Aging Medicine and Healthcare 2020;11(1):10-19. doi:10.33879/AMH.2020.033-1904.010 Aging Medicine and Healthcare https://www.agingmedhealthc.com

Original Article Health Status of Elderly Population in the Buea Health District, *Agbor Nathan Emeh1,2, Fongang Che Landis1,3, Tambetakaw Njang Gilbert1,2, Atongno Ashu Humphrey1,2

1University of Buea, Cameroon 2Ministry of Public Health, Yaounde, Cameroon 3Cameroon Christian University, Cameroon

ABSTRACT

Background/Purpose: The purpose of this study was to assess the socio- clinical profile, heath status and determine the impact of age on health related behaviors of geriatric population in the Buea Health District. Since studies on the subject are lacking in Cameroon, we believe this study provides ground work for further studies on geriatrics in Cameroon.

Methods: Two-stage systematic sampling was used. Firstly, 30 communities of the Buea Health District were randomly selected. Eligible participants in these communities were then selected in turns. Interviewer-administered questionnaire, physical examination and health record checks were used to capture the study objectives.

Results: Of the 142 sampled elderlies, 57.7% (82/142) were females with the young-old (60-75 years) constituted the majority (69.01%; 98/142). Most of the elderlies (88%; 125/142) had at least one chronic disease, 35.9% (51/142) had *Correspondence at least two and 9.86% (14/142) had at least three chronic diseases. The major Dr. Agbor Nathan Emeh chronic diseases suffered by elderlies included arthritis (38.73%; 55/142), gastritis (38.73%; 55/142) and hypertension (29.58%; 42/142). Most affected Department of Public Health body systems were musculoskeletal (86.62%; 123/142), neurologic (85.21%; and Hygiene, University of 121/142), and eye (76.76%; 109/142). Arthritis (p=0.072) and musculoskeletal Buea, Cameroon system disorders (p=0.028) were more prevalent in elderly women than men. Email: Majority of the elderlies perceived their health state as “good” (44.37%; [email protected] 63/142), then “fair” (35.21%; 50/142), and then “poor” (20.42%; 29/142) (p=0.889). Statistically significant higher proportion of women (54.88%; 45/82) Received 5 April 2019 than men (25%; 15/60) consumed addictive substances (p <0.001). Accepted 28 October 2019

Conclusion: The health status of older adults in Cameroon deserves more Keywords attention and more studies are needed to further improve it. Chronic diseases, elderly, health status, signs and ISSN 2663-8851/Copyright © 2020, Asian Association for Frailty and Sarcopenia and Taiwan symptoms. Association for Integrated Care. Published by Full Universe Integrated Marketing Limited.

1. INTRODUCTION gradually increasing due to decline in fertility and adult mortality.2,3 Life expectancy is increasing as Aging is a natural process, which presents an unique a result of overall socio-economic development challenge for all sections of the society.1 Globally, and development in medical science,4 including the proportion of elderly people in countries are improvement in health-care delivery services.1 Year-

10 Aging Medicine and Healthcare 2020;11(1):10-19. doi:10.33879/AMH.2020.033-1904.010

wise distribution of old persons in 1901, 1951, therefore important to put into perspective these 2001, were 12 million, 19 million, and 77 million, different factors when building a health structure to respectively, estimating that it will be 177 million manage an elderly community. by 2025,5 and subsequently to 2 billion in 2050.6 Although this appears to be a success in the history of Self-reported health status has widely been used in public health, this also seems to give rise to social and census, survey and observational studies as a measure economic consequences. In addition to increasing that may encompass the subjective concept of dependency ratio that accompanies increasing elderly health.19,20 The determinants of reported health status population,7 there is expected to be an overburdened have also been widely studied21 and their outcome health-care delivery system as utilisation of healthcare has been shown to predict future morbidity and services for chronic diseases, physical disabilities, mortality.22 Saurabh and collaborators reported the mental illness, and other co-morbidities increase in existence of an array of determinants of self-reported the elderly.8,9 Aging of the population creates two health status and quality of life of elderlies including potential major pressure on health care finances: social concerns such as isolation without physical increase utilization of health services and decreased support in daily activities, maltreatment towards revenue (as a declining share of the population is elderlies, psycho-emotional concerns, financial economically active).3 With such increase in the constraints, health-care system factors, etc.1 In our elderly population, medical practice will have to suffer study, we assessed the relationship between different adaption.10 self-reported health status of the elderlies.

