Table_1_Care of Older Persons in Eastern Africa: A Scoping Review of Ethical Issues.pdf

IntroductionThe aging population is rapidly increasing globally, with 80% of the older population living in low- and middle-income countries. In Eastern African countries, there exists an incongruence between readiness–economically, structurally, politically, and culturally–to create a conducive environment for healthy aging, which implies public health as well as ethical concerns. The aim of this scoping review was to explore existing evidence addressing the various ethical issues in connection with elder care in the region of Eastern Africa.
MethodsWe searched six databases (Africa-Wide Information, AgeLine, CINHAL, MEDLINE, APA PsycInfo, and SocINDEX) to identify peer-reviewed journal articles that could meet some eligibility criteria such as being a peer-reviewed journal article written in English, having been published in any year until July 2020, and focusing on ethical issues in the care of older people aged 60 years and older from Eastern Africa. We also searched for additional evidence in the references of included papers and web-based platforms. We included 24 journal articles and analyzed them using the inductive content analysis approach.
ResultsThe included articles represent seven (38.9%) of the 18 countries in the Eastern African region. The articles covered six ethical concerns: lack of government attention to older persons (n = 14, 58.3%), inaccessibility of health care services (n = 13, 54.2%), loneliness and isolation (n = 11, 45.8%), gender inequalities in old age (n = 9, 37.5%), mistreatment and victimization (n = 8, 33.3%), and medical errors (n = 2, 8.3%).
ConclusionThis scoping review summarized ethical issues arising in relation to providing care for older persons in the Eastern African context. In light of the rapid increase in the number of older persons in this region, it is critical for governments and responsible bodies to implement and accelerate efforts promptly to generate more evidence to inform programs and policies that improve the health and wellbeing of older persons. Further research is needed to inform global health efforts that aim at improving the lives of older persons, particularly in low- and middle-income countries.
Clinical Trial Registrationhttps://osf.io/sb8gw, identifier: 10.17605/OSF.IO/SB8GW.

引言 全球老年人口规模正快速扩张，其中80%的老年群体居住于中低收入国家（low- and middle-income countries）。东非地区国家在经济、结构、政治与文化层面的筹备就绪程度，与打造健康老龄化友好环境的需求之间存在显著不协调，这一问题同时涉及公共卫生与伦理议题。本范围综述（scoping review）旨在探索东非地区老年照护（elder care）相关各类伦理议题的现有研究证据。
方法 本研究检索了6个数据库，分别为泛非信息数据库（Africa-Wide Information）、老龄问题数据库（AgeLine）、护理及相关健康文献累积索引（CINHAL）、医学文献分析与检索联机系统（MEDLINE）、美国心理学会心理学文摘数据库（APA PsycInfo）以及社会学文摘数据库（SocINDEX），以筛选符合以下入选标准的同行评议期刊论文：以英文撰写、发表时间截至2020年7月、聚焦东非地区60岁及以上老年群体照护中的伦理议题。此外，本研究还通过纳入文献的参考文献列表及网络平台补充检索相关证据。最终共纳入24篇期刊论文，并采用归纳式内容分析法（inductive content analysis）对其进行分析。
结果 纳入的文献覆盖东非18个国家中的7个（占比38.9%）。这些文献共涉及6类伦理议题：政府对老年群体关注度不足（n=14，58.3%）、医疗服务可及性匮乏（n=13，54.2%）、孤独与社会隔离（n=11，45.8%）、老年时期的性别不平等（n=9，37.5%）、虐待与受害（n=8，33.3%）以及医疗差错（n=2，8.3%）。
结论 本范围综述总结了东非地区老年照护实践中出现的各类伦理议题。鉴于该地区老年人口数量正快速增长，各国政府及相关主管机构亟需迅速落实并加大工作力度，生成更多研究证据以指导改善老年群体健康与福祉的相关项目与政策制定。未来仍需开展更多研究，为旨在提升老年群体生活质量的全球卫生工作提供依据，尤其针对中低收入国家。
临床试验注册 链接：https://osf.io/sb8gw，标识符：10.17605/OSF.IO/SB8GW。