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.

Day and night blood pressure variability among older persons in South-Western Nigeria.

Background: Hypertension is the largest contributor to the global burden of disease. Emerging risk factors for cardiovascular disease include blood pressure variability (BPV), but evidence on BPV is lacking among older Nigerians. We reported BPV in a cohort of older persons at the University College Hospital (UCH), Ibadan. Methods: We conducted a retrospective cohort study of respondents aged >50 years within the Ibadan Ambulatory Blood Pressure Registry at the UCH, Ibadan, Nigeria. Socio-demographic characteristics, lifestyle habits and anthropometric measurements were obtained. Results: Among 639 respondents, 332 (52.0%) were female. The blood pressure (BP) variables were strongly associated with age. Compared with younger age groups, mean diastolic BP (DBP) was less at an older age, whereas mean pulse pressure was greater. During the wake-up and sleep periods, mean DBP and mean arterial BP were less with each increasing age category, whereas mean pulse pressure was larger with each increasing age category. BP dipping, systolic, diastolic and mean arterial BP decreased with age. Overall, timed BPV increased significantly with increasing age. The prevalence of white-coat hypertension was greater among older participants than younger participants. Most respondents in the 50-59 years' age group were non-dippers (55.8%), whereas 33.7% of older respondents were reverse-dippers. Conclusion: Older persons experienced a greater abnormal circadian blood variation and greater BPV than younger people. In Nigeria, follow-up data are needed to determine the prognostic significance of these data in this population.

Day and night blood pressure variability among older persons in South­Western Nigeria

Background: Hypertension is the largest contributor to the global burden of disease. Emerging risk factors for cardiovascular disease include blood pressure variability (BPV), but evidence on BPV is lacking among older Nigerians. We reported BPV in a cohort of older persons at the University College Hospital (UCH), Ibadan. Methods: We conducted a retrospective cohort study of respondents aged >50 years within the Ibadan Ambulatory Blood Pressure Registry at the UCH, Ibadan, Nigeria. Socio-demographic characteristics, lifestyle habits and anthropometric measurements were obtained. Results: Among 639 respondents, 332 (52.0%) were female. The blood pressure (BP) variables were strongly associated with age. Compared with younger age groups, mean diastolic BP (DBP) was less at an older age, whereas mean pulse pressure was greater. During the wake-up and sleep periods, mean DBP and mean arterial BP were less with each increasing age category, whereas mean pulse pressure was larger with each increasing age category. BP dipping, systolic, diastolic and mean arterial BP decreased with age. Overall, timed BPV increased significantly with increasing age. The prevalence of white­coat hypertension was greater among older participants than younger participants. Most respondents in the 50­59 years' age group were non-dippers (55.8%), whereas 33.7% of older respondents were reverse-dippers. Conclusion: Older persons experienced a greater abnormal circadian blood variation and greater BPV than younger people. In Nigeria, follow­up data are needed to determine the prognostic significance of these data in this population

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.

Predictors of mortality among older patients in the medical wards of a tertiary hospital in Nigeria.

BACKGROUND: Older people face the biggest challenges in the overburdened healthcare services in Nigeria especially when hospitalized. There is no reliable data on the predictors of mortality in this population. AIMS: To determine the predictors of mortality among older patients on admission in the medical wards of University College Hospital, Ibadan. METHODS: Using a prospective cohort design, we investigated 450 patients (> 60 years) from the day of admission to death or discharge. Variables assessed included sociodemographic, family dynamics, lifestyle habits, healthcare utilization, quality of life, frailty, anxiety, depression, cognition, functional disability and anthropometric parameters. Kaplan-Meier method and Log-rank test were used to estimate and compare survival functions, respectively. Cox proportional hazard regression analysis was used to determine the predictors of mortality. RESULTS: The mean age of the subjects was 71.5 ± 8.0 years and 234 (52.0%) were females. Overall, there were 99 (22.0%) in-hospital deaths. The median survival time (MST) was 36.0 ± 3.0 days [females = 40.0 ± 3.5 days vs males = 31.0 ± 4.5 days (p < 0.001)]. There was a significant negative correlation between MST and age (r = - 0.931). Predictors of mortality on Cox's proportional hazard regression analyses were male sex HR = 2.03 (95% CI 1.27-3.24), severe frailty HR = 2.07 (1.02-4.20), cognitive impairment HR = 1.90 (1.14-3.17) and having ≥ 5 morbidities HR = 1.94 (1.14-3.30). CONCLUSION: There was a high mortality among older patients particularly the frail, male or those with multiple morbidities. Prompt and holistic management of morbidities and targeted interventions for cognitive impairment and frailty are needed to improve survival during hospitalization.

