"I Was Afraid to Go to the Hospital": A Qualitative Analysis and Ethical Implications of the Impacts of COVID-19 on the Health and Medical Care of Older Adults in Ethiopia

Overview

Journal SAGE Open Med

Publisher Sage Publications

Specialty General Medicine

Date 2024 Aug 2

PMID 39092158

Authors

Kirubel Manyazewal Mussie

Jenny Setchell

Mirgissa Kaba

Bernice Simone Elger

Affiliations

Soon will be listed here.

Abstract

Objective: The COVID-19 pandemic has brought severe health consequences among older adults and posed ethical challenges. The aim of this study was to explore the impacts of COVID-19 on the health and medical care of older adults in Ethiopia and associated ethical implications, regardless of older adults' COVID-19 infection status.

Methods: In this qualitative study, we followed an inductive exploratory approach based on reflexive thematic analysis. We conducted semistructured interviews between March 2021 and November 2021 with 20 older adults and 26 health professionals who were selected from healthcare facilities and communities in Ethiopia using purposive and snowball sampling techniques. We audio-recorded, transcribed, translated, and inductively analyzed the interviews using thematic analysis.

Results: Participants reported that the pandemic compromised the accessibility and quality of both COVID and non-COVID healthcare services for older adults, which negatively impacted older adults' health conditions and medical care. Moreover, participants elaborated on the health conditions and care of older patients with COVID-19 and highlighted that older COVID-19 patients often have severe health conditions, do not get adequate COVID-19 care, and may receive lower priority for admission to intensive care units compared to younger patients when resources are limited.

Conclusions: Results of this study showed that practices of COVID-19 care and measures may have led to adverse consequences such as limited availability and access to aged care in Ethiopia, which could have further health consequences on older patients. Our results contribute to a better understanding of ethical issues such as distributive justice and prioritization arising in the healthcare of older patients in times of global pandemic. It is imperative for local and international health policymakers and ethicists to further analyze and address the challenges that compromise the accessibility and continuity of quality care for older persons during a public healthcare crisis.

Citing Articles

"I Do Not Believe We Should Disclose Everything to an Older Patient": Challenges and Ethical Concerns in Clinical Decision-Making in Old-Age Care in Ethiopia.

Mussie K, Kaba M, Setchell J, Elger B Health Care Anal. 2024; 32(4):290-311.

PMID: 39354236 PMC: 11532312. DOI: 10.1007/s10728-024-00494-y.

References

Lebrasseur A, Fortin-Bedard N, Lettre J, Raymond E, Bussieres E, Lapierre N . Impact of the COVID-19 Pandemic on Older Adults: Rapid Review. JMIR Aging. 2021; 4(2):e26474. PMC: 8043147. DOI: 10.2196/26474. View

Kifle Habtemariam M, Semegn S . Setting health sector priorities: a brief overview of Ethiopia's experience. Cost Eff Resour Alloc. 2018; 16(Suppl 1):46. PMC: 6225615. DOI: 10.1186/s12962-018-0117-8. View

Leulseged T, Hassen I, Edo M, Abebe D, Maru E, Zewde W . Duration of Supplemental Oxygen Requirement and Predictors in Severe COVID-19 Patients in Ethiopia: A Survival Analysis. Ethiop J Health Sci. 2021; 31(4):699-708. PMC: 8512943. DOI: 10.4314/ejhs.v31i4.3. View

Meis-Pinheiro U, Lopez-Segui F, Walsh S, Ussi A, Santaeugenia S, Garcia-Navarro J . Clinical characteristics of COVID-19 in older adults. A retrospective study in long-term nursing homes in Catalonia. PLoS One. 2021; 16(7):e0255141. PMC: 8301631. DOI: 10.1371/journal.pone.0255141. View

Zelalem A, Kotecho M . Challenges of Aging in Rural Ethiopia: . J Gerontol Soc Work. 2020; 63(8):893-916. DOI: 10.1080/01634372.2020.1814475. View

Ekoh P, Agbawodikeizu P, Ejimkararonye C, George E, Donatus Ezulike C, Nnebe I . COVID-19 in Rural Nigeria: Diminishing Social Support for Older People in Nigeria. Gerontol Geriatr Med. 2021; 6:2333721420986301. PMC: 7783879. DOI: 10.1177/2333721420986301. View

Archard D, Caplan A . Is it wrong to prioritise younger patients with covid-19?. BMJ. 2020; 369:m1509. DOI: 10.1136/bmj.m1509. View

Largent E, Lynch H . Paying Research Participants: Regulatory Uncertainty, Conceptual Confusion, and a Path Forward. Yale J Health Policy Law Ethics. 2017; 17(1):61-141. PMC: 5728432. View

Wu Z, McGoogan J . Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323(13):1239-1242. DOI: 10.1001/jama.2020.2648. View

10.

