The right to sanitation is a core human right vital for maintaining health and preserving dignity; however, insufficient access continues to pose a major problem around the world. This issue particularly adversely affects susceptible groups, including elderly individuals. The present research examines the geographical patterns and socioeconomic factors associated with sanitation access for older persons in Ghana. Data were drawn from the 2021 Population and Housing Census, with Moran's I, Getis-Ord Gi* hotspot analysis, and Anselin Local Moran's I cluster and outlier techniques applied to evaluate spatial patterns in sanitation access. Logistic regression was utilized to identify predictors of sanitation access. Results revealed notable variations across regions and districts in Ghana regarding sanitation availability for the elderly. Factors at the individual level, including gender, age group, marital situation, educational background, urban/rural location, religious affiliation, possession of household items, and presence of disabilities, played a key role in determining access to sanitation. In particular, the multivariable logistic regression showed that women exhibited greater likelihood of having sanitation access compared to men (AOR: 1.054, CI 1.023, 1.087, p-value < 0.001). Similarly, individuals aged 80 and older demonstrated increased odds relative to the 60–69 age category (AOR: 1.171, CI 1.129, 1.214, p-value < 0.001). Furthermore, persons who were separated or divorced (AOR: 1.374, CI 1.263, 1.494, p-value < 0.001), widowed (AOR: 1.143, CI 1.059, 1.234, p-value < 0.001), or single (AOR: 1.208, CI 1.077, 1.354, p-value < 0.001) showed higher probabilities of sanitation access than those in informal cohabitation arrangements. Moreover, individuals with any history of school attendance had markedly elevated odds compared to those without (AOR: 2.749, CI 2.662, 2.838, p-value < 0.001). These results underscore the importance of comprehensive strategies that account for geographic differences and personal characteristics to successfully tackle inequalities in sanitation provision.
