Moving More, Less Bodily Pain? Findings From a Representative Ghanaian Aging Survey.

OBJECTIVE: The association of physical activity (PA) with pain has been characterized. Although the literature largely comes from high-income countries, the mechanistic pathways underlying this association remain unknown, particularly in low- and middle-income countries (LMICs). We aim to examine the association between meeting the World Health Organization (WHO) PA guidelines and pain among aging adults and identify the factors that may mediate this association. DESIGN: We used a quantitative cross-sectional study design. SETTING AND PARTICIPANTS: Representative data from adults aged ≥50 years who participated in the Aging, Health, Psychological Well-being, and Health-seeking Behavior Study were used. METHODS: PA was defined using the International Physical Activity Questionnaire (IPAQ). Self-reported pain experience using a cross-culturally validated item over the past month assessed pain severity. Adjusted multivariable ordinal logistic regression and mediation models quantified the hypothesized associations. RESULTS: The analysis included 1201 adults (mean 66.1 ± 11.9 years; 63.3% female). After adjusting for confounders, adhering to the WHO-recommended PA guidelines was associated with 42% lower odds for severe/extreme pain [odds ratio (OR) 0.58, 95% CI 0.44-0.77]. The association was much stronger among men (OR 0.52, 95% CI 0.31-0.85) than women (OR 0.60, 95% CI 0.42-0.87). The PA-pain association was explained by functional limitations (84.7%), self-rated health (76.6%), sleep problems (20.4%), and injury (6.6%). CONCLUSIONS AND IMPLICATIONS: Moving more was associated with less pain in older adults from LMICs. Interventions for pain management in old age may focus on enhancing compliance with PA doses, particularly in LMICs. However, longitudinal data will need to confirm these findings.

Risk of Sleep Problems in Middle-Aged and Older Adults Experiencing Bodily Pains: Serial Multiple Mediation Estimates of Emotional Distress and Activity Limitations.

OBJECTIVES: Pain is increasingly becoming common among middle-aged and older adults. While research on the association between pain characteristics and sleep problems (SP) is limited in low- and middle-income countries, the underlying mechanisms of the association are poorly understood. This study examines the association of bodily pain intensity and pain interference with SP and investigates the mediating role of activity limitation and emotional distress in this association. METHODS: We analyzed population-based data, including 1,201 individuals aged ≥50 (mean [SD] age 66.14 [11.85] years) from the 2016-2018 AgeHeaPsyWel-HeaSeeB study in Ghana. Multiple OLS regressions and serial multiple mediation modeling using bootstrapping analyses examined direct and indirect effects from pain to SP through activity limitation and emotional distress. RESULTS: Regressions demonstrated that pain intensity and interference were significantly associated with higher levels of activity limitation, emotional distress, and SP (range: ß = 0.049-0.658). Bootstrapping analysis showed that activity limitation and emotional distress serially mediated the relationship between pain intensity and SP (total effect: ß = 0.264, Bootstrap 95% confidence interval [CI] = 0.165-0.362; direct effect: (ß = 0.107, Bootstrap 95% CI = 0.005-0.210; total indirect effect: ß = 0.156, Bootstrap 95% CI = 0.005-0.210) accounting for ∼59%. Activity limitation and emotional distress mediated pain interference and SP association (total effect: ß = 0.404, Bootstrap 95% CI = 0.318-0.490; direct effect: ß = 0.292, Bootstrap 95% CI = 0.201-0.384; and total indirect effect: ß = 0.112, Bootstrap 95% CI = 0.069-0.156) yielding ∼28%. CONCLUSION: Our data suggest that activity limitation and emotional distress may convey stress-related risks of pain on SP. Future research should evaluate if activity limitation and emotional distress could be effective targets to reduce the effect of pain on sleep in later-life.

Meeting the WHO Physical Activity Guidelines is Associated With Lower Odds of Depression in Older Adults: Potential Psychosomatic Mechanisms.

