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.

Training of Doctors at the Geriatric Centre, University College Hospital, Ibadan, Nigeria.

BACKGROUND: The population of older people is increasing exponentially and geriatric care is just evolving in Nigeria. There is a shortage of training opportunities for doctors in Nigeria to care for older people. METHODS: This was an account of the conceptualisation, structure, and outcomes of the annual two-week basic certificate course in geriatric medicine for doctors at the University College Hospital (UCH), Ibadan, Nigeria, between 2016 and 2022. RESULTS: In all, 204 doctors were trained. Their mean age was 40.1 ± 8.5 years, and 105 (51.5%) were females. Majority (80%) worked in public hospitals, especially in the tertiary health sector (62.2%). Annual participation increased from 26 participants in 2016 to 39 participants in 2022. Knowledge acquisition was the main reason for attending the course (56.7%). There were 42 didactic lectures and ten clinical/practical sessions. On average, participants' self-rating in caring for older persons improved significantly after (80.2 ± 12.7%) than before (49.9 ± 16.4%) the course [mean difference = 30.24%, 95%CI (25.91-34.57), p<0.0001]. Similarly, the overall post-course test score in the 20 MCQs (14.08 ± 2.89) was significantly higher than the pre-course test (12.51 ± 2.01) scores [Mean difference = 1.57, 95%CI (0.45-2.69), p = 0.007]. Some participants (37.8%) had commenced special clinics for older persons in 39 institutions across Nigeria. CONCLUSION: Our training programme has yielded a modest increase in the capacity building of doctors for the care of older Nigerians. However, more concerted efforts are needed to train more doctors throughout Nigeria.

CONTEXTE: La population des personnes âgées augmente de façon exponentielle et les soins gériatriques sont en pleine évolution au Nigeria. Les médecins nigérians manquent de possibilités de formation pour s'occuper des personnes âgées. MÉTHODES: Il s'agit d'un compte rendu de la conceptualisation, de la structure et des résultats du cours annuel de certificat de base de deux semaines en médecine gériatrique pour les médecins à l'University College Hospital (UCH), Ibadan, Nigéria, entre 2016 et 2022. RÉSULTATS: Au total, 204 médecins ont été formés. Leur âge moyen était de 40,1±8,5 ans et 105 (51,5%) étaient des femmes. La majorité (80%) travaillait dans des hôpitaux publics, en particulier dans le secteur tertiaire de la santé (62,2%). La participation annuelle a augmenté de 26 participants en 2016 à 39 participants en 2022. L'acquisition de connaissances était la principale raison de participer au cours (56,7 %). Il y a eu 42 conférences didactiques et dix sessions cliniques/pratiques. En moyenne, l'auto-évaluation des participants en matière de soins aux personnes âgées s'est améliorée de manière significative après (80,2±12,7%) qu'avant (49,9±16,4%) le cours [différence moyenne=30,24%, 95%CI (25,91-34,57), p<0,0001]. De même, le score global au test post-cours dans les 20 QCM (14,08±2,89) était significativement plus élevé que le score au test pré-cours (12,51±2,01) [différence moyenne=1,57, 95%CI (0,45- 2,69), p=0,007]. Certains participants (37,8%) ont commencé à travailler dans des cliniques spéciales pour les personnes âgées dans 39 institutions à travers le Nigeria. CONCLUSION: Notre programme de formation a permis une augmentation modeste de la capacité des médecins à soigner les Nigérians âgés. Cependant, des efforts plus concertés sont nécessaires pour former davantage de médecins dans tout le Nigeria. Mots-clés: Main-d'œuvre, Formation, Médecins, Gériatrie, Nigeria.

Relationship between family dynamics, spirituality, quality of life and happiness among older adults in Nigeria.

Happiness of older adults in rarely studied in the global south like Nigeria compared with the global north. This study assessed the relationship between family dynamics, spirituality, quality of life and happiness among older adults in Nigeria. Cross-sectional study of 378 older adults (≥60 years) were selected. Oxford Happiness questionnaire, the family dynamics, spirituality, and quality of life (QoL) were determined with the Family Relationship Index, spiritual Index of Well-being scale and Quality-of-Life Brief questionnaire respectively. Descriptive and inferential statistics were carried out at α0,05. The mean age was 72,8±7,1 years and 255 (67,5%) were females. Majority 313 (82,8%) were assessed to be happy. Overall, family dynamics, spirituality, and health related QoL were significantly determinants of happiness (p<0,05). Among the women, there was good cohesion in the family dynamics (p=0,031), good health related QoL in the physical domain (p<0,001) and satisfaction with health (p=0,036) were the predictors of happiness. Having higher self-efficacy (p=0,018) and life scheme spirituality (p=0,050) were the predictors of happiness among the men. The present findings showed that most of the older adults were happy. Routine assessment and interventions could increase the feeling of happiness among older adults in the global south.

