1Socio-demographic characteristics of respondents by gender distribution. http://phcfm.org/index.php/phcfm/article/downloadSuppFile/211/500
Based on the ICPC 871 health problems were self-reported, with an average of 1.7 health problems per respondent (range 1–6). The majority of problems (n = 206, 41.2%) related to general body symptoms like fever, body pains and malaise. Almost an equal number of neurological and musculoskeletal problems were reported (n = 132, 26.4% and n = 130, 26.0% respectively). In addition, 99 respondents(19.8%) reported eye problems such as pain, redness and poor vision (Table 2).
2Self-reported health problems of respondents using ICPC classification. http://phcfm.org/index.php/phcfm/article/downloadSuppFile/211/501
A total of 1349 morbidities were diagnosed amongst the group, with an average of 2.7 per respondent (range 1–8). Figure 1 illustrates the morbidities according to the ICPC, organised according to gender. The most prevalent morbidities were found in the eyes (males = 50.8%; females = 52.7%), and cardiovascular (males = 49.2%; females = 46.3%) and musculoskeletal systems (males = 24.9%; females = 28.6%). Erectile dysfunction was the only cause of genital morbidity in the male respondents. Distribution across specific morbidities is shown in Table 3. Hypertension (40.0%) was the most commonly observed morbidity, followed by cataracts (39.4%) and osteoarthritis (26.8%).
3Morbidity pattern among respondents. http://phcfm.org/index.php/phcfm/article/downloadSuppFile/211/504
Anthropometric measurement of the respondents showed their mean height ± s.d to be 1.6 ± 0.1 m (range = 1.2–1.8 m) and mean weight ± s.d to be 63.5 ± 13.5 kg (range = 30.0– 109.0 kg). At a mean height of 1.62 ± 0.07 m the men were significantly taller than the women, whose mean height was 1.53 ± 0.06 m (p = 0.001; t = 15.543). However, mean weight of men and women (63.47 ± 12.12 kg vs 63.47 ± 14.32 kg) was not significantly different ( p = 0.998; t = –0.002). The mean BMI of the respondents was 25.9 ± 5.5 (range = 13.3–47.2), which was significantly higher amongst women (27.1 ± 5.7) than men (24.1 ± 4.6) (p = 0.001; t = 5.876). According to BMI cut-off values, the majority (n = 205, 41.0%) were described to have a normal BMI, 160 (32.0%) were overweight, 106 (21.2%) were obese and 29 (5.8%) were underweight. More men than women were underweight (63.3% vs 36.7%). Conversely, more women than men were obese (82.7% vs 17.3%). There was a significant association between BMI and gender (χ2 = 31.003, p = 0.001).Laboratory investigation showed the overall prevalence of anaemia to be 8.0%, which was significantly higher among women (11.2%) than men (2.6%) (χ2 = 13.011, p = 0.001). The mean PCV was 35.6 ± 4.6% (range = 10.0–50.0%); 37.8 ± 4.3% amongst men and 34.2 ± 4.3% amongst women. The urinalysis showed that 8.8% of respondents had glycosuria and 17.8% had proteinuria. DiscussionOutline of results This study highlighted the morbidity pattern of the elderly patients presenting at a general outpatient clinic in Nigeria. There was a predominance of female respondents who outnumbered their male counterparts by 1.7 to 1. This may be attributed to life expectancy, which is higher for women than men. At the time of the study, the life expectancy of Nigerian women was 47 years compared to 46 years for men. 13Also, women visit clinics for more frequently than men. The average number of self-reported health problems (presenting complaints) was less than the average number of morbidities (diagnoses) found amongst the respondents. This shows that the elderly often under-report their health problems and may attribute certain health problems to ageing, thus finding it unnecessary to complain about them to a physician. Finding multiple morbidities per respondent was similar to findings of earlier studies, although fewer were found than for studies in Botswana and India. 1,14 The average number of morbidities (diagnoses) found amongst the respondents (2.7 morbidities) was less than those reported for Botswana (5.2 morbidities) and India (6.0 morbidities). 1,14 These disparities could be related to cultural perception of illnesses and global differences in the prevalence of diseases. 1,6 Thus, the importance of a detailed history, comprehensive examination and necessary investigations cannot be emphasised enough in the management of elderly patients. Eye problems were the most commonly diagnosed morbidity amongst the respondents; cataracts accounted for more than three-quarters of the diagnoses. The high prevalence of cataracts (39.4%) amongst the respondents may be attributed to cultural fear of surgery, the cost of surgery and the belief that the diminution of vision is the consequence of ageing. In addition, elderly people seldom complain of health problems that do not inflict pain6 and they may not readily agree to have eye surgery. Hypertension was registered in two-fifths of the respondents. Globally, studies have shown that the prevalence of hypertension is increasing and may become a major primary health care problem with an increasing elderly population because blood pressure rises with age in nearly all populations. 1,6,10,15,16 Musculoskeletal problems were the third most common morbidities found amongst the respondents, with osteoarthritis found amongst 26.8% of the respondents. In previous studies amongst elderly African communities, osteoarthritis was one of the commonly observed problems. 1,6,17 Osteoarthritis compromises mobility and consequently tends to impair social and occupational functioning. 6 It leads to dependency on others, especially family members. Problems related to mental health were observed more often amongst the female respondents (28.6%) than the males (18.0%). The mental problems diagnosed included psychosomatic disorders, depression and psychosis. Uwakwe 18reported mental illness to occur at a prevalence of 23.1% among elderly Nigerians. At 13.2% diabetes mellitus was the most common endocrine problem found in this study. This prevalence was higher than what has been reported for the general population in a previous study, 19 probably because the present study was hospital based and also owing to a higher prevalence of diabetes with advancing age. Thus, the higher prevalence of diabetes in this study might not be surprising. Overweight and obesity were found in more than half of the respondents. Obesity was significantly more prevalent amongst women than men (p = 0.001). Bakare 5 reported similar findings amongst elderly people in south-western Nigeria. The dietary habits of elderly Nigerians tend towards consumption of high-energy foods like carbohydrates and animal fats. This nutritional habit and minimal physical activity have been implicated as the main reasons for the development of obesity, a situation that is contrary to the recipe for a healthy weight and healthy life. 5 Anaemia was found in 8.0% of the respondents and was significantly more prevalent among women than men (p = 0.001). Nutritional anaemia is common amongst the elderly due to intrinsic physiological decrease in food intake, taste, smell and gastric emptying, and dysregulation of satiation called ‘physiological anorexia of ageing’. 20 Another common cause of anaemia in the elderly is malignancy, which becomes more prevalent with advancing age. 20Practical implication The physician’s goals in the management of the elderly should include health promotion, early disease detection and prevention of frailty when possible. The traditional screening tests used during evaluation of younger patients should not be withheld from the elderly. The elderly should have routine urinalysis and BMI, PCV and blood pressure measurement. Limitation This was a hospital-based study of which the results may not be applicable to the general population. Recommendation The elderly should be encouraged to undergo periodic medical checks at a clinic for routine appraisal of their health status, so as to allow early detection and treatment of their morbidities. More studies on the morbidities of elderly patients presenting at hospitals in developing countries are needed to formulate a longitudinal frontline health care plan for the elderly. Conclusion This study has demonstrated that the elderly present with multiple morbidities and under-report their health problems, which they often attribute to ageing. The most prevalent health problems of the elderly were chronic medical illnesses like hypertension, cataracts, osteoarthritis and psychosomatic disorders – all conditions that are treatable. The high prevalence of overweight and obesity (found in more than half of the respondents) is worrisome when its public health impact is considered. 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