OBJECTIVES: Limited data exist on the association between physical activity (PA) and depression in older adults from low- and middle-income countries (LMICs). In this study, we examine the association between meeting the World Health Organization (WHO) PA guidelines and depression in adults aged ≥50 years in Ghana and investigate the psychosomatic factors explaining this association. METHODS: Cross-sectional data from the Aging, Health, Psychological Well-being, and Health-seeking Behavior Study in Ghana (2016-18) were analyzed. Depression was assessed with the Center for Epidemiological Studies Depression Scale (CES-D-10). PA was assessed using the International Physical Activity Questionnaire Short Form (IPAQ-SF). Multivariable logistic regression and Hayes PROCESS macro with bootstrapping mediation analyses were performed to evaluate the hypothesized associations. RESULTS: The study included 1201 individuals (mean [SD] age 66.1 [11.9] years; 63.3% women). The prevalence of meeting PA guidelines and depression was 36.7% and 29.5%, respectively. Meeting the WHO-recommended PA guidelines was associated with a 16% lower rate of developing depression even after adjusting for potential confounders (OR = 0.84, p <0.001). This association was much stronger among men and those aged 50-64 years. Loneliness, social isolation, sleep problems, functional limitations, and pain characteristics largely mediated the association of PA with depression. CONCLUSIONS: PA was negatively associated with depression among older adults in Ghana, and psychosocial and physical factors partially explained the association. The promotion of PA in old age may aid in the prevention of depression, especially in men and those aged 50-64 years. Longitudinal data may confirm our findings.

Public expenditure on health care and the incidence of non-communicable diseases (NCDs) in China from 2008 to 2018.

OBJECTIVES: This study investigates whether differences in individual-level and provincial-level health funding could explain or mitigate health inequalities among older people in terms of non-communicable diseases within a population served by fragmented health insurance schemes. STUDY DESIGN: A national repeated cross-sectional analysis was done of the 2008, 2011, 2014, and 2018 Chinese Longitudinal Healthy Longevity Surveys. These provided a total of 44,623 persons aged 60 and over. MAIN OUTCOME MEASURES: Respondents were asked whether they had been diagnosed with any types of non-communicable diseases by doctors. A dichotomous outcome variable was constructed to indicate whether older people had any diagnosed non-communicable diseases. RESULTS: Compared with uninsured older persons, those who were enrolled in social health insurance schemes designed for civil servants as cadres, urban employees and urban residents were more likely to report a higher incidence of non-communicable diseases. There were no significant differences in the prevalence of non-communicable diseases between uninsured older people and those in the New Rural Cooperative Medical Scheme. Although the incidence of non-communicable diseases among older persons increased over the study period, greater health expenditure was significantly associated with a lower risk of non-communicable diseases. The interaction results between individual social health insurance schemes and public health expenditure indicate that disparities in the incidence of non-communicable diseases among different health insurance schemes diminish as public health expenditure increases. Older individuals with Public Free Medical Services benefited the most in provinces with higher public health expenditure compared with other health insurance schemes. CONCLUSIONS: Given the evidence of the beneficial effects of universal health coverage on non-communicable diseases among older persons, these results should encourage policy makers to increase public health funding and to raise the overall benefit packages for social health insurance schemes.

Ageing Happily in Ghana: How Does Social Inclusion Contribute?

BACKGROUND: Promoting happiness has become increasingly important in old age for a wide range of reasons. In this study, we aim to examine the association between social inclusion (SI) and happiness among older adults in Ghana and identify the mediating factors. METHODS: The study included 1201 community-dwelling adults aged ≥50 (mean age = 66.4 ± SD 11.9 years; 63.3% female) from the 2016-2018 Ageing, Health, Psychological Well-being, and Health-seeking Behaviour Study. We assessed happiness with a self-rated and cross-culturally validated item on a five-point scale. SI was operationalised using the modified Berkman-Syme Social Network Index. The hypothesised associations were evaluated by hierarchical regressions and bootstrapping techniques from Hayes' PROCESS macro programme. RESULTS: The prevalence of happiness was 24.3% (all of the time), 43.6% (most of the time), 28.3% (little of the time), and 3.7% (none of the time). After controlling for potential confounders, higher SI was associated with increased levels of happiness (odds ratio (OR) = 1.36; 95% confidence interval (CI) = 1.16-2.51). Aside from family/friends contacts, all other SI domains positively influenced happiness (OR = 1.45-1.81). The link between SI and happiness was mediated by depressive symptoms (65.2%), generalised anxiety (30.1%), and sleep problems (9.5%). CONCLUSIONS: Our data suggest that psychological factors may largely explain the positive SI-happiness link. Efforts should target these factors to promote happiness in old age. Longitudinal analysis may confirm our findings.

