Nexus Between Demographic Change and Elderly Care Need in the Gulf Cooperation Council (GCC) Countries: Some Policy Implications.

Population ageing is a phenomenon affecting the whole world. The countries that make up the Gulf Cooperation Council (GCC) are no exception but transitions in population ageing are still in the early stages of the process. With current demographic dividends experienced by the GCC and the rest of the Middle-East, the pace of population ageing will be faster than that experienced by many European countries. The purpose of this paper is to explore the population ageing experience of different GCC countries while situating this within a context of social policies that still at the very early stages of acknowledging such change. We utilise data from sources such as the United Nations and the World Bank, complemented by policy analysis of current age-related social security measures in the GCC. Given the importance of the family aged care system in the region, we consider the implications of changes in family structures, living conditions, and care needs for the elderly. The findings confirm the declining trend in fertility combined with increased life expectancy in all the six GCC countries. However, they highlight that social policy measures focused on the older generations and their care needs are still relatively at the early stages of each country's policy agenda. The implications of such changes are serious in term of both the demand for and supply of care. Policy-makers need to adapt cohesive social policy strategies that strengthen the complementing relationships between the state, family and wider community as stakeholders in the provision of aged care

Neighbourhood walkability as a moderator of the associations between older adults’ information technology use and social activity: A cross-sectional study with sensitivity analyses

Background Research to date suggests that information technology use by older adults can be positively associated with social activity, but whether neighbourhood walkability can play a role in this relationship has not been investigated. Aim To assess the associations between information technology use and social activity as well as the moderating influences of walkability in these associations. Methods This study adopted a cross-sectional design with sensitivity analyses as well as techniques against common methods bias. The study population was community-dwelling older residents of Accra aged 60 years or higher. A total of 890 older adults participated in this study. The hierarchical linear regression analysis was used to analyse the data. Results Information technology use was found to be positively associated with social activity. Among the three domains of information technology use, only packaged software use assessment was positively associated with social activity. Walkability was found to positively moderate the associations between social activity and information technology use as well as packaged software use assessment. Walkability strengthened the negative association between innovativeness attitude (another domain of information technology use) and social activity. Conclusions Information technology use can facilitate social activity, but experimentation with new information technologies can discourage social engagement, even in higher walkability. Packaged software use assessment, which measures the ability to use packaged software such as WhatsApp, can more significantly support social activity in higher walkability

Intergenerational differences in walking for transportation between older men and women in six countries

Background – Research on potential differences in walking between men and women have mixed and inconclusive results, and no study has examined differences in walking between men and women across multiple countries and generations (i.e., young-old, old-old, and oldest-old). This study aims to compare older men and women walking for transportation across three generations and among six countries (i.e., China, Mexico, Russia, South Africa, Ghana, and India). Methods – This study adopted the cross-sectional design that utilised data from the World Health Organization Study on AGEing and Adult Health (SAGE – wave one). The sample included 12,125 older adults aged 60-114 years from the six countries. The participants were selected with a cluster random sampling method in each country. The data was analysed using three-way Analysis of Variance (ANOVA). Results – There were significant differences in walking for transportation among countries. In only South Africa there was a significant difference in walking between men and women, as well as among the three older generations. South African men reported more walking than South African women, and younger-old South Africans reported more walking than older-old and the oldest South Africans. Conclusions – There are differences in older adult walking for transportation among countries. Differences in walking between men and women and among the three generations were only significant in South Africa

Associations of frailty with partial and absolute sedentary behaviours among older adults: A STROBE-compliant analysis of modifiability by gender and age

Background – Research shows that frailty is associated with higher sedentary behaviour, but the evidence to date regarding this association is inconclusive. This study assessed whether the above association is moderated or modified by gender and age, with sedentary behaviour measured with a more inclusive method. Methods – This study adopted a STROBE-compliant cross-sectional design with sensitivity analyses and measures against common methods bias. The participants were community-dwelling older adults (mean age = 66 years) in two Ghanaian towns. A self-reported questionnaire was used to collect data from 1005 participants after the minimum sample size necessary was calculated. The hierarchical linear regression analysis was used to analyse the data. Results – After adjusting for the ultimate confounders, frailty was associated with higher sedentary behaviour (β = 0.14; t = 2.93; p <0.05) as well as partial and absolute sedentary behaviour. Gender modified the above associations in the sense that frailty was more strongly associated with sedentary behaviour among women, compared with men. Age also modified the association between frailty and sedentary behaviour, which suggests that frailty was more strongly associated with higher sedentary behaviour at a higher age. Conclusion – Sedentary behaviour could be higher at higher frailty among older adults. Frailty is more strongly associated with sedentary behaviour at a higher age and among women, compared with men

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Associations between Social support Provided and Walkability among Older Adults: Health Self-Consciousness as a Moderator

Background The social support provided or given to others play a key role in healthy ageing. Empirical and anecdotal evidence suggests that walkable neighbourhoods can positively influence social support given. Higher health self-consciousness may strengthen the positive association between walkability and social support provided. Aim This study investigated whether the association between walkability and social support provided is moderated by health self-consciousness. Methods A cross-sectional design with sensitivity analysis and recommended procedures against common methods bias was employed. The study's population was community-dwelling older adults living in Accra, Ghana. Data from 923 participants were analysed using the hierarchical linear regression analysis. Findings The study found a positive association between walkability and social support provided after adjusting for the ultimate confounding variables. Health self-consciousness positively moderated the association between walkability and social support provided. Conclusion The study concludes that social support provided in older adults may be higher in more walkable neighbourhoods. Health self-consciousness can enhance the contribution of walkability to social support provided. Our results reinforce the importance of campaigns aimed at improving walkability of neighbourhoods