Integrative Care of the Older Persons in Nigeria: An Appraisal of the Geriatric Centre, University College Hospital, Ibadan.

BACKGROUND: Geriatric medicine is an emerging subspecialty in Nigeria. The interest in the care of older Nigerians followed the Madrid International Plan of Action on Ageing in April 2002. This led to an increase in research, publications and advocacy culminating in the establishment of the pioneer geriatric centre in Nigeria in 2012. Since then, there has been an increase in capacity building, manpower development and institutionalization of geriatric care in Nigeria. This is an account of the evolution of the Chief Tony Anenih Geriatric Centre, University College Hospital, Ibadan (UCH). METHODS: We undertook the review of the history, structure and key service elements in the Geriatric Centre, UCH from January 1, 2013, to December 31, 2020. RESULTS: The number of patients rose from 2,559 in the first year to 19,300 by the end of 2020. The initial four multidisciplinary units increased to 12 over the review period. Likewise, the in-patient admission increased between the first year (122 patients) and 2020 (141 patients). The overall mortality rate was 11.4% over the review period. Internship opportunities were provided to students including resident doctors, undergraduates (medical) and postgraduate students (Masters and PhD). Besides, 139 medical doctors have undergone the annual basic certificate training in geriatric medicine organised by the Centre. Also, 7 fellowship dissertations and 11 peer-reviewed papers have been published. CONCLUSION: The centre has demonstrated the possibility of caring for older patients in a low-resource setting. The employment of the multidisciplinary approach yielded a low mortality rate, higher attendance and manpower development.

CONTEXTE: La médecine gériatrique est une sous-spécialité émergente au Nigéria. L'intérêt pour les soins aux Nigérians âgés a suivi le Plan d'action international de Madrid sur le vieillissement en avril 2002. Cela a conduit à une augmentation de la recherche, des publications et du plaidoyer aboutissant à la création du centre gériatrique pionnier au Nigéria en 2012. Depuis lors, il y a eu Il y a eu une augmentation du renforcement des capacités, du développement de la main-d'œuvre et de l'institutionnalisation des soins gériatriques au Nigeria. Ceci est un compte rendu de l'évolution du Chief Tony Anenih Geriatric Centre, University College Hospital, Ibadan (UCH). MÉTHODES: Nous avons entrepris l'examen de l'historique, de la structure et des éléments de service clés du Centre gériatrique, UCH du 1er janvier 2013 au 31 décembre 2020. RÉSULTATS: Le nombre de patients est passé de 2 559 la première année à 19 300 fin 2020. Les quatre unités multidisciplinaires initiales sont passées à 12 au cours de la période d'examen. De même, l'hospitalisation a augmenté entre la première année (122 patients) et 2020 (141 patients). Le taux de mortalité global était de 11,4 % au cours de la période d'examen. Des opportunités de stages ont été offertes aux étudiants, notamment aux médecins résidents, aux étudiants de premier cycle (médecine) et aux étudiants de troisième cycle (maîtrise et doctorat). Par ailleurs, 139 médecins ont suivi la formation annuelle certifiante de base en médecine gériatrique organisée par le Centre. En outre, 7 thèses de bourses et 11 articles évalués par des pairs ont été publiés. CONCLUSION: Le centre a démontré la possibilité de prendre en charge des patients âgés dans un milieu à faibles ressources. L'emploi de l'approche multidisciplinaire a donné un faible taux de mortalité, une fréquentation plus élevée et un développement de la main-d'œuvre. Mots-clés: Soins intégratifs, personnes âgées, Centre gériatrique, Ibadan, Nigéria.

Attitude towards ageing and perceived health status of community-dwelling older persons in a low resource setting: a rural-urban comparison.

