Browsing by Author "Adebusoye, L."

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30-day all-cause mortality rate amongst older patients admitted to the medical ward of a tertiary hospital in Nigeria.
(Medknow / Obafemi Awolowo University, 2021) Adebusoye, L.; Cadmus, E. O.
Introduction: Older people face challenges in the overburdened health‑care services in Nigeria, especially when hospitalised. Few available studies on mortality were retrospective, oftentimes with incomplete data which may affect the establishment of the outcome. Objectives: This study determined the 30‑day all‑cause mortality rate (MR) and associated factors amongst older patients in the medical wards of University College Hospital, Ibadan. Materials and Methods: A prospective cohort study of 417 patients (>60 years) from the 1st day of admission to death or discharge at the end of 30th day of admission. Data were collected with a semi‑structured questionnaire. Information obtained included respondents’ sociodemographic characteristics, anthropometric measurements, frailty and functional status. Others were morbidity profile, quality of life, cognition, nutrition, anxiety and depression. Data were analysed using SPSS version 24 at a level of significance P < 0.05. Results: The mean age was 71.6 ± 8.1 years and 216 (51.8%) were females. Eighty‑seven (20.9%) deaths were recorded. The unadjusted 30‑day all‑cause MR was 13.7 deaths (95% confidence interval [CI]: 11.0–16.9/1000 patient‑days). This was significantly higher amongst males than females with a MR ratio (MRR) of 1.93 ([95% CI: 1.23–3.05]; P = 0.01). Factors significantly associated with mortality were being financially self‑supporting (MRR = 2.82; 95% CI: 1.01–6.41), having a cognitive impairment (MRR = 1.92; 95% CI: 1.12–3.20), frailty (MRR = 1.65; 95% CI: 1.01–2.84), ischemic heart disease (MRR = 1.93; 95% CI: 1.18–3.07) and acute exacerbation of bronchial asthma (MRR = 3.92; 95% CI: 1.04–9.42). Conclusion: The 30‑day MR was high amongst older patients, especially the males. Modifiable factors contributing to hospital mortality should be addressed at admission.
Assessment of knowledge and reasons for medication non-adherence in ambulatory elderly patients with hypertension and diabetes mellitus in a geriatric centre in Nigeria
(Oxford University Press, 2021) Akande-Sholabi, W.; Ogini, D. E.; Adebusoye, L.; Fakeye, T. O.
Introduction: Hypertension and type 2 Diabetes mel¬litus are global health disorders afflicting millions of elderly patients worldwide with an ever-increasing incidence and prevalence. Non-adherence to medications affects the quality and length of life, and has been associated with negative health outcomes and increasing healthcare costs especially in the elderly [1]. Few empirical data exist on the know¬ledge and medication adherence among elderly patients in sub-Saharan Africa countries. Aim: This study aimed to assess the knowledge, medi¬cation adherence, and the factors associated with patient’s knowledge on diabetes mellitus and hypertension. Methods: A cross-sectional study of 423 elderly patients aged ≥60 years diagnosed with hypertension and diabetes mellitus, selected consecutively at the Geriatric centre in the University College Teaching Hospital, Ibadan was car¬ried out between October 2019 and January 2020. Socio-demographic information, knowledge of the indication of the medications, possible side effects, and details of medi¬cation adherence level with reasons for non-adherence were obtained using interviewer-administered semi-structured questionnaire. Bivariate and multivariate analyses were car¬ried out using SPSS 23. Alpha was set at 0.05. Results: The mean age (±SD) of the older patients was 69.6 ± 6.4 years and 253 (59.8%) were females. About three-quarter of participants (320; 75.7%) were retired. Majority of the elderly (381; 90.1%) were hypertensive, while 270 (63.8 %) were diabetic, and 85 (20.1%) had multimorbidity of both hypertension and diabetes mel¬litus. Patients that were non-adherent with their medication were 138 (32.6%). The most common reasons reported for non-adherence included patient slept off (41; 56.6%), pre-occupation (24; 33.1%) and unavailability of medications (12; 16.6%). Thirty-seven (8.7%) participants intentionally missed doses, out of which 22 (59.5%) reported pill burden as its reason for medication non-adherence. All patients 423 (100.0%) knew the indication for their medications and 20 (4.7%) experienced medication-related side effects. Overall, 299 (70.6%) and 309 (73.0%) of patients with hypertension and diabetes mellitus showed good knowledge about their conditions. Adherence to medication was associated with good knowledge in hypertensive patients (p=0.002), while being male (p=0.002), age-group of 60–69 (p=0.001) and poor adherence (p=0.001) were associated with good knowledge in diabetes mellitus patients. Conclusion: We found non-adherence was mainly as a result of patients’ behaviors, attitude, and unavailability of medications which could be the cause of low medication adherence among the elderly patients. A systematic review on factors associated with medication adherence in older patients reported medication review aimed at simplifying regimens and educating patients about their treatment as intervention.