Sleep and Happiness in Urban-Dwelling Older Adults in Ghana: A Serial Multiple Mediation Model of Generalized Anxiety and Depressive Symptoms.

OBJECTIVE: Sleep problems (SP) are highly prevalent and seriously affect health and well-being in old age. The aim of this study was to examine the association between SP and happiness in an urban-dwelling older sample. The authors further explore the effects of generalized anxiety and depressive symptoms in the SP-happiness link using serial mediating modeling. METHODS: Data came from the 2016 to 2018 Aging, Health, Psychological Well-being, and Health-seeking Behavior Study in Ghana (n = 661). The authors measured happiness with the cross-culturally validated item on a five-point scale. The GAD-7 and the CESD-8, respectively, assessed generalized anxiety and depressive symptoms. Participants reported nighttime and daytime SP in the last 30 days. The SPSS-based Hayes' PROCESS macro program (Model 6) was constructed to quantify the hypothesized mediation effect. RESULTS: The analysis included 661 adults aged greater than or equal to 50 years (mean age = 65.53 [SD] = 11.89 years; 65.20% women). After full adjustment, path models showed that SP was negatively associated with happiness (ß = -0.1277, 95%CI = -0.15950 to -0.096). Bootstrapping estimates revealed that the SP-happiness link was serially mediated via generalized anxiety representing 8.77%, depressive symptoms yielding 18.95%, and anxiety symptoms→depressive symptoms accounting for 26.70% of the total effect. CONCLUSION: Generalized anxiety and depressive symptoms may explain the negative association between SP and happiness in urban-dwelling older adults in the sub-Saharan African (SSA) context. Interventions, social and clinical, to improve happiness through sleep quality should include ways to improve mental health. Longitudinal and cross-cultural data are warranted to assess the bi-directionality of this relationship.

Bodily Pain in Physical Function and the Role of Physical Activity Among Community-Dwelling Adults Aged 50-69 Years in Ghana.

BACKGROUND: Older adults who experience pain are likely to report higher functional limitations (FL) and lower physical activity (PA) levels. However, the extent to which PA explains the association of pain with FL is largely unknown, particularly in low- and middle-income countries. This study estimates whether and how much pain in FL is mediated by PA engagement. METHODS: We used cross-sectional data from 770 adults aged 50-69 years who participated in the Aging, Health, Psychological Well-being, and Health-seeking Behavior Study in Ghana. FL and pain characteristics were defined using the Medical Outcomes Study Short Form-36. PA was assessed by the International Physical Activity Questionnaire-Short Form. Bootstrapped mediation analyses estimated the direct and indirect hypothesized associations. The control variables included age, sex, residential type, level of education, monthly income, social isolation, emotional distress, multimorbidity, and self-rated health. RESULTS: After adjusting for potential confounders, higher pain interference (ß = 0.091, p < .05) and higher pain severity (ß = 0.075, p < .05) were associated with greater FL. The bootstrapping analyses showed that PA mediated the pain interference-FL association, accounting for approximately 58% (ß = 0.124, Boots 95% confidence interval (CI): 0.078-0.175) of the total effect (ß = 0.215, Boots 95% CI: 0.095-0.335). Similarly, PA mediated the association between pain severity with FL, accounting for approximately 37% (ß = 0.044, Boots 95% CI: 0.001-0.094) of the overall effect (ß = 0.119, Boots 95% CI: -0.011 to 0.249). CONCLUSIONS: Our data suggest that the higher pain severity and pain interference may lead to higher FL in middle and old age, and the associations are partially explained by PA. Effective and low-cost PA participation could be targeted in efforts to reduce the effect of pain on physical functioning among middle-aged and older adults.

Physical activity and gender buffer the association of retirement with functional impairment in Ghana.

