Gender and Urban–Rural Disparities in Housing, Environmental Sustainability and the Physical Well-Being of Older Adults in Ghana
Abstract
Background: The rapid growth in the population of older adults creates challenges such as workforce shortages, higher healthcare costs and poor living conditions. These strain the existing social support systems and the decline in the physical well-being of older adults. This study examines how gender, urban–rural differences, housing conditions and environmental sustainability impact the physical well-being of older adults in Ghana.
Methods: Using a nationally representative dataset from the 2021 Ghana Population and Housing Census, the authors analysed 47,962 adults aged 60 years and over. Logistic regression analyses were used to examine the association between gender, urban–rural differences, housing conditions, environmental sustainability and older adults’ physical well-being. The output was reported as odds ratios (OR).
Results: Findings indicate that males, urban residence and improved housing conditions (e.g., better building materials, roofing (OR = 1.08, 95% CI = 0.99, 1.17), walls (OR = 1.11, 95% CI = 1.04, 1.18), floors (OR = 1.10, 95% CI = 0.99, 1.23) and lighting (OR = 1.05, 95% CI = 0.96, 1.14)) are significantly associated with higher physical well-being. Environmental factors like access to clean drinking water (OR = 1.12, 95% CI = 1.02, 1.23), improved sanitation (solid waste disposal methods (OR = 1.18, 95% CI = 1.09, 1.27), bathing facilities (OR = 1.01, 95% CI = 0.95, 1.07) and toilet facilities (OR = 1.00, 95% CI = 0.94, 1.07)) and safer cooking conditions ((improved cooking fuel) (OR = 1.24, 95% CI = 1.14, 1.34) and (improved cooking space) (OR = 1.18, 95% CI = 1.12, 1.26)) are also associated positively with physical health.
Conclusion: The study highlights the need for policies targeting gender and geographic health disparities, suggesting that enhancing housing and environmental conditions could improve the quality of life for older adults in Ghana.
1. Introduction
Population ageing is a defining global phenomenon of our time, driven by declining birth rates and rising life expectancy [1, 2]. As people live longer and fewer children are born, the age structure of societies is shifting dramatically, resulting in a growing proportion of older adults. This transformation carries profound health implications, as ageing is closely linked to an increased risk of chronic conditions such as heart disease, diabetes and dementia [2]. These challenges place unprecedented demands on healthcare systems and social support structures, including pensions and caregiving services [3]. Beyond health, ageing populations also pose significant economic challenges, including workforce shortages, escalating healthcare costs and deteriorating living conditions for older adults [3].
In Ghana, these global trends are reflected in the country’s demographic shifts. According to the 2021 Ghana Population and Housing Census (GPHC), individuals aged 60 years and above now constitute 6.2% of the population, a figure that continues to rise as life expectancy improves [5]. However, older adults in Ghana face a unique set of challenges, including limited access to healthcare, inadequate social support, scarce economic opportunities and substandard living conditions [4, 5]. These issues are compounded by the broader socioeconomic and environmental realities of a developing nation.
The health challenges confronting older adults in Ghana are stark and multifaceted. Chronic illnesses such as cardiovascular disease, diabetes and respiratory conditions are prevalent, often exacerbated by poor living conditions and limited access to medical care [6]. Mobility limitations, a common issue among older adults, are further aggravated by age-related decline, inadequate healthcare and unsafe living environments [6, 7]. Poor infrastructure, including uneven roads and a lack of accessible facilities, restricts their ability to move safely and independently [7]. Overcrowded homes with inadequate sanitation increase exposure to infectious diseases, while environmental hazards and poor nutrition contribute to the burden of chronic illnesses [8, 9].
Housing quality plays a pivotal role in shaping the health and well-being of older adults. Factors such as building materials, sanitation and living space directly impact physical health [7, 9]. Substandard housing materials can expose residents to harmful substances like lead or asbestos, leading to respiratory problems and other health complications [10]. Inadequate sanitation systems facilitate the spread of infectious diseases, while overcrowded living conditions heighten stress and diminish quality of life [11]. Conversely, well-constructed housing with proper sanitation and sufficient space fosters better health outcomes, providing a safe and comfortable environment for older adults [9, 11].
Access to basic resources such as clean water, proper sanitation and safe cooking fuel is critical for the health of older adults. Clean water prevents waterborne diseases, proper sanitation reduces infection risks, and safe cooking fuel minimises indoor air pollution, which is particularly harmful to respiratory health [12, 13]. For older adults, who are more vulnerable to these risks, such resources are not just conveniences—they are lifelines.
Socioeconomic factors further shape the experiences of older adults in Ghana. Gender disparities often leave older women more financially insecure and with less access to healthcare [14, 15]. Marital status also plays a role, as married individuals may benefit from spousal support, while widowed or single older adults face higher risks of loneliness and health complications [16]. Employment status and access to pensions are equally critical, as they provide financial stability, social engagement and better overall health outcomes [17].
Despite growing awareness of the challenges faced by older adults, there is a notable gap in research examining how gender, housing quality and environmental factors intersect to influence their physical health, particularly in contrasting urban and rural settings. This study seeks to address this gap by exploring the impact of gender and location on housing and environmental sustainability and how these factors shape the physical well-being of older adults in Ghana. Urban areas often grapple with overcrowded housing, poor sanitation and exposure to pollutants, while rural areas face inadequate infrastructure, limited access to clean water and scarce healthcare facilities. By uncovering these disparities, the study aims to inform targeted interventions that improve living conditions and reduce health inequities between urban and rural older adults.