Ripley E . A Review of Paying Research Participants: It's Time to Move Beyond the ethical Debate. J Empir Res Hum Res Ethics. 2009; 1(4):9-20. DOI: 10.1525/jer.2006.1.4.9. View

11.

Tessema G, Kinfu Y, Dachew B, Tesema A, Assefa Y, Alene K . The COVID-19 pandemic and healthcare systems in Africa: a scoping review of preparedness, impact and response. BMJ Glob Health. 2021; 6(12). PMC: 8637314. DOI: 10.1136/bmjgh-2021-007179. View

12.

Manyazewal T, Woldeamanuel Y, Fekadu A, Holland D, Marconi V . Effect of Digital Medication Event Reminder and Monitor-Observed Therapy vs Standard Directly Observed Therapy on Health-Related Quality of Life and Catastrophic Costs in Patients With Tuberculosis: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2022; 5(9):e2230509. PMC: 9478770. DOI: 10.1001/jamanetworkopen.2022.30509. View

13.

Mussie K, Yimer S, Manyazewal T, Gradmann C . Exploring local realities: Perceptions and experiences of healthcare workers on the management and control of drug-resistant tuberculosis in Addis Ababa, Ethiopia. PLoS One. 2019; 14(11):e0224277. PMC: 6853283. DOI: 10.1371/journal.pone.0224277. View

14.

Berhane Defaye F, Danis M, Wakim P, Berhane Y, Norheim O, Miljeteig I . Bedside Rationing Under Resource Constraints-A National Survey of Ethiopian Physicians' Use of Criteria for Priority Setting. AJOB Empir Bioeth. 2019; 10(2):125-135. PMC: 7673658. DOI: 10.1080/23294515.2019.1583691. View

15.

Okereke M, Ukor N, Adebisi Y, Ogunkola I, Favour Iyagbaye E, Owhor G . Impact of COVID-19 on access to healthcare in low- and middle-income countries: Current evidence and future recommendations. Int J Health Plann Manage. 2020; 36(1):13-17. DOI: 10.1002/hpm.3067. View

16.

Bastani P, Mohammadpour M, Samadbeik M, Bastani M, Rossi-Fedele G, Balasubramanian M . Factors influencing access and utilization of health services among older people during the COVID - 19 pandemic: a scoping review. Arch Public Health. 2021; 79(1):190. PMC: 8572573. DOI: 10.1186/s13690-021-00719-9. View

17.

Gebremariam K, Sadana R . On the ethics of healthy ageing: setting impermissible trade-offs relating to the health and well-being of older adults on the path to universal health coverage. Int J Equity Health. 2019; 18(1):140. PMC: 6727389. DOI: 10.1186/s12939-019-0997-z. View

18.

Mussie K, Elger B, Kaba M, Pageau F, Wienand I . Bioethical Implications of Vulnerability and Politics for Healthcare in Ethiopia and The Ways Forward. J Bioeth Inq. 2022; 19(4):667-681. PMC: 9908630. DOI: 10.1007/s11673-022-10210-x. View

19.

Mussie K, Gradmann C, Yimer S, Manyazewal T . Pragmatic Management of Drug-Resistant Tuberculosis: A Qualitative Analysis of Human Resource Constraints in a Resource-Limited Country context-Ethiopia. Int J Public Health. 2021; 66:633917. PMC: 8380763. DOI: 10.3389/ijph.2021.633917. View

20.

Emanuel E, Persad G, Upshur R, Thome B, Parker M, Glickman A . Fair Allocation of Scarce Medical Resources in the Time of Covid-19. N Engl J Med. 2020; 382(21):2049-2055. DOI: 10.1056/NEJMsb2005114. View