Background

The global population is swiftly ageing and this is attributed to significant reductions in mortality at younger ages in low and middle-income countries (LMICs) and continuing increases in life expectancy among the aged globally [1, 2]. In the year 2020, an estimated 727 million people were over 65 years and by 2050, an estimated 20% of the global population will be over 65 years [3]. According to WHO, about 2 billion people globally will be over 60 years by 2050 and over 400 million will be aged 80 years and above, out of which 80% will dwell in LMICs [4]. This trend in ageing will increase following the scientific, medical and technological advancements globally [5].

Ageing is inevitable, however, rapid ageing is problematic for people in LMICs [6] and this requires critical attention [7]. Unfortunately, the world is unable to address the swift demands arising from the growing numbers of aged, even in higher-income countries [6]. In sub-Saharan Africa (SSA), including Ghana, the rapid ageing population is presenting challenges to the already weakened health systems. By 2050, SSA is projected to have 8.3% of its population as aged [4]. Ghana had 7% of the aged (60+ years) in 2010, a figure among the highest proportions in SSA, and projected to increase to 12% by 2050 [8]. As of 1960, life expectancy in Ghana was 46.9 years, however, in 2020, it increased to 63.7 years which is further projected to increase to 70 years by 2050, and 76.2 years by 2100 [9]. Meanwhile, this increase in life expectancy is not tantamount to an increase in good health [10]. This is a clear-cut indication of the impending burden of care for the aged.

The inadequate preparedness to deal with this demographic shift, coupled with little attention given to the aged is quite problematic [11]. Ageing brings about a deterioration in health leading to high levels of morbidity and difficulty with mobility, termed as impaired movement [11]. Mobility is key to living independently and quality of life. Mobility also accounts for the well-being of the aged population because it promotes healthy living [12]. However, mobility limitations are increasingly prevalent among the aged, especially those aged 70 years and above, affecting more than one-third (35%) [13]. The difficulty in mobility among the aged contributes to increased falls, hospitalisation, mortality and decreased quality of life [13]. Hence, as the population ages, maintaining independent mobility is critical, especially for women who mostly have heightened risk of functional decline and disability [14]. The difficulty with mobility among aged could result in loss of muscle mass (sarcopenia), osteoporosis and obesity and it is associated with health problems and injuries [11]. The aged with mobility difficulties have increased rates of morbidity, poorer quality of life and are more probable to be socially isolated [15]. Hence, it is important to pay critical attention to the situation of the aged, particularly in areas of research and policy [11]. There is currently a paucity of literature in Ghana regarding mobility among the aged. This lack of data means there will be inaccurate and unreliable data for policymaking, apt interventions and formulation of policies and programs in relation to mobility [16]. The aim of this paper was to investigate difficulty with mobility among the aged in Ghana. Thus, the paper provides current evidence and contributes to bridging the literature gap on difficulty with mobility among the aged in Ghana.

Methods

Results

Table 1 presents the socio-demographic characteristics of the 1,856 study participants. Descriptively, 458 (39.6%) were aged between 50–59 years, 1,091 (52.9%) reside in rural areas, and 958 (56.1%) were males. Nine hundred and fifty-eight (60.2%) were married, 976 (61.0%) had formal education, 937 (46.9%) belonged to the Akan ethnic group, and 1,359 (75.3%) were Christians.

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Table 1. Socio-demographic characteristics of respondents.

https://doi.org/10.1371/journal.pone.0290517.t001

Difficulty with mobility among the aged in Ghana

Fig 1 is a pictorial presentation of the weighted prevalence of difficulty with mobility among the aged in Ghana. More than half of the participants (59.7%) had no difficulty and 747 (40.3%) had difficulty with mobility.

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Fig 1. Self-reported difficulty with mobility among the aged in Ghana.

https://doi.org/10.1371/journal.pone.0290517.g001

The results of the chi-square test of independence showed that age group, gender, marital status, ever attended school, health status, difficulty house activities, experience bodily pains, sleep problems, visual difficulty, engage in vigorous activities and ever had road traffic accident were associated with difficulty with mobility among the aged at 5% alpha level (Table 2).