BACKGROUND: Older person's attitude to ageing is critical for their adjustment, acceptance of health-related behaviour, survival and choices. Their attitude influences how they cope with the challenges experienced while ageing, which affects their quality of life and health-related outcomes. Despite the increasing number of older persons in sub-Saharan Africa, there is limited information about their experience. This study examines the experience and attitude of older persons in Nigeria regarding the ageing process. METHODS: A descriptive cross-sectional study among older persons aged 60 years and above was carried out in a selected rural and an urban community in Oyo State, south-western Nigeria. The study participants were selected using a multi-stage sampling technique. Trained research assistants collected data with the aid of an interviewer-administered, semi-structured questionnaire. The Attitude to Ageing Questionnaire (AAQ) was used to measure participants' perception of ageing in three domains (psychosocial loss, physical changes and psychological growth). Data were analysed using Stata version 14 at a level of significance p < 0.05. RESULTS: A total of 1,180 participants (588 rural vs. 592 urban) were recruited for the study. The mean age was 73.2 ± 9.3 years. The majority (69.7 %) were females and still working (50.5 %). Overall, urban-dwelling participants had a better attitude to the ageing process in all the domains compared with rural-dwelling participants (psychological growth 32.5 ± 3.4 vs. 32.4 ± 3.3, p = 0.30; physical change 27.5 ± 5.1 vs. 26.9 ± 5.0, p = 0.03; and psychosocial loss 25.3 ± 5.7 vs. 25.0 ± 5.3, p = 0.60). Among the rural and urban-dwelling participants, good self-rated health was significantly associated with a positive attitude to ageing across the domains. CONCLUSIONS: Older persons residing in urban communities had higher positivity to ageing than their rural older counterparts. The common factor significantly associated with a positive attitude to ageing in both groups was good self-rated health. This information can be used for the planning of targeted interventions and informing policy formation for improved provisions for community-dwelling older persons in Nigeria and other sub-Saharan African countries.

Visual Morbidities among Patients at a Geriatric Center in Southwest Nigeria and the Merits of Designated Geriatric Health Care Centers Incorporating Eye Care Services.

BACKGROUND: : Visual morbidities increase the burden of care and negatively impact the quality of life of older people. Few empirical reports exist on the visual status of older Nigerians. AIM: This study describes the visual morbidities and determinants of visual impairment among persons aged 60 years and above who presented at a geriatric center in southwestern Nigeria and discusses the merits of focused geriatric care at a single location. MATERIALS AND METHODS: Data were obtained from electronic health records and case files of 628 older patients (≥60 years) who attended the facility between January 1, 2014 and December 31, 2018. Data extracted included, age, sex, married status, occupational status, visual acuity, eye diagnoses, eye medications, previous surgeries, and anthropometric measurements. RESULTS: Mean age of patients was 70.1 ± 7.4 years and 378 (60.2%) were females. Two out of every three patients had more than one visual diagnosis. Significantly, glaucoma (P < 0.001) and cataract (P = 0.01) were common among men, whereas dry eye syndrome (P < 0.001) and allergic conjunctivitis (P = 0.01) were common in women. Antiglaucoma medications (55.8%) were the commonest medications used and 21.0% had previous eye surgery. Assessment of presenting visual acuity demonstrated that 28.7% of patients had moderate-severe visual impairment (MSVI) in both eyes at presentation while 10.3% were bilaterally blind. Increasing age (P < 0.001) and male sex (P = 0.01) were the factors significantly associated with blindness. CONCLUSION: MSVI and blindness were common in our setting with glaucoma and cataract being the most prevalent associated diagnosis. Information obtained should stimulate advocacy for the prompt management of preventable causes of poor vision in older Nigerians.

Adult Pneumococcal Vaccination: A Review of Current Status and Challenges in Nigeria.

Pneumococcus is a major cause of life-threatening invasive infections accounting for considerable morbidity and mortality among older adult population. The burden of pneumococcal infections (non-invasive) is mostly determined by Community Acquired Pneumonia. Globally and from public health perspective, vaccination has been recognised as a preventive measure of infectious diseases, thereby reducing health care cost, morbidity and mortality. Most high-income countries have included the pneumococcal vaccination in their mandatory and voluntary vaccination policies. However, many low and middleincome countries of the world have not adequately addressed the issue of adult pneumococcal vaccine. This overview describes the current status of pneumococcal vaccination and strategies to reduce the rate of pneumonia in this age group. Our aim is to stimulate the adoption of policies and production of national guidelines for the use of pneumococcal vaccines in Sub-Saharan Africa.

Le pneumocoque est une cause majeure d'infections invasives potentiellement mortelles et représente une morbidité et une mortalité considérables chez les personnes âgées. Le fardeau des infections à pneumocoques (non invasives) est principalement déterminé par la pneumonie communautaire. À l'échelle mondiale et du point de vue de la santé publique, la vaccination a été reconnue comme une mesure préventive des maladies infectieuses, réduisant ainsi le coût des soins de santé, la morbidité et la mortalité. La plupart des pays à revenu élevé ont inclus la vaccination antipneumococcique dans leurs politiques de vaccination obligatoire et volontaire. Cependant, de nombreux pays à revenu faible et intermédiaire du monde n'ont pas suffisamment abordé la question du vaccin antipneumococcique adulte. Cet aperçu décrit l'état actuel de la vaccination antipneumococcique et les stratégies visant à réduire le taux de pneumonie dans ce groupe d'âge. Notre objectif est de stimuler l'adoption de politiques et la production de directives nationales pour l'utilisation des vaccins antipneumococciques en Afrique subsaharienne. Mots clés : pneumonie acquise dans la communauté, personnes âgées, charge de morbidité, vaccin antipneumococcique polyosidique, vaccin conjugué antipneumococcique.

