Profile of cognitive impairment and health status of the elderly in a sub-Saharan African community: relevance to public policy and health service design

Abstract

Background: There is scanty report on the cognitive impairment and health status of the elderly in the sub-saharan African community.

Objective: This study is to investigate the pattern of cognitive impairment and health morbidities among the elderly in a sub-Saharan African community.

Methods: A household survey was conducted among 350 elders. They were interviewed with a questionnaire to ascertain their socio-demographic and health status information. Subsequently, the modified Mini-Mental State Examination [MMSE] was administered to elicit cognitive impairment based on cut-off score ≥13.

Results: The mean MMSE score among participants was 20.7(±5.3) and about one-tenth of them 38(10.9%) had cognitive impairment. Of the study sample, 44% reported physical health morbidities; hypertension (23.2%), diabetes mellitus (10%) and visual impairment (5.4%) were the most frequently occurring morbidities. Cognitive impairment was associated with increasing age and most prevalent among the middle olds [70-79 years] (p<0.001), while formal education seems protective (p=0.022). Likewise, those with formal education were more likely to report medical illnesses (p=0.004). Following logistic regression to control for effects of confounders, absence of formal education (Odd Ratio [OR] =0.465; 95% Confidence Interval [95%CI] =0.207-1.046) and increasing age ([OR] =6.617; 95%CI= 3.129- 13.993) were independent predictors of impairment in cognitive function.

Conclusion: A high burden of cognitive impairment along with health morbidities was prevalent among the elderly; while increasing age and formal education were the identifiable determinants. Evolvement of public policies, health resource planning and service design to address geriatric health issues using age-related prioritization model are advocated. Similarly, the promotion of population literacy is indicated as it seems to have positive, long-lasting socioeconomic as well as health effects into old age. Further research is also justified.

Keywords: Africa; Cognitive impairment; Health service; Morbidity; Public policy