adults than those who have never and ever married [15,23]. Wang et al. 's [26] study among older adults in China found that married older adults recorded better functional disability outcomes than never and ever married older adults. ...
BMC Geriatrics Prevalence and correlates of disability in older adults, Ghana: evidence from the Ghana 2021 Population and Housing Census
Article
Full-text available
  • Jan 2024
  • BMC Geriatr
Background Although there are studies on disabilities in older persons, most of these studies have been carried out in developed countries. Hence, there are limited studies on disability in older adults in sub-Saharan Africa, including Ghana. The few studies that have examined the prevalence and correlates of disability in older adults used survey data for their analyses. To contribute to addressing this knowledge gap that has arisen, this study used a national census, the 2021 Ghana Population and Housing Census, to examine the prevalence and correlates of disability in older adults in Ghana. Methods The 2021 Ghana Population and Housing Census data was used for this study. A sample size of 197,057 Ghanaians aged 60 years and above was used for this study. The Washington Group questions on disability were used to measure disability by asking older adults about their difficulties in performing the six domains of disability (physical, sight, intellectual, hearing, self-care, and speech). A multinomial logistic regression housed in STATA was used to analyse the correlates of disability in older adults in Ghana. A p-value less than 0.05 was used for statistical significance. Results The results show that slightly more than one-third (38.4%) of the older adults were disabled. In terms of the number of disabilities in older adults, 16.9% had one disability condition, while 2.4% had six disability conditions. Also, 9.4% had two disability conditions. Older adults who were females, aged 70–79 years and 80 years and above, resided in rural areas, with primary, JHS/Middle, SHS, unaffiliated with religion, ever married and never married, unemployed, and belonged to the middle and rich households were more likely to have a disability condition. Also, older adults residing in the Middle and Northern zones, having no health insurance, and using clean cooking fuel were less likely to have a disability condition. Conclusions The results show that socio-demographic and household factors were associated with disability in older adults in Ghana. Hence, policymakers and researchers should target these factors when designing appropriate policies, programmes, and interventions to improve the wellbeing of older adults.
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... However, these studies refer to community interpretation of mental illness in the general population. The study also acknowledges studies on depression in Uganda among various groups of people particularly on the prevalence and meaning by Akimana Wandera et al. (2014). These studies, however, do not explicitly address the lay meaning and its impact on treatment seeking among the aging population in Uganda. ...
... There is also a common belief that aging is associated with thinking and depression is perceived to be a normative response to difficult life circumstances and the aging phase. Whereas it's true both physical and psychological issues are associated with aging (Wandera et al., 2014), these must be diagnosed and addressed. Service users in this study would consider further support only when the depressive condition becomes chronic and gets associated with other features. ...
The lay meaning (s) and understanding of depression among the middle-aged and elderly patients at Butabika Hospital. Implication for formal mental healthcare utilisation in Uganda
Article
Full-text available
  • Feb 2024
ABSTRACT This article explores the lay meaning(s) and understanding of depression among middle-aged and elderly patients in Uganda and its impact on treatment seeking. Through an interpretive phenomenological approach, data was collected using in-depth interviews with purposively selected participants and analyzed using thematic content analysis. The findings revealed that depression with disruptive behaviors is regarded as “clan illness,” “witchcraft” or “madness” while depression with non – disruptive symptoms is perceived to be a “disease of thoughts” normative to life circumstances and aging. Conclusively, the cultural understanding of depression may imply that the western medical approach would be less recommended compared to traditional healing.
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... Apparently, the observed disability rates in the current study are close to those with severely/extremely disabled in HIES 2010 [31], signifying that the severe/extreme form of disability in any of Washington Group's short set of six questions was considered as disability in SVRS 2010, 2012-2013, and BSVS 2014-2016. This conservative cut-off (i.e., severe/extreme disability in any of the six tasks) has not been utilized to define disability in the extant literature in Bangladesh [11,12] and in other settings [33][34][35]. Further, such conservative definition of disability minimizes specificity, such that those designated as 'without disability' may have 'some difficulty' with two or more of the Washington Group's recommended six tasks, and may not be able to perform a comprehensive range of activities that are required for independent living, particularly at �60 years. Thus, instead of conservative cut-off, adopting prudent and practicable cutoff for measuring disability, particularly for older adults, is warranted. ...