Prevalence and Correlates of Frailty Syndrome among Older Adults Attending Chief Tony Anenih Geriatric Centre, University College Hospital, Ibadan.

BACKGROUND: Frailty has emerged as an important clinical measurement among older adults because of its negative health outcomes. OBJECTIVE: This study measured the prevalence and factors associated with frailty among older adults aged 60 years and above at a Geriatric Centre in Nigeria. METHODS: In this descriptive cross-sectional study, 971 older adults were recruited consecutively. Data on sociodemographics characteristics and clinical parameters were obtained using an interviewer-administered questionnaire and physical examination performed. The Frailty syndrome and Frailty Index were assessed using the Fried Frailty Criteria (FFC) and Canadian Study of Health and Aging (CSHA) scale respectively. Bivariate and multivariate analyses were carried out using SPSS version 21 at a p <0.05. RESULTS: The mean age of the participants was 71.3 (± 7.1) years with a female to male ratio of 2.4:1. Based on FFC scale, 498 older persons (51.3%) had frailty syndrome while only 148 (15.2%) were frail using the CSHA scale. The measure of agreement (Kappa statistics) was 0.22 (p<0001) indicating weak agreement between the two scales. Logistic regression analysis revealed increasing age (OR=1.948 [1.219-3.113]), multiple morbidities (OR= 1.584, [1.177-2.201]), depression (OR= 5.050, [2.501-9.442,]), imbalance or increased risk of fall (OR 1.623, [1.192-2.211,]), and inability to perform IADL (OR= 0.599 [0.535-0.670,]) to be the most significant determinants of frailty syndrome while obesity (OR=0.660, [0.449-0.971]), unusually appeared a deterrent. CONCLUSION: The prevalence of frailty syndrome was high among the older adults. Targeted and timely interventions on the modifiable factors may delay progression into frailty and the eventual negative health outcomes.

CONTEXTE: La fragilité a ete emerge comme un élément clinique important mesure chez les personnes âgées en raison de son état de santé négatif les résultats. OBJECTIF: Cette étude a mesuré la prévalence et les facteurs associée à la fragilité chez les personnes âgées de 60 ans et cidessus dans un centre gériatrique au Nigéria. MÉTHODES: Dans cette étude transversale descriptive, 971 des adultes plus âgés ont été recrutés consécutivement. Les données sur les caractéristiques sociodémographiques et les paramètres cliniques ont été obtenu à l'aide d'un questionnaire administré par l'enquêteur et un examen physique effectué. Le syndrome de fragilité et l'indice de fragilité ont été évalués à l'aide du Fried Frailty Critères (FFC) et étude canadienne sur la santé et le vieillissement (CSHA) respectivement. Bivarié et multivarié les analyses ont été réalisées à l'aide de SPSS version 21 à p <0,05. RÉSULTATS: L'âge moyen des participants était de 71,3 (± 7,1) ans avec un ratio femmes / hommes de 2,4: 1. Basé sur l'échelle FFC, 498 personnes âgées (51,3%) avaient un syndrome de fragilité alors que seulement 148 (15,2%) étaient fragiles selon l'échelle de la SCVS. La mesure d'accord (statistiques Kappa) était de 0,22 (p <0001) indiquant faible accord entre les deux échelles. Une analyse de régression logistique a révélé une augmentation de l'âge (OR = 1,948 [1,219-3,113]), morbidités multiples (OR = 1,584, [1.177-2.201]), dépression (OR = 5.050, [2.501-9.442,]), déséquilibre ou risque accru de chute (OR 1.623, [1.192-2.211,]), et l'incapacité d'effectuer une IADL (OR = 0,599 [0,535-0,670,]) pour être les déterminants les plus importants du syndrome de fragilité obésité (OR = 0,660, [0,449-0,971]), apparaissait inhabituellement dissuasif. CONCLUSION: La prévalence du syndrome de fragilité était élevée parmi les personnes âgées. Interventions ciblées et opportunes sur les facteurs modifiables peuvent retarder la progression vers la fragilité et les éventuels effets négatifs sur la santé. Mots clés: Syndrome de fragilité; Corrélats; Les adultes plus âgés; Gériatrie.

Insights into the gut microbiota of Nigerian elderly with type 2 diabetes and non-diabetic elderly persons.

