Ethical issues in caring for older persons in Sub-Saharan Africa: a scoping review

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BACKGROUND: Rapid population ageing in sub-Saharan Africa (SSA) is unfolding within fragile health systems, weak social protection, and limited geriatric and palliative services, creating ethical challenges in older adult care. This study critically reviews current literature and policy reports, synthesizes key themes, and proposes evidence-based recommendations for policy, practice, and research. METHODS: This scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology and reported following PRISMA-ScR guidelines. A comprehensive search of biomedical, ethics, social science, and grey literature databases was undertaken to identify studies published between 2000 and 2025 on ethical issues in the care of older adults in Sub-Saharan Africa. Eligible English-language sources were screened by predefined inclusion criteria, and data were charted and synthesized thematically to map key ethical issues, concepts, and evidence gaps. RESULTS: We identified multiple ethical challenges that affect older adult care in SSA, including justice, equity, autonomy, dignity, vulnerability, abuse, and ageism. Healthcare-related concerns involve unmet needs, resource allocation dilemmas, limited palliative and end-of-life care, and age-biased clinical decisions. Socially, weakening family support systems create moral tensions for caregivers. Policy analyses emphasise rights-based, culturally sensitive, and equitable approaches, highlighting the need for integrated ethical, social, and systemic care strategies. CONCLUSIONS: Addressing ethical issues in older care in SSA requires legally enshrined protections, health-system investments, public campaigns to counter ageism, supportive decision-making frameworks that respect cultural contexts and individual rights and strengthened research and surveillance. A right-based, culturally sensitive approach focused on the voices of older persons is essential. REGISTRATION: The protocol for this scoping review was registered on the Open Science Framework (OSF) and is available at https://doi.org/10.17605/OSF.IO/9AXVW.

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