ABSTRACT
The study explored the issue of ageing and chronic diseases by looking at the types of chronic diseases, contributing factors, challenges and coping strategies of the elderly. The elderly are among the groups most vulnerable to chronic disease worldwide. The prevalence and associated risk factors for these chronic diseases have been observed to have increased over time in Ghana, including Akim Oda. The views and opinions of 19 elderly persons between the ages of 60 and 90 years receiving treatment from Akim Oda Government Hospital were solicited with four key informants. Data was collected through in-depth interview and analysed following Attride-Stirling’s (2001) thematic analysis using NVivo 11. Four main types of chronic diseases identified in the study were hypertension, diabetes, stroke and AIDS. According to study participants’ understanding, chronic diseases like diabetes, hypertension and stroke are caused by excessive alcohol consumption, physical inactivity, and emotional, psychological or stress-related trauma. The findings further revealed that challenges encountered by the elderly living with chronic diseases include high cost of health care. Other challenges include social challenges such as loss of vision, limited mobility, sexual weakness and inability to shoulder responsibility. The findings also revealed challenges such as neglect by family members and delay in reporting to hospital. This study concludes that the elderly in Akim Oda employ the use of the media (listening to preaching, watching children programmes), change in lifestyle behaviour (adhering to prescribed medication and food), and drawing on faith and the support of spouses, siblings and children as strategies to cope with the biographical disruptions they experience. This study concludes that there are different biographical disruption experiences among the elderly in Akim Oda and the precise impacts of these experiences on the lives of the elderly influences the kind of strategies they adopt to manage their health, social and economic conditions. Social workers are to encourage individuals to save during their youthful years and to maintain healthy family ties.
Introduction
CHAPTER ONE BACKGROUND OF THE STUDY
Population ageing is a well-recognized global phenomenon (Bowling, 2007). The section of the population aged 60 and over is growing faster than any other age set in the world, and the ageing of the population remains both a success and a challenge for public health (World Health Organization, 2002). It is projected that by 2025 there will be about 1.2 billion people over 60 years of age. By 2050 they will reach 2 billion, of which 80% are in developing countries, including Ghana (WHO, 2002). The United Nations (2003) also reports that the number of people aged 60 and over has grown significantly in recent years in most countries and regions, and that the increase in elderly population will accelerate in the coming decades.
The population aged 60 and over increased from 200 million in 1950 to 600 million in 2000; in 2006, the number of elderly persons exceeded 700 million, and current projections suggest that, in 2050, there will be 2 billion elderly people alive. In other words, their number will triple in 50 years (Mba, 2003). According to the National Institute of Ageing (NIA) in 2007, in 2006, nearly 500 million people in the world were 65 years of age or older. By 2030, it is expected that this total will increase to 1 in 8 people on the planet. Significantly, the fastest increases in the population aged 65 and over occur in developing countries, including Ghana, which will see a 100% increase by 2030.
In sub-Saharan Africa, the estimated elderly population (60 years and over) will exceed 10% of the total population by 2050. The number of elderly aged 60 and above in Africa is expected to surge by more than 63% by 2030 (United Nations, 2002). The ageing of the African population is expected to increase rapidly between 2010 and 2030, as more and more people turn 65, and projections show that elderly could represent 4.5% of the population by 2030 and almost 10% of the population by 2050 (Nabalamba et al., 2009). This
increase in the ageing of the population will have a profound impact on labor markets, health, aggregate demand, politics and social structures. Nabalamba et al. (2009) reported that in 1980, 3.1% of the African population was 65 years of age and older and had increased steadily over the last forty years. According to the same report, as of 2010, 36 million elderly persons were 65 years and above, accounting for 3.6% of the population—an increase of 3.3% in ten years.