Type 2 diabetes (T2D) is a prevalent non-communicable disease among the world's growing elderly population. The contribution of the gut microbiota to T2D in several Westernized countries has been established. However, there is little information on the role of the gut microbiota in T2D from the African continent where lifestyle and life expectancy are different. AIMS: This study sought to investigate gut microbiota variation in relation to elderly people living with T2D. in Nigeria. METHODS: Whole microbial community DNA were derived from the stool samples of healthy urban-dwelling elderly individuals and urban-dwelling elderly individuals with T2D. The V4 region of the 16S rRNA gene was Illumina-sequenced and analyzed using QIIME2. RESULTS: Beta taxonomic diversity was significantly different between healthy elderly individuals and elderly individuals with T2D. However, no difference in the alpha taxonomic diversity and predicted functional alpha diversity of the gut microbiota was observed. The genus Ruminococcus (T2D versus Healthy: 2.89% vs 2.21%), families Coriobacteriaceae (Collinsella, T2D versus Healthy: 2.62 % vs 1.25%) and Bifidobacteriaceae were enriched in elderly individuals with T2D, while members of Clostridiaceae (Clostridium, Healthy versus T2D: 5.6% vs 3.2%) and Peptostreptococcaceae (Healthy versus T2D: 3.45% vs 1.99%) were enriched in healthy volunteers. Pathways involved in amino acid biosynthesis were enriched in elderly individuals with T2D, while pathways involved in respiration and the biosynthesis of vital building blocks were enriched in healthy volunteers. CONCLUSIONS: The study demonstrated for the first time in an African elderly population that the abundance of Bifidobacteriaceae, Collinsella, and Ruminococcus within the gut varies in relation to T2D. Findings from this study suggest that the restoration of features associated with healthiness via the way of gut microbiota modification could be one step needed to improve elderly patient care.

Mortality Trends among Older Patients Admitted to the Geriatric Centre, University College Hospital, Ibadan, Nigeria, 2013-2017.

BACKGROUND: Attaining successful clinical outcomes in the management of hospitalised older patients in the overburdened healthcare services in Nigeria constitutes a major challenge against the backdrop of dearth of data on the predictors of mortality among them. OBJECTIVES: To describe the mortality trends and associated factors among older patients (>60 years) at the Geriatric Centre, University College Hospital, Ibadan between January 2013 and December 2017. METHODS: Hospital records of older patients admitted were analysed. Data extracted included socio-demographic, diagnoses, length of stay from date of admission to discharge or death. Results of vital signs, anthropometric measurements and laboratory tests carried out at admission were also obtained. RESULTS: The mean age of the 1,091 older patients admitted was 73.6±8.6 years. The overall crude proportion of in-hospital deaths was 9.0% (males=11.3% > females=7.2%, p=0.024) and it increased from 4.1% in 2013 to 12.1% in 2017. The overall unadjusted 30-day mortality rate per 1000 patient-days was 28.9 deaths (95% CI 23.5-35.3). The predictors of mortality were increased length of stay on admission OR=1.061 (95% CI 1.005-1.119), being retired OR=1.672 (95% CI 1.011-2.778), stroke OR=4.019 (95% CI 2.258- 7.138), heart failure OR=3.435 (95% CI 1.455-8.100), Sepsis OR=2.176 (95% CI 1.294-3.654), Anaemia OR=2.820 (95% CI 1.320-6.017), Dementia OR=3.701 (95% CI 1.433-9.549) and malignancies OR=2.658 (95% CI 1.181-5.979). CONCLUSION: There was a temporal increase in mortality among older patients. Similarly, staying longer on admission and chronic medical conditions with their complications were the most significant contributors to mortality.

FACTORS ASSOCIATED WITH SEXUAL DYSFUNCTION AMONG FEMALE PATIENTS IN A NIGERIAN AMBULATORY PRIMARY CARE SETTING.

BACKGROUND: Sexual dysfunction is a common but under-reported problem of public health importance among female adults in Nigeria. Empirical evidence on sexual dysfunction among female Nigerians is scarce. OBJECTIVE: To determine the prevalence and risk factors associated with sexual dysfunction among female patients presenting at the General Outpatient Clinic (GOPC), University College Hospital (UCH), Ibadan, Nigeria. METHODOS: This was a cross-sectional study of 480 married female patients who presented consecutively at the GOPC, UCH, Ibadan, Nigeria. The 28-item Sexual Function Questionnaire (SFQ-28) was used to determine sexual dysfunction. Information on their sociodemographic characteristics, obstetric and gynecological history were obtained. Bivariate and multivariate analyses were carried out and alpha was set at 0.05. RESULTS: Point prevalence of sexual dysfunction was 80.0%. The most common sexual dysfunction was problems with sexual desire (99.4%), while the least common was problems with arousal cognition (5.8%). There was a significant association between the prevalence of sexual dysfunction and age, years of relationship, number of children alive, parity, level of education, age at coitarche and family dysfunction. Age (OR=0.893; 95% CI=0.821-0.972, p=0.008), parity (OR=3.093; 95% CI=1.174- 8.151, p=0.022), having family dysfunction (OR=2.096; 95% CI= 1.129-3.891, p=0.019) and having ≥10 years of formal education (OR=4.808; 95% CI= 2.604-8.928, p<0.0001) were found to be the predictors of sexual dysfunction. CONCLUSION: Sexual dysfunction among female married adults in our setting was high. We propose that modifiable factors such as socio-demographic and gynaecological variables should be evaluated during the consultation of female patients at first contact.

