Frailty and mortality among older patients in a tertiary hospital in Nigeria

Background: This study determined the frailty status and its association with mortality among older patients.Design: A prospective cohort design.Setting: Study was conducted at the medical wards of University College Hospital, Ibadan, Nigeria. Participants and study tools: Four hundred and fifty older patients (>60 years) were followed up from the day of admission to death or discharge. Information obtained includes socio-demographic characteristics and clinical frailty was assessed using the Canadian Study of Health and Aging (CSHA) scale. Bivariate and multivariate analyses were carried out using SPSS version 21 at a p <0.05.Results: Overall, frailty was identified in 285 (63.3%) respondents. Mortality was significantly higher among frail respondents (25.3%) than non-frail respondents (15.4%) p=0.028. Logistic regression analysis showed factors associated with frailty were: male sex (OR=1.946 [1.005–3.774], p=0.048), non-engagement in occupational activities(OR=2.642 [1.394–5.008], p=0.003), multiple morbidities (OR=4.411 [1.944–10.006], p<0.0001), functional disability (OR=2.114 [1.029–4.343), p=0.042], malnutrition (OR=9.258 [1.029–83.301], p=0.047) and being underweight (OR=7.462 [1.499–37.037], p=0.014).Conclusion: The prevalence of frailty among medical in-hospital older patients is very high and calls for its prompt identification and management to improve their survival.Keywords: Frailty, Mortality, Older patients, in-hospital, NigeriaFunding: The study was self-funded by the author

Potential inappropriate prescribing among ambulatory elderly patients in a geriatric centre in southwestern Nigeria: Beers criteria versus STOPP/START criteria

Purpose: To identify potentially inappropriate prescribing in ambulatory elderly patients and compare the appropriateness of guidelines; Beers' and Screening Tool of Older Person’s Prescription (STOPP)/Screening Tool to Alert Right Treatment (START) criteria to detect potentially  inappropriate prescribing among the elderly.Methods: A retrospective study was conducted using case files of 335 elderly patients aged ≥ 60 years between 1st January and 31st December  2016, using a data extraction sheet. The 2015 American Geriatrics Society (AGS)-Beers Criteria, and version 2 of the STOPP and START were  subsequently used to identify the Potentially Inappropriate Prescribing (PIP) and Potential Prescribing Omissions (PPOs).Results: Mean age of patients was 69 ± 0.4 years (range 60 - 85 years) and 219 (65.4 %) were females. An average of 4.2 medications per patient prescription was found. The Beers criteria identified 26.5 % PIP, while STOPP criteria identified 57.1 % PIP. START detected 29 PPOs in 15 (4.4 %) of the patient’s prescription. The most prevalent disease conditions were hypertension 235 (70.1 %) and osteoarthritis 64 (19.3 %). Polypharmacy was significantly associated with PIP in both Beers (p = 0.002) and STOPP (p = 0.001) criteria.Conclusion: The prevalence of PIP is high among elderly patients. The STOPP/START criteria identified a higher proportion of PIP among elderly patients compared with Beers criteria. The frequency of PIP should stimulate efforts to curtail potentially inappropriate prescribing and may require the need for advocating for a national criterion to be adopted by health care professionals in Nigeria. Keywords: Potential inappropriate prescribing, Beers’ criteria, STOPP/START criteria, Elderl

Potentially inappropriate medication use among older patients attending a geriatric centre in south-west Nigeria

Objectives: To determine the prevalence and describe factors associated with the use of potentially inappropriate medication (PIM) among older patients. Methods: Cross sectional study of 400 older patients selected systematically at the geriatric centre, University College Hospital, Ibadan between July and September 2016. With the aid of semi-structured questionnaires, information on the socio-demographic characteristics, lifestyle habits, healthcare utilisation and morbidities was obtained. The Beer’s criteria 2015 update was used to identify the PIMs. Predictors of PIMs were determined using multivariate analyses at alpha 0.05. Results: Age was 70.2 (SD=5.9) years and 240 (60%) were females. General prescription pattern showed antihypertensives (34.7%) as the commonest medications used. The point prevalence of PIMs use was 31%. In all, 10 PIMs were used by the respondents. The majority (81.5%) were using one PIM, while (17.7%) used two PIMs and (0.8%) 3 PIMs. NSAIDs (72.6%) were the commonest PIMs identified, followed by the benzodiazepines (24.2%). Respondents had an average of 1.9 morbidities, and mulitmorbidity found in 60.5%. Logistic regression analysis showed self-rated health assessed as better compared with age-mates [OR =1.718 (1.080–2.725)] and being physically active [OR =1.879 (1.026–3.436)] as the most significantly associated with PIMs use. Conclusions: The use of PIMs among older patients in our setting was high with NSAIDs being the most frequently used medications. An interdisciplinary approach, of medication review by pharmacists’, working with physicians may improve prescribing practices among older persons. Therefore, it is necessary to create public health awareness on the use of PIMs among older persons