The quality of life changes over time and health Although a substantial number of geriatric studies becomes one of the major concerns at old age for have been conducted in different parts of the globe4 both individuals and society.11 By assessing how the with few in the developing countries,23 very little is activities of daily living deviates from the normal role known about the major morbidities, health status and function, one can assess the impact of age on social the health-seeking behavior of elderly people in Buea aspect of health.12 Participation of elderly people in Health District and Cameroon as a whole. It was, different social work, community activities, staying therefore, important to conduct a study that will stage together with family members and their mental, ground information for further work on the geriatric emotional supports are therefore significant predictors population in the country. Our research objectives of the perceived health of elderly peoples.5 were to identify the major health problems affecting elderly people, determine the morbidity pattern and There is a general tendency of deterioration of the to identify the impact of age on functional habits health status of elderly people as chronic disabilities among the elderly people in the Buea Health District. in this group of people are higher than in any other age group.13 Geriatric persons present 3.5 times The operational definition of elderly: Defining more health problems when comparing to persons an individual as being old, elderly or classifying who are younger than 65 years of age.14 Out of five him/her as belonging to the geriatric population geriatric patients, four (80%) will present at least one is controversial.1 This concept has both physio- chronic disease, the majority of who will have more anatomical and social implications. Generally, an than one associated condition.14 As a result, there is a individual is classified as geriatric when he is 60 tendency that elderly people remain on permanent/ years and above. In a study in 2009, Zizza and semi-permanent drugs to manage these multiple collaborators24 subclassed the geriatric population disabilities. Common chronic conditions affecting into the young-old (aged 60-75), the middle-old (aged the elderly population include hypertension, cancers, 76-85) and the old-old (aged over 85). We used the diabetes mellitus, respiratory diseases, heart disease, above age limits to define the elderly in our study. and arthritis.13,15 Major morbidities in elderly people include visual impairment, locomotor disabilities, 2. METHODS respiratory, and digestive disorders.16 WHO suggested that by 2015 death from chronic diseases such as 2.1. Study Setting and Population cancer, hypertension, and cardiovascular system, and diabetes were to have a 17% increase.17 The Buea Health District (BHD), situated in the Division of Cameroon is bounded to the West Due to these complex array of determinants/ and the North by Mt Cameroon, to the South by predictors of health at old age, it will be expected Mutengene and the East by Ekona town. As of that these groups of persons have a complex health- the time of this study, the BHD had about 86272 seeking behavioral pattern.1 The major reasons inhabitants. It has 7 Health Areas (HAs) and a total of postulated why elderly people delay seeking health 66 communities (Appendix 1). The equatorial climate care from health facilities include lack of money, with a temperature range of 25-29ºC has attracted attributing ill-health to aging, negative attitude of so many elderly persons during their retirement health workers toward the care of the elderly.18 It is period. There are two seasons encountered in

11 Aging Medicine and Healthcare 2020;11(1):10-19. doi:10.33879/AMH.2020.033-1904.010

this area: rainy season (June to October) and the RN+2SI, RN+3SI, etc. until the 30 communities were dry season (November to May). Although this is a gotten (Appendix 1). The positions were rounded cosmopolitan area, subsistence farming is the main to the nearest whole numbers. In the second stage, occupation, with capitalizing agriculture dominated eligible participants were selected in turns from the by the Cameroon Development Corporation (C.D.C.) sampled communities by systematically inquiring and in Banana and Tea Estate. The rapid development in selecting the households in which there was an eligible this area is attracting many people to the area making participant, beginning from the house of the quarter it very strategic a location for all groups of people, head and moving towards the main nearby street. particularly the elderly to live in. 2.7. Data Collection and Tools 2.2. Study Design Each household was visited once and only one The study was a community based cross-sectional participant was selected per household. Eligible study where participants were requested to self- participants were interviewed using an interviewer- report past and current socio-economic indicators of administered questionnaire. The information was their health status. They were also requested to self- provided by the elderly themselves. Elderlies who had report the presence of any diagnosed chronic disease communication difficulties were asked for permission condition that was validated upon verification of a to involve their guardian to facilitate data collection. medical record. Physical examination was done to The questions were read by the data collector and elucidate signs. response was provided by the participants. They were asked whether or not they had experienced any 2.3. Study Duration such signs and symptoms within the past 6 months. Physical examination was done to elucidate signs and This study was carried out in 2012, from June to health records where checked to confirm for chronic October. health conditions.