Females on average live longer but with higher rates of functional impairment and lower physical and economic activities than men. However, research linking retirement to functional impairment and the modifying role of gender and physical activity (PA) is limited especially in low- and middle-income countries. This paper examines the association between retirement and functional impairment in Ghana and evaluates the effect modification of the association by gender and PA. The sample included 1201 adults aged ≥ 50 years from a population-based study. Functional impairment was assessed with the activities of daily living scale. Ordinary least squares regression models adjusted for confounding variables and estimated gender-wise and PA heterogeneity effect of retirement on functional impairment. Regressions showed that retirement predicted an increase in functional impairment score in the full sample (ß = .76, p < .001) and in men (ß = 1.96, p < .001), but not in women. Interestingly, retirement significantly increased functional impairment in ≥ 65 age cohort (full sample: ß = .71, p < .005; men: ß = 1.86, p < .001) although not in women. However, the effect was significantly moderated by PA such that retirement × PA predicted a decrease in functional impairment in the full sample (ß = -.81, p < .005) and the ≥ 65 age group (ß = -.43, p < .005). Functional impairment risk of retirement is gender-specific, but PA buffers the relationship. Retirement is generally commonplace, but these findings imply that promoting PA may hold promise for addressing functional impairment in old age. Attending to the physical health needs of men during retirement should be a social policy priority.

The effect-modification of physical activity on the association of pain with impaired physical function in aging adults.

OBJECTIVES: Pain is prevalent among older adults and may result in impairment in physical function. However, little is known about the effect-modification of this relationship by physical activity (PA) participation. This large and representative study sought to estimate the effect of pain on physical function among older adults in Ghana and evaluate whether PA modifies this association. METHODS: Data came from 1201 adults aged ≥50 years participating in the AgeHeaPsyWel-HeaSeeB Study in Ghana. Pain constructs were defined using the Medical Outcomes Study Short Form-36 (MOS SF-36). PA was assessed using the International Physical Activity Questionnaire short form (IPAQ-SF) and physical function impairment was measured by seven-item domains based on the activities of daily living (ADL) and instrumental ADL (IADL). Adjusted hierarchical OLS regressions were fitted to estimate the direct and moderating relationships between pain facets, PA, and impaired physical function. RESULTS: The relationships of pain severity (ß = 0.348, p < .001), and pain interference (ß = 0.424, p < .001) with impaired physical function were robust after full adjustment for confounding variables. Persons with pain experiences had significantly increased impaired physical function risks. PA significantly modified the association between pain severity (ß = -0.232, p < .001) and pain interference (ß = -0.143, p < .001) with impaired physical function. CONCLUSIONS: Our data indicate that the relationships of pain with physical function impairment are modified by PA intensity. Future studies are warranted to understand the indirect effect of pain on functional limitations and how PA promotion could manage pain and improve functional ability in aging adults.

Loneliness and physical function impairment: Perceived health status as an effect modifier in community-dwelling older adults in Ghana.

BACKGROUND: Although loneliness and physical function impairment (PFI) are common geriatric syndromes and public health issues, little is known about how their associations vary via self-perception of health. We examine how loneliness is associated with PFI, and whether the association is modified by perceived health status. METHODS: We conducted a cross-sectional analysis of 1201 adults aged ≥ 50 years from the Aging, Health, Psychological Well-being and Health Seeking Behavior Study (AgeHeaPsyWel-HeaSeeB) in Ghana. We assessed loneliness using the three-item short-form of the UCLA Loneliness Scale, and PFI was measured with a seven-item scale on mobility-related deficiencies. Adjusted logistic regressions and moderation analysis evaluated the hypothesized associations. RESULTS: The prevalence of moderate, severe loneliness, and PFI were 37.5%, 17.7%, and 36.1%, respectively. Regressions showed that loneliness was associated with a 23% increased risk of PFI after adjusting for several potential confounders (OR = 1.23; 95%CI = 1.03-2.81). PFI sub-types revealed similar risks. The loneliness-PFI association was significantly moderated by perceived health status such that a positive health perception attenuated the effect of loneliness on PFI (OR = 0.46, 95%CI = 0.23-0.90). CONCLUSIONS: Individuals who were lonely had significantly higher odds for PFI but the effect was tempered by perceived health status. Social policy and public health practices for healthy aging should address loneliness and negative health perception among older people.

Food insecurity and sleep quality among older adults: Findings from a population-based study in Ghana.