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Table 2. Bivariate analysis of factors associated with difficulty with mobility.

https://doi.org/10.1371/journal.pone.0290517.t002

Table 3 presents the multi-level logistic regression results of difficulty with mobility among the aged. Participants aged 80 and above compared to 50–59 years [OR = 9.04, 95%CI = 6.07–13.46], females compared to males [OR = 1.39, 95%CI = 1.13–1.72], the widowed compared to those never married [OR = 3.56, 95%CI = 1.86–6.80] and those who had formal education compared to those who never had formal education [OR = 2.13, 95%CI = 1.71–2.65] and participants who had severe/extreme difficulty with household activities [OR = 78.00, 95%CI = 33.72–99.06] had higher odds of difficulty with mobility. Additionally, participants who experienced severe/extreme bodily pains compared to no pains [OR = 24.98, 95%CI = 14.55–42.87], participants who had severe/extreme difficulty sleep problem compared with no sleep problem [OR = 11.40, 95%CI = 5.76–22.55], participants who had difficulty with vision/sight compared with no difficulty [OR = 4.61, 95%CI = 3.71–5.73] and those who do not engaged in vigorous activities compared to those who do [OR = 2.35, 95%CI = 1.84–3.00] had higher odds of difficulty with mobility.

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Table 3. Multilevel mixed-effects logistic regression of factors associated with difficulty with mobility.

https://doi.org/10.1371/journal.pone.0290517.t003

In the adjusted model (Model II), participants aged 80 and above compared to 50–59 years [AOR = 3.05, 95%CI = 1.78–5.22], participants who self-reported poor/bad health status compared to good health [AOR = 2.39, 95%CI = 1.35–4.23], and participants with severe/extreme difficulty performing household activities compared to no difficulty [AOR = 25.12, 95%CI = 11.49–44.91] had higher odds of difficulty with mobility. Additionally, participants who experienced severe/extreme bodily pains compared to no pains [AOR = 4.56, 95%CI = 2.16–9.64], participants who had severe/extreme sleep problems compared to no sleep problem [AOR = 4.15, 95%CI = 1.68–10.29], and participants who had difficulty with sight/vision compared to no difficulty [AOR = 1.56, 95%CI = 1.16–2.10] had higher odds of difficulty with mobility.

Discussion

We investigated the difficulty with mobility among the aged (≥50 years) in Ghana. The key findings were that among the aged in Ghana, more than one-third (40.3%) had difficulty with mobility. Moreover, difficulty with mobility among the aged in Ghana is associated with age (≥80), self-reported poor health, having severe/extreme difficulty performing household activities, experienced severe/extreme bodily pains, severe/extreme sleep problems, and participants with difficulty with vision.

A global study by Webber et al. revealed that about half of people aged 65 years or older reported difficulties with respect to walking or climbing stairs [23]. Other studies conducted among the aged in other parts of Africa however reported lesser prevalence. For instance, a study conducted among the aged (≥50 years) in Nigeria revealed that 35.8% had difficulty with mobility [24] indicating that nearly two-thirds (64.2%) had no difficulty with mobility. Also, Yaya and colleagues in their cross-national study in South Africa and Uganda revealed that 20% of the aged had difficulty with mobility [25]. However, this study revealed that more than one-third (40.3%) had difficulty with mobility. The likely justification for the difficulty with mobility found in this study is the loss of strength and function that is characterised by sarcopenia in adulthood [26] leading to slow walking, less stability, inefficiency, poor timing and coordination of postures and poor gaiting [27]. Another plausible explanation is the alteration of muscular strength during old age [26] and decrease in physical strength each year after sixty years [26]. Despite the prevalence of difficulty with mobility reported across studies, variations exist in the prevalence estimates which could be attributed to the differences in study settings, sample size, genetic make-up and study designs employed.

This study revealed that participants aged 80 years and above had increased odds of difficulty with mobility. It is logical to argue that mobility difficulties increases with ageing stemming from the deterioration in functioning and degenerative conditions owing to sarcopenia [28]. This argument is supported by research in Ghana that revealed that the aged are mostly confronted with degenerative conditions and physical deterioration that affect their capacity to effectively function including mobility [29]. Even though, mobility challenges could be prevalent at younger ages, research revealed that mobility difficulties are mostly prevalent at old age which could also be attributed to the decline in strength in the muscles [30]. A research conducted in Nigeria also revealed that the aged (>70 years) are at heightened risk of mobility difficulties [24]. This decline in mobility could be present even in the absence of co-morbidity because ageing induces biological and functional decline at several levels (including loss of muscle strength and mass and decline in balance) resulting in difficulty in mobility [26].