2.4. Sample Size The questionnaires were pre-test with 20 elderly persons and corrections were done to obtain the Our sample size was calculated using the formula final questionnaire used for the study. Pre-tested below:25 questionnaires were not included in the final data analysis. z 2 pq n= The questionnaire was organized into five parts: d 2 demographic data, health problems/complaints, Where q=1-p; n=sample size; at 95% confidence health seeking behaviours, psychological perceptions interval, z=1.96; we used a 5% marginal error (d)=0.05; and lifestyle. Behavioural predictors of health included ‘p’, the proportion of elderly person presenting with feeding habit, consumption of addictive substances at least one health complain is estimated at 90%=0.9. and physical exercise. Leisure activities including This gives a sample size n≈140. reading of newspapers/books and washing television were assessed as current behaviours that could 2.5. Inclusion and Exclusion Criteria influence self-reported health status. Health seeking behaviour was assessed by inquiring health options Our participants were those aged 60 years and above used by elderly persons when they fall ill/sick. residing in the Buea Health District who gave their consent for the study. We excluded those who did not Morbidities assessed included symptoms, signs and give consent and those elderly persons who suffered chronic diseases. The participants were asked whether severe memory impairment and had not guardian to they had experience any health complaints within the assist in providing the needed information. past 6 months or had ever been diagnosed of any chronic disease condition. Symptoms of participants 2.6. Sampling were assessed as self-reported complaints while physical examination was performed to elucidate Two stage sampling technique26 was used. First, 30 physical signs and hospital records were assessed to communities were selected from the 66 communities confirm chronic diseases. The impact of the disease of the Buea Health District using systematic random indicators on the participants were assess using a three- sampling. The 66 communities of the district were scale subjective severity score (mild=1, moderate=2, arranged in alphabetic order and then numbered and severe=3) associated to each morbidity. from 1 to 66. The first community (Bokova) was gotten by selecting a random number (RN) between 1 and Indictors used to assess psychological health in this the sampling interval SI (66/30=2.2). Subsequent study included set of questions to determine how communities were identified by selecting the confident the participants could be that he/she communities corresponding to the number: RN+SI, could carry on with their daily livelihood despite the

12 Aging Medicine and Healthcare 2020;11(1):10-19. doi:10.33879/AMH.2020.033-1904.010

deterioration associated with aging. We were also Table 1. Socio-economic profile of study population. interested to know whether or not the elderlies sorely Number Percent Characteristics Variables associated their present health status to aging process (N=142) (%) or whether they believed that despite age, something Male 60 42.3 can be done to improve their health state. Sex Female 82 57.7 60-75 98 69.01 2.8. Data Analysis and Presentation Age group (years) 76-85 28 19.72 All data collected were entered into a questionnaire ≥85 16 11.27 template in the EpiData 3.1, cleaned and then Married 68 47.9 exported to SPSS version 20 for analysis. Statistical Unmarried 15 10.6 Marital status significant was set at p ≤0.05. Odd ratio was used Divorced 7 4.9 to determine relationships between gender and Widow(er) 52 36.6 morbidities. Morbidities were grouped into eight body systems (genito-urinary, skin, gastro-intestinal, None 63 44.4 Primary 70 49.3 cardiorespiratory, ear-nose-throat, eye, neurological, Education and musculoskeletal), and subjective severity score Secondary 5 3.5 was associated to each reported symptom, signs and Tertiary 4 2.8 chronic disease and a mean subjective severity score Have a guardian 135 95.1 Social network was calculated to approximate the subjective disease Have no guardian 7 4.9 burden per body system and disease as reported by Yes 87 61.27 the participants. Independent income source No 55 38.73 3. RESULTS 3.2.2. Signs and symptoms Of 145 questionnaires administered, 3 were excluded due to incompleteness in the information. Thus our final Most participants presented with more than one sign sample analysed was 142. and/or symptom in the different body system. The most reported affected body system per participant 3.1. Socio-demographic Profile was the musculoskeletal system (86.62%; 123/142), with a sum up total of 245 reported symptoms and The age of study participants range from 60-104 signs; joint pains (84.51%; 120/142) and joint stiffness years, with a mean age of 74.15 for men and 70.95 (49.3%; 70/142) were the most common complaints for women. Eighty two participants (57.7%; 82/142) in the musculoskeletal system; a greater proportion were females and 42.3% (60/142) males. There was of women (91.46%; 75/82) than men (80%; 48/60) a significant relationship (p=0.042) between gender were affected in the MS (Table 3 and Appendix) and widowhood; among 82 women, 45 (54.9%) were (OR= 2.679; p=0.028). The nervous system second widows while 7 men of the 60 male participants the MS (85.21%; 121/142) with a sum up total of 274 (11.7%) were widowers. Majority of the participants reported symptoms and signs; chronic headache (49.3%; 70/142) ended education at primary school. (54.23%; 77/142), insomnia (49.3%; 70/142) and Among those with independent sources of income, memory impairment (44.37%; 63/142) were most the major source was farming (56.3%; 49/87); majority common complaints affecting the nervous system; of the elderly (95%; 135/142) had social support (lived a greater proportion of men (88.33%; 53/60) than with a guardian), among whom 67.4% were their close women (82.93%; 68/82) were affected by NS signs relatives and 28.9% children (Table 1). and symptoms (OR=1.559; p=0.193). Genito-urinary system was least reported to be affected by the 3.2. Disease Indicators participants (16.2%; 23/142). Accidental falls was also significant among the elderlies in the Buea Health 3.2.1. Chronic diseases District.

