Email your comments

I spent my medical elective in Ghana, a country dubbed, “Africa for beginners” by virtue of its relatively well-developed tourist infrastructure.

Contrary to many people’s expectations of the demography of Africa, the continent is as much affected by a growing ageing population as is the developed world. Publicly, this issue is vastly overshadowed by the publicity given to infectious diseases. In Ghana, between the years 1950 and 2000, the number of people aged 60+ has risen five-fold but there has only been a 1 per cent increase in representation in relation to the whole population. It is expected however, that by 2025 and 2050, this ratio will change, with the elderly cohort representing 7.4 per cent and 15 per cent of the total population respectively. This guesstimate is attributable to falling fertility rates and improvements in health care delivery with a suspected concurrent reduction in HIV death rates which generally affects the middle aged. The UN predicts that developing countries will have less time to adapt to this “burden”, owing to the rapidity of the populations changes. In the developed world, the demographic transition process has taken place over about a century. In Africa, it is occurring in a few decades.

During my two month stay, it became evident that there was a general feeling that elderly people in Ghana were neglected and, speaking to Ghanaians; the situation seemed to be deteriorating.

The challenges of an ageing population have some similarities to the UK with respect to disease burden, but Ghana carries a “transitional disease profile pattern” – infectious diseases are still prevalent but chronic degenerative diseases associated with modern lifestyles are increasing.² A double whammy exists: the country is acquiring new health problems, while traditional ones persist. In a recent cross sectional survey of elderly inhabitants (aged 60+) in Accra, it was found that 8% of those aged 60 and over suffered from diabetes and 33% had hypertension. One in twenty reported having suffered a stroke.¹

“Not worth it”
The formal health system in Ghana certainly appears to marginalise older people. The median age within a typical African population is 18.4 years, so health resources are primarily targeted at youth and related communicable diseases. The non-communicable health care needs of older persons do not appear to be viewed as a priority. Very few health professionals have any training in elderly care medicine. Added to this is the fact that 75 per cent of Ghana’s population lives in rural areas where formal health care is scarce4, and many elderly people are inclined to seek relief through traditional herbal medicine which is more prevalent in rural areas.

Throughout my time at Ridge hospital, Accra’s second largest regional hospital, I did not witness any admissions for falls or confusion in older people - syndromes that are very common in any UK District General Hospital. The survey mentioned above found these complaints are relatively common in the elderly community dwelling population. Despite this, 30 per cent of all those admitted to the medical unit were 60 years or over and presented mainly with a severe crisis such as a stroke or diabetic coma. One reason for this disparity could be admission costs for the family. Many families deem it “not worth it” to invest in medication or scans for chronic diseases, particularly in an older person. Just a bare hospital bed, without any treatment or investigations for one day costs $2, which is in excess of many of the working population’s daily wage. Or perhaps, akin to some mentalities here in the UK, families are just accepting that these “old age” changes are inevitable. This emphasises the need for both health education and promotion of monetary investment in health. The relatively recently introduced National Health Insurance Scheme may improve this situation.

As in much of the developing world, on top of the resource shortage, changing demographics and attitudes seem to be perpetuating the neglect of elderly people. One demographic change hindering the welfare of the elderly is that of youth rural - urban migration, a trend that became obvious when we visited the rural districts where few young adults were to be seen. This observed fact was confirmed by villagers. There is a resultant disintegration of the extended family structure and the so called “family insurance”, leaving the elderly population with little or no means of support. The elderly continue to lead physically stressful lives – firewood collecting and water retrieval - and often have to resort to petty trading and begging. For 9 out of 10 Africans, the concept of retirement is unknown.⁴

Through lengthy conversations with patients’ families, a common theme became apparent, that of changing attitudes of the younger generation towards their elders. The mentality seemed to have diverged from that of admiration to a lack of respect. Traditionally, the elderly were the people the communities could consult to seek help and spiritual guidance as they were believed to be “closer to the ancestors.” Many local people I spoke to blamed the internet, claiming youths spend endless time interacting online, instead of engaging with adult relatives. Young pop stars and sportsmen are becoming more iconic. In addition, there have been significant changes in religion, with more young religious leaders. These changes in mentality have occurred alongside urbanisation leaving older people a vulnerable and neglected.

As in much of Africa and the developing world, the benefits of modernisation in Ghana are numerous (greater life expectancy, slightly better healthcare, greater material benefits), but one cannot ignore the attendant destabilisation of traditional values which have long sustained older people in close-knit societies. Despite the average Ghanian’s declared dismay at the increasing youth-orientation and the growing indifference towards and neglect of their society’s elders, it would appear that Ghana’s societal attitudes are fast catching up with some of the worst of those of the developed Western world. A triad of issues will impinge on the welfare of an increasing older population, namely a lack of resources, changing population dynamics and shifting attitudes.

Lukas Kalinke
4th year Medical Student
Southampton University

References

1. A Cross Sectional Survey of Health Problems in Older Ghanaians; Spice C, Adotey A, Ajetey E (abstract in press)
2. Reflections on the ageing in the tropical world; Gilles; BOLD; Feb 2004;14 (2):3
3. Africa’s Ageing Populations; Mbamaonyeukwu; BOLD; 2001; 11(4):2-7.
4. Ageing, Support and Care in Africa: How feasible are high standards in low economics? Ferreira; BOLD; 2004; 14(2):5
5. The need for geriatric services in Ghana; Duodu; Southern African journal of Gerontology; 1998, 7(2): 33-34

BGS Newsletter, Oct 2008
Issue 18 ISSN 1748-6343 18