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A scoping review of age-related health conditions among geriatric populations in sub-Saharan Africa

Background Globally people are living longer, resulting in an increased demand for primary care services to be responsive to geriatric health needs. There is however, little data on the nature and prevalence of age-related health conditions among people aged 60 years and older in the sub-Saharan African (SSA) region. This scoping review was undertaken to synthesise evidence on the scope and nature of age-related health needs among people aged 60 years and older in SSA, in order to inform reforms in health systems and health professions education. Methods We systematically searched five electronic databases for studies published prior to 30 June 2019. Using the keywords “Africa”, “older adult” or “geriatric”, and “health”, two independent reviewers used a set of eligibility criteria to extract and screen the abstracts and full-text publications. Particular focus was given to age-dependent disorders in people over 60 years such as dementia, disability and falls. Results Sixty-four studies met the inclusion criteria. The review revealed a noticeable absence of studies from the majority of Sub-Saharan African countries. Publications included for review represent twelve countries from this region. The morbidities reported on included dementia, functional impairment, mental health, falls, sarcopenia and nutritional disorders, sensory impairment, frailty and musculoskeletal disorders. Many of these conditions co-existed among older adults, resulting in impaired quality of life and disability. Modifiable factors for geriatric morbidity such as hypertension, depression, cognitive and sensory impairments were under-diagnosed and often untreated. empiric research and age-related health conditions related health conditions was comparable to that in high-income countries. However, chronic conditions in the elderly were underdiagnosed and undertreated, often resulting in disability. An urgent review of current health systems and health professions training is required, taking into consideration the findings of this study. Ethics and dissemination : This study did not include human participants. Data was sourced from published literature.

increasing demand for geriatric health services in SSA could further compromise the fragile and resource-constrained health systems in SSA.(9, 10, 14) Most of the evidence on geriatric heath needs are derived from studies conducted in high income countries (HIC) with different health systems and resources to this region.
Health systems in SSA are resource-limited and often fragmented. It is unclear how the complex health needs of geriatric populations are identified and managed by health providers in SSA countries. It is also important to identify geriatric health needs not currently addressed by existing health systems in order to inform the planning of future services. Health professions educators and policy makers need to consider the unique health needs of aged populations in order to deliver quality health services that will address the various age-related health conditions in older adults and preserve function.
This study was conducted to identify, explore and map literature on age-related health conditions and associated factors among geriatric people in SSA. It forms part of a study on the undergraduate medical geriatric curriculum, and is intended to inform educational guidelines for the training of health professionals in geriatric care. The results of this review are also intended to inform health policymakers and health professions educators of services required by people aged 60 years and older in SSA. It is anticipated that the study will also identify gaps for further research, and help advocate for increased resources for research and training in geriatric health services.

Methods
The objectives of the review, the inclusion criteria and methods were specified in advance and documented in a protocol. (16) This scoping review was guided by the methodological framework proposed by Arksey and O'Malley. (15) Thus, the following five steps were followed in conducting the scoping review, (i) identifying the research question, (ii) identifying relevant studies, (iii) selection of eligible studies, (iv) charting the data and (v) collating and summarizing the results.

Identifying the research question
The specific research questions were as follows: What are the different age-related health conditions reported on in people aged 60 years and older in in sub-Saharan Africa(SSA)?
What is the reported incidence and prevalence of age-related conditions in people aged 60 years and older in SSA? What are the factors associated with age-related disorders in people aged 60 years and older in SSA? These databases include clinical trials, theses, and scientific publications. The following Medical Subject Headings (MeSH) were used: older adult, geriatric, aged, primary care, health and Africa. An example of the full search strategy can be seen in Table 1. The inclusion criteria applied to studies from the literature search are described in Table 2. Particular focus was given to age-dependent disorders in people over 60 years such as dementia, disability and sensory impairments. These conditions are associated with increased use of health services and therefore most likely to affect the quality of life in this age group. Studies published outside the study period, from countries other than the SSA countries, that involved residential care or inpatient participants, not primary studies and not available in full text, were excluded from the analysis. Studies on older adults that did not report specifically on participants aged 60 years and older were also excluded.

Results
This review was conducted to map and describe the prevalence and associated factors of age-related health conditions among geriatric populations in SSA as reported in the literature. A total of sixty-four observational studies on age-related health conditions in people aged 60 years and older in SSA were included in the review.

Characteristics of included studies
All studies included both male and female participants over the age of 60 years.
Eighteen studies investigated participants 60 years and older, while some were restricted to participants 65 years and older (n=36), and some 70 years and older The studies included for review originated from twelve SSA countries Most of the publications described research from Nigeria (n=33), while nine each were from South Africa and Tanzania, four combined studies from the Republic of Congo(three of which include participants from Central Africa Republic) and three from Ghana.
There was one study each from Benin, Botswana, Kenya, Malawi, Rwanda and Zimbabwe. There was a noticeable absence of studies from the majority of countries in the SSA region ( Figure 2) All publications reported on observational or descriptive studies. The studies were grouped and analysed according to reported areas of geriatric health as indicated in Table 3. The findings are described according to each reported age-related health condition.

Dementia and cognitive impairment
Almost a third of the included studies reported on dementia and/or cognitive The twelve included studies all highlight the short-comings of single-disease orientated primary care in assisting the elderly who have a high prevalence of functional disability. Social and health system support was found lacking for the disabled elderly in sub-Saharan Africa.

Mental and neurological disorders
Dewhurst Despite the high prevalence rates reported in these studies, the majority of people over 60 years with depressive symptoms went undiagnosed and undertreated. (49) Mental health screening was recommended as part of routine health screening in the elderly.

Falls
Three of the studies reporting on falls originated in South Africa (62, 63, 66), three from Nigeria(59, 61, 64), one from Malawi(60) and one from Rwanda (65). The prevalence of falls, as reported in eight studies, ranged between 23% and 26%.
Recurrent falls were also highly prevalent.

Musculoskeletal disorders
Two studies, one from Kenya (80)  agenda. This is likely to mobilise more funding towards geriatric health services, and stimulate research in this area.

Limitations
The scarcity of publications on people over 60 years is partly due to researchers still categorizing people over 50 years in SSA, rather than above 60 years, as old.
This study focussed specifically on geriatric populations in SSA, as defined by the

Conclusions
The body of empiric research and evidence on age-related health conditions in geriatric people in SSA remains small. Publications included in this review centre around functional impairment and psychogeriatric conditions, with a few studies describing falls, sensory impairment, frailty and musculoskeletal conditions in this population. There was a notable absence of publications on many chronic noncommunicable diseases associated with advancing age. Taking into consideration of the limitations of the study mentioned above, the reported prevalence of agerelated health conditions among SSA geriatric populations was comparable to that in high-income countries(HIC). However, there were little resources available to meet the demand for age-related health services. The complex associations described in this review between chronic morbidities in the elderly necessitate a patient-centred approach by primary healthcare providers who work with people older than 60 years. Changes are required to the current models of health care to integrate the