{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T05:45:05Z","timestamp":1788673505066,"version":"build-2803163510"},"reference-count":61,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2022,11,3]],"date-time":"2022-11-03T00:00:00Z","timestamp":1667433600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\nBackground<\/jats:title>\nFunctional disability is a common public health problem that affects the health and quality of life of older adults. This causes them to be highly dependent on other members of their family, receive home care, or to be institutionalized. Although functional disability has been widely studied in developed country settings, very limited studies have focused on age-related functional disability in sub-Saharan Africa, and in particular Ghana. The purpose of this study is to assess various factors associated with the difficulties in performing basic and instrumental activities of daily living among older adults in Ghana.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nThis cross-sectional study used data on 1610 older adults aged 50 years and above from the Study on Global Ageing and Adult Health (SAGE) survey Wave II conducted in Ghana. Nine standard functioning difficulty tools of WHODAS II was used for the analysis. The WHODAS II offers continuous summary scores with higher scores showing higher disability, and vice versa. A multi-level regression model was used to identify individual and household level risk factors linked to the functional disability of older adults.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nFemale older adults (53.7%) reported having functional disability. The mean functional disability among older adults aged 50 years and above was 5.2 (\u00b1 5.9). Results indicated that older adults who are females, aged 70 years and above, and had three or more chronic conditions had a higher functional disability. Also, older adults who have adequate fruit intake and belong to wealthier households were found to have a lower functional disability.<\/jats:p>\n<\/jats:sec>\n\nConclusions<\/jats:title>\nThe study reveals that functional disability among older adults is frequent in Ghana and is associated with having three or more chronic conditions and being overweight\/obese. Prevention of functional disability in old age in Ghana is therefore a matter of great social and economic concern, which calls for coordinate efforts across the board to mitigate this public health challenge.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0277125","type":"journal-article","created":{"date-parts":[[2022,11,3]],"date-time":"2022-11-03T17:47:22Z","timestamp":1667497642000},"page":"e0277125","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":15,"title":["Characterization of functional disability among older adults in Ghana: A multi-level analysis of the study on global ageing and adult health (SAGE) Wave II"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0962-0885","authenticated-orcid":true,"given":"Kwasi 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Bleijenberg","year":"2017","journal-title":"Disability in the individual ADL, IADL, and mobility among older adults: a prospective cohort study"},{"key":"pone.0277125.ref011","article-title":"Biological sciences, sciences m","author":"A Edjolo","year":"2020","journal-title":"Heterogeneous Long-Term Trajectories of Dependency in the Elderly: The PAQUID Cohort, a 22-year Population-Based Study"},{"issue":"11","key":"pone.0277125.ref012","first-page":"1332","article-title":"Group FJJotAGS","volume":"44","author":"JO Judge","year":"1996","journal-title":"The relationship between physical performance measures and independence in instrumental activities of daily living"},{"issue":"1","key":"pone.0277125.ref013","first-page":"236","article-title":"Disability, quality of life and all-cause mortality in older Mexican adults: association with multimorbidity and frailty","volume":"18","author":"A Rivera-Almaraz","year":"2018"},{"issue":"9","key":"pone.0277125.ref014","first-page":"e0222992","article-title":"Disability and its association with sociodemographic factors among elderly persons residing in an urban resettlement colony, New Delhi, India","volume":"14","author":"AK Goswami","year":"2019"},{"key":"pone.0277125.ref015","first-page":"2018","article-title":"Assessment of disability and factors determining disability among inhabitants of South-Eastern Poland aged 71\u201380 years","author":"A \u0106wirlej-Soza\u0144ska","year":"2018"},{"issue":"1","key":"pone.0277125.ref016","first-page":"e53879","article-title":"Associations and impact factors between living arrangements and functional disability among older Chinese adults","volume":"8","author":"H Wang","year":"2013"},{"issue":"1","key":"pone.0277125.ref017","first-page":"492","article-title":"Prevalence and correlates of physical disability and functional limitation among community dwelling older people in rural 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Carmona-Torres","year":"2019"},{"issue":"4","key":"pone.0277125.ref026","first-page":"305","article-title":"Fruit and vegetable intake among older adults: a scoping review","volume":"75","author":"EJ Nicklett","year":"2013"},{"issue":"3","key":"pone.0277125.ref027","first-page":"170","article-title":"Low serum carotenoids are associated with a decline in walking speed in older women","volume":"13","author":"Health","year":"2009"},{"issue":"6","key":"pone.0277125.ref028","first-page":"790","article-title":"Global physical activity questionnaire (GPAQ): nine country reliability and validity study","volume":"6","author":"health","year":"2009"},{"key":"pone.0277125.ref029","doi-asserted-by":"crossref","DOI":"10.1017\/CBO9780511790942","volume-title":"Data analysis using regression and multilevel\/hierarchical models","author":"A Gelman","year":"2006"},{"issue":"2","key":"pone.0277125.ref030","first-page":"490","article-title":"Use of the estimated intraclass correlation for correcting 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College Station, TX: StataCorp LP, 9(10)."},{"key":"pone.0277125.ref032","article-title":"Multivariate data analysis: Prentice hall Upper Saddle River, NJ","author":"JF Hair","year":"1998"},{"key":"pone.0277125.ref033","article-title":"What are the main risk factors for disability in old age and how can disability be prevented","author":"EJCWROfE Heikkinen","year":"2003"},{"issue":"8","key":"pone.0277125.ref034","first-page":"694","article-title":"Functional decline in residents living in nursing homes: a systematic review of the literature","volume":"17","author":"A Palese","year":"2016"},{"issue":"4","key":"pone.0277125.ref035","article-title":"Functional disability and associated chronic conditions among geriatric gablepopulations in a rural community of India","volume":"44","author":"D Chakrabarty","year":"2010"},{"issue":"6","key":"pone.0277125.ref036","first-page":"739","article-title":"Trends in disability in activities of daily living among Chinese older adults, 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