Breast examination as a cost-effective screening tool in a clinical practice setting in Ibadan, Nigeria

Background: Breast cancer is a disease of public health importance. It results in high morbidity and mortality in women worldwide. The high morbidity and mortality from breast cancer can be decreased by measures targeted at early detection such as screening. Breast examination as a screening tool for breast cancer in developing countries is advocated in view of its costeffectiveness. Method: The article selection method was obtained from primary and secondary literature sources which included original research articles, case control studies, review articles, proceedings, transactions and textbooks. The authors cited a clinical audit and articles published between 1988 and 2011. The search strategy included the use of internet search engines. This review was part of a larger research and the study protocol was approved by the University of Ibadan/University College Hospital, Ibadan Institutional Review Board (UI/UCH IRB). Clinical trial registration number-NHREC/05/01/2008a. Results: Breast self-examination (BSE) and clinical breast examination (CBE) as screening tools for breast cancer were analysed in detail. Conclusion: Breast examination is a screening tool that is cost-effective and reliable and should be encouraged in resource-constrained countries. Given the high cost and expertise required for mammography, current efforts at screening for breast cancer in developing countries should rely more on a combination of BSE and CBE

Factors Associated with Insomnia among Elderly Patients Attending a Geriatric Centre in Nigeria

Background. Insomnia is a form of chronic sleep problem of public health importance which impacts the life of elderly people negatively. Methods. Cross-sectional study of 843 elderly patients aged 60 years and above who presented consecutively at Geriatric Centre, University College Hospital, Ibadan, Nigeria. The World Health Organization Composite International Diagnostic Interview was used to diagnose insomnia. We assessed the following candidate variables which may be associated with insomnia such as socidemographic characteristics, morbidities, and lifestyle habits. Statistical analysis was done with SPSS 17. Results. The point prevalence of insomnia was 27.5%. Insomnia was significantly associated with being female, not being currently married, having formal education, living below the poverty line, and not being physically active. Health complaints of abdominal pain, generalized body pain, and persistent headaches were significantly associated with insomnia. Conclusion. The high prevalence of insomnia among elderly patients in this setting calls for concerted effort by healthcare workers to educate the elderly on lifestyle modification

Profile and correlates of functional status in elderly patients presenting at a primary care clinic in Nigeria

Background: Assessing the functional status of elderly patients is central in measuring their health outcome. Little is known about the functional status of elderly patients attending our primary care clinic in Nigeria. Objective: To assess the correlates of functional status in elderly patients presenting at the General Outpatient Clinic of the University College Hospital, Ibadan, Nigeria. Method: A cross-sectional study of 360 randomly selected patients aged 60 years and above was undertaken to assess their functional status by scoring their basic activities of daily living (BADL) using the Modified Bathel Index. An interviewer-administered questionnaire was used to obtain the socio-demographic data, anthropometric measurements and morbidities of each patient. Results: The mean age was 69.1 ± 6.6 years with a female-to-male ratio of 1.9: 1. The prevalence of overall functional disability (defined as when assistance was sought in the performance of at least one of the components of BADL) was 88.3%. The highest prevalence of functionaldisability was experienced in the area of personal hygiene and grooming (95.3%) and transferring from bed to chair (95.3%). Overall functional disability significantly increasedwith increasing age (χ2 for trend=14.004, p < 0.0001), living in a polygamous family unit (p = 0.025), and lack of formal education (p = 0.020). Conclusion: Functional disability was high amongst the elderly in this setting. Age, education, and living in a polygamous type of family unit had significant influence on the functional status. High premium should, therefore, be placed on considering these factors in reducing functional disability in the elderly