OBJECTIVE: Sleep architecture in older age is an important public health concern. However, little is known about the effect of food insecurity on sleep quality among older people. We provide the first representative study of the association between food insecurity and poor sleep quality (PSQ) in older adults in the sub-Saharan African context. METHODS: Data were drawn from the 2016-2017 AgeHeaPsyWel-HeaSeeB Study in Ghana. Past 30-day food insecurity was assessed with two items on the frequency of hunger and breakfast-skipping due to lack of food and resources. Participants reported night- and day-time sleep problems and sleep duration. Multiple OLS regressions were used to evaluate the hypothesized associations. RESULTS: Data on 1201 adults aged ≥ 50 years (mean = 63 [SD = 12]; women = 63%) were analyzed. In the full OLS adjusted model, moderate (ß = .144; p < .001) and severe (ß = .184; p < .001) levels of food insecurity were positively and significantly associated with PSQ. Also, older adults reporting moderate (ß = -.153; p < .001) and severe (ß = -.128; p < .001) food insecurity hadfewer sleep hours than those who were food-secure. Women and those aged ≥ 65 were at higher risks of PSQ in the context food insecurity. CONCLUSIONS: Addressing food insecurity may be an effective policy and public health intervention for improving sleep quality and overall well-being in older age.

Association of Health Literacy and Socioeconomic Status with Oral Health Among Older Adults in Ghana: A Moderation Analysis of Social Capital.

We examined the moderating role of social capital (SC) in the association of socioeconomic status (SES) and health literacy (HL) with oral health (OH) status and the intentions to use OH services (IUOHS) among older Ghanaians. Data were derived from a cross-sectional survey (n = 522) and analyzed using ordinal and binary logistic regressions. Bridging SC moderated the relationship between HL and oral health status (B = 0. 0.117, p < .05) and the association of SES with IUOHS (adjusted odds ratio [AOR] = 1.144; 95% confidence interval [CI] = [1.027, 3.599]). Trust modified the association between HL and IUOHS (AOR = 1.051; 95% CI = [1.014, 3.789]). Bonding SC moderated the association between SES and oral health status (B = 0.180, p < .05). However, bonding SC negatively modified the association between SES and IUOHS (AOR = 0.961; 95% CI = [0.727, 0.997]). Cognitive and structural SC modify the associations of SES and HL with OH and IUOHS.

Does social capital interact with economic hardships in influencing older adults' health? A study from China.

BACKGROUND: The importance of social and economic capital as predictors of health is widely documented, yet the complexity of interactions between them and effects on older people's health is still unclear. Combining the material and psychosocial explanations of health, this study explores the potential interactions between social and economic capital in influencing older adults' health in urban and rural China. METHODS: Using data from the China Family Panel Survey, physical and mental health in 2018 were regressed on social and economic capital indicators in 2016, controlling for sociodemographic characteristics of 3535 respondents aged 65 and older. Rothman's synergy index was calculated to investigate potential interaction effects. RESULTS: Economic hardships were significantly related to both self-reported health and mental health. Neighborhood cohesion and social participation were significantly associated with mental health for all, bonding trust was significantly associated with mental health for urban older people. We found no significant associations between social capital components and self-reported health. There was an interaction effect between low neighborhood cohesion and economic hardships, and between low social participation and economic hardships, creating an increased burden of poor mental health. The interaction effect between low bonding trust and economic hardships on mental health was apparent only among urban older people. CONCLUSIONS: Geographical settings are important factors in the complexity between social and economic capital in affecting older health. Intervention efforts directed towards reducing simultaneously multiple dimensions of deprivation, such as poverty, social exclusion, social isolation, could be helpful in improving older people's health. In materially deprived places, policies to promote health equity by improving social capital but without eliminating poverty may be less effective.

How Far Is Inclusivity of Financial Services Associated With Food Insecurity in Later Life? Implications for Health Policy and Sustainable Development Goals.

This study investigates how financial services inclusion (FSI) may affect food insecurity among older Ghanaians and seeks to identify any modifying roles of age and gender in the associations. Data were analyzed for 1,200 adults aged 50+ years. Generalized linear models with a logit link function examined associations and interaction terms. Average FSI score was 1.9 (SD = 1.8), and the prevalence of hunger and breakfast skipping were 35.6% (95% confidence interval [CI]: [32.9%, 38.4%]) and 28.8% (95% CI: [26.3%, 31.5%]) respectively. After full adjustment for potential confounders, FSI was associated with 0.459 (95% CI: [0.334, 0.629]) and 0.599 (95% CI: [0.434, 0.827]) times lower odds for hunger and breakfast skipping respectively. However, the corresponding interactions were statistically insignificant. The findings indicate the potentially important role of FSI in reducing food insecurity in later life. Development of policies to empower older people economically through increased financial literacy and easier access to financial services may help actualize the Sustainable Development Goal 2.