... Thus, instead of conservative cut-off, adopting prudent and practicable cutoff for measuring disability, particularly for older adults, is warranted. Practicable cut-off may contemplate an individual as disabled if s/he is having 'severe difficulty' with any of the six indicators, or being unable ('extreme difficulty') to perform any of the six indicators at all, or having 'some difficulty' with at least two of the six indicators [11,[33][34][35]. In addition, an explicit definition with cut-offs to measure disability from the Washington Group's short set of six questions in upcoming government reports (e.g., BSVS) is vital. ...
Trends in health expectancy at age 60 in Bangladesh from 1996 to 2016
Article
Full-text available
Background: Life expectancy (LE) is increasing all over the world, and relying on LE alone is no longer sufficient to identify whether a country is having a healthier population. Examining the increase in LE in relation to health - health expectancy estimation - is advised to ascertain the increase (or decrease) in LE without disability over time. This study examines the trends in health expectancy at age 60 in Bangladesh from 1996 to 2016. Methods: Mortality information from United Nations and World Health Organization and morbidity information from Bangladesh Bureau of Statistics were combined using the Sullivan method. Results: With an overall declining trend over the study period and a big drop in disability rates during 2012-2013, the disability rates were observed 1.6-1.7% in 2016. The declining trend in disability may have two-fold implications: (1) among the 98.3% older adults (≥60 years) with no severe/extreme disability, those were in jobs could have continued their work if there was no mandatory retirement at age 59, and (2) the 1.7% (translates into 0.2 million in 2020) older adults with severe/extreme disability require care assistance with their daily activities. The observed gain in disability-free life expectancy, the decrease in life expectancy with disability and its proportion allude to the compression of morbidity and healthier older adults over time. Conclusion: In 2020, Bangladesh had 13.2 million (i.e., 8% of the total population) older adults, which is increasing day by day. The policy makers and government are suggested to prioritize the issues of older adults, particularly disability, care needs, retirement age, and health in the light of the current study's findings. Utilizing health expectancy research is suggested to understand the combined effect of disability and mortality for considering policy changes.
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... Individuals with at least one of the six disabilities were declared disabled. This approach of assessing impairment was previously applied with HIES-2010 data in Bangladesh [15], and a similar strategy had previously been used in several researches in other countries [22,23,37] and in some studies of Bangladesh [34,35]. ...
Age and sex-specific disability-free life expectancy in urban and rural settings of Bangladesh
Article
Full-text available
  • Apr 2024
Background Disability-free life expectancy (DFLE) has been used to gain a better understanding of the population’s quality of life. Objectives The authors aimed to estimate age and sex-specific disability-free life expectancy (DFLE) for urban and rural areas of Bangladesh, as well as to investigate the differences in DFLE between males and females of urban and rural areas. Methods Data from the Bangladesh Sample Vital Statistics-2016 and the Bangladesh Household Income and Expenditure Survey (HIES)-2016 were used to calculate the disability-free life expectancy (DFLE) of urban and rural males and females in Bangladesh in 2016. The DFLE was calculated using the Sullivan method. Results With only a few exceptions, rural areas have higher mortality and disability rates than urban areas. For both males and females, statistically significant differences in DFLE were reported between urban and rural areas between the ages of birth and 39 years. In comparison to rural males and females, urban males and females had a longer life expectancy (LE), a longer disability-free life expectancy, and a higher share of life without disability. Conclusion This study illuminates stark urban–rural disparities in LE and DFLE, especially among individuals aged < 1–39 years. Gender dynamics reveal longer life expectancy but shorter disability-free life expectancy for Bangladeshi women compared to men, emphasizing the need for targeted interventions to address these pronounced health inequalities.
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... The much higher prevalence of IADL disability compared to ADL observed in this study and other studies was in agreement with the literature because physical and cognitive integrity reduces with age, and they are required more in IADL performance than in ADL. 2,12,[18][19][20][21][22] This study found a 21.5% prevalence of functional disability in ADL and 44.2% in IADL. These findings are also similar to 21.8% for ADL and 57.1% for IADL reported by Veerapu et al in South India, 19 9 The reason for this difference is obvious, since Amer's study was conducted on inpatient frail elderly who were at higher risk of functional dependence. ...