Elderly persons, as defined by the Ghana Statistical Service (GSS), are people aged
60 years and over (GSS, 2013). In Ghana, the population of the elderly has increased sevenfold since the 1960 census, from 213,477 in 1960 to 1,643,381 in 2010 (GSS, 2013). A greater percentage of the older population (54%) are from rural areas, while 47% of women and 44% of men live in urban areas (GSS, 2013). In Ghana, the elderly population is expected to nearly double from 6% in 2013 to 12% in 2050 (Yawson, 2015).
Ageing is continually viewed as a negative step in the life cycle of humanity, in which there is a great need for support, as there is a cognitive deterioration and perceived diminished quality of life (GSS, 2013). In this study, the researcher used the functional age groups: 60-74 ages (young-old), 75-84 ages (old-old) and above 85 (very old) as reported by the Population and Housing Census of 2010 in Ghana (GSS, 2013). The increase in the ageing of the population, which is common in developed countries, also occurs in developing countries, including Ghana. Globally, there are eight hundred and ten million people who are sixty years and above, representing 11.5% of the world’s population of 7 billion (GSS, 2013).
The ageing process exposes elderly persons to an increased threat of chronic disease and infirmity (WHO, 2010). Ageing is associated with brittleness and the appearance of chronic diseases (Mba, 2006). An estimated 57 million deaths worldwide were recorded in 2008 and 63% of them were due to chronic diseases, mainly cardiac diseases, diabetes, cancers and chronic lung diseases (WHO, 2010). In addition, most of the deaths due to
chronic diseases (80%) occurred in low- and middle-income countries, such as Ghana, and these conditions prevail at Akim Oda. The WHO predicts that the number of deaths from chronic diseases will increase by 15% worldwide between 2010 and 2020, resulting in 44 million deaths (WHO, 2010). Yach et al., (2004) estimated that chronic diseases will be the principal cause of death worldwide by 2025 and that the least industrialized countries in Africa, Asia and Latin America are the most affected by this increasing international burden of chronic disease. Murray et al., (1996) argue that people seek medical care in developed countries mainly because of chronic disease. Ghana is one of a number of countries in sub- Saharan Africa experiencing an epidemiological transition where chronic diseases are increasing, including among the elderly population. As in other global contexts, the increase in chronic diseases and mortality from chronic disease has been attributed to urbanization, nutritional transition and the effects of globalization (Aikins et al., 2012). Elderly people in Ghana are prone to chronic diseases that affect them for the rest of their lives (GSS Report, 2013). Awareness and knowledge of these chronic diseases is limited; health systems are weak; and the Government has no specific chronic disease policies, resulting in increased risk, morbidity, and mortality (Aikins et al., 2012). In a 2003 Ghana chronic disease burden analysis, Aikins reported that hypertension, stroke, diabetes and cancer are now among the top ten chronic diseases reported in Ghana (2007). Diabetes, hypertension, and stroke are suffered by both young and elderly, urban and rural, rich and underprivileged populations (GSS, 2013).
In Ghana, the number of older persons is increasing, but optimal attention has not been paid to the health and care of this segment of the population. In 2010, the Ministry of Employment and Social Welfare (MESW) launched its national ageing policy (first developed in 2002), but the policy does not comprehensively cover chronic diseases. The policy recognized health, living environment, and gender equality as three of the top seven
challenges faced by the elderly in the country. The policy document proposes to improve the health, nutrition, well-being, housing and living environments of older people, and to give sufficient attention to overcoming these challenges (MESW, 2010). While the policy represents a crucial first step in directing much-needed public attention to the ageing population, there are many challenges to implementing it. First, budget allocations to support planned activities for the ageing population are insufficient. In addition, the paucity of data at the national level is an inhibiting factor for the provision of specific interventions with limited national resources (MESW, 2010).
Health systems in Ghana are poorly fortified to cope with the dual burden of infectious and chronic diseases, and, although diabetes, hypertension and other chronic diseases have been a priority in authorized documents since the early 1990s, the chronic disease policy or plan has not been transformed into tangible action (MESW, 2010).
