In this study, fifteen Healthcare Practitioners and ten elderly patients were selected and interviewed. The average age of the healthcare practitioners was 33 years. The proportion of females was slightly above average, while the remainder were males. Most participants were nurses and only a few were doctors. Regarding the educational level of the participants, the majority had a first degree in the relevant professions and on average, Healthcare Practitioners had practiced for about seven years old in medical field (Table 1).
Table 1
Distribution of sociodemographic characteristics of Healthcare Practitioners
Participants | Age | Sex | Education | Profession | Rank | Years of service |
HP1 | 36 years | F | Degree | Nursing | SNO | 13years |
HP2 | 35 years | F | Degree | Nursing | SNO | 11 years |
HP3 | 36 years | F | Masters | Nursing | PNO | 14 years |
HP4 | 35 years | M | Diploma | Nursing | SSN | 5 years |
HP5 | 31 years | M | Degree | Nursing | NO | 4 years |
HP6 | 35 years | F | Diploma | Nursing | NO | 6 years |
HP7 | 34 years | M | Degree | Physician | SMO | 3 years |
HP8 | 26 years | M | Degree | Physician Assistant | PA | 2 years |
HP9 | 28 years | M | Degree | Physician Assistant | PA | 3 years |
HP10 | 39 years | F | Degree | Nursing | PNO | 13 years |
HP11 | 30 years | M | Certificate | Nursing | SEN | 10 years |
HP12 | 32 years | M | Degree | Physician | SMO | 4 years |
HP13 | 36 years | F | Degree | Physician | MO | 3 years |
HP14 | 28 years | F | Degree | Nursing | SSN | 6 years |
HP15 | 37 years | F | Degree | Nursing | SNO | 8 years |
HP; Health Care Practitioner; SNO: Senior Nursing Officer, PNO: Principal Nursing Officer, SSN: Senior Staff Nurse, NO; Nursing Officer, SMO: Senior Medical Officer, PA: Physician Assistant, SEN: Senior Enrolled Nurse, MO; Medical Officer.
Among the adult patients, their mean age was 73 years. Most were women, while the rest were men. most of participants had primary education, followed by non-formal education and secondary education. Regarding the occupation of the participants, most were farmers, then traders and civil servants. Most of the participants lived in rural areas, while remaining lived in urban areas (Table 2).
Table 2
Distribution of Socio-demographic Characteristics of adult population
Participants | Age (years) | Sex | Occupation | Education | Residency |
P1 | 67 | Female | Farming | JHS | Rural |
P2 | 78 | Male | Trading | SHS | Urban |
P3 | 66 | Female | Farming | JHS | Rural |
P4 | 70 | Male | Farming | NFE | Rural |
P5 | 75 | Female | Farming | NFE | Rural |
P6 | 86 | Male | Farming | JHS | Rural |
P7 | 79 | Female | Farming | NFE | Rural |
P8 | 67 | Male | Trading | JHS | Rural |
P9 | 66 | Female | Civil servant | JHS | Urban |
P10 | 73 | Female | Civil servant | JHS | Urban |
JHS: Junior High School, NFE: Non-Formal Education, SHS: Senior High School
Table 3
Distribution of themes and Sub-themes
Themes | Sub-themes |
Practitioners Assessment of geriatric needs | Experiences of practitioner in geriatric services |
Common geriatric conditions/ diseases |
Practitioners Training and Skill acquisition |
Assets and Resources for Geriatric care | Practitioners view on establishing geriatric centre |
Medical equipments or logistics for geriatrics |
Expectations for potential geriatrics | Common Conditions of reporting to health facility |
Patient satisfaction to services |
Geriatrics challenges to accessing care | Financial challenges to accessing healthcare |
Service delayence at the hospital |
Experiences of healthcare practitioner in geriatric services
Participants indicated that they provide healthcare services to adult’s patients both at home and in the healthcare facility and therefore have sufficient experience in providing care. They also revealed that some elderly patients come to the hospital alone, without being accompanied by close relatives. As such, their inability to report to the hospital early for medical examination, resulting in frequent hospitalizations. Other participants noted that access to other services such as diagnostic and medication services had become very difficult. Regarding healthcare practitioners’ experiences in providing geriatric care, participants noted that older people are generally physically and psychologically weak, which leads to the development of degenerative diseases such as diabetes and cerebrovascular accidents. Therefore, caring for the elderly requires professionals to have special skills such as communication skills in order to get along well and provide quality services as demonstrated below;
….. because of their multiple diseases and conditions such as diabetes, the aged patients complain a lot on their health conditions [Senior Nursing Officer].
For some of them (aged patients), they are too old and they do not even come to the hospital with immediate relatives [Physician Assistant].
The participants shared that; aged patients would require frequent communication and social support. They also found that their perception of disease events changed as they grew. Therefore, effective communication and patience in service delivery provide a sense of hope and relief to improve their well-being as shown below;
One thing I have noticed about aged patients is the little time you give to them in a form of good communication, they feel fine [Medical Practitioner].