Evaluation of Prescription Pattern of Analgesic use Among Ambulatory elderly in Southwestern Nigeria.
(Wolters Kluwer - Medknow, 2020) Akande-Sholabi, W.; Agha, C. P.; Olowookere, O. O.; Adebusoye, L.
Background: Inappropriate prescribing of analgesics has a global impact on the health of elderly patients and the society. Empirical evidence on the prescription of analgesics among elderly Nigerians is scarce. Objectives: The objective of the study was to evaluate the prescription pattern of analgesics and describe the co-prescribing of gastroprotective agents with non-steroidal anti-inflammatory drugs (NSAIDs) among elderly patients at the geriatric center, University College Hospital, Ibadan. Methods: A retrospective cross-sectional, hospital-based study was carried out among elderly patients(≥60 years) who were prescribed analgesics. Using a data extraction sheet, information on demographic characteristics, drug utilization pattern, and morbidities was obtained from patients’ case files via electronic health records. Results: A total of 337 patients case files were reviewed, the mean age was 72 ± 8.8 years, and 210 (62.3%) were females. There were a total of 2074 medications prescribed, with 733 (35.3%) being analgesics. Majority of the elderly patients(259, 76.9%) were on nonopioids, with 252 (74.8%) on NSAIDs. Paracetamol was the most commonly prescribed analgesics (181, 24.6%), followed by diclofenac/misoprostol (177, 24.1%), opioid analgesic prescribed was 88 (12.0%), with paracetamol/codeine 58 (65.9%), and tramadol 16 (18.2%) being the most prescribed opioid. A significant proportion of the hypertensive elderly patients (160, 78.8%; P < 0.036) were on NSAIDs. The oral route of administration (302, 89.6%) was the most common route of administration. Majority (310, 92%) of elderly patients taking NSAIDs had a co-prescription for gastroprotective agents. Conclusions: Majority of hypertensive patients were on NSAIDs. This calls for prompt awareness of rational analgesic use among the elderly to improve management and their survival
Insights into the gut microbiota of Nigerian elderly with type 2 diabetes and non-diabetic elderly persons.
(U.S. Department of Health and Human Services., 2020) Afolayan, A.; Adebusoye, L.; Cadmus, E.O.; Ayeni, F
Type 2 diabetes (T2D) is a prevalent non-communicable disease among the world's growing elderly population. The contribution of the gut microbiota to T2D in several Westernized countries has been established. However, there is little information on the role of the gut microbiota in T2D from the African continent where lifestyle and life expectancy are different. Aims: This study sought to investigate gut microbiota variation in relation to elderly people living with T2D. in Nigeria. Methods: Whole microbial community DNA were derived from the stool samples of healthy urban-dwelling elderly individuals and urban-dwelling elderly individuals with T2D. The V4 region of the 16S rRNA gene was Illumina- sequenced and analyzed using QIIME2. Results: Beta taxonomic diversity was significantly different between healthy elderly individuals and elderly in- dividuals with T2D. However, no difference in the alpha taxonomic diversity and predicted functional alpha diversity of the gut microbiota was observed. The genus Ruminococcus (T2D versus Healthy: 2.89% vs 2.21%), families Coriobacteriaceae (Collinsella, T2D versus Healthy: 2.62 % vs 1.25%) and Bifidobacteriaceae were enriched in elderly individuals with T2D, while members of Clostridiaceae (Clostridium, Healthy versus T2D: 5.6% vs 3.2%) and Peptostreptococcaceae (Healthy versus T2D: 3.45% vs 1.99%) were enriched in healthy volunteers. Pathways involved in amino acid biosynthesis were enriched in elderly individuals with T2D, while pathways involved in respiration and the biosynthesis of vital building blocks were enriched in healthy volunteers. Conclusions: The study demonstrated for the first time in an African elderly population that the abundance of Bifidobacteriaceae, Collinsella, and Ruminococcus within the gut varies in relation to T2D. Findings from this study suggest that the restoration of features associated with healthiness via the way of gut microbiota modification could be one step needed to improve elderly patient care.