The study hypothesises that better living conditions—such as improved housing, access to clean water, and safer environments—have a positive impact on the physical well-being of older adults. Its findings are intended to guide policies and programs that prioritise housing standards and environmental sustainability, ultimately enhancing the quality of life for older men and women across Ghana. In a world where population ageing is inevitable, understanding and addressing these issues is not just a moral imperative—it is a necessity for building healthier, more equitable societies.
1.1. Theoretical Perspective
The ecological systems theory, developed by Urie Bronfenbrenner [18], provides a suitable framework for understanding this study’s focus on older adults in Ghana. This theory emphasises the interactions between individuals and their various environmental systems, aligning with the study’s exploration of factors such as housing conditions, environmental sustainability and social circumstances. At the microsystem level, housing quality, sanitation and social factors (e.g., marital status and employment) directly influence physical well-being. The mesosystem highlights interactions among these factors, such as how urban versus rural living affects access to improved services [18]. The exosystem encompasses broader societal influences, including public policies on housing and environmental sustainability, while the macrosystem represents the cultural and economic contexts that shape societal attitudes toward ageing. Lastly, the chronosystem reflects changes over time, such as advancements in infrastructure and healthcare access, which affect the long-term well-being of older adults [18]. The study posits that improved housing conditions and environmental factors enhance physical well-being, resonating with Bronfenbrenner’s emphasis on the importance of environmental influences on health outcomes.
Ecological systems theory has been widely applied across various disciplines due to its comprehensive view of human development within environmental contexts. In psychology, it explains how family, school, and societal factors shape cognitive and emotional development in children [19, 20]. In education, it explores the impact of family involvement and community resources on student achievement [20, 21]. Social work utilises the theory to assess how environmental factors like housing and social services affect mental health, while public health analyses the effects of socioeconomic and environmental conditions on health outcomes [20, 22, 23]. These applications have led to interventions addressing both individual and systemic influences.
Despite its utility, the theory has faced critiques. Some argue that it overemphasises the role of the environment while neglecting individual agency and biological factors. The complexity of its multilayered systems can make research applications challenging, as it lacks clear mechanisms for how these systems interact. Critics also suggest that the theory may be outdated, as it does not fully account for rapid changes in modern environments, such as digital media and globalisation, which may require adaptations for contemporary relevance. Nonetheless, the theory remains influential for its broad applicability across fields.
In the context of this study on the physical well-being of older adults in Ghana, ecological systems theory provides a valuable framework for understanding how various environmental factors such as housing conditions, access to clean water, sanitation and social support systems influence health outcomes. Similar to its application in public health, the study demonstrates that improved living conditions, such as access to clean cooking spaces, better waste disposal and enhanced housing, are associated with better physical well-being. Just as the theory has been used to address systemic barriers in public health, this study highlights how structural factors in urban and rural settings, along with gender and employment status, shape the physical health of older individuals. Moreover, the mesosystem and exosystem levels of Bronfenbrenner’s theory are evident in the study’s examination of how social and environmental factors interact to affect well-being.
2. Methods
2.1. Study Area
The GPHC of 2021, which included all residents of Ghana, regardless of nationality, was the source of the data used in this study. Ghana borders the Gulf of Guinea to the south, Burkina Faso to the east, Cote d’Ivoire to the west, and Burkina Faso to the north [5]. Urban areas are home to more than half of the population (56.7%). Furthermore, 58.1% of Ghanaians are in the 15–59 age group, 35.4% are in the 0–14 age group, and 6.5% are 60 years of age and above [5].
2.2. Data Sources, Study Design and Sampling
The study used a secondary analysis of a 10% representative sample from the 2021 PHC provided by the Ghana Statistical Service (GSS). A cross-sectional design was employed during the 2021 PHC to collect comprehensive data on demographic, social, economic, housing, and dwelling information, providing a nationally representative dataset. The 2021 PHC is the first Ghanaian census to use computer-assisted personal interviewing (CAPI). The 2021 GPHC covered 3,083,572 individuals. However, in this study, only 47,962 older adults who were 60 years and older and had complete information on the subject were analysed. Thus, older respondents below 60 years were not sampled. The functional age brackets were used to categorise respondents into 60–74 years (young-old), 75–84 years (old-old) and 85+ years (oldest old) [24].
2.3. Study Variables
2.3.1. Response Variables
The key response variable was the physical well-being of older adults 60 years and over. This study conceptualises it as the ability to perform fundamental physical tasks such as walking or climbing stairs. These tasks reflect their mobility, strength and balance. It was captured as an intellectual disability (remembering or concentrating) in the 2021 GPHC. During the census, older adults were asked to indicate their difficulties in performing physical activities [5]. Their physical well-being was assessed by the difficulty they experienced in performing these activities: (1) No difficulty: The individual can walk or climb stairs without any physical limitations. (2) Some difficulty: The individual can perform the activities but with some effort or minor physical limitations. (3) A lot of difficulty: The individual struggles significantly to walk or climb stairs and may need assistance or frequent rest. (4) Cannot do at all: The individual is unable to walk or climb stairs due to severe physical limitations. These were categorised as 1 = 1, “high physical well-being,” and “2, 3 and 4 = 0 “low physical well-being.” The study focussed on “high physical well-being” in the analysis.
