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Rules of Thumb
Rules of thumb in Geriatrics

Author's details

  • Dr.Khashau Eleburuike
  • MBBS (Ilorin) MSc. Global Health Karolinska Institute.
  •  Resident doctor in family medicine in Northen Sweden.

Reviewer's details

  • Dr. Kumbet John Sonny
  • MBBS(Jos), FMCFM, CCG(UK),DGM (Ireland).
  • Consultant Family Physician and Geriatrician, Geriatric Medicine Subdivision, Family Medicine Department, Federal medical Centre Keffi, Nigeria.

Rules of thumb in Geriatrics

Background

Geriatrics in sub-Saharan Africa faces unique challenges due to the region’s healthcare infrastructure, cultural practices, and socio-economic conditions. The care of older adults requires tailored guidelines that address both the physical and psychosocial needs of elderly patients, considering the context of limited resources. Below are some important rules of thumb for providing geriatric care in sub-Saharan Africa, along with relevant guidelines.

Rules of thumb
1. Holistic, Family-Centered Approach
Rule of Thumb
In sub-Saharan Africa, families are often the primary caregivers for the elderly. Medical interventions should be designed to support the family unit in caring for older adults. And if possible, care should be given in client’s household and community,
Guideline
Healthcare providers should involve family members in discussions about care and offer education on how to manage chronic illnesses like hypertension, diabetes, and dementia.
2. Cultural Sensitivity
Rule of Thumb
Respect for elders is deeply ingrained in many African cultures. Healthcare professionals should practice culturally sensitive care that honours the status of elders.
Guideline
Acknowledge and respect traditional health beliefs and practices, but also educate families on evidence-based care. Partnering with traditional healers can improve compliance with modern medical treatments.
3. Addressing Polypharmacy and Medication Management
Rule of Thumb
Older adults in sub-Saharan Africa are often on multiple medications due to comorbidities (multi-morbidities) Over prescription and medication interactions are common risks.
Guideline
Regularly review medications and adjust prescriptions to avoid unnecessary polypharmacy. Ensure medication affordability and availability, and educate caregivers on proper drug administration.
4. Chronic Disease Management with Limited Resources
Rule of Thumb
Chronic diseases such as hypertension, diabetes, and stroke are increasingly common, but diagnostic tools and medications may be scarce.
Guideline
Emphasize non-pharmacological interventions like diet, exercise, and community-based support programs. For medication, use affordable, widely available options that can be easily managed by caregivers.
5. Functional Assessment Over Diagnostic Tests
In caring for older adults, use a holistic approach such as comprehensive geriatric assessment which involves assessment of their functional status.
Rule of Thumb
Functional status assessment often provides more relevant information than diagnostic tests investigations in resource-poor settings.
Guideline
Prioritize functional assessments like the ability to perform Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) when determining the needs of elderly patients. This helps guide care decisions without relying on expensive or unavailable diagnostic tools.
6. Malnutrition and Frailty
Rule of Thumb
Malnutrition is a common and under-recognized issue among the elderly in sub-Saharan Africa, contributing to frailty.
Guideline
Screen for malnutrition using simple tools such as body mass index (BMI), mid-upper arm circumference, or visible weight loss. Incorporate affordable, nutrient-dense foods into the diet and provide nutritional counselling to families.
7. Infectious Disease Prevention
Rule of Thumb
Older adults are particularly vulnerable to infectious diseases such as tuberculosis, HIV, and malaria, which remain prevalent in the region.
Guideline
Maintain vigilance for infectious diseases in elderly patients, as they may present with atypical symptoms. Advocate for vaccinations (such as influenza and pneumococcal vaccines) and screen regularly for TB and HIV.
8. Dementia and Cognitive Decline
Rule of Thumb
Dementia is often underdiagnosed due to limited awareness and stigma associated with cognitive decline.
Guideline
Use simple cognitive screening tools (e.g., the Mini-Mental State Examination) to assess for dementia. Provide family education about dementia, as caregivers may mistake symptoms for normal aging or witchcraft. Focus on non-pharmacological management strategies where drug options are limited.
9. Palliative Care and End-of-Life Discussions
Rule of Thumb
Access to formal palliative care services may be limited, and discussions about death can be culturally sensitive.
Guideline
Provide compassionate care focused on relieving pain and improving quality of life for elderly patients with terminal illnesses. Encourage early, respectful discussions with families about end-of-life care preferences, and collaborate with community leaders or spiritual guides when needed.
10. Community-Based Approaches
Rule of Thumb
Due to a shortage of geriatric specialists, community health workers, nurses and geriatric social caregivers often play a key role in delivering care to the elderly.
Guideline
Train and empower community health workers to manage basic geriatric care, such as monitoring chronic diseases, providing education, and offering psychosocial support. Leverage existing community support structures to improve care for older adults in rural areas.
11. Social Support and Mental Health
Rule of Thumb
Social isolation and mental health issues, such as depression, are often under-recognized in elderly populations.
Guideline
Screen for depression and anxiety using simple tools, and provide social support by integrating elders into community activities. Strengthen community-based mental health initiatives that offer psychosocial support for the elderly.
Conclusion

In sub-Saharan Africa, geriatric care must be adaptable to the local context, focusing on family involvement, cultural sensitivity, and community-based care. By addressing the unique challenges of chronic disease management, polypharmacy, infectious disease prevention, and social support, healthcare providers can improve the quality of life for older adults in the region.

Implementing these rules of thumb and guidelines can ensure that geriatric care is both effective and culturally appropriate in sub-Saharan Africa.

Further readings

1. Naidoo K, van Wyk J. Protocol for a scoping review of age-related health conditions among geriatric populations in sub-Saharan Africa. Systematic Reviews. 2019 Jun 7;8(1):133.

2. Attafuah PY, Eliason C, Amertil NP. Reconceptualizing Geriatric Care in a Sub-Saharan African Context. InNew Research in Nursing-Education and Practice 2023 Jan 30. IntechOpen.

3. National Research Council (US) Committee on Population; Cohen B, Menken J, editors. Aging in Sub-Saharan Africa: Recommendation for Furthering Research. Washington (DC): National Academies Press (US); 2006. 1, Aging in Sub-Saharan Africa: Recommendations for Furthering Research. Available from: https://www.ncbi.nlm.nih.gov/books/NBK20296/

4. Ashirifi G, Teshome A, Adamek M, Adeniji D. DEFINING OLD AGE IN SUB-SAHARAN AFRICA: THE PERSPECTIVE OF AFRICAN SCHOLARS AND PROFESSIONALS. Innov Aging. 2023 Dec 21;7(Suppl 1):718. doi: 10.1093/geroni/igad104.2326. PMCID: PMC10738734.

5. Priscilla Yeye Adumoah Attafuah, Cecilia Eliason and Ninon P. Amertil. Reconceptualizing Geriatric Care in a Sub-Saharan African Context.  24 November 2022 Reviewed: 09 January 2023 Published: 30 January 2023 DOI: 10.5772/intechopen.109920

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