Editor’s Note: This week’s Thought Leadership Piece comes from Nigeria Health Watch Editorial Assistant Beti Baiye. She explores the world of geriatric care in Nigeria and seeks to understand both how we as a country are taking care of our elderly and what we need to do to ensure that age is not a detriment to proper healthcare in Nigeria.
“Although age is a risk factor for a lot of diseases, it is not a disease.” Dr. Ogugua Osi-Ogbu, Chief Consultant Physician and Geriatrician, National Hospital, Abuja.
I was away at boarding school when my mother brought my 68-year-old grandmother to live with us. When I came home, her eyes lit up in recognition as I walked into the sitting room and I ran to hug her. I saw nothing unusual in her welcome. After all, I was her favourite grandchild, but my parents were overjoyed that she recognized me. Later, I got to learn that in the months I had been away, she had started to forget. She forgot names, then faces and sometimes, she forgot time. I don’t think she was ever formally diagnosed. What I do remember is her doctor telling my mother to learn to accept these changes as just one of the many signs of ageing.
The United Nations (UN) describes a person who is 60+ years as an older adult while the World Health Organisation (WHO) describes an older adult as a person who is over 65 years old. Most developed countries have accepted the chronological age of 65 years as a definition of ‘elderly’ or older person as it is often linked with the age at which they can begin to receive a pension. However, with increasing life expectancy, and people remaining active longer, there have been calls for a redefinition of old age. Geriatrics, or geriatric medicine is a specialty that focuses on the health care of elderly people. It aims to promote health by preventing and treating diseases and disabilities in older adults.
According to Dr. Ogugua Osi-Ogbu, Chief Consultant Physician and Geriatrician at the National Hospital, Abuja, the practice of ‘Geriatrics’ was established to look at the peculiarities of medical and other issues in older adults. “In the field of geriatrics, we look at an older adult as an entity. All of what is involved in their wellbeing; physical, mental, spiritual and social circumstances because when all of those are right, then you are in a good state of health,” she said.
I met Dr Osi-Ogbu at a workshop on the Use of Evidence for Health Planning, hosted by public health consulting firm, EpiAFRIC and the World Bank Development Impact Evaluation (DIME) Nigeria. My interest was piqued when she was introduced as a geriatrician. The practice of geriatric medicine is not popular in Nigeria and Dr Osi-Ogbu, is the only geriatrician in the National Hospital and in Abuja.
According to Dr. Osi-Ogbu, ageing doesn’t begin at 60, it begins from birth. As a person gets older, what happens to them is dependent significantly on what they have done with their health in the previous years. “If you have been careless, by 40 you want to make sure you become careful. We find that you are a more functional, healthier older adult if you have maintained a good healthy practice from a younger age,” she said. She pointed out that the three most common conditions seen in those who visit the geriatric clinic at the National Hospital are hypertension, diabetes and osteoarthritis. . “But of course, we have also seen people who have cancer, dementia and depression,” she said.
Pointing out that a sedentary lifestyle, especially as an older person, puts you at risk of developing diabetes and hypertension, she urges people to eat right, stay active, avoid chemicals like tobacco, alcohol and maintain annual checks. “I talk about knowing numbers -everybody should know these four numbers for themselves – blood pressure, blood sugar, cholesterol level and your body mass index. Annually, go in and get a check. It’s a good idea to do those annual checks as a birthday gift,” she said.
By the year 2050, says Dr Osi-Ogbu, for the first time globally, there will be more adults over the age of 60 than there are adolescents and youth aged 10 – 24 years. In Nigeria today, over 9 million Nigerians are 60 years and above but estimates released by the global age watch index state that by 2030, over 20 million Nigerians will be 60 years and above. “The developing world is not aging as rapidly as the developed world, but this is our opportunity to start putting structures in place so that when we are actually getting as close as to what is happening in the developed world, we have a system ready to take care of all our older adults,” she said. The index also has Nigeria ranked as one of the worst nations for any older adult to live in based on indices such as income security, health status and education and employment.
For Dr. Osi-Ogbu, it is important that the needs of the older adult are addressed holistically and this requires the medical team, the patient and their family members or care givers to all work together as a team. “We do not impose anything on our clients,” she said, adding, “We go into a relationship like a team. We say, okay, this is what we are finding, of these four different issues – visual and hearing impairment, your joint issues, dementia – which is most important to you for us to address? Because at that stage in life, it is about functional capacity and quality. So, if they say it is the eyes, we start from there. It is almost like a discussion, when we finish with one, they get to choose the next one.”
Geriatric care is multi-disciplinary and since working at the National Hospital, Dr Osi-Ogbu has been able to draw in physiotherapists, pharmacists, and psychiatrists, to name a few. She says that one major challenge in geriatric practice she has faced is in not having the full accompaniment of supporting disciplines. Another major challenge is not having a space that can serve as a dedicated centre. “The older adults are better served if they can come in to one spot and everybody who needs to see them is there, the eye doctor, the ear doctor, the dentist,” she said. “Right now, what I have is, when I see them, I put a call to my colleagues and say, I have an older adult, is it possible to take him or her in now so they don’t have to go home and make another trip back? That is the way we sort of try to help them and reduce the burden of them going back and forth.”
There are only a handful of specialist geriatric centres in Nigeria; the Tony Anenih Geriatric Centre at the University College Hospital in Ibadan and the geriatric units at the University of Benin Teaching Hospital and the University of Port Harcourt Teaching Hospital. There is currently no training programme for geriatric specialists in Nigeria leading to a dearth of specialist capacity. However, the Geriatric Centres at the National Hospital and the University of Port Harcourt Teaching Hospital have now been accredited by the West African College of Physicians to start training geriatric specialists. Dr. Osi-Ogbu believes that all allied health training facilities, those that train nursing, pharmacy, and physiotherapy students, should incorporate geriatrics, “so that we can build capacity for those who will be taking care of our aging population.”
Recently the Federal Government established a national senior citizen centre. Dr Osi-Ogbu believes that this is a laudable move that needs to progress to implementation, with input from the private sector. At two hearings, the National Assembly considered regulating the establishment of residential facilities for older adults as well as protecting their rights. “There is a lot of concentration on the youth and the children, but out of respect to this group of people who have made their contribution to our nation, we also need to pay some attention to the elderly and make their later years meaningful and happy, not forgetting that we are going to get there and if we have a structure in place, we will also enjoy it when we do get there,” she said.
Dr. Osi-Ogbu believes that government should ensure that senior citizens have some social protection by giving them access to health insurance as well as paying their pension and gratuity when due. Family members should treat their elderly with respect. The health system must understand that being old is not a disease. Senior citizens have a right to medical care and their family members should ensure that they have access to health care. Health care providers must approach older adults with warmth and respect and provide an environment where they can interact with the health professionals with dignity. It is important that those who prescribe and provide medication for the elderly are clear with their instructions so that they are not put at risk of adverse reactions from drugs.
In the 2018 appropriation bill, advancing adolescent healthcare, elderly healthcare and well-being projects in Nigeria are allocated a mere N2,990,663. How many senior citizen centres can this paltry sum build? How much training can it provide? Given Nigeria’s ranking as one of the worst nations for any older adult to live in, we need to examine the parameters that resulted in that ranking and start addressing them. This will ensure that our older adults can live in a healthier environment and we can achieve a better ranking in the future. As Hubert Humphrey (1911-1978) who served as U.S. Vice President from 1965 to 1969 once said: “the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; those who are in the shadows of life; the sick, the needy and the handicapped.”