2.3.2. Explanatory Variables
The primary explanatory variables considered were gender and residence. Housing conditions and environmental sustainability were considered secondary explanatory variables. In this study, gender was defined as the male and female older individuals. During the 2021 PHC, gender was captured as sex with responses such as (1) “male” and (2) “female”. Also, the residence was captured as the location of respondents during the GPHC 2021 with a dichotomous response, urban and rural. In this study, it is conceptualised as the place of residence and defined as the usual place in a country/region where an older person lives. It was recoded as 0 = urban and 1 = rural.
Variables measuring housing conditions were the type of dwelling, building materials (e.g., wall material, roofing material and floor material), lighting system and number of sleeping rooms in households. To establish the type of dwelling of older adults, the question asked was “In what type of dwelling does the household live?” Based on WHO categorisation, “improved dwelling types” included separate houses (detached), semidetached houses, flats/apartments and compound houses (rooms). However, dwelling type with the following huts/buildings (same compound), tent, metal container, kiosk/poly kiosks, wooden structures, living quarters attached to office/shops and uncompleted buildings was considered “unimproved dwelling types” [25].
Also, to assess whether the building/construction materials used were “improved” or “unimproved”, three questions were asked. The “wall material” was assessed by the question, “What is the main construction material of the walls of this dwelling? Categorised as “improved wall material” (stone, burnt bricks and cement blocks/concrete) and “unimproved wall materials” (mud bricks/earth, wood, metal sheet/slate/asbestos, concrete, bamboo, palm leaves/thatch (grass)/raffia and tarpaulin/fabric/canvas) [25]. For the roofing material, responses to the question “What is the main roofing material of this dwelling?” included metal sheets, cement/concrete and roofing tiles categorised as “improved roofing material” and mud/mud bricks/earth, wood, slate/asbestos, bamboo, thatch/palm leaves or raffia as “unimproved” [25]. Floor type was measured with the question, “What is the main construction material of the floor of this dwelling?” The response included “improved floor materials” (cement/concrete, stone, vinyl tiles, ceramic/porcelain/granite/marble tiles and terrazzo/terrazzo tiles) and “unimproved floor materials” (earth/mud, burnt bricks and wood).
The question “What is the source of lighting for your dwelling?” was used to determine energy-efficient lighting systems. Response categories comprised “improved lighting” (electricity (mains), electricity (community-based grid), electricity (private generator), electricity (solar panel/inverter) and electricity (wind energy) and “unimproved lighting” (kerosene lamp, gas lamp, solar lamp, candle and flashlight/torchlight, and none). The number of rooms in a household was determined by the question, “How many rooms does this household occupy?” the responses were grouped into (1) 1–4 rooms, (2) 5–8 rooms, (3) 9–12 rooms and (4) 13+ rooms.
Environmental sustainability factors include subgroups like sources of drinking water, sanitation and cooking conditions. The question used to evaluate the source of drinking water was “What is the main source of drinking water for the household?” “Improved water sources” included pipe-borne inside the dwelling, pipe-borne outside dwelling but on the compound, pipe-borne outside dwelling but in neighbour’s house/compound, public tap/standpipe, borehole/tube well, protected well, rainwater, protected spring and bottled water. “Unimproved water sources” comprised sachet water, tanker supplied/vendor provided, unprotected well, unprotected spring, river/stream and dugout/pond/lake/dam/canal [25].
Sanitation was determined by the methods of solid waste disposal, bathing and the toilet facilities used in households. The method of solid waste disposal was assessed by the question “How does the household mainly dispose of rubbish (refuse)?” Categorisation included compaction trucks and central containers as “improved waste disposal.” “Unimproved waste disposal” included other vehicles, tricycles and central containers buried in the ground, burned, public dump/open spaces, pushcarts/walk-in attendants/bicycles/wheelbarrows and dumped indiscriminately [25]. The question “What type of bathing facility is used by this household?” was used to determine the “type of bathing facility.” Based on WHO-JMP categorisation, an “improved bathing facility” includes own bathroom for exclusive use by households. On the other hand, shared separate bathroom in the same house, bathroom in another house, open space around the house, private open cubicle, shared open cubicle, public bathhouse, in/near the river, pond, lake, dam, etc., were categorised as “unimproved bathing facility.” The type of toilet facility used by older adults was assessed by the question “What type of toilet facility is mainly used by the household?” categorised as “improved toilet facility” (septic tank (manhole), KVIP/VIP, enviro loo, bio-digester ((e.g., bio fill) biogas)) and “unimproved” (pit latrine, bucket/pan, portable toilet (e.g., water potti), sewer, public toilet and none).
Concerning their cooking conditions, two questions were asked of older adults. The responses to the question “What is the source of cooking fuel for this household?” were categorised as “improved cooking fuel” (LPG, Bio Gas and Electricity) and “unimproved” (Kerosene, Charcoal, Crop residue, sawdust, Animal waste and cooking gel, none). The question “What type of cooking space does this household use?” was used to measure improved and unimproved cooking space. “Improved cooking space” constituted a separate room for the exclusive use of the household and a separate room shared with other household(s). “Unimproved cooking space” included enclosure without a roof, structure with a roof but without walls, bedroom/hall/living room, veranda/porch and open space in the compound [25].
2.4. Confounders
A range of demographic variables were considered as confounders, including age, marital status, level of education, health insurance status, employment status and employment sector of older adults [26]. These were selected based on the evidence of their possible influence on the association between gender, residence, housing conditions, environmental sustainability and physical well-being [26]. Thus, these variables must be taken into account in the Ghanaian context.
