Impairment in activities of daily living and unmet need for care among older adults: a population-based study from Burkina Faso

Objectives The importance of impairment in performing activities of daily living (ADL) is likely to increase in sub-Saharan Africa because few care options for affected people exist. This study investigated the prevalence of ADL impairment, the extent to which care need was met, and described characteristics of people with ADL impairment and unmet need in Burkina Faso. Methods This study used data from the Centre de Recherche en Santé de Nouna Heidelberg Aging Study, a population-based study among 3,026 adults aged older than 40 years conducted in rural Burkina Faso. Information on 6 basic ADL items was sought, with a follow-up question asking whether care need was not met, partially met, or met. Bivariable correlations and multivariable logistic regression were used to determine sociodemographic and health characteristics associated with ADL impairment and unmet need. Results ADL impairment of any kind was reported by 1,202 (39.7%) respondents and was associated with older age (adjusted odds ratio: 1.05 [95% CI: 1.04–1.06]), being a woman (1.33 [1.06–1.60]), and reporting depressive symptoms (1.90 [1.65–2.18]). Among those with ADL impairment, 67.8% had at least one unmet need. Severe ADL impairment was found in 202 (6.7%) respondents, who reported a lower prevalence of unmet need (43.1%). Severe ADL impairment was associated with depressive symptoms (2.55 [2.11–3.07]) to a stronger degree than any ADL impairment. Discussion Prevalence of ADL impairment and unmet need was high in this setting. Variation in impairment across the population highlighted key groups for future interventions. Unmet need for care was highest in middle-aged adults, indicating a gap in care provision.This work was supported by the Alexander von Humboldt Foundation through an Alexander von Humboldt Professorship award to T. Bärnighausen, which is funded by the German Federal Ministry of Education and Research. I. V. Kohler acknowledges support by the Population Aging Research Center at the University of Pennsylvania and support by the National Institutes of Health (NIH) Award (R03AG069817). C. F. Payne is supported by an Australian Research Council Discovery Early Career Researcher Award (DE210100087) and the Australian National University Futures Scheme. M. D. Witham acknowledges support from the National Institute for Health Research Newcastle Biomedical Research Centre. G. Harling is supported by a fellowship from the Wellcome Trust and Royal Society (210479/Z/18/Z