Socio-economic and Lifestyle Determinants of Functional Capacity of the Senior Attendees of an Outpatient Clinic in Northern Nigeria: A Cross-Sectional Study
Article
Full-text available
  • Jun 2023
  • W Afr J Med
Background: Typical ageing changes and the associated health concerns frequently manifest themselves as reduction in their efficiency and functional capacity. Objective: To identify the socioeconomic and lifestyle determinants of the functional capacity of elderly patients. Methods: A cross-sectional study involving 329 patients aged ≥ 60 years who presented to the General Outpatient Clinic. Data on socioeconomic, lifestyle, and functional capacity were collected. The functional capacity was assessed by the self-reported questionnaires: the Lawton and Katz indexes for the activity of daily living (ADL) and instrumental activity of daily living (IADL) respectively. The chi-square test and logistic regression analysis were used to determine associations between the variables. The level of significance was set at a p-value ≤ 0.05. Results: A total of 312 respondents completed the study, with 59.6% females and a mean age of 67.67 ± 7.69 years. The majority of the respondents (76.3%) belong to the low socioeconomic status (classes V and VI). The prevalence of functional dependence was 21.5% and 44.2% for ADL and IADL respectively. The disability in continence and food preparation had the highest prevalence among the components of ADL and IADL respectively. Advancing age, Hausa/Fulani tribe, polygamy, poor social support, and chronic pain were the determinants of functional dependence in ADL while age, female gender, marital status, and Fulani tribe were the determinants of functional dependence in IADL among the respondents. Unlabelled: CONCLUSION: The identified determinants of functional capacity among the older persons should be considered when assessing their functional capacity in the primary care or similar settings.
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... Chronic pain is a key factor responsible for physical inactivity [18,19], and a risk factor for functional disability in older adults [20]. Other known moderating factors include poor health status [21,22], residing in urban areas [21,[23][24][25], being an older female [26,27], educational level [22,28], and marital status [18,29,30]. ...
Physical activity and functional disability among older adults in Ghana: The moderating role of multi-morbidity
Article
Full-text available
  • Mar 2023
Knowledge about how physical activity levels relate to functional disability is essential for health promotion and planning older adults’ care or rehabilitation. The risk of living with one or more chronic health conditions increases with increasing age in lower and higher income countries–many of which are associated with physical inactivity. We conducted a cross-sectional study to examine the moderating role of multimorbidity on physical activity and its measures on functional disability among older adults in Ghana. Data from WHO’s Study on global AGEing and adult health Ghana Wave 2 with a sample of 4,446 people aged 50+ years was used for this study. Functional disability was assessed using the 12-item WHO Disability Assessment Schedule 2.0. Three categories of physical activity levels were used: vigorous intensity, moderate intensity, and walking. Past month diagnosis by a doctor was used to assess the presence of a chronic condition, and the presence of two or more conditions was used to define multi-morbidity. Logistic regressions with a post hoc interactional tests were used to examine the associations. Overall, physical activity had a significant association with functional disability (OR = 0.25, 95%CI; 0.12, 0.32). A similar relationship was found for vigorous-intensity (OR = 0.19, 95%CI: 0.12, 0.29), moderate-intensity (OR = 0.19, 95%CI: 0.15, 0.25) and walking (OR = 0.41, 95%CI: 0.33, 0.51). Older adults living with one condition and physically active were 47% less likely to experience functional disability compared with the less active counterparts living with at least two chronic conditions. Among the three measures of physical activity, multimorbidity moderated the relationship between walking and functional disability. Future strategies for meeting the health and long-term care needs of older adults, particularly those living with only one chronic condition in Ghana should consider encouraging walking. Policies, financial assistance, family, and community level interventions aimed to promote and sustain physical activity among older adults should be a priority for stakeholders in Ghana.
