Interplay of gender, environmental sustainability, and cognitive impairment among older adults in Ghana: insights from the 2021 population and housing census.

backgroundCognitive impairment, which includes difficulties with memory and concentration, poses a growing challenge to healthy ageing, particularly in low- and middle-income countries. In Ghana, the prevalence of cognitive impairment is significant, yet the combined associations of key social and environmental determinants remain under-researched. This study investigated how sex and environmental sustainability factors are associated with cognitive impairment among older adults in Ghana.

methodsThis study analysed pooled data from the 2021 Ghana Population and Housing Census (GPHC), focusing on a sample of 32,486 adults aged 60 years and older. Cognitive impairment was assessed based on self-reported difficulties in remembering or concentrating. The primary independent variables were sex and environmental sustainability factors, including household sources of drinking water, toilet facilities, methods of solid waste disposal, cooking fuel, and cooking space. Descriptive statistics, chi-squared tests, and hierarchical multivariate logistic regression were employed to examine associations, with results presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). The outcome was coded as "no cognitive impairment" to align with a health assets/strengths-based perspective, facilitating interpretation of protective factors.

resultsThe analysis revealed that older women were significantly less likely to be free from cognitive impairment compared to their male counterparts (AOR = 0.61, 95% CI = 0.55, 0.69). Regarding environmental factors, the use of clean cooking fuel (LPG, biogas, or electricity) was independently and significantly associated with a higher likelihood of no cognitive impairment (AOR = 1.41, 95% CI = 1.23, 1.61). While access to improved water (AOR = 1.16, 95% CI = 0.87, 1.55), improved toilet facilities (AOR = 1.08, 95% CI = 0.97, 1.20), improved waste disposal (AOR = 1.14, 95% CI = 0.98, 1.32), and improved cooking space (AOR = 1.01, 95% CI = 0.91, 1.12) showed positive point estimates, none of these associations reached statistical significance. These null findings should not be interpreted as evidence of no effect; rather, they highlight the need for longitudinal studies with more detailed environmental exposure measures to fully understand the relationship between WASH factors and cognitive health in this population.

conclusionsThis study suggests that cognitive health in later life is shaped by modifiable structural factors. The pronounced sex disparity, with older women at higher risk of cognitive impairment, underscores the need for gender-sensitive health strategies that address cumulative socioeconomic disadvantages. Furthermore, the significant protective association found for clean cooking fuel highlights household energy transitions as a promising intervention for cognitive preservation. These findings advocate for integrating healthy ageing objectives into Ghana's gender equality and environmental sustainability agendas. CLINICAL TRIAL NUMBER: Not applicable.