3. Results
Out of the 3,083,572 participants, 47,962 fulfilled the inclusion criteria and were included in the analysis. More than half (60.5%) were males, and 53.5% lived in urban areas. Most of the respondents were young olds (60–74 years) (92.0%). A higher percentage of the older adults have completed middle/JHS level of education (57.1%), are married (62.0%), have health insurance (71.1%), are self-employed (82.4%) and are in the private sector (94.2%).
Concerning their housing conditions, the results in Table 1 show that the majority of older respondents lived in improved dwelling type (80.2%) and used improved construction materials: roofing (88.2%), walls (64.7%), floors (94.0%), improved or energy efficient lighting systems (87.5%) and with 1-4 sleeping rooms (91.9%) in the houses where they reside.
| Variables | Frequency (n) | Percent (%) |
|---|---|---|
| Gender | ||
| Male | 29,005 | 60.5 |
| Female | 18,957 | 39.5 |
| Residence | ||
| Urban | 25,637 | 53.5 |
| Rural | 22,325 | 46.5 |
| Age | ||
| 60–74 years | 44,119 | 92.0 |
| 75–84 years | 3428 | 7.1 |
| 85+ years | 415 | 0.9 |
| Education | ||
| No education | 137 | 0.3 |
| Primary | 8096 | 16.9 |
| Middle/JHS | 27,400 | 57.1 |
| Secondary/SHS | 5222 | 10.9 |
| Vocational | 2519 | 5.3 |
| University graduate | 4588 | 9.6 |
| Marital status | ||
| Never married | 1079 | 2.2 |
| Married | 29,742 | 62.0 |
| Separated/Divorced | 8306 | 17.3 |
| Widowed | 8835 | 18.4 |
| Health insurance | ||
| Yes | 34,098 | 71.1 |
| No | 13,864 | 28.9 |
| Employment status | ||
| Not employed | 275 | 0.6 |
| Employee | 6978 | 14.5 |
| Self-employed | 39,531 | 82.4 |
| Casually employed | 1178 | 2.5 |
| Employment sector | ||
| Public | 1789 | 3.7 |
| Private | 45,203 | 94.2 |
| NGO/Religious org/international org | 970 | 2.0 |
| Housing conditions | ||
| Dwelling type | ||
| Improved | 38,482 | 80.2 |
| Unimproved | 9480 | 19.8 |
| Roofing | ||
| Improved | 42,290 | 88.2 |
| Unimproved | 5672 | 11.8 |
| Walls | ||
| Improved | 31,011 | 64.7 |
| Unimproved | 16,951 | 35.3 |
| Floors | ||
| Improved | 45,061 | 94.0 |
| Unimproved | 2901 | 6.0 |
| Lighting system | ||
| Improved | 41,977 | 87.5 |
| Unimproved | 5985 | 12.5 |
| Number of sleeping rooms | ||
| 1–4 rooms | 44,079 | 91.9 |
| 5–8 rooms | 3551 | 7.4 |
| 9–12 rooms | 304 | 0.6 |
| 13+ rooms | 28 | 0.1 |
| Environmental sustainability | ||
| Sources of drinking water | ||
| Improved | 29,909 | 62.4 |
| Unimproved | 18,053 | 37.6 |
| Sanitation | ||
| Waste management | ||
| Improved | 8490 | 17.7 |
| Unimproved | 39,472 | 82.3 |
| Bathing facilities | ||
| Improved | 22,363 | 46.6 |
| Unimproved | 25,599 | 53.4 |
| Toilet facilities | ||
| Improved | 22,210 | 46.3 |
| Unimproved | 25,752 | 53.7 |
| Cooking conditions | ||
| Cooking fuel | ||
| Improved | 14,623 | 30.5 |
| Unimproved | 33,339 | 69.5 |
| Cooking space | ||
| Improved | 29,054 | 60.6 |
| Unimproved | 18,908 | 39.4 |
| Physical well-being | ||
| Low physical well-being | 6353 | 13.2 |
| High physical well-being | 41,609 | 86.8 |
Regarding the environmental sustainability factors, results show that about two-thirds (62.4%) drank from improved sources of water and used improved cooking space (60.6%). However, older adults lived in unimproved sanitation conditions, unimproved methods of solid waste disposal (82.3%), bathing (53.4%) and toilet facilities (53.7%). They used polluted cooking fuel (69.5%) but have high physical well-being.
Except for dwelling type and roofing materials used, all the variables were statistically significant, with the high physical well-being of older adults 60 years and over. Male older adults (62.3%) who lived in urban residences (54.6%) had high physical well-being. The results in Table 2 show that older adults with better housing conditions had high physical well-being. Most older adults who had improved dwelling types (80.4%) used improved construction materials; roofing (88.2%), walls (65.7%), floors (94.2%), energy-efficient lighting (88.0%) and with 1-4 sleeping rooms (91.7%) had high physical well-being.