Mortality among older patients admitted to the medical wards of Groote Schuur Hospital, Cape Town, South Africa, 2010 - 2013.

BACKGROUND: Geriatric medicine is an evolving specialty in Africa, and little is known about mortality among older patients admitted to medical wards. OBJECTIVES: To determine mortality rates and associated factors among older medical inpatients. METHODS: Electronic data on patients aged ≥60 years admitted to the medical wards of Groote Schuur Hospital, Cape Town, South Africa, between January 2010 and December 2013 were analysed. Data extracted included sex, age, causes of death, and length of stay from date of admission to discharge or death. Results of laboratory tests carried out during the admission were also obtained. RESULTS: In all, 11 254 older patients were admitted (mean (standard deviation) age 70.7 (7.9) years). There were 1 701 deaths (15.1%). The unadjusted mortality rate was 29.6 deaths per 1 000 patient-days (PD). The majority (87.5%) were admitted as emergency cases. Mortality in the first 24 hours was 32.4 deaths per 1 000 PD. There was a significant increase in mortality with increasing age (p<0.001). Stroke was the commonest cause of mortality (14.5%). The predictors of mortality were short length of stay on admission (odds ratio (OR) 1.047, 95% confidence interval (CI) 1.033 - 1.061), high white blood cell count (OR 1.064, 95% CI 1.054 - 1.074), low platelet count (OR 0.999, 95% CI 0.996 - 1.000), low haemoglobin (OR 0.940, 95% CI 0.917 - 0.964) and high blood urea (OR 1.042, 95% CI 1.033 - 1.051). CONCLUSIONS: Mortality among older medical inpatients was high. Modifiable predictors of mortality, especially related to laboratory derangements, should be identified and addressed promptly.

Factors associated with sarcopenia among older patients attending a geriatric clinic in Nigeria.

CONTEXT: Aging is characterized by progressive and generalized loss of skeletal muscle mass and strength called sarcopenia which causes poor health and disability. There is paucity of data on this syndrome of public health importance among older Nigerians. AIM: This study determined the prevalence and factors associated with sarcopenia among persons aged 60 years and above at a geriatric center in Nigeria. MATERIALS AND METHODS: A cross-sectional study of 642 persons aged ≥60 years who attended the geriatric center between March and July 2014. Sarcopenia was diagnosed using the European Working Group on Sarcopenia in Older People criteria. Bivariate and multivariate analyses were carried out using SPSS 20. Alpha was set at 0.05. RESULTS: The mean age ± standard deviation of the respondents was 69.1 ± 7.2 years, and 378 (60.6%) were females. The point prevalence of sarcopenia was 5.4% which was significantly higher among the females compared with the males (7.1% vs. 2.8%) P = 0.02. Low muscle mass and low gait speed were found in 10.9% and 36.1%, respectively. Logistic regression analysis showed age (odds ratio [OR] =1.090; 95% confidence interval [CI] =1.034-1.149, P = 0.01), having no formal education (OR = 2.810; 95% CI = 1.043-7.573, P = 0.04), malnutrition (OR = 5.817; 95% CI = 1.471-23.434, P = 0.01), and female gender (OR = 3.068; 95% CI = 1.068-8.817, P = 0.04) to be the predictors of sarcopenia. CONCLUSION: Older people in this setting are at risk of developing sarcopenia, especially the females. Healthcare workers should address the social and health-related factors which could lead to sarcopenia.

A descriptive study of the morbidity pattern of older persons presenting at a Geriatric Centre in Southwestern Nigeria.

