1. Study on global AGEing and adult health (SAGE) | 1 |1 | Health of older Ghanaians: Health Risks and Chronic Non-communicable Diseases Dr Alfred E Yawson Health of older Ghanaians: Health Risks and Chronic Non-communicable Diseases Dr Alfred E Yawson

2. Study on global AGEing and adult health (SAGE) | 2 |2 | Introduction Globally, low fertility and mortality rates are contributing to rapid increase in older populations Ghana is also experiencing progressive increases in the percentage of the older population o The population of those aged 60 years and above in Ghana is projected to increase from 6.5% in 2010 to 11.9% in 2050 o In low and middle income countries there is a double burden of disease (high levels of both communicable and non- communicable diseases)

3. Study on global AGEing and adult health (SAGE) | 3 |3 | Introduction Socio-demographic characteristics of Ghana show fertility rates and mortality rates to be falling gradually over the years : implication is the upward movement of the percentage of older population There is a need for information to address policy The goal of SAGE survey is generally to strengthen, gather, process and manage data on older persons and to respond to health needs

4. Study on global AGEing and adult health (SAGE) | 4 |4 | Methodology The multi-country Study on global AGEing and adult health (SAGE) Wave 1 (China, Ghana, India, Mexico, Russia, and South Africa) Interviewed a nationally representative sample of adults aged 50 years and older, with a smaller comparison group of adults aged 18- 49 years. Health, disability, subjective well-being, quality of life, social cohesion, risk factors, performance tests, anthropometric measurements and biomarkers. Data were collected in 2007-08.

5. Study on global AGEing and adult health (SAGE) | 5 |5 | Assessment tools

6. Study on global AGEing and adult health (SAGE) | 6 |6 | Enumeration Areas Visited

7. Study on global AGEing and adult health (SAGE) | 7 |7 | Health Risks: older adults and health risk identify health risks focus on interventions that improve health through effective health promotion in a supportive health and social policy environment

8. Study on global AGEing and adult health (SAGE) | 8 |8 | Health Risks: five major risk factors Tobacco use, alcohol consumption, intake of fruit and vegetables, physical activity levels and environmental risk factors  Morbidity and Interventions

9. Study on global AGEing and adult health (SAGE) | 9 |9 | Tobacco use The prevalence was higher among males, those with no education, the currently married rural residents and the poorest income quintile group Overall prevalence of current daily smokers among older adults in Ghana was 7.6%. Men were three times as likely as women to be current tobacco users

10. Study on global AGEing and adult health (SAGE) | 10 | Alcohol Use Generally, alcohol use declined with increasing age frequent heavy drinkers were highest among those who had completed Secondary and High school Life time abstention from alcohol increased as income quintiles increased (Q1=48.2% and Q5=61.4%) Proportion of older persons who reported heavy alcohol use was 3%

11. Study on global AGEing and adult health (SAGE) | 11 | Nutrition: intake of fruits and vegetables  Over two-thirds of older adults (males and females) had insufficient intake of fruits and vegetables in their diet Insufficient dietary intake was worse for: o Those 70 years or more. It worsened with increasing age! o Rural residents o Lowest income group. It worsened with decreasing income! o Those with little or no education. Relatively better for those with higher educational levels.

12. Study on global AGEing and adult health (SAGE) | 12 | Levels of Physical Activity High level of physical activity decreased with increasing age, (70% in 50-59yrs vs. 46.5% in 80+ age group) High level physical activities was more common amongst o Males ; Rural residents and t he currently married (compared to the widowed and divorced/separated ) o Lowest income quintiles (75%) than the higher income groups (Q5= 49%) o and those with little or no education (level of physical activity decreased as educational level increased)

13. Study on global AGEing and adult health (SAGE) | 13 | Obesity and overweight The overall prevalence of obesity was 30% More common among : o Females (35% vs. 25% in males) o separated/divorced or widowed o Urban residents o Older persons with higher education and o Those in highest income group

14. Study on global AGEing and adult health (SAGE) | 14 | Access to improved water sources and sanitation Urban household had improved sources of domestic water and sanitation, (95% and 19%) than Rural households (75% and 11%). Highest income quintile households had the highest improved water and sanitation and easier access to drinking water A fifth of all rural households spends more than 30 minutes to get to source of drinking water (10% for urban households)

15. Study on global AGEing and adult health (SAGE) | 15 | Indoor air pollution: cooking fuel used by Households(HH) Huge difference existed in type of cooking fuel by urban and rural HH (17% of urban HH used clean fuel; <1% by rural HH) Almost all the rural households (98.9%) used solid fuel. Use of clean fuel increased with increasing income quintile.