Polypharmacy and Factors Associated with their Prevalence Among Older Patients Attending a Geriatric Centre in South-West Nigeria
(West African Postgraduate College of Pharmacists (WAPCP), 2018) Akande-Sholabi, W.; Olowookere, O.; Adebusoye, L.
Background: Polypharmacy among older people in Nigeria are prominent issues of public health dimension. Polypharmacy especially in older people with multiple diseases often results in poor health status and outcomes. Objectives: To determine the prevalence and factors associated with polypharmacy among older patients attending the geriatric clinic. Methods: Cross sectional study of 400 elderly patients aged 60 years and above who presented at geriatric clinic, UCH, Ibadan. Polypharmacy was taken as concurrent consumption of =5 medications. Socio-demographic characteristics, lifestyle habits, attitudinal factors on medication understanding, medication pattern and intake were assessed through a questionnaire. Bivariate and multivariate analyses were carried out using SPSS 20 and alpha was set at 0.05. Results: Mean age of the respondents was 70.2 ± 5.9 years and 240 (60.0%) were females. The point prevalence of polypharmacy was 23.8%. The average medications consumed were 4 without sex difference. Logistic regression analysis showed that taking too many prescription medications (OR = 2.188; 95% CI =1.014 – 4.808, p = 0.05), intentionally skipping my medications because they are too many (OR = 3.756; 95% CI = 1.354 – 10.424, p = 0.01) and receiving prescriptions from more than one physicians on regular basis (OR= 2.336; 95% CI = 1.058 – 5.155, p = 0.04) were the most significant factors associated with polypharmacy. Conclusion: Polypharmacy is common among older people in this setting. Healthcare workers should address the attitudinal, social and health related factors, which could lead to polypharmacy.
Potential Inappropriate Prescribing Among Ambulatory Elderly Patients in a Geriatric Centre in Southwestern Nigeria: Beers criteria versus STOPP/START criteria.
(Pharmacotherapy Group, Faculty of Pharmacy, University of Benin, 2020-05) Akande-Sholabi, W.; Ajilore, O. C.; Showande, J. S.; Adebusoye, L.
Purpose: To identify potentially inappropriate prescribing in ambulatory elderly patients and compare the appropriateness of guidelines; Beers' and Screening Tool of Older Person’s Prescription (STOPP)/Screening Tool to Alert Right Treatment (START) criteria to detect potentially inappropriate prescribing among the elderly. Methods: A retrospective study was conducted using case files of 335 elderly patients aged ≥ 60 years between 1st January and 31st December 2016, using a data extraction sheet. The 2015 American Geriatrics Society (AGS)-Beers Criteria, and version 2 of the STOPP and START were subsequently used to identify the Potentially Inappropriate Prescribing (PIP) and Potential Prescribing Omissions (PPOs). Results: Mean age of patients was 69 ± 0.4 years (range 60 - 85 years) and 219 (65.4 %) were females. An average of 4.2 medications per patient prescription was found. The Beers criteria identified 26.5 % PIP, while STOPP criteria identified 57.1 % PIP. START detected 29 PPOs in 15 (4.4 %) of the patient’s prescription. The most prevalent disease conditions were hypertension 235 (70.1 %) and osteoarthritis 64 (19.3 %). Polypharmacy was significantly associated with PIP in both Beers (p = 0.002) and STOPP (p = 0.001) criteria. Conclusion: The prevalence of PIP is high among elderly patients. The STOPP/START criteria identified a higher proportion of PIP among elderly patients compared with Beers criteria. The frequency of PIP should stimulate efforts to curtail potentially inappropriate prescribing and may require the need for advocating for a national criterion to be adopted by health care professionals in Nigeria.