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Elderly people’s perceptions on the use of mobile phones to support the self-management of long-term illnesses at Kiruddu National Referral Hospital
Article
Full-text available
  • Apr 2024
  • Afr Health Sci
Introduction: The global estimate of the aging population is progressively increasing in low and middle-income countries and this is accompanied by the limitations associated with the need for equitable and efficient healthcare delivery among this dire population. Unfortunately, despite the increasing numbers, the adoption of mobile phones is not balanced in the different populations with research showing young persons’ adoption rate is higher than that of elderly persons. Objective: This current study was conducted to identify elderly people’s perceptions of the use of mobile phones to support the self-management of long-term illnesses at Kiruddu National Referral Hospital. Methods: This descriptive-cross-sectional design study was conducted on a sample population of 30 elderly individuals older than 60 years admitted at the outpatient department of Kiruddu National Referral Hospital, Kampala, Uganda. We conducted face-to-face interviews following an interview guide and one focus group discussion. We later used a feature mobile phone and a tablet mobile phone to assess the individual ease of use of each device. The audio recordings were professionally transcribed and transcripts were coded into NVIVO version 12 analysis software for thematic analysis Results: Almost all of the respondents who visited the facility had an ailment that hindered their full utilization of the mobile phone to support their self-care. This together with other factors like financial constraints, lack of support from the health workers on how to use mobile phones to support health, inadequate support from the facility, and cost of mobile data among others. Background and Conclusion: This study provides empirical evidence that there is hardly a known mobile phone adoption model to enable policymakers, systems developers, and health workers to promote the elderly population’s use of mobile phones to manage their long-term illnesses in Uganda. Keywords: Healthcare technology; older persons; mobile phone.
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Exploring the Intersectionality of Place and Gender Among Older Adults in Ghana: An Examination of Women’s Disability Disadvantage
Article
  • Dec 2023
Background and Objectives Ghana’s older adult population is growing rapidly and is projected to double by 2050. It is well-documented that social, health, and housing factors influence segmented aging trajectories that lead to disparate rates of disability. However, little is known about how the intersection of place (i.e., urban and rural) and gender (i.e., woman and man) inform rates of disability among older Ghanaians. We seek to examine this gap in the literature through an intersectional approach. Research Design and Methods Using logistic regression with Wave 1 (2007/2008) data from the World Health Organization’s Study on global AGEing and adult health (SAGE) Ghana, we investigate the prevalence of reporting activities of daily living (ADL) disability among respondents ages 50+ (n = 4,106). To document gender differences by place, we compute separate adjusted odds ratio models among urban and rural respondents. We also control for health, social, and housing factors that might explain gender differences. Results Compared to urban men, urban women’s ADL disability disadvantage was explained by marital status, particularly widowhood. In contrast, rural women consistently reported an ADL disability disadvantage when compared to rural men. Additionally, we found that the morbidity profiles of those who reported ADL disability differed by place and that certain ADL difficulties (i.e., bed transferring and toileting) were especially common among women respondents. Discussion and Implications Women, regardless of urban or rural residence, were especially vulnerable to ADL disability. Marital status, particularly widows, explained the difference in disability risk between urban men and urban women. This finding suggests that urban women’s risk of ADL disability is attenuated during the partnership. Also, we speculate that varied morbidity associations with ADL disability are due to different stressors in urban versus rural environments. These findings also generate further interest in about rural women’s disability disadvantage.
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  • Oct 2022
  • INT J AGING HUM DEV
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Intergenerational family support and the health and well-being of older adults in sub Saharan Africa: a systematic review
Chapter
  • Feb 2022
Many countries in sub Saharan Africa (SSA) have experienced an ageing of their population and this is projected to increase in the future. Family support is the main source of support for most older adults in SSA. Yet, relatively little is known about intergenerational family support provided to older adults in SSA and its effects on their health and well-being. This review adds to the scientific discussion synthesizing the health and well-being effects of family support provided to older adults in SSA. A systematic literature review was conducted to identify and analyze studies that focus on the provision of family support to older adults and its effects on their health and well-being. Eight (8) databases and other sources were searched for English Language publications between January 2000 and May 2020. Narrative synthesis was used to summarize the findings of the studies included. Out of 2426 records screened and 26 full-text publications retrieved and assessed, 8 studies were included in the review. The results suggest that receiving social and financial support from family as well as having frequent contact with family were positively related to better psychological well-being, self-rated health, and quality of life of older adults in SSA.