Majority of the participants (88%; 125/142) had at Signs and symptoms of the skin, musculoskeletal least one chronic disease; fifty one (35.9%; 51/142) system and the genito-urinary system were reported had at least two chronic diseases; and fourteen (9.86%; as most severe, with a mean subjective severity score 14/142) had at least three chronic diseases. The most of 2.42, 2.37, and 2.31, respectively (Table 3). reported chronic diseases among these elderlies were arthritis (38.73%; 55/142) and gastritis (38.73%; 3.3. Psychological Health Indicators 55/142). The chronic condition reported as most severe was chronic lower respiratory tract conditions Majority of the respondents (44.37%; 63/142) with an average subjective severity score of 3.0 perceived their health status as good. While a greater reported by six participants (4.23%; 6/142) (Table 2). proportion of men (46.67%; 28/60) than women

13 Aging Medicine and Healthcare 2020;11(1):10-19. doi:10.33879/AMH.2020.033-1904.010

(42.68%; 35/82) perceived their health as good, 4. DISCUSSION greater proportion of women (37.8%; 31/82) than men (31.67%; 19/60) perceived their health as fair This community based study was aimed at assessing (p=0.889). the socio-clinical profile of elderly people leaving in the Buea Health District. Majority (59.68%; 85/142) of the elderly were totally confident of their ability to carry-out their day-to-day Majority of the participants fell in the young-old activities despite their aged state (Table 4). group, then old-old and then very-old. This trend of population distribution among the elderly is similar 3.4. Health Seeking and Psychosocial Behaviours to that reported by Arun Ghosh and Arun Singh in a study conducted in India.27 The proportion of females Sixty respondents (42.25%; 60/142) consumed (57.7%; 82/142) was more than that of males (42.3%; addictive substances for which a greater proportion 60/142). This is consistent with the male/female of women (54.88%; 45/82) than men (25%; 15/60) ratio of Cameroon, which is <1 from 55 years.28 The consumed these substances (p <0.001) which included literacy level of 55.5% (79/142) is lower than that (78%) cigarette (1.4%; 2/142); alcohol (10.56%; 15/142); reported by Moharana and his collaborators in 2008.29 “snuff” (23.24%; 33/142); cigarette and alcohol (1.4%; 2/142); alcohol and “snuff” (2.11%; 3/142); five The effect of joint pains on the social habits of an (3.25%; 5/142) consumed other addictive substances. elderly person has been stated in literature30 and the Eighty three (58.45%; 83/142) respondents were on finding of our study was confirmatory. Due to the regular medications for chronic health conditions; effect of this complaint on the daily activities of the majority (35.21%; 50/142) were on less than three elderly, those with joint pains are therefore forced different medications; thirty three (23.24%; 33/142) to change some or all of their usual activities like were on three or more different drugs. exercising on a regular bases. Due to this alteration in

Table 2. Prevalence of chronic diseases and their average severity score.