Physical activity and predictors of loneliness in community-dwelling older adults: The role of social connectedness.

This study sought to examine whether and how social connectedness impacts the association between physical activity and loneliness among older people in Ghana. Data for the analysis were obtained from the 2016-2017 Aging, Health, Psychological Wellbeing and Health-seeking Behavior Study (AgeHeaPsyWel-HeaSeeB) (N = 1200; mean age 66±12 years; women = 63%). Loneliness was assessed with the Short Form Revised UCLA Loneliness Scale. Multivariate linear regressions showed that increases in physical activity were associated with decreases in loneliness in the overall sample (ß= -0.338, p < 0.005) and for men (ß= -0.712, p < 0.005) but not in women (ß = -0.039, p = 0.840). The negative association between physical activity and loneliness was moderated by social connectedness such that persons highly connected were much less likely to experience loneliness following physical activity engagement (ß= -0.709, p = 0.023). Age-based analysis showed differential effects of physical activity on loneliness among the 65+ group (ß = -0.437, p = 0.002) compared to the 50-64 group (ß= -0.502, p = 0.031). Later life social connectedness tempers with the beneficial impact of physical activity on loneliness. Interventions to heal loneliness and for active aging should target physical activity and interpersonal engagements among older adults.

Aging and the Rising Burden of Noncommunicable Diseases in Sub-Saharan Africa and other Low- and Middle-Income Countries: A Call for Holistic Action.

Noncommunicable diseases (NCDs) are a prevalent and growing burden among older cohorts in sub-Saharan Africa and other low- and middle-income countries (LMICs) as in many wealthier parts of the world. This stems from the combined effects of factors such as demographic aging, behavioral transitions, and developmental origins of health and disease. A crucial characteristic of many NCDs is that their personal and family impacts and costs are not accurately reflected in mortality data. Their effects are often chronic and long-term and can cause morbidity, loss of work ability, and impaired quality of life over a prolonged period. Unless addressed seriously, the continuing increase of NCDs and their burden in sub-Saharan African countries and other LMICs will almost certainly undermine progress toward achieving the target of reducing by 25% premature mortality from NCDs in these countries by 2025 and also one-third reduction of NCDs target by 2030. To have any chance of meeting or even getting near to these targets, this article calls for action by national and regional governments to strengthen universal health coverage (UHC), economic empowerment of vulnerable groups, public-private partnerships, effective fiscal regulation, and public education on NCDs, their risk factors and impacts in sub-Saharan Africa in particular and most LMICs globally.

Socio-demographic and behavioral correlates of health literacy: a gender perspective in Ghana.

Relatively little research has been conducted on the place of health literacy (HL) as an essential mechanism to achieve the Sustainable Development Goal for gender equality (SDG 5) or to enhance its role in SDG 3, good health and well-being, particularly in sub-Saharan Africa (SSA). The present analyses examined the role of socio-economic, health and behavioral factors associated with HL among men and women in the Ashanti Region of Ghana using a cross-sectional design and data collected from 779 rural and urban residents from June 2015 to October 2015. HL was higher among men. In multivariate logistic regression analyses, income and education were positively associated with HL for both men and women. Ethnicity showed a positive relationship with HL among men, while religious affiliation was associated with HL of overall population. Smoking was negatively associated with HL among men. Among women, self-reported health was positively associated with HL but having health insurance was inversely related. These gender differences may be due to dominant male gender roles and differing expectations and opportunities for socio-economic advancement for men and women. An inter-disciplinary approach is suggested for understanding and improving HL in both genders and especially in women, given their current low HL.

Risk of Psychological Distress Among Community-Dwelling Older Adults Experiencing Spousal Loss in Ghana.