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Full-text available
  • Oct 2013
According to previous reports, the risk of disability as a result of diabetes varies from none to double. Disability is an important measure of health and an estimate of the risk of disability as a result of diabetes is crucial in view of the global diabetes epidemic. We did a systematic review and meta-analysis to estimate this risk. We searched Ovid, Medline, Embase, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature up to Aug 8, 2012. We included studies of adults that compared the risk of disability-as measured by activities of daily living (ADL), instrumental activities of daily living (IADL), or mobility-in people with and without any type of diabetes. We excluded studies of subpopulations with specific illnesses or of people in nursing homes. From the studies, we recorded population characteristics, how diabetes was diagnosed (by doctor or self-reported), domain and definition of disability, and risk estimates for disability. We calculated pooled estimates by disability type and type of risk estimate (odds ratio [OR] or risk ratio [RR]). Our systematic review returned 3224 results, from which 26 studies were included in our meta-analyses. Diabetes increased the risk of mobility disability (15 studies; OR 1·71, 95% CI 1·53-1·91; RR 1·51, 95% CI 1·38-1·64), of IADL disability (ten studies; OR 1·65, 95% CI 1·55-1·74), and of ADL disability (16 studies; OR 1·82, 95% CI 1·63-2·04; RR 1·82, 95% CI 1·40-2·36). Diabetes is associated with a strong increase in the risk of physical disability. Efforts to promote healthy ageing should account for this risk through prevention and management of diabetes. Monash University, Baker IDI Bright Sparks Foundation, Australian Postgraduate Award, VicHealth, National Health and Medical Research Council, Australian Research Council, Victorian Government.
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The vulnerability of older adults: What do census data say? An application to Uganda
Article
Full-text available
  • Dec 2011
  • Afr Popul Stud
Older adults are generally considered as being among the most vulnerable groups of the population. Yet, being over 55, 60 or 65 years old, does not necessarily mean being vulnerable in any way. Older adults are stakeholders in a social system in which they both receive and give. In Africa, where rapid population growth and economic changes have greatly transformed livelihoods in the past century, the social role of the older population has also undergone substantial change. Even in a context where their power is being eroded, older adults are often involved as providers until very late in life. In a situation where social security for pensioners is almost non-existent, elderly persons who need special care rely exclusively on their children or their social networks. According to their economic or family situation, the capability of older people to withstand difficulties is highly variable. In this context, we define in this paper two components of the vulnerability of older adults based on the structure of the household: structural and relational vulnerabilities. Then, using data from Uganda Population and Housing Censuses of 1991 and 2002, we measure the situations of vulnerability affecting older adults and possible changes that have taken place in this regard over the past two decades in this country. In Uganda older men and women are about equal in numbers. Men are less frequently in situations of vulnerability, however. Logically, the prevalence of vulnerability among older adults increases with age, but has not significantly changed from 1991 to 2002. Structural and relational vulnerability affect women much more frequently than men. Disability is more common among older adults in situations of structural vulnerability than among others, i.e. among older adults who live alone and have children in their care, which questions the capacity of family support systems to care for their members.
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Disability and poverty: A survey of World Bank Poverty Assessments and implications
Article
Full-text available
  • Jul 2009
Disability has often been associated with poverty, but few studies examine the relationship empirically in developing countries. For example, a review of World Bank Poverty Assessments finds that while most countries acknowledge the issue, few have the data to investigate it. This paper sets forth a preferred methodology for examining disability and poverty that is in line both with a more functional approach to disability incorporated in the WHO's International Classification of Functioning and Sen's Capabilities Model. Applying that methodology to two developing countries reveals the strong connection between poverty and disability and the need for a separate poverty line for families with disabled members.RésuméOn a souvent associé le handicap à la pauvreté, mais rares sont les études qui analysent empiriquement ce lien dans les pays en développement. Ainsi, un rapport de la Banque mondiale sur les estimations de la pauvreté montre qu’en dépit de la reconnaissance du problème par la plupart des pays, peu d’entre eux disposent des données nécessaires à son étude. Cet article présente une méthodologie pour analyser le handicap et la pauvreté concordante tant avec l’approche fonctionnelle contenue dans la Classification internationale du fonctionnement, du handicap et de la santé de l’OMS qu’avec le modèle des « capabilités » de Sen. L’application de cette méthodologie à deux pays en voie de développement montre la relation forte entre pauvreté et handicap et la nécessité de disposer d’un seuil de pauvreté différent pour les familles dont certains membres sont handicapés.