The aged patients come to the hospital with different perceptions relating to their sickness. As such they demand a lot of patience to provide care to them [Principal Nursing Officer].
Despite the good geriatric services, healthcare practitioners found that most aged patients face financial difficulties when they report to the hospital, even though their national health insurance is still valid to cover their medical costs. In addition, participants indicated that elderly patients, due to their inability to afford the cost of medical care, results in being unable to receive diagnostic and medication services and therefore returning home with some care services that are not fully provided as evidenced by the quote below;
With the aged patients, when they are unable to afford the cost of medical services, we provide them with care based on the little money they have [Senior Enrolled Nurse].
Geriatrics common medical conditions and diseases
Participants highlighted that they encountered several conditions that prompted them to report to the hospital which often result in ailments or diseases such as diabetes, hypertension, mucoskeletal system pain, dementia and malaria. In addition, the participants revealed that due to these ailments, cause most aged patients to suffer from vision and hearing impairments, body weakness, which leads to frequent falls and thus breakage of body parts;
Most (aged patients) report with chronic illness such diabetes and hypertension [Senior Nursing Officer].
Most of the aged patients have difficulties in hearing and sight (Impaired with hearing and vision) and this result to their frequent fall leading to bone fracture and dislocations [Senior Enrolled Nurse].
Due to the impact of elderly patients’ diseases and conditions, participants identified that elderly patients required special health care needs to address some of their health concerns. They also stated that due to their general physical weakness and sometimes difficult access to regular healthcare, there is an urgent need to provide ambulatory and telephone services in their respective homes. They again showed that some of the older people had difficulty walking and paying for services. They also highlighted the following: Some older people had difficulty maintaining personal hygiene. In addition, participants stated that most aged patients are admitted to the hospital unaccompanied and this delays their services, especially when they seek other medical services such as laboratory services, as shown below;
…… on their general body weakness and difficulty in accessing health regularly, we can provide ambulatory health services to aged patients in their respective homes [Senior Staff Nurse].
Most aged patients come to the hospital without support. Some of them, when they come, they virtually come alone [Senior Nursing Officer].
Care practitioners Training and Skill acquisition in providing Geriatric Care
Geriatrics is a specialty in medical practice and requires special training and the acquisition of skills by healthcare practitioners. Participants shared their sources of knowledge and training skills related to elderly care. They pointed out that elderly healthcare requires patience and the ability to communicate effectively because older people are fragile to manage. In addition, they emphasized that healthcare practitioners should be good at paying attention and understand the health needs of aged patients;
Hmmm, this aged patients, all that they require of healthcare practitioners is for them to be patient giving them your attention [Senior Staff Nurse].
In addition, participants indicated that acquisition of these skills occurred through on-the-job experiences, knowledge sharing, workshops, seminars, and elder care training. Although healthcare practitioners noted that studying geriatric care at school and attended geriatric care training, this is evidenced below;
Honestly, I have not had any training on geriatric care aside the course we did on geriatric care at school [Nursing Officer].
I learn from seniors at work. Sometimes, at work when we faced difficulties, we consult immediate bosses [Physician Assistant].
Assets and Resources for establishing geriatric care
To ensure effective elderly care, it is paramount to first consider the physical infrastructure required to deliver such services. When developing physical infrastructure, the health needs of elderly patients should be taken into account. For example, such a building should be geriatric user-friendly. It is also important to equip such a centre with appropriate medical equipment and logistics to provide comprehensive elderly services to promote their health and well-being;
Practitioners view on establishing geriatric centre
Participants reported that they had not gotten the opportunity to visit a geriatric center. They showed that in order to establish a geriatric centre, it would be of utmost importance to consider geriatric center (physical infrastructure) with clearly defined and structured units specifically designed for elderly health care and support. They also expressed that such infrastructure should be geriatric-friendly. Participants also stated that the situation in Ghana is different compared to geriatric care in advanced countries that receive more attention, as care for elderly patients is provided within a mix of general hospitalization, which does not take into account all the necessary equipment, required for aged services as supported by the following citations;
The number one requirement needed to consider in providing elderly care is a well-designed and friendly geriatric infrastructure [Medical Officer].
The aged patients need specialised environment that can accommodate them and provide their specific health needs [Staff Nurse].
In support of the above quotes, participants noted that the provision of physical infrastructure alone cannot ensure effective elderly care. They indicated that the centre should be equipped with medical equipment’s and logistics such as walkers, wheelchairs and carrier bags. They reiterated that a well-established geriatric centre should have a padded bed, blankets, equipment for elderly vital examinations and diagnostic equipment such as X-ray machines. This would increase the speed of care for potential aged patients and prevent them from unnecessarily falling to the ground, as shown below;
Wheelchairs are good. Walking aids are also good, let’s say our beds, some may need extra blankets and all those things [Physician Assistant].
I think that beds are one of the things that we can consider. We have to also consider what we call mobile x-rays where these clients, those that are challenged, the x-rays can be taken to the beds [Principal Nursing Officer].
