A Survey of What Healthcare Professionals Consider as Relevant for Decisional Autonomy in Health and Treatment in Nigeria.

BACKGROUND: Autonomy is one of the key ethical principles enshrined in Part II of the Nigerian National Health Act 2014. To ensure compliance with this principle, it is pertinent that Health Care Professionals (HCPs) understand and know what it entails to ensure that patients are empowered to pursue their decisional autonomy. This survey seeks to explore what HCPs consider as relevant for empowering patients to exercise decisional autonomy, in line with the Nigerian Health Act. METHODS: An online survey, targeted at Nigerian HCPs, was conducted to explore what they consider as relevant in enabling an individual to make autonomous decisions about their health and treatment. RESULTS: HCPs consider patients' soundness of mind as relevant in making autonomous decisions about their health and treatment. Factors such as patients' current health status, their understanding of treatment options, risks, benefits, and patients' ability to understand and retain information were considered relevant in making informed decisions about their health. Factor analysis of the study questionnaire revealed that the designed questionnaire can be used to audit how well HCPs empower their patients with their decisional autonomy. The reliability coefficient of the questionnaire was found at 0.718. CONCLUSIONS: Our study found a convergence of views by HCPs and the Nigerian Health Act on enabling the decisional autonomy of patients regarding their health and treatment. Competent patients should be given the necessary knowledge about their condition, available diagnosis, and available treatment as well as support to empower them to make truly autonomous decisions regarding their health and treatment.

CONTEXTE: L'autonomie est l'un des principes éthiques clés consacrés dans la partie II de la loi nationale nigériane sur la santé de 2014. Pour garantir le respect de ce principe, il est pertinent que les professionnels de la santé (PS) comprennent et sachent ce que cela implique pour garantir que les patients soient habilités à poursuivre leur autonomie décisionnelle.Cette enquête vise à explorer ce que les professionnels de la santé considèrent comme pertinent pour permettre aux patients d'exercer leur autonomie décisionnelle, conformément à la loi nigériane sur la santé. METHODES: Une enquête en ligne, destinée aux professionnels de santé nigérians, a été menée pour explorer ce qu'ils considèrent comme pertinent pour permettre à un individu de prendre des décisions autonomes concernant leur santé et traitement. RÉSULTATS: Les professionnels de la santé considèrent que la santé mentale des patients est importante pour prendre des décisions autonomes concernant leur santé et leur traitement. Les facteurs tels que l'état de santé actuel des patients, leur compréhension des options de traitement, des risques, des avantages, ainsi que leur capacité à comprendre et à retenir les informations ont été jugés pertinents pour prendre des décisions éclairées concernant leur santé. L'analyse factorielle du questionnaire de l'étude a révélé que le questionnaire conçu peut être utilisé pour vérifier dans quelle mesure les professionnels de la santé responsabilisent leurs patients grâce à leur autonomie décisionnelle. Le coefficient de fiabilité du questionnaire a été trouvé à 0,718. CONCLUSION: Notre étude a révélé une convergence de points de vue entre les professionnels de la santé et la loi nigériane sur la santé sur la manière de permettre l'autonomie décisionnelle des patients concernant leur santé et traitement. Les patients compétents doivent recevoir les connaissances nécessaires sur leur état, le diagnostic disponible et le traitement disponible, ainsi qu'un soutien pour leur permettre de prendre des décisions véritablement autonomes concernant leur santé et leur traitement. MOTS CLÉS: Autonomie décisionnelle, Professionnels de santé, Professionnels de santé, Santé et traitement, Éthique des professionnels.

A Triple Jeopardy: Inadequate Knowledge about COVID-19 among Older Persons with Psychiatric Diagnosis attending a Geriatric Centre in Southwest Nigeria.

BACKGROUND: Older persons with mental illnesses have been affected by COVID-19 because of reduced access to routine health care, the adverse social impacts of preventive strategies and inadequate knowledge of the COVID-19 pandemic. Adequate knowledge is crucial to ensuring adherence to the right preventive practices. OBJECTIVES: This study evaluates the knowledge gaps about COVID-19 and preventive practices among older persons with psychiatric diagnoses (PD) in comparison with older persons with non-psychiatric diagnosis (nPD). METHODS: A hospital-based comparative study was conducted among older persons attending the sycho-geriatric and Healthy Ageing clinics of the Geriatric Centre, University College Hospital, Ibadan, Nigeria. Data were gathered with a semi-structured interviewer-administered questionnaire, and SPSS version 23 was used to analyse the data. Level of significance was set at 5%. RESULTS: 390 respondents aged 60 and above were sampled in the two groups: 195 with PD and 195 with nPD. Their mean age was PD:72.2 (±7.4) years and nPD:71.0 (±8.0) years. Majority were aware of the ongoing pandemic (PD:95.9%; nPD:96.4%). The use of facemask (PD:89.7%; nPD:86.7%) was the commonest preventive practice. Male gender (OR: 2.09, CI ;1.14-3.86, p = 0.018) and education (OR: 5.10, CI; 1.15-22.67, p=0.032) were predictors of knowledge among PD and nPD respectively. CONCLUSION: Older persons with psychiatric diagnoses have more gaps in their knowledge of COVID-19. Inadequate knowledge about COVID-19 could further put them in jeopardy of contracting the virus with its associated morbidity and mortality, in addition to the risk that old age and mental illness contribute. Health education programs about COVID-19 targeting the older population with mental illnesses would be beneficial.