Factors associated with reported snoring among elderly patients attending the geriatric centre in Nigeria.

INTRODUCTION: Snoring is the major symptom of sleep disordered breathing (SDB) which is of immense public health importance. It is associated with some morbidities and mortality in the elderly. Few studies have addressed this problem in the elderly Nigerians. METHODS: Cross-sectional study of 843 elderly patients at the Geriatric Centre, University College Hospital, Ibadan, Nigeria. Data were collected on the following candidate variables which may be associated with snoring such as socio-demographic characteristics, morbidities, lifestyle habits and functional disability using Katz index. Anthropometric measurements such as body mass index and neck, waist and hip circumferences were taken. Statistical analysis was done with SPSS 17. RESULTS: The point prevalence of reported snoring was 31.2%. Habitual snoring was reported by 24.8%. Snoring was significantly associated with obesity, moderate to severe oropharyngeal crowding, wide neck and waist circumferences in both sexes. Logistic regression analysis showed wide neck circumference (OR = 6.005; 95%CI= 2.150-16.770) among the males and obesity (OR = 2.028; 95%CI= 1.344-3.061) and moderate to severe oropharyngeal crowding (OR = 1.639; 95%CI= 1.057-2.543) in the females to be the most significant factors associated with snoring. CONCLUSION: The high prevalence of snoring among elderly patients in Nigeria calls for concerted effort by healthcare workers to educate the elderly.

Prevalence and correlates of erectile dysfunction among primary care clinic attendees in Nigeria.

INTRODUCTION: Erectile dysfunction (ED) has become a public health issue in Nigeria because of its increasing magnitude, association with chronic medical conditions and negative impact on sexual life. MATERIALS AND METHODS: Cross-sectional study of 450 male patients aged 18-70 years who presented with non-ED related complaints. Main outcome measurements were prevalence and severity of ED which was assessed with International Index of Erectile Function (IIEF-5) and single-item sexual function questionnaire. Also assessed were socio-demographic characteristics, physical activities, sexual satisfaction and morbidities. RESULTS: The prevalence of ED was 55.1% (mild, moderate and severe were 32.6%, 17.8% and 4.7% respectively). Prevalence of ED was significantly associated with age (p < 0.0001), marital status (p = 0.032), income (p = 0.001), social class (p = 0.004), physical activities (p = 0.006) and BMI (p = 0.012). Prevalence of ED was significantly high among men with diabetes mellitus (72.7%), hypertension (70.7%), peptic ulcer disease (70.4%) and previous prostate surgery (76.2%). Logistic regression showed dissatisfaction with sexual life (OR = 0.689, CI = 1.233-5.866; p = 0.013) and having sexual activities less than desired (OR = 3.331, CI = 1.416-7.839; p = 0.006) to be the most significant factors associated with ED. There was a strong positive correlation between the IIEF-5 and single-item sexual function questionnaire (r = 0.747, p < 0.0001). CONCLUSION: The prevalence of ED is high among males attending a primary care clinic in Nigeria with non-ED related complaints. ED was more prevalent in men with chronic medical illnesses and sedentary lifestyle. Family physicians should inquire about this condition in these men and refer them early for specialist consultation.