Expectations of Care by potential Elderly Patients
The elderly population in the facility is expected to receive necessary services upon arrival at the hospital. They expected that the conditions under which they came to the facility would be well cared for by health practitioners. Although aging comes with its own diseases such as general body aches there is a need to report to the healthcare facility for regular check-ups. Regular hospital visits within one to two months health and prevent medical complications, thereby reducing the severity of the disease. It is expected that aged patients would be satisfied with the services they provide. Care givers were expected to provide the necessary attention. Though it is expected that not all aged patients are satisfied with the services provided by healthcare practitioners and therefore may be forced to seek medical services from other health centers.
Elderly Patients common medical diseases and conditions
Aged patients reported that common diseases led them to report to a health facility and to seek medical attention. They established those common diseases such as high blood pressure, diabetes, general body aches and waist pain led them to difficulty sitting and standing upright. Regarding the frequency with which participants reported to a health facility for medical assessment of their condition, they reported that they actually sought medical care from a medical practitioner every one to two months. Some also reported that they come to the facility for medical care depending on their medical condition, as outlined below
I was diagnosed with high blood pressure, so I come to the hospital every month and or two months to get medication [67-year-old female patient].
I have diabetes and high blood pressure. That is why I come here every two months to get medicine [67 years old female patient].
Practitioners service satisfaction by elderly patients
Participants indicated that they were satisfied with the healthcare practitioners services. They mentioned some of the services that make them satisfied with the providers’ services. For example, they expressed that they were pleased with the way care givers welcomed them and checked their vital signs. They also expressed that once you informed the healthcare practitioners about needs, they responded quickly by providing immediate medical attention, as evidenced by the quote:
If you come in and tell them your medical needs, they will give you the care you want [86-year-old patient].
Although participants expressed satisfaction with health practitioners’ services, they reported of being dissatisfied with the provider’s services due to certain circumstances. For example, due to unavailability of some medications, they are compelled to purchase those medications outside the hospital. In addition, they stated that the aged patients found it uncomfortable to queue for services and therefore they were dissatisfied with such services. This had made most aged patients to seek services elsewhere as outlined below;
When you come here, getting drugs sometimes becomes a problem. Therefore, I prefer not to come here but to go to another clinic for treatment where I can get all my medications [66-year-old male patient].
Sometimes the queue in front of the doctor is long and we are forced to join the younger population [67-year-old patient, 78-year-old female patient].
Challenges to Accessing healthcare by elderly patients
Elderly Patients challenges in accessing healthcare depend on several factors. The patient-related factor arises from the lack of funds to pay medical bills, thereby denying access to quality healthcare. When patients report to a health facility and pay all medical costs without financial support, it becomes a challenge for them to hospital because providers deny them access to medical care. An expression of poor attitudes towards treatment of patients could discourage them from seeking health care. Again, aged patients face challenges of having to purchase their own medicines due to unavailability of medication and other essential materials, which explains their difficulty in accessing healthcare. Among the various challenges enumerated by patients were unavailability of medications and insufficient funds to cover medical expenses. It was difficult for most patients to access healthcare when they were mixed with the younger population, resulting in higher patient volume and therefore making them wait in long queues at the doctor’s office. In addition, they usually face challenge of not availing themselves to hospital services when they find it difficult to find the available space to sit.
Financial challenges
Participants expressed concerns about purchasing medications outside the hospital premises due to the unavailability of such medications. They said their concern is that they are being told to buy their medicine outside. They said that once they come to the hospital with their government health insurance, they expect all medicines to be provided to them free of charge as sometimes they cannot buy them due to the high cost of medicines. In addition, they stated that they were inactive in terms of active employment and therefore were not financially able to cover the costs of medication. This becomes difficult for them as they are forced to seek financial support from children, relatives and friends. They explained that without financial support, they could not get finances to purchase the drugs, which would lead to their condition worsening or worsening;
Caregivers always write out the medicines for us, it worries us, especially when we don’t have enough money to buy such medicines [73-year-old, female participant].
Once we come with national health insurance, we expect that every medication prescribed will be provided free of charge [70-year-old male patient].
In addition to financial challenges, participants highlighted delays in outpatient clinics were another challenge. They explained reasons for the delay in services. They explained that services were delayed when the number of patients increases and few health practitioners present. In addition, they express that the large number of patients in the outpatient clinic deny them free spaces and therefore compelled to stand for a long time before seeing a physician. Due to their prolonged standing combined with their illness, participants reported they sometimes felt dizzy and hence fall down. They further stated that meeting the youthful patients was one of their concerns and also a reason for the delay in their services. They said the youth competed with and sometimes overtook available seats, making it difficult for them to access health care at the facility
There are too many patients in the facility, it becomes difficult for doctors to take care of us, hence our delay [79 years old male patient].
The young patient always walks past us to go to the doctor, which causes us to be late at the hospital [67-year-old patient].