| Variables | High physical well-being | p value | |
|---|---|---|---|
| % | n (95% CI) | ||
| Gender | < 0.001 | ||
| Male | 62.3 | 29,005 (0.62, 0.63) | |
| Female | 37.7 | 18,957 (0.37, 0.38) | |
| Residence | < 0.001 | ||
| Urban | 54.6 | 25,637 (0.54, 0.55) | |
| Rural | 45.4 | 22,325 (0.45, 0.46) | |
| Housing conditions | |||
| Dwelling type | 0.083 | ||
| Improved | 80.4 | 38,482 (0.80, 0.81) | |
| Unimproved | 19.6 | 9480 (0.19, 0.20) | |
| Roofing | 0.845 | ||
| Improved | 88.2 | 42,290 (0.88, 0.89) | |
| Unimproved | 11.8 | 5672 (0.11, 0.13) | |
| Walls | < 0.001 | ||
| Improved | 65.7 | 31,011 (0.65, 0.66) | |
| Unimproved | 34.3 | 16,951 (0.34, 0.35) | |
| Floors | < 0.001 | ||
| Improved | 94.2 | 45,061 (0.94, 0.94) | |
| Unimproved | 5.8 | 2901 (0.56, 0.60) | |
| Lighting system | < 0.001 | ||
| Improved | 88.0 | 41,977 (0.88, 0.88) | |
| Unimproved | 12.0 | 5985 (0.11, 0.13) | |
| Number of sleeping rooms | < 0.001 | ||
| 1–4 rooms | 91.7 | 44,079 (0.91, 0.92) | |
| 5–8 rooms | 7.6 | 3551 (0.75, 0.77) | |
| 9–12 rooms | 0.6 | 304 (0.03, 0.09) | |
| 13+ rooms | 0.1 | 28 (−0.03, 0.05) | |
| Environmental sustainability | |||
| Sources of drinking water | < 0.001 | ||
| Improved | 61.9 | 29,909 (0.61, 0.62) | |
| Unimproved | 38.1 | 18,053 (0.37, 0.39) | |
| Sanitation | |||
| Waste management | < 0.001 | ||
| Solid waste disposal | |||
| Improved | 18.2 | 8490 (0.17, 0.19) | |
| Unimproved | 81.8% | 39,472 (0.81, 0.82) | |
| Bathing facilities | < 0.001 | ||
| Improved | 47.3 | 22,363 (0.47, 0.48) | |
| Unimproved | 52.7 | 25,599 (0.52, 0.53) | |
| Toilet facilities | < 0.001 | ||
| Improved | 47.2 | 22,210 (0.47, 0.48) | |
| Unimproved | 52.8 | 25,752 (0.52, 0.53) | |
| Cooking conditions | |||
| Cooking fuel | < 0.001 | ||
| Improved | 31.9 | 14,623 (0.31, 0.33) | |
| Unimproved | 68.1 | 33,339 (0.68, 0.69) | |
| Cooking space | < 0.001 | ||
| Improved | 61.5 | 29,054 (0.61, 0.62) | |
| Unimproved | 38.5 | 18,908 (0.38, 0.39) | |
| Age | < 0.001 | ||
| 60–74 years | 93.2 | 44,119 (0.93, 0.93) | |
| 75–84 years | 6.2 | 3428 (0.60, 0.64) | |
| 85+ years | 0.7 | 415 (0.05, 0.09) | |
| Education | < 0.001 | ||
| No education | 0.3 | 137 (0.00, 0.06) | |
| Primary | 15.8 | 8096 (0.11, 0.17) | |
| Middle/JHS | 57.4 | 27,400 (0.57, 0.58) | |
| Secondary/SHS | 11.1 | 5222 (0.10, 0.12) | |
| Vocational | 5.3 | 2519 (0.51, 0.55) | |
| University graduate | 10.1 | 4588 (0.09, 0.11) | |
| Marital status | < 0.001 | ||
| Never married | 2.3 | 1079 (0.20, 0.26) | |
| Married | 63.9 | 29,742 (0.63, 0.64) | |
| Separated/Divorced | 16.8 | 8306 (0.16, 0.18) | |
| Widowed | 17.0 | 8835 (0.16, 0.18) | |
| Health insurance | < 0.001 | ||
| Yes | 70.9 | 34,098 (0.70, 0.71) | |
| No | 29.1 | 13,864 (0.28, 0.30) | |
| Employment status | < 0.001 | ||
| Not employed | 0.6 | 275 (0.03, 0.09) | |
| Employee | 15.1 | 6978 (0.14, 0.16) | |
| Self employed | 81.9 | 39,531 (0.82, 0.82) | |
| Casually employed | 2.4 | 1178 (0.22, 0.26) | |
| Employment sector | < 0.001 | ||
| Public | 3.9 | 1789 (0.37, 0.41) | |
| Private | 94.2 | 45,203 (0.94, 0.94) | |
| NGO/Religious org/International org | 1.9 | 970 (0.17, 0.21) | |
Older respondents with improved sources of drinking water (61.9%) and used improved cooking space (61.5%) had better physical well-being. Conversely, those with poor sanitation (unimproved methods of waste disposal [81.8%], bathing [52.8%] and toilet facilities [52.7%]) and somewhat poor cooking conditions (unimproved cooking fuel [68.1%]) were associated with better physical health.
The young-olds (60–74 years) (93.2%), those with middle/JHS education (57.4%), married (63.9%), those who have health insurance (70.9%), self-employed (81.9%) and in the private sector (94.2%), had high physical well-being.