CONTEXT: Rapid population ageing is a demographic reality in most countries of the world. Old age is associated with changes which may culminate in health problems, necessitating provision of appropriate preventive, curative, and rehabilitative services. However, reports from many low- and middle-income countries have shown lack of preparedness to cater for the healthcare needs of older persons. AIM: This study described the morbidity profile and its determinants among persons aged 60 years and above who presented at an established geriatric centre in southwestern Nigeria. MATERIALS AND METHODS: Data were obtained from electronic health records of 4886 patients aged ≥60 years who visited the facility between 1st January 2013 and 31st December 2014. Data were analyzed using Stata version 13 (Texas, USA). Frequency distributions were used for descriptive analysis, and chi-square test was used to test associations. RESULTS: More than a half, 2919 (59.7%), of the respondents were females and almost three quarters 3501 (71.7%) were aged between 60 and 74 years. Mean number of morbidities was 1.81 ± 0.9, and less than half, 1097 (42.0%), presented with only one morbidity, most commonly, hypertension. There were significant age-related differences for musculoskeletal (P = 0.001), endocrine (P = 0.01), and psychological problems (P = 0.01). In addition, gender differences were observed as a significantly higher proportion of females presented with general symptoms (P = 0.02) and musculoskeletal problems (P = 0.0001) than men. CONCLUSION: The most common presenting morbidities at this geriatric health centre were mostly noncommunicable diseases. Information obtained will be useful in the design of similar facilities in other parts of the country and region at large.

Physical functionality and self-rated health status of adult patients with knee osteoarthritis presenting in a primary care clinic.

BACKGROUND: Knee osteoarthritis is a chronic medical condition of public health importance in Nigeria which causes disability and impacts daily activities in the sufferers. This study aimed to describe the physical functionality and self-rated health status of adult patients with clinical knee osteoarthritis presenting at the Family Medicine Department, University College Hospital, Ibadan, Nigeria. METHODS: This was a cross-sectional study of 400 respondents. Knee osteoarthritis was diagnosed clinically using the criteria of the American College of Rheumatology. Morbidities, self-rated health status and physical functionality of the respondents were also assessed. RESULTS: Knee osteoarthritis was diagnosed in 46(11.5%) respondents. Respondents with knee osteoarthritis significantly rated their health worse than those without knee osteoarthritis (p <0.0001). Experience of pain, stiffness and performance of daily activities were significantly worse among respondents with knee osteoarthritis. Those who had knee osteoarthritis had significantly higher waist (p <0.0001), hip (p <0.0001) and knee circumferences (p <0.0001) respectively. Logistic regression analysis showed increasing age (OR=1.103; 95% CI=1.022 - 1.191), self-rated health worse than six months ago (OR=12.562; 95% CI=1.178-125.243), experience of stiffness after waking up in the morning (OR=12.758; 95% CI=3.572-45.569), stiffness after sitting/lying down/resting (OR=21.517; 95% CI=2.213-209.220) and waist circumference (OR=1.225;95% CI=1.017-1.477) to be the most significantly associated with knee osteoarthritis. CONCLUSION: Knee osteoarthritis significantly impairs the health and daily activities of adult patients in Ibadan, Nigeria. Healthcare workers need to screen adult patients routinely at first-contact to detect knee osteoarthritis clinically early and manage appropriately.

Plasma homocysteine, B vitamins and bone mineral density in osteoporosis: a possible risk for bone fracture.

BACKGROUND: Changes in plasma total homocysteine (tHcy) folic acid, vitamins B12 and B6 in individuals with osteoporosis are reported to impair collagen cross-linking and contribute to low bone mineral density (BMD). There is paucity of information on these associations in osteoporotic patients at risk of bone fractures in Nigeria. The study evaluated plasma tHcy, folic acid, vitamins B12 and B6, in relation to BMD in individuals with osteoporosis. METHODS: Fifty osteoporotic patients age 57.05 +/- 1.9 years were selected and fifty non osteoporotic volunteer's age 54.8 +/- 0.9 years were included as controls. The osteoporotic group consisted of 11 males and 39 females (1:3.5) while the controls consisted of 13 males and 37 females (1:2.8) respectively. Bone mineral density, anthropometric indices plasma tHcy, folic acid, vitamins B12 and B6, were determined using standard procedures. RESULTS: The results showed remarkably significant increase in plasma tHcy (p < 0.001) (180%) compared with the control value. Striking significant decreases were observed in folic acid (62%), vitamins B12 (42%), B6 (59%) and BMI p < 0.001) compared with control values. Positive correlation was obtained between vitamin B12 and BMD (r = 0.311, p < 0.05). CONCLUSION: Significant increase in tHcy with corresponding decreases in folic acid, vitamins B12 and B6 are related to decrease in BMD in osteoporotic patients. These changes could be important risk factors for bone fracture in osteoporotic Nigerians. Supplementation with the B vitamins may be beneficial to the patients.

Nutritional status of older persons presenting in a primary care clinic in Nigeria.