Potentially Inappropriate Medication Use Among Older Patients Attending a Geriatric Centre in South-West Nigeria
(Sage, 2018) Akande-Sholabi, W.; Olowookere, O.; Adebusoye, L.
Objectives: To determine the prevalence and describe factors associated with the use of potentially inappropriate medication (PIM) among older patients. Methods: Cross sectional study of 400 older patients selected systematically at the geriatric centre, University College Hospital, Ibadan between July and September 2016. With the aid of semi-structured questionnaires, information on the socio-demographic characteristics, lifestyle habits, healthcare utilisation and morbidities was obtained. The Beer’s criteria 2015 update was used to identify the PIMs. Predictors of PIMs were determined using multivariate analyses at alpha 0.05. Results: Age was 70.2 (SD=5.9) years and 240 (60%) were females. General prescription pattern showed antihypertensives (34.7%) as the commonest medications used. The point prevalence of PIMs use was 31%. In all, 10 PIMs were used by the respondents. The majority (81.5%) were using one PIM, while (17.7%) used two PIMs and (0.8%) 3 PIMs. NSAIDs (72.6%) were the commonest PIMs identified, followed by the benzodiazepines (24.2%). Respondents had an average of 1.9 morbidities, and mulitmorbidity found in 60.5%. Logistic regression analysis showed self-rated health assessed as better compared with age-mates [OR =1.718 (1.080–2.725)] and being physically active [OR =1.879 (1.026–3.436)] as the most significantly associated with PIMs use. Conclusions: The use of PIMs among older patients in our setting was high with NSAIDs being the most frequently used medications. An interdisciplinary approach, of medication review by pharmacists’, working with physicians may improve prescribing practices among older persons. Therefore, it is necessary to create public health awareness on the use of PIMs among older persons.
Prescribing Pattern of Antihypertensive Medications in a Geriatric Center In Southwestern Nigeria
(Nigeria Association of Pharmacists in Academia (NAPA), 2019) Akande-Sholabi, W.; Adebusoye, L.
Background: Hypertension is a prominent public health problem, with considerable health consequences. Recommended guidelines encourage use of antihypertensive medications with the best evidence of reducing cardiovascular risk. Data on antihypertensive medications use among older Nigerians is limited. Objective: This study evaluated the antihypertensive medication use among older persons with hypertension in compliance with the Eighth Joint National Committee guidelines (JNC 8). Method: A retrospective cross-sectional study, of older patients diagnosed with hypertension between the 1st January 2017 and 31st December 2017 at the geriatric center, University College Hospital, Ibadan. Results: The mean age was 70.2 ± 7.2 years and 62% were female. The mean number of medications used by the patient was 4.5 ± 1.4. Of the patients, 56% were receiving combination therapy, 42% two drugs and 14% three drugs. Most patients were receiving calcium channel blockers (33.8%), followed by diuretics (29.6%), angiotensin receptor blockers (23.4%) and angiotensin-converting enzyme inhibitors (10.8%). Commonest combination therapy was calcium channel blockers and thiazide diuretics (28.3%), while the commonest multi-morbidities were osteoarthritis (32.7%), diabetes (17.3%) and dyslipidemia (8.7%). Conclusion: This study showed that more than half of older persons with hypertension were on combination therapy, and the most frequently used class of antihypertensive drugs were calcium channel blockers, followed by diuretics. The guidelines and data for black ≥60 years indicate that lower doses of combination therapy are more effective in achieving blood pressure target. Despite the numerous advantages of ACEIs, they remain underutilized.