CONTEXTE: Les personnes âgées atteintes de maladies mentales ont été différemment touchées par la COVID-19 en raison d'un accès réduit aux soins de santé de routine, les impacts sociaux négatifs des stratégies de prévention et la connaissance insuffisante de la pandémie de COVID-19. Des connaissances adéquates sont essentielles pour garantir le respect des bonnes pratiques de prévention, en particulier chez les personnes âgées. OBJECTIFS: Cette étude évalue les lacunes dans les connaissances sur le COVID19 et les pratiques réventives chez les personnes âgées ayant des diagnostics psychiatriques par rapport à ceux avec un diagnostic non psychiatrique. METHODES: Une étude comparative en milieu hospitalier a été menée auprès de personnes âgées fréquentant les cliniques de psychogériatrie et de vieillissement en santé du Centre gériatrique, Hôpital du Collège Universitaire, Ibadan, Nigéria. Les données ont été recueillies à l'aide d'un questionnaire semi-structuré administré par un intervieweur, et SPSS version 23 a été utilisé pour analyser les données. Le seuil de signification a été fixé à 5%. RESULTATS: 390 répondants âgés de 60 ans et plus ont été échantillonnés dans les deux groupes: 195 avec undiagnostic psychiatrique (PD) et 195 avec undiagnostic non psychiatrique (nPD). Leur âge moyen était PD : 72.2 (± 7.4) ans et nPD: 71.0 (±8.0) ans. La majorité était au courant de la pandémie en cours (PD:95.9 %; nPD: 96.4 %). L'utilisation du masque facial (PD:89.7 %; nPD:86.7 %) était la pratique préventive la plus courante. Le sexe masculin (OR:2.09, IC;1.14-3.86, p=0.018) et l'éducation (OR :5.10, IC ;1.15-22.67, p=0.032) étaient des prédicteurs des connaissances chez les PD et les nPD respectivement. CONCLUSION: Les personnes âgées avec des diagnostics psychiatriques ont plus de lacunes dans leurs connaissances sur le COVID-19. Une connaissance insuffisante du COVID-19 pouurait les mettre davantage en danger de contracter le virus et c'est la morbidité et la mortalité associées, en plus du risque que la vieillesse et la maladie mentale contribuent. Des programmes d'éducation sanitaire sur le COVID-19 ciblant la population âgée souffrant de maladies mentales seraient bénéfiques.

Access and Discontinuity of Care at an Outpatient Mental Health Service for Older People in South Western Nigeria.

We examined frequency and reasons for dropout from follow-up care at an outpatient mental health service for older people in South-Western Nigeria. This was a cross-sectional study. Administrative reviews of 201 case records of clinic attendees who received a psychiatric diagnosis that required follow-up consultations were conducted. Records were those of patients seen between January 2015 and December 2017. Chart extraction was followed by Key Informant Interview (KII) to explore the reasons for drop out and partial non-attendance. We identified 37(18.4%) regular clinic attendees, as well as 147(73.1%) and 17(8.5%) dropout and partially attending patients, respectively. Approximately 45.6% of the dropouts occurred after the first consultation. In KII, distance from the hospital, long waiting times and financial constraints were the common reasons for dropout. The findings of this study should inform the development of strategies to improve access to mental health services in Nigeria and other low- and middle-income countries.

CLINICAL PROFILE AND PATTERN OF DEMENTIA IN A GERIATRIC CENTRE.

Background: Knowledge on the clinical presentation of dementia is essential for appropriate care, especially in Low-and-Middle-Income Countries where these cases are on a sharp rise and can also aid early detection of other underlying conditions.This study sought to provide a broad and updated socio-demographic, clinical profile, pattern of diagnosis and treatment features of people diagnosed with dementia in this setting. Method: A retrospective cohort study which reviewed the medical case records of all older adults with dementia receiving treatment at the psychogeriatric and the neurology clinic of the Geriatric Centre (N=192). A proforma was designed to collect information from the case records. Results: The mean (±SD) age of the participants was 74.0(±7.2) years, 97.9% lived with other persons, 50.0% had at least one comorbidity and 52.6% presented late for treatment. Overall, hypertension (64.1%) and diabetes (22.4%) were the most common comorbidity, 55.2% had complaints bordering on behavioural problems; irrational speech (31.3%) being the most common, while 91.7% had forgetfulness as a cognitive symptom. Conclusion: A high rate of comorbidities, as well as late presentation was common among the participants. Our findings appraise the clinical importance of detailed knowledge of the patterns and profiles of older adults with dementia for early presentation and treatment.