Being a female was less likely to be associated with better physical well-being (OR = 0.64, 95% CI = 0.60, 0.68) when compared with being a male. Also, the results in Table 3 show that residing in a rural environment was associated with lower odds of having better physical well-being (OR = 0.86, 95% CI = 0.81, 0.92) when compared with older urban dwellers.
| Variables | Model 1 | Model 2 | Model 3 |
|---|---|---|---|
| Primary variables | OR [95% CI] p value | OR [95% CI] p value | OR [95% CI] p value |
| Gender | |||
| Male | 1.00 | 1.00 | |
| Female | 0.55 (0.53, 0.59)∗∗ | 0.54 (0.51, 0.57)∗∗ | 0.64 (0.60, 0.68)∗∗ |
| Residence | |||
| Urban | 1.00 | 1.00 | |
| Rural | 0.67 (0.64, 0.71)∗∗ | 0.84 (0.79, 0.90)∗∗ | 0.86 (0.81, 0.92)∗∗ |
| Secondary factors | |||
| Housing conditions | |||
| Dwelling type | |||
| Unimproved | 1.00 | ||
| Improved | 1.06 (0.99, 1.13) | 1.05 (0.98, 1.13) | |
| Roofing | |||
| Unimproved | 1.00 | ||
| Improved | 1.08 (0.99,1.17) | 1.08 (0.99, 1.17) | |
| Walls | |||
| Unimproved | 1.00 | ||
| Improved | 1.12 (1.05, 1.19)∗∗ | 1.11 (1.04, 1.18)∗∗ | |
| Floors | |||
| Unimproved | 1.00 | ||
| Improved | 1.11 (0.99, 1.24)∗ | 1.10 (0.99, 1.23) | |
| Lighting system | |||
| Unimproved | 1.00 | ||
| Improved | 1.08 (0.99, 1.17)∗∗ | 1.05 (0.96, 1.14) | |
| Number of sleeping rooms | |||
| 1–4 rooms | 1.00 | ||
| 5–8 rooms | 0.63 (0.15, 2.67) | 0.65 (0.15, 2.75) | |
| 9–12 rooms | 0.70 (0.16, 2.96) | 0.72 (0.17, 3.05) | |
| 13+ rooms | 0.60 (0.14, 2.64) | 0.65 (0.15, 2.87) | |
| Environmental sustainability | |||
| Sources of drinking water | |||
| Unimproved | 1.00 | ||
| Improved | 0.94 (0.88, 1.00)∗ | 1.12 (1.02, 1.23)∗ | |
| Sanitation | |||
| Waste management | |||
| Unimproved | 1.00 | ||
| Improved | 0.88 (0.92, 1.08)∗∗ | 1.18 (1.09, 1.27)∗∗ | |
| Bathing facilities | |||
| Unimproved | 1.00 | ||
| Improved | 1.02 (0.97, 1.09) | 1.01 (0.95, 1.07) | |
| Toilet facilities | |||
| Unimproved | 1.00 | ||
| Improved | 1.00 (0.94, 1.06) | 1.00 (0.94, 1.07) | |
| Cooking conditions | |||
| Cooking fuel | |||
| Unimproved | 1.00 | 1.00 | |
| Improved | 1.30 (1.20, 1.40)∗∗ | 1.24 (1.14, 1.34)∗∗ | |
| Cooking space | |||
| Unimproved | 1.00 | 1.00 | |
| Improved | 1.21 (1.14, 1.28)∗∗ | 1.18 (1.12, 1.26)∗∗ | |
| Confounders | |||
| Age | |||
| 60–74 years | 1.00 | ||
| 75–84 years | 0.46 (0.42, 0.50)∗∗ | ||
| 85+ years | 0.31 (0.25, 0.38)∗∗ | ||
| Education | |||
| No education | |||
| Primary | 0.81 (0.48, 1.35) | ||
| Middle/JHS | 0.98 (0.59, 1.64) | ||
| Secondary/SHS | 1.00 (0.59, 1.67) | ||
| Vocational | 0.89 (0.52, 1.50) | ||
| University graduate | 1.12 (0.66, 1.89) | ||
| Marital status | |||
| Never married | |||
| Married | 1.14 (0.95, 1.38) | ||
| Separated/Divorced | 0.85 (0.70, 1.03) | ||
| Widowed | 0.77 (0.64, 0.94)∗ | ||
| Health insurance | |||
| Yes | 1.00 | ||
| No | 1.12 (1.05, 1.19)∗∗ | ||
| Employment status | |||
| Not employed | 1.00 | ||
| Employee | 1.01 (0.70, 1.45) | ||
| Self employed | 0.90 (0.64, 1.29) | ||
| Casually employed | 0.90 (0.61, 1.33) | ||
| Employment sector | |||
| Public | 1.00 | ||
| Private | 1.29 (1.07, 1.55)∗ | ||
| NGO/Religious org/International org | 0.72 (0.57, 0.91)∗ | ||
- ∗p < 0.05.
- ∗∗p < 0.01.
Older adults with improved dwelling types (OR = 1.05, 95% CI = 0.98, 1.13), improved building materials, roofing (OR = 1.08, 95% CI = 0.99, 1.17), walls (OR = 1.11, 95% CI = 1.04, 1.18), floors (OR = 1.10, 95% CI = 0.99, 1.23) and lighting (OR = 1.05, 95% CI = 0.96, 1.14) had higher odds of high physical well-being when compared with their colleagues with unimproved dwelling types and construction materials. Those with more sleeping rooms (13+) were less likely to be associated with high physical well-being (OR = 0.65, 95% CI = 0.15, 2.87) when compared with older adults with less (1-4 rooms).
Drinking from improved sources was associated with high physical well-being (OR = 1.12, 95% CI = 1.02, 1.23) when compared with drinking from polluted sources. Having improved solid waste disposal methods, bathing and toilet facilities were more likely to be associated with better physical well-being (OR = 1.18, 95% CI = 1.09, 1.27) (OR = 1.01, 95% CI = 0.95, 1.07) and (OR = 1.00, 95% CI = 0.94, 1.07), respectively, when compared with using unimproved sanitation systems. Older adults with clean cooking conditions (improved cooking fuel) (OR = 1.24, 95% CI = 1.14, 1.34) and (improved cooking space) (OR = 1.18, 95% CI = 1.12, 1.26) had higher odds of high physical well-being when compared with those with polluted cooking conditions.
