Networks, Not Just Cash: Perceived Social Support, LEAP Participation and Long-Term Care Needs Among Older Adults in Ghana

Background: Long-term care needs are rising in sub-Saharan Africa, yet the interplay between informal social capital and formal social protection in shaping functional dependence among older adults remains poorly understood.
Objectives: To examine how perceived social support from significant others, family and friends relates to dependence in activities of daily living (ADL), instrumental ADL (IADL) and long-term care need among older adults in Ghana, and whether these associations differ by participation in the Livelihood Empowerment Against Poverty (LEAP) cash transfer programme.
Methods: We analysed cross sectional data from 830 adults aged 60 years and older in six districts of Ghana. ADL and IADL indices were constructed from Barthel and Lawton items with good internal consistency. Perceived social support was measured using the Multidimensional Scale of Perceived Social Support. Sequential logistic regression models estimated associations between support subscales, LEAP participation and functional outcomes, adjusting for covariates and testing interactions.
Results: ADL dependence prevalence was 51.9%, while IADL and any dependence reached 95.5%. High friends support was associated with lower ADL dependence, and high significant other support with lower IADL and long-term care need, whereas high family support was associated with higher odds. LEAP main effects were null, but friends support interacted with LEAP to predict greater ADL dependence among beneficiaries. Advanced age, widowhood, manual work and urban residence predicted higher dependence. Conclusions: Long-term care needs are pervasive and shaped more by social support configurations and structural disadvantage than cash transfers alone. Policies strengthening social networks and local care systems may better address functional decline in older age.