1435 THE BURDEN OF MULTIMORBIDITY AMONGST OLDER HOSPITALISED ADULTS IN NORTHERN TANZANIA: A MULTI-CENTRE STUDY

• Published in: Age and ageing Vol. 52; no. Supplement_2
• Main Authors: Davidson, S L, Bickerstaff, E, Emmence, L, Motraghi-Nobes, S M, Rayers, G, Lyimo, G, Kilasara, J, Mitchell, E, Urasa, S, Walker, R W, Dotchin, C L
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 21-07-2023; Oxford Publishing Limited (England)
• Subjects: Aging; Chronic illnesses; Comorbidity; Exemption; Geriatric assessment; Health care; Health care access; Health insurance; Hospitalization; Hospitals; Hypertension; Inpatient care; Medical diagnosis; Medical history; Medical screening; Multicenter studies; Multimorbidity; Older people; Policy making; Population studies; Public health; Questionnaires; User fees; Tanzania
• ISSN: 0002-0729; 1468-2834
• DOI: 10.1093/ageing/afad104.062

Abstract
Background
Populations in sub-Saharan Africa are ageing rapidly and Tanzania is one country experiencing this acute demographic shift. Multimorbidity (the presence of two or more chronic conditions [1]) is common in the community and associated with greater risk of hospitalisation. To-date, the prevalence amongst older hospital inpatients is unknown.
Objective
To establish the prevalence of multimorbidity amongst older hospitalised adults in northern Tanzania.
Methods
For 6-months, adults aged ≥60 admitted to medical wards in four hospitals were invited to participate. A standardised questionnaire, structured around the Comprehensive Geriatric Assessment, was completed. This included items regarding health insurance and exemption from health user fees (granted based on age and low socioeconomic means). Multimorbidity was self-reported using a list of 16 conditions from the Study of Global Ageing and Adult Health Questionnaire, with additional screening for hypertension.
Results
Between March and August 2021, 540 adults aged ≥60 years were admitted and 308 (57%) underwent assessment. Reasons for non-participation included discharge (n=159) and death (n=34) prior to researcher attendance. Of 277 participants, 145 (52%) had self-reported multimorbidity. Data were unavailable for 31 participants who were unsure of their past medical history. Hypertension was reported by 146 (52%) and an additional 35 (11%) had mean readings ≥140/90 when screened. Mann-Whitney U revealed a significantly greater burden of multimorbidity in those with health insurance (p<0.001) or exemption from user fees (p=.34), compared with participants without.
Conclusion
Multimorbidity is common amongst hospitalised older adults in Tanzania. Higher rates amongst those with insurance or exemption are likely because of greater access to healthcare services and therefore diagnosis. Simple screening for hypertension identified further individuals with multimorbidity, demonstrating that it may remain underestimated. Widening access to healthcare is a government priority, but the impact of multimorbidity also poses a challenge to hospitals and policymakers.
Reference
1. Johnston MC et al. European Journal of Public Health 2018; 29: 182–9.