Ageing in place or stuck in place: Preferred care setting for community-dwelling older persons in a low-resource country in Sub Saharan Africa.

BACKGROUND: Ageing in Place is the emerging social policy drive for long-term care coordination of older persons globally. This decision may be the only viable option in many low- and middle-income countries like Nigeria. Nevertheless, the risk of older persons being 'stuck in place' is high if their preferences are not considered or other alternatives are neither acceptable nor available. This study determined factors associated with the preferred care setting among community-dwelling older persons and explored their views about their choices. METHODS: The study utilised a mixed-methods approach. Participants were older persons (≥ 60 years) in a selected rural and urban community in Oyo State, south-western Nigeria. Quantitative data were collected using an interviewer-administered, semi-structured questionnaire and analysed using Stata version 14 at p<0.05. Qualitative data collection involved 22 Focus Group Discussions (FGD). The discussions were audiotaped, transcribed verbatim and analysed thematically using ATLAS.ti version 8. Selected quotations were used to illustrate themes. RESULTS: 1,180 participants (588 rural vs 592 urban) were interviewed with a mean age of 73.2 ±9.3 years. More rural participants preferred to AIP (61.6%) compared to urban participants (39.2%), p = 0.001. Factors associated with the decision for rural participants were older age [OR:2.07 (95%CI:1.37-3.14)], being male [OR:2.41(95%CI:1.53-3.81)] and having assistance at home [OR:1.79 (95%CI:1.15-2.79)]. In comparison, significant factors for urban participants were older age (≥70years) [OR:1.54(95%CI:1.03-2.31)] and home-ownership [OR:5.83 (95%CI:3.82-8.91)]. The FGD revealed that the traditional expectation of reciprocity of care mostly influenced the desire to AIP. Advantages include improved social connectedness, quality of care, community participation and reduced isolation. Interestingly, participants were not opposed to the option of institutional care. CONCLUSION: Ageing in place is preferred and influenced by advanced age and home ownership in our setting. Information provided could guide age-friendly housing policies and community-based programmes for the care of older persons.

Caring for older adults during the COVID pandemic and beyond: experience from a specialized tertiary facility for the care of older persons in a low resource setting.

The ongoing Coronavirus disease (COVID-19) pandemic has markedly changed health care provisions and arrangements for patient care. Older adults are most susceptible to worse outcomes. The public health impact of the disease in terms of morbidity and mortality has necessitated the evolution of management protocols for effective care of older persons. This review describes our experience during this period attending to the healthcare needs of both the acutely ill and clinically stable patients at the first purpose-built facility for the care of older persons in Nigeria, the Chief Tony Anenih Geriatric Centre (CTAGC), University College Hospital, Ibadan. A major strategy recommended by the World Health Organization was a lockdown with restricted movements and laid down rules for engagement. As such, the CTAGC also embarked on steps to ensure patient safety as well as effective care. Prior to the lockdown, targeted activities included fumigation of the centre as well as health education and promotional activities. Measures were put in place to care for up to 95% of our patients at home. Thus, a "Care in Place" approach was adopted to enable them to take ownership of their care. Ambulatory older patients were seen on an out-patient basis following scheduled appointments after a telephone consultation through the hospital's designated lines. Clients were managed for their routine health conditions which were mostly non-communicable diseases (NCDs). Also, acutely ill older patients were admitted for acute exacerbation and/or complications of their chronic morbidities. Importantly, 60% of admitted patients presented with COVID like symptoms but they all tested negative for COVID 19. Based on our experience at the CTAGC, older persons can be successfully managed through a "Care in place" approach in a resource-poor setting during pandemics with high infectivity rates such as COVID 19. The information hereby generated is beneficial for future practice.

Older persons' perceptions about advanced directives and end of life issues in a geriatric care setting in Southwestern Nigeria.

INTRODUCTION: Advanced directives enable the planning of care and support services independent of the older person's ability to make the decision. There is a paucity of information regarding the views and preferences regarding advanced directives and other end of life issues among older persons in low and middle-income countries such as Nigeria. The study aimed to explore the knowledge, attitude and belief of older persons regarding decision making surrounding end of life and advance directives. METHODS: Data were collected through focus group discussions at a monthly social gathering of outpatients in a geriatric center in Oyo State, Nigeria. Discussions were audiotaped, transcribed and analyzed manually using a thematic approach. RESULTS: Respondents' knowledge about the end of life care and advanced directives as prescribed in high income settings were sparse and did not include choices about treatment options or any medical directives. The predominant perceptions among the participants bordered mainly on the arrangements for place of death, burial and property sharing. Participants listed in order of preference the major decision makers in the advanced directive process mainly, the oldest male child, religious leaders and legal practitioners. CONCLUSION: Our findings imply the need for improving knowledge and awareness about the benefits of advanced directives among older persons with a focus on opportunities for their active participation.

Older persons' views and experience of elder abuse in South Western Nigeria: a community-based qualitative survey.

OBJECTIVES: Conventionally, existing information on elder abuse has been institution based, professionally driven, and in high-income countries. This study addresses the prevailing gap in knowledge through direct consultation of older persons in the community about their perceptions of elder abuse. METHOD: Eight focus group discussions were carried out among males and females aged 60 years and above in a rural and an urban community in south western Nigeria. Data were transcribed and analyzed based on emergent themes. RESULTS: Findings from the study show that the perception of abuse by the respondents included the standard typologies except sexual abuse as well as societal issues such as disrespect and lack of recognition. DISCUSSION: Our study revealed a high level of awareness and experience of elder abuse among the participants in both communities. Effective social welfare and health services aided by targeted government policies are needed to improve the quality of life of the elderly.