Being the oldest-old (85+ years) was associated with lower odds of high physical well-being (OR = 0.31, 95% CI = 0.25, 0.38) compared to being young-old (60–74 years). Older adults with secondary (OR = 1.00, 95% CI = 0.59, 1.67) and university (OR = 1.12, 95% CI = 0.66, 1.89) levels of education were more likely to have high physical well-being when compared with those with no education. Older respondents who were married had higher odds of better physical well-being (OR = 1.14, 95% CI = 0.95, 1.38) when compared with the not married. Having health insurance was more likely to be associated with high physical well-being (OR = 1.12, 95% CI = 1.05, 1.19). Also, employees were 10% more likely to be associated with high physical well-being (OR = 1.01, 95% CI = 0.70, 1.45) when compared with the not employed. Lastly, older adults in the private sector had higher odds of better physical well-being (OR = 1.29, 95% CI = 1.07, 1.55) when compared with their counterparts in the public sector.
4. Discussion
This study explored how gender and place of residence in housing conditions and environmental factors affect the physical well-being of older adults in Ghana. It found that factors like gender, location, housing and environmental conditions significantly impact those aged 60 years and over. Females and residents of rural areas have lower odds of better physical well-being. Conversely, higher housing quality, access to clean drinking water, and improved sanitation and cooking conditions are associated with better physical health.
Being female is associated with poorer physical well-being, particularly among older women, due to various social, economic and health factors. Women often face financial insecurity in old age because of lower lifetime earnings and reduced access to pensions, limiting their ability to access quality healthcare and maintain healthy living conditions [4]. Although women generally live longer than men, they often spend more years with chronic conditions, such as osteoporosis and arthritis, which negatively affect mobility and functioning [27]. At the microsystem level, gender influences access to essential resources like healthcare and social support, impacting physical well-being. In Ghana, cultural norms and economic inequalities further heighten older women’s vulnerabilities [18].
Additionally, living in rural areas is linked to lower physical well-being due to significant infrastructural challenges, such as limited healthcare access, inadequate housing and poor sanitation [28]. Urban areas typically offer better infrastructure and healthcare access, leading to improved health outcomes [29]. This study supports the notion that rural living correlates with challenges that negatively impact health, as evidenced by global trends showing that older adults in rural settings often experience worse health outcomes [28]. The theory highlights how systemic and environmental factors contribute to the health disparities faced by rural residents [18].
Older adults living in improved housing with better building materials, roofing, walls, floors and lighting have higher odds of physical well-being. Enhanced housing conditions create safer environments that support mobility, reduce injury risks and prevent chronic illness exacerbation [11]. This aligns with studies highlighting the built environment’s role in promoting health and preventing falls among the elderly [12]. Improved housing types and construction materials enhance insulation and protection from environmental hazards, which can positively affect older adults’ respiratory health by reducing exposure to harmful substances like asbestos. Better roofing and walls provide stability and lessen the physical challenges of living in deteriorating conditions, supporting overall physical health [30]. Additionally, good lighting systems improve visibility, which is crucial for the safety and mobility of older adults. Poor lighting increases the risk of falls, particularly for those with vision impairments [31]. Enhanced lighting aligns with recommendations for safer living conditions, promoting physical activity and reducing injury risks. Housing conditions are part of the microsystem, where the immediate environment directly impacts health outcomes [18]. Higher housing quality fosters an environment conducive to physical well-being, aligning with findings that older adults in better housing experience improved physical health [18].
Households with 13 or more sleeping rooms were less likely to be associated with high physical well-being, contrary to the typical view that larger living spaces promote health by reducing overcrowding and stress [11]. This study suggests that older adults in these larger homes may not reap the expected health benefits. One plausible explanation could be that a large, underutilised home can create physical and financial burdens, requiring more maintenance and exertion, which may be detrimental to physical well-being, especially for older adults with mobility issues [32]. Additionally, larger homes are often found in rural areas with limited access to healthcare and services, undermining potential health benefits [32]. From an ecological systems perspective, while macrosystem factors like home size might indicate better health, interactions at the microsystem level (daily challenges within the home) and mesosystem level (community support) may negate these advantages [18].
Access to improved drinking water is linked to better physical well-being, particularly for older adults who are more susceptible to waterborne diseases, especially in developing countries like Ghana. Clean water reduces the risk of infections and chronic illnesses, significantly enhancing health outcomes in vulnerable populations [12]. This finding aligns with Wolf et al. study [33], which emphasises the importance of clean water in reducing disease burden and improving quality of life [12]. Providing access to clean water is essential for promoting environmental sustainability and better living conditions, as informed by the ecological systems theory [18].
Improved solid waste disposal methods and bathing and toilet facilities are linked to better physical well-being. Enhanced sanitation and waste management reduce exposure to harmful pathogens, lowering disease risk and benefiting health [9]. This finding supports the notion that better physical environments, access to proper sanitation and effective waste disposal reduce health risks and enhance physical well-being, aligning with the ecological systems theory [18]. The theory highlights that physical well-being is influenced by both immediate environments (microsystem) and broader societal structures (exosystem), suggesting that improved household conditions create safer living environments for older adults, leading to better health outcomes.