Frequency (%) Female (%) Male (%) Mean severity Score Chronic Diseases p value Odds Ratio (OR) [95% CI] N=142 N=82 N=60 (n=3.00) Lung diseases 6 (4.23) 4 (4.88) 2 (3.33) 3.00 0.346 1.487 [0.263-8.398] Diabetes 11 (7.75) 4 (4.88) 7 (11.67) 2.36 0.078 0.388 [0.108-1.392] Hypertension 42 (29.58) 31 (37.80) 11 (18.33) 2.21 0.006* 2.708 [1.227-5.977] Gastritis 55 (38.73) 35 (42.68) 20 (33.33) 2.44 0.133 1.489 [0.745-2.977] Arthritis 55 (38.73) 36 (43.90) 19 (31.67) 2.04 0.072 1.689 [0.841-3.391] HIV 2 (1.41) 1 (1.22) 1 (1.67) 2.50 0.423 0.728 [0.045-11.884] Infectious diseases 13 (9.15) 7 (8.54) 6 (10.00) 2.15 0.384 0.840 [0.267-2.640] Others 85 (59.86) 52 (63.41) 33 (55.50) 2.76 / / Total 269 / / / / / NB: Some people reported to have more than one chronic disease accounting for the total chronic diseases exceeding the sample size (N=142).

Table 3. Signs and symptoms summed up into their respective body systems.

Total Signs and Mean 1Respondents, Female, n Male, n (%) Body Systems Symptoms Reported Severity p value Odds Ratio (OR) [95% CI] n (%), N=142 (%), N=82 N=60 per System Score Genito-urinary 23 (16.20) 34 11 (13.41) 12 (20.0) 2.31 0.153 0.620 [0.253-1.519] Gastro-intestinal 63 (44.37) 83 36 (43.90) 27 (45.0) 1.98 0.449 0.957 [0.490-1.869] Cardiorespiratory 69 (48.59) 123 38 (46.34) 31 (51.67) 2.27 0.268 0.808 [0.415-1.574] Neurologic 121 (85.21) 274 68 (82.93) 53 (88.33) 2.17 0.193 0.642 [0.242-1.702] Musculoskeletal 123 (86.62) 245 75 (91.46) 48 (80.0) 2.37 0.028* 2.679 [0.985-7.281] Ear-nose-throat 74 (52.11) 111 54 (65.85) 20 (33.33) 2.17 <0.001* 3.857 [1.907-7.803] Eye 109 (76.76) 159 63 (76.83) 46 (76.67) 2.17 0.489 1.009 [0.459-2.219] Skin 55 (38.73) 83 36 (43.90) 19 (31.67) 2.42 0.072 1.689 [0.841-3.391] 2Accidental falls 19 (13.38) 19 9 (10.98) 10 (16.67) 2.00 0.170 0.616 [0.234-1.626] *Statistically significant associations 1Number of respondents who reported with different signs and symptoms in a particular body system. Some participants reported with more than one sign and/or symptom in each particular system and signs and/or symptoms in more than one body system. 2Accidental falls was classified as a separate health problem since it could be a result of a wide variety other health problems originating from different body systems such as arthritis pain (MS) and blurred vision (eye).

14 Aging Medicine and Healthcare 2020;11(1):10-19. doi:10.33879/AMH.2020.033-1904.010

the usual habits, elderly persons with joint pains often reported in this study. This finding is in line with perceived themselves as not being in “good health”. that of a study conducted in 2003,16 but differs from The figure (84.5%) of elderly with joint pains reported that of singh and his collaborators32 where the most in the study is much higher than 65.4% reported common morbidities were anaemia, hypertension, in a cohort study.31 The fact that a large proportion and arthritis. In our study, the hypertension had a of people in the rural communities do not go to reported prevalence of 29.58%. This low prevalence consult at the hospital for such complaints (since they of hypertension in our study may be due to fact that attribute such to aging) means that a hospital base there could be some other cases of hypertension in study may under report joint pains in such setting. the community unknown to the participants since blood pressure check was not part of our community In a community based study,32 body systems with study methods. The reported prevalence of diabetes most prevalent morbidities were haemopoitic mellitus in our study population was 7.75%. In a system, locomotor, ocular, and cardiovascular. In study in 2007,18 it was reported a prevalence of our study, major systems with morbidities were 11.9%. These discrepancies may be attributed to the musculoskeletal (86.62%), nervous (85.21%), difference in the methodology of the studies. eye (76.76%), cardiorespiratory (48.59%), and gastro-intestinal (44.4%) systems. In a study on Current health status perceived as being good had a institutionalized elderly persons in Nairobi, the main higher proportion among the men than the women, health complaints reported were musculoskeletal while those who perceive health status as fair were problems (79.7%), respiratory (67.5%), sight problems higher in the women than in the men. In India, several (44.2%), digestive problems (33%), traumatic injuries studies have been conducted evaluating health (26.2%) and hearing problems (24.5%).16 The reason status of elderly people, majority of which revealed for these differences is unclear. However, factors such that the perceived health status as being excellent/ as difference in the study settings and study design good is more among the men than women.34 This may contribute to these discrepancies. We did not also corresponds with the findings of Hambleton and carry-out any laboratory or para-clinical evaluation collaborators in 2005.35 This may be because most to confirm participants’ report disease unlike in of the chronic diseases, such as respiratory diseases, comparative studies. To limit the chances of errors in diabetes mellitus, hypertension, gastritis and arthritis, the self-reported disease conditions, we insisted that had the greatest mean subjective severity scores were participants provide medical records to confirm any more prevalent in women than men. It is logical that self-reported disease, otherwise it was rejected. those having more of the diseases with high severity scores will perceive their health as being fair or poor. In our study, the musculoskeletal conditions were registered as more prevalent in women that in men, a Over 33.8% used health facility as primary means to finding which is consistent with literature.16,31 Hormonal re-establish their health. This rate might be accounted changes that often accompany menopause may account for by that the greatest majority of the elderly believe for a high prevalence of MS problems in women.33 that their health status could be improved if measures are taken to do so as also postulated in early Eighty eight percent of respondents of this study studies.36 Some elderly associated their present health had one or more chronic conditions. In a hospital conditions to the process of aging37 thus accounting based study,14 it was reported that 80% of elderlies for the health options they make when they fall sick. have at least one chronic condition. Gastritis and A small proportion of our study population made arthritis were the most common chronic conditions use of the traditional healers as primary means to re-