16. Study on global AGEing and adult health (SAGE) | 16 | Health State: self-reported health Respondents were asked to rate their “overall health today” and level of difficulty with “household and work activities over the last 30 days”. Rating of health states worsened with increasing age Women always rated their health worse than men

17. Study on global AGEing and adult health (SAGE) | 17 | Health State: Mean health scores Mean health score generally showed higher values for males than females urban residents than rural residents In addition mean health score decreased as age increased and decreased as income levels decreased.

18. Study on global AGEing and adult health (SAGE) | 18 | Frailty by country-SAGE Wave 1

19. Study on global AGEing and adult health (SAGE) | 19 | Frailty by sex in Ghana

20. Study on global AGEing and adult health (SAGE) | 20 | Morbidity and Intervention  In most countries, as in Ghana, the contribution from chronic conditions to overall burden of disease is increasing.  More older persons self-reported chronic non-communicable diseases compared to acute conditions, (21.8% vs. 11.6%).

21. Study on global AGEing and adult health (SAGE) | 21 | Chronic non-communicable diseases

22. Study on global AGEing and adult health (SAGE) | 22 | Chronic non-communicable diseases: high prevalence groups Prevalence of chronic diseases was higher among: o Females o urban residents o separated/divorced and the widowed o the highest income quintile. Clear sex and rural-urban differences existed: Women (≥50 years) and Urban residents had higher self- reporting of the chronic diseases.

23. Study on global AGEing and adult health (SAGE) | 23 | Chronic diseases- Example sex, rural-urban difference Chronic condition Prevalence (%)P- valueFemale: Male ratio UrbanRural Hypertension22.87.30.0011.8 Diabetes6.42.20.0011.3 Stroke4.01.70.0041.2

24. Study on global AGEing and adult health (SAGE) | 24 | Health care responsiveness: Health Care Received in last 12 months Overall 97% of older persons said they needed health care in last 12 months and only 71% actually received care Quality of care: older persons rated responsiveness of inpatient care as 73% and out patient care as 63%

25. Study on global AGEing and adult health (SAGE) | 25 | Health care responsiveness: health services coverage Inpatient care was lowest among: o females o > 60 years (Retired) o lowest income quintile o rural residents o the widowed These are vulnerable groups among the older population

26. Study on global AGEing and adult health (SAGE) | 26 | Health care responsiveness: preventive health care Two indicators were used : Breast cancer screening and Cervical cancer screening  only 3% of women > 50 yrs had access to breast cancer screening through mammography  only 3% of women > 50 yrs had access to cervical cancer screening through Pap smear

27. Study on global AGEing and adult health (SAGE) | 27 | Policy implication  Health risks and chronic non-communicable diseases are prevalent among older persons in Ghana  Health services do not seem responsive to the health care needs of vulnerable groups among the older adult population  These issues clearly deserve special attention as Ghana implements the 2010 National ageing Policy

28. Study on global AGEing and adult health (SAGE) | 28 | Take Home Message: As we grow old We slow down – become obese, less mobile We lose income – less able to afford We lose our partners – issues with widows We become frail- unable to support our selves We lose some functions_ sight, teeth, hearing Unable to access health Unable to fight infections, Susceptible to all kinds of afflictions

29. Study on global AGEing and adult health (SAGE) | 29 | For more information http://apps.who.int/healthinfo/systems/surveyda ta/index.php/catalog/6/study-description www.who.int/healthinfo/sage Thank you very much