The study revealed that participants who had severe/extreme difficulty performing household activities had difficulties with mobility. This is because the age-related decline in capabilities and functions may inhibit or compromise older adults’ ability to perform household activities. Corroborating and affirming the above finding, a study in Taiwan revealed that engaging in household activities was associated with the probability of survival, and respondents with difficulty engaging in household activities had mobility limitations [31]. Similarly, in Finland, research revealed that persons having problems conducting daily activities had mobility difficulties [32]. In the USA, research revealed that the aged with problems conducting home and daily activities were more likely to have mobility difficulties [33]. Engaging in household activities makes the elderly physically active, and more productive thereby increasing mobility [31].

The study indicated that participants who had severe/extreme sleep problems had higher odds of difficulty with mobility. Corroborating and affirming the study, a cross-sectional study conducted in Finland among the aged revealed that having sleeping disorders or insomnia was positively linked to mobility limitations in both men and women aged 55 and above [32]. Consistent with the findings, a research conducted in the USA also confirmed that having fragmented sleep was more associated with functional limitations including difficulty with mobility for the aged [34]. This fragmented or difficulty sleeping occurs chronically among the older populations [32], and because ageing is linked to a decline in physical performance which often translates into physical disability and loss of independence, concomitant sleep problems may worsen or exacerbate the age-related decline in physical function [32], leading to difficulty in mobility.

The study also revealed that participants who experienced severe/extreme bodily pains had increased odds of difficulty with mobility. In a related study in West Africa, health conditions including bodily pains and discomfort are risk factors for mobility disability [30]. Consistent with the above finding, in USA, research found that the presence of mild-to-moderate pain among the aged was independently associated with poor or difficulty with mobility among the aged [35]. The association between severe/extreme bodily pain and mobility limitation could however be a result of reverse causation. Musich et al. for instance, in their study in the USA found that higher levels of mobility limitations were linked to pain among the aged. The authors, therefore, recommended mobility-enhancing interventions that could promote successful ageing [36].

Participants who had severe/extreme difficulty with vision had higher odds of difficulty with mobility. Similarly, in a study in rural India, the authors found mobility losses of 5.1, 10.2, and 23.4 points of 100 among older people with visual difficulties, low vision, and blindness, respectively [37]. This finding is also similar to other related studies conducted in high-income countries. For instance, related studies in Israel, Canada, China, and USA found that the aged who had visual difficulty had walking and stair-climbing difficulties [38–41]. Research revealed that older adults with vision difficulties had significantly difficulty with mobility including slower walking speeds compared to non-visually impairment individuals [42]. The likely explanation is that the slowness in walking speed is a way to maintain or improve their mobility safety.

Additionally, the study revealed that the aged who reported having poor health status compared with good health had higher odds of difficulty with mobility. Poor health has been shown to be a determinant of mobility limitations among the aged in a similar study in Nigeria [24]. In other words, the aged who perceived to have good health (that is, devoid of cardiovascular and metabolic diseases, osteoporosis, muscular weakness) had decreased odds of difficulty with mobility [43]. In congruence with the above, a study published elsewhere revealed that difficulties with mobility are central to ageing [44]. The authors further justified that having poor health is associated with limitations in both walking and driving. Also, research in the United Kingdom revealed that even older adults who perceived their health to be good are not devoid of mobility limitations due to ageing [45]. However, among these healthy older people, mobility limitation is due to weakness of the body and not their health status [45].

Conclusion

The aged in Ghana had relatively higher prevalence (40.3%) of difficulty with mobility which is influenced by demographics, health status, and degeneration associated with ageing. This highlights the need to provide social support and strengthen social capital for the aged in Ghana, especially those with difficulty with vision, experiencing bodily pains and had poor health status. Additionally, the Government and stakeholders should provide assistive devices for the aged and geriatric care including recreational fields and care homes to address the health and physical needs of the aged in Ghana.

Supporting information

Acknowledgments

We are grateful to all participants and the interviewers who made the SAGE study in Ghana possible. We are also grateful to the Ministry of Health, Ghana, the University of Ghana’s Department of Community Health, and the Ghana Statistical Service for the contributions and assistance provided. Finally, we are most grateful to the WHO SAGE team for granting us access to use the dataset.