The study objective was to determine the nutritional status and its association with sociodemographic characteristics and health complaints of older persons presenting at the General Outpatients Department (GOPD) Clinic of University College Hospital (UCH), Ibadan, Nigeria. A cross-sectional descriptive design was used to select 500 consecutively presenting participants aged 60 years and older between September and December, 2009. The Mini-Nutritional Assessment (MNA) tool and body mass index were used to assess undernutrition and overweight, respectively. The prevalence of nutritional problems was 61.9% (undernutrition = 7.8% and overweight = 54.1%). Being unmarried (P < 0.001), engagement in a job after the age of 60 years (P < 0.001), constipation (P = 0.009), rectal bleeding (P = 0.008), and oral problems (mouth, teeth, and tongue) were significantly (P < 0.001) associated with undernutrition. Younger age (P = 0.050) and female gender (P = 0.011) were significantly associated with being overweight. Logistic regression analysis showed being unmarried OR = 1.355 (95%CI 1.075-1.708) to be the most important factor for the development of undernutrition. The high prevalence of nutritional problems in this study underscores the need for intervention in this population. Correlation analysis (Pearson's) showed a positive association between BMI and MNA scores (r = 0.152, P = 0.001).

Visual morbidities among elderly patients presenting at a primary care clinic in Nigeria.

BACKGROUND: Visual challenges compromise mobility, increase dependency on family members and constitute a major health problem mainly seen by the primary care physicians among the elderly. However, there is little information on the pattern of visual problems of elderly patients attending the primary care clinics in Nigeria. OBJECTIVE: To describe the visual problems among elderly subjects in a hospital setting. METHODS: Five hundred consecutive patients (311 females and 189 males) aged 60 years and above were interviewed using a structured questionnaire based on the World Organization of Family Doctors (Wonca) format between September 2004 and April 2005. The main outcome measurements were sociodemographic characteristics, visual acuity and ocular problems. RESULTS: The main visual problems reported by the elderly were impaired vision 224 (44.8%) and abnormal sensations in the eyes 64 (12.8%). Cataract 198 (39.7%) was the commonest eye disorder diagnosed by the Family Physician, followed by pterygium 32 (6.4%). Assessment of binocular acuity revealed blindness in 109 (21.8%) and low-vision in 68 (13.6%). The prevalence of visual impairment increased significantly with age. CONCLUSION: Visual impairment is a common problem of the elderly people in the hospital setting, with cataract being the main cause. Efforts should be made to detect these conditions early and institute treatment promptly.

Factors associated with undernutrition and overweight in elderly patients presenting at a primary care clinic in Nigeria

Background: Undernutrition and overweight are commonly overlooked health problems of the elderly, often due to the implicit assumption that undernutrition is a rare occurrence in old age and overweight is an invariable consequence of ageing. Method: A cross-sectional descriptive study of 500 patients aged 60 years and above who presented consecutively at the general outpatient department, University College Hospital, Ibadan, between September and October 2009, was undertaken. The main outcome measures were prevalence of nutritional problems (undernutrition and overweight), healthcare utilisation pattern and morbidities. The Mini Nutritional Assessment (MNA) tool was used to assess undernutrition, while body mass index was used to assess body weight. Results: The prevalence of undernutrition and overweight was 7.8% and 54.1%, respectively. Previous hospital admission (p < 0.001) and chronic morbidities like hypertension (p < 0.001), osteoarthritis (p < 0.001) and psychosomatic disease (p < 0.001) were significantly associated with undernutrition, but not with overweight. Logistic regression analysis showed that previous hospital admission (OR = 2.105, 95% CI 1.479-2.996) and hypertension (OR = 0.122, 95% CI 0.048-0.306) were the most important factors contributing to the development of undernutrition. Conclusion: Nutritional problems were prevalent among the elderly in this setting. Co-morbidities in the elderly constitute risk factors to be addressed in order to reduce the occurrence of nutritional problems. Health workers should always assess the elderly for nutritional problems, together with other morbidities with which they may present, and institute appropriate management

Complications of classical tracheostomy and management.

Tracheostomy can prevent many deaths in otherwise fatal airway diseases and problems but has numerous complications that are mostly avoidable if the procedure is carefully performed together with strict postoperative management. This is a retrospective review of tracheostomy complications over a 10 year period (1991-2002) in the Department of Otorhinolaryngology (ORL), University College Hospital, Ibadan. A total of 179 tracheostomies performed on 168 patients with 69 complications (38.6%) were documented. There was a significantly greater number of complications in the 43 emergency cases (54%) than in the 26 elective cases 1(46%), P = 0.0002]. The overall mortality rate was 2.2%. The most common complications of tracheostomy were infective in origin, representing 43% of all complications. This study highlights the complications and mortality and gives details of management that will prevent or minimize their occurrences. Those who require long-term tracheostomy must be on regular follow-up and taught home-care of the tracheostomy before discharge from the hospital.