Older adults with access to clean cooking conditions (improved fuel and cooking space) experience better physical well-being. This finding aligns with existing literature, which shows that clean cooking environments reduce indoor air pollution, a major risk factor for respiratory and cardiovascular diseases [34]. Improved cooking conditions limit exposure to harmful pollutants like particulate matter and carbon monoxide, reducing the burden of chronic diseases and enhancing functional mobility. This result supports ecological systems theory, which emphasises how environmental factors influence health outcomes [35]. Clean cooking conditions represent a microsystem where access to safe fuels (e.g., LPG and biogas) and safe cooking spaces minimise health risks, promoting a better quality of life and encouraging physical activity. By improving air quality and reducing the physical strain associated with traditional cooking methods (e.g., using wood or charcoal), these conditions create a healthier living environment [35]. This enables older adults to maintain better mobility and efficiently perform daily tasks. Such findings underscore the broader public health perspective on the importance of safe cooking fuels and environments in enhancing health, particularly among ageing populations in developing countries like Ghana.
Being 85 years or older is linked to lower odds of high physical well-being, likely due to increased chronic illnesses, mobility issues and frailty common in advanced age [36]. Conversely, older adults with secondary or university education tend to have better physical well-being, reflecting the connection between higher education and improved health outcomes [4]. Education enhances health literacy, enabling informed health decisions and access to healthcare. In Ghana, educated older adults often enjoy better socioeconomic conditions, including improved housing and healthcare, and may have worked in less physically demanding jobs, reducing chronic limitations in old age [4].
Older married respondents experienced better physical well-being due to the emotional and social support that marriage provides. Spouses assist each other with daily tasks and healthcare, reducing loneliness and stress, which positively influences health [37]. In Ghana, marriage offers crucial support for navigating economic and healthcare challenges. Additionally, having health insurance is linked to higher physical well-being, as it enhances access to healthcare services [4]. This access supports the management of chronic conditions, medication availability and preventive care, reducing financial barriers and enabling timely medical attention, especially for older adults [4].
Employees were 10% more likely to have high physical well-being, consistent with literature showing that employment improves health outcomes through financial stability, healthcare access and social engagement [38]. In Ghana, employment likely provides older adults with purpose, financial resources and an active lifestyle, enhancing their physical well-being. Lastly, older adults in the private sector had better physical well-being, likely due to greater financial stability, which improves access to healthcare and healthier living conditions [4]. Employment also fosters social engagement and access to resources, both crucial for maintaining physical health as people age.
4.1. Strengths and Limitations
This study has notable strengths, including its large, nationally representative sample from the GPHC (2021), which improves the generalisability of the findings to older adults across Ghana. The research offers a detailed examination of housing and environmental factors, investigating their connections to physical well-being, a depth often lacking in existing studies on ageing populations. Additionally, the study applies ecological systems theory, a comprehensive framework that captures the layered influences of living environments on older adults. By focussing on gender and urban–rural disparities, the study highlights significant social determinants of health that could inform tailored policies for at-risk groups. The statistical rigour, with adjustments for confounding variables through logistic regression, further strengthens the validity of the observed associations.
However, the study also has limitations. Its cross-sectional design restricts causal interpretations, as the data only capture associations at a single point in time. Physical well-being relies on self-reported data, which may introduce bias, particularly regarding health recall. Additionally, while physical well-being is the primary outcome, the study does not measure other health aspects, such as mental health or chronic diseases, limiting a more comprehensive understanding of well-being. Residual confounding from unmeasured factors like diet or lifestyle may affect the results despite adjustments for key variables. Finally, focussing on housing quality alone may overlook some socioeconomic and cultural complexities specific to urban and rural contexts in Ghana, potentially simplifying the full scope of influences on older adults’ health.
5. Conclusion
The study concludes that gender, place of residence, housing quality and environmental factors significantly affect the physical well-being of older adults in Ghana. Males and urban residents tend to have better physical health than females and rural residents, largely due to differences in access to essential resources. Improved housing, clean drinking water, proper sanitation and safe cooking conditions are linked to higher physical well-being, highlighting the importance of basic infrastructure and environmental quality. Women and rural dwellers face unique challenges due to limited healthcare, economic vulnerability and inadequate living conditions, all of which contribute to poorer health outcomes. The findings suggest that targeted policies aimed at improving housing standards, sanitation and healthcare access, particularly in rural areas, could help reduce health disparities among older adults. Such interventions align with the ecological systems theory, which emphasises how individuals’ environments, from housing quality to social support, directly influence health outcomes.
Ethics Statement
In accordance with national legal frameworks and international statistical standards, this study was carried out in compliance with the relevant norms and regulations. The 2021 PHC followed the United Nations Principles and Recommendations for Population and Housing Censuses as well as the Statistical Service Act, 2019: Act 1003. The census’s ethics framework was authorised by the Ghana Health Service Ethical Review Committee (GHS-ERC). Consent to participate in the 2021 PHC was voluntary. Consent to participate in the survey was given by participants in accordance with international guidelines for gathering public data. This manuscript’s author requested access to the data rather than participating directly in the data collection procedures.
Consent
Please see Ethics Statement.
Conflicts of Interest
The authors declare no conflicts of interest.
Author Contributions
J.K.O. conceptualised the study, analysed the data, wrote methods, and contribute to discussion. M.A.O. wrote the introduction and reviewed the first draft of the manuscript. The final manuscript was validated and approved by the authors.
Funding
No funding was received for the current study.
Acknowledgement
The data utilised in the analysis of this study was made available to me by the Ghana Statistical Service, for which the author is grateful.
Open Research
Data Availability Statement
The datasets analysed during the current study are available at the Ghana Statistical Service database at the repository: https://www2.statsghana.gov.gh/nada/index.php/catalog/110.