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Measuring Disability Prevalence, Social Protection Discussion Paper, No. 0706, World Bank 2007
Article
Full-text available
  • Mar 2007
Guide to issues in identifying disability in quantitative data
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The health condition of older women in Ghana: A case study of Accra city
Article
  • Nov 2006
In the context of increased rural-urban migration, social exclusion of some of the recent urban arrivals and the sharp change in life style in urban communities, some of the most critical health problems of older people may be found in cities. This paper attempts to characterize the general health condition of older women (50 years and over) in Accra, Ghana's capital city. It employs secondary analysis of data from the Accra Women's Survey, 2004. The findings broadly suggest that an overwhelming majority of older women lack basic education, are not in any form of paid employment, and are widowed, separated or divorced. 3% the women rate their general health condition as excellent, 18% as very good, 41% as good. 35% believe there health condition has worsened in the last 12 months. Such perception of deterioration in health status is associated with increasing age. Almost 4 in 5 older women have difficulty climbing stairs and have pains in their joints; 53 % have malaria, 42 % have high blood pressure, and 8% have diabetes. Thus, older women in urban Ghana are experiencing a double burden of disease. They are afflicted with the common tropical diseases such as malaria, while simultaneously experiencing chronic illnesses such as hypertension and diabetes. Older persons' concerns have remained marginal to the major social and economic debates in the country. Health services need to be oriented to responding to chronic as well as infectious diseases among ageing individuals.
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A hierarchical model of domains of disablement in the elderly: a longitudinal approach
Article
  • Jan 2000
Purpose : the aims of this paper are to verify that a hierarchical relationship exists between the concepts of Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) and mobility and to use this hierarchical model to describe the evolution of disability. Methods : 3751 elderly community dwellers were followed-up 3 and 5 years after baseline interview. A hierarchic disability scale was computed by summing up the number of domains (ADL, IADL, mobility) in which a subject was dependent. Coefficients of scalability and reproducibility of the scale were computed. The hierarchic scale was used to describe transitions between states at each follow-up. Results : the hierarchical model fitted 99.3% of the subjects at baseline. At each follow-up most transitions were towards contiguous grades of disability in survivors, whatever their age. There was a significant trend towards increasing disability. Death rates were higher in subjects aged 75 and over, whatever their disability level. The patterns of evolution differed according to gender. Conclusions : the cumulative disability scale can be used to describe the evolution of disability with time in elderly community dwellers.
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The Global Burden of Disease: Generating Evidence, Guiding Policy
Book
  • Jan 2013
The Global Burden of Disease (GBD) approach is a systematic, scientific effort to quantify the comparative magnitude of health loss due to diseases, injuries, and risk factors by age, sex, and geography for specific points in time. Box 1 describes the history of GBD. The latest iteration of that effort, the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010), was published in The Lancet in December 2012. The intent is to create a global public good that will be useful for informing the design of health systems and the creation of public health policy. It estimates premature death and disability due to 291 diseases and injuries, 1,160 sequelae (direct consequences of disease and injury), and 67 risk factors for 20 age groups and both sexes in 1990, 2005, and 2010. GBD 2010 produced estimates for 187 countries and 21 regions. In total, the study generated over 1 billion estimates of health outcomes.
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Uganda Demographic and Health Survey (UDHS)
Chapter
  • Aug 2012
his chapter presents findings relevant to child health and survival, including characteristics of the neonate (birth weight and size), the vaccination status of young children, and treatment practices— particularly contact with health services—among children suffering from three childhood illnesses: acute respiratory infection (ARI), fever, and diarrhoea. Because appropriate sanitary practices can help prevent and reduce the severity of diarrhoeal disease, information is also provided on how children’s faecal matter is disposed of. These results from the 2011 UDHS are expected to assist policymakers and program managers as they formulate appropriate strategies and interventions to improve the health of children in Uganda. In particular, the results can be used to assess the Health Sector Strategic Plan (HSSP) III. One of the four priority intervention areas of the plan is improving child health, with the goal being to ensure that Uganda achieves Millennium Development Goal 4 (MOH, 2010c).
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