BACKGROUND: Spousal loss, common in older age, has been linked to negative mental health outcomes and well-being, yet the mechanisms linking spousal loss and mental health are still unclear. OBJECTIVE: To investigate whether physical activity, social support, and gender modify the psychological distress effects of marital loss among community-dwelling older persons in Ghana. METHODS: Data from a 2016/2017 Ageing, Health, Psychological Well-being, and Health-seeking Behavior Study (N = 1,200) were examined. OLS regression models examined associations between spousal loss and psychological distress outcomes and interaction terms. RESULTS: Spousal loss (widowhood and divorce/separation) was associated with psychological distress (measured by the Kessler Psychological Distress Scale [KPDS-10]) for the full sample (ß = .798, p < .001), women (ß = .831, p < .001) and for men (ß = .533, p < .05). After adjusting for potential confounders, the associations between spousal loss and psychological distress persisted for the full sample (ß = .727, p < .001) and females only (ß = .730, p < .001). In particular, when experiencing spousal loss, those with meaningful social support (ß = -.856, p < .005) and engaged in physical activity (ß = -.258, p < .001) were less likely to be psychologically distressed. CONCLUSIONS: Spousal loss precipitates an independent risk of psychological distress in older age particularly among women, but social support and physical activity engagements moderate the relationship. These findings support the premise that providing opportunities to improve social support and regular physical activity may buffer the effects of psychological distress among older persons experiencing spousal loss. Providing support for older adults in times of divorce and widowhood, and working towards changes in social attitudes towards divorce are important considerations.

The Role of a Health Protection Scheme in Health Services Utilization Among Community-Dwelling Older Persons in Ghana.

OBJECTIVES: This study examines the relationships between National Health Insurance Scheme (NHIS) enrollment and the frequency and "timing" of health services utilization among community-dwelling older Ghanaians. It also investigates whether the NHIS policy has improved equity in access to health care in later life. METHODS: Cross-sectional data were derived from an Ageing, Health, Psychological Wellbeing and Health-seeking Behavior Study collected between August 2016 and January 2017 (N = 1,200). Descriptive and bivariate analyses described the sample. Generalized Poisson and logit regression models, respectively estimated the predictors of frequency of health services utilization and time from onset of illness to health facility use and during last illness episode. RESULTS: Older persons with active NHIS membership frequently used health facilities (ß = 0.237, standard error [SE] = 0.0957, p ˂ .005), but the association was largely a function of health-related factors. The NHIS enrollees were more likely to attend health facility earlier (ß = 1.347, SE = 0.3437, p ˂ .001) compared with nonenrollees, after adjusting for theoretically relevant covariates. Moreover, given the NHIS enrollment, the rich (eß = 2.149, SE = 0.240, p ˂ .005), social support recipients (eß = 1.366, SE = 0.162, p ˂ .05) and those living with relevant others (eß = 2.699, SE = 0.175, p ˂ .001) were more likely to consume health services. DISCUSSION: Ghana's NHIS policy generally increases health services utilization but at present lacks the capability to improve equitable access to health care, especially between poor and nonpoor older adults. This may hamper the progress toward universal health coverage (UHC), indicating the need for further refinements in the policy including ways to improve the health status of older persons.

Multidimensional Social Support and Health Services Utilization Among Noninstitutionalized Older Persons in Ghana.

Objectives: This study examines multidimensional social supports as predictors of health services utilization among community-dwelling older Ghanaians. Method: Using data from a 2016/2017 Aging, Health, Psychological Wellbeing and Health-Seeking Behavior Study (N = 1,200), Poisson regression models estimated the associations of aspects of informal social support and health facility utilization among older people. Results: Findings suggest that regular contacts with family/close friends (odds ratio [OR] = 1.299; 95% confidence interval [CI] = [1.111, 1.519]), social participation (OR = 1.021; 95% CI = [1.140, 1.910]), and remittances from adult children (OR = 1.091; 95%CI = [1.086, 1.207]) were associated with increased health services utilization with some gender variations. Having caregivers increased health care use generally (OR = 1.108; 95% CI = [1.016, 1.209]) and among men (OR = 1.181; 95% CI = [1.015, 1.373]). However, we found decrease in health care use among those who received pecuniary assistance (OR = 0.893; 95% CI = [0.805, 0.990]). Discussion: Perceived structural and functional social support domains appear influential in health care utilization among older adults in Ghana. The findings underscore the need for intervention programs and social policies targeted at both micro-factors and wider social factors, including the novel area of remittances to older adults.