Table 4. Health status and psychological capability as perceived by respondents.

Subjective Scale Respondents, n (%), Female, n (%), Male, n (%) Odds Ratio Psychological Indicators p value (Score) N=142 N=82 N=60 (OR) Good (2) 63 (44.37) 35 (42.68) 28 (46.67) 0.889 1.000 Perceived health status Fair (1) 50 (35.21) 31 (37.80) 19 (31.67) 1.305 Poor (0) 29 (20.42) 16 (19.51) 13 (21.67) 0.985 Totally confident (3) 85 (59.86) 52 (63.41) 33 (55.00) 0.857 1.000 Level of confidence in carrying out daily activity Slightly confident (2) 49 (34.51) 24 (29.27) 25 (41.67) 0.609 without fear of limitations that Indifferent (1) 6 (4.23) 4 (4.88) 2 (3.33) 1.269 are associated with age Not confident (0) 2 (1.41) 2 (2.44) 0 (0) ∞ Totally confident (3) 123 (86.62) 71 (86.59) 52 (86.67) 0.507 1.000 Level of confidence that something can always be Slightly confident (2) 15 (10.56) 10 (12.20) 5 (8.33) 1.465 done to improve their health Indifferent (1) 3 (2.11) 1 (1.22) 2 (3.33) 0.366 status despite aging Not confident (0) 1 (0.70) 0 (0) 1 (1.67) 0.000

15 Aging Medicine and Healthcare 2020;11(1):10-19. doi:10.33879/AMH.2020.033-1904.010

establish health (3.52%). However, this proportion is management of their health problems. This is higher higher than the 2% predicted by the study of Waweru than the 26% reported by Waweru in Kenya.16 Lack in 2005,16 but contradicts the higher utility rate of of strict policies placed on the use of drugs supplied traditional healers predicted by other studies.38,39 This by over-the-counter drug dealers in the Buea Health could be the result of modernization.40 District and Cameroon as a whole may account for this high value. The higher prevalence of chronic disease Lack of money and the fact that the health facilities in our study population when compared to the study were “too far” were the most important reasons in Kenya16 may also account for the high proportion of accounting for the varied health options used. Cost elderly on drugs in our study population. of purchasing healthcare in our society is relatively high for the average elderly. In attempt to address Among those who perceived their health status as the issue of health cost at old age, some countries being good, it was found that majority carried out provide health insurance policies and even free health physical exercise at least on moderate basis while services to elderly people.41 Lack of an effective among those who perceived their health as being health insurance policy for the elderlies in Cameroon poor, 6.8% carried out regular exercise and 44.8% do makes it difficult for them to afford medical care. not carry out exercise at all (p=0.01). Previous study has shown that regular exercises are associated with Over 58.45% of the elderly people were on drugs for improved health status at old age.42

Table 5. Health seeking behaviours.

Respondents, n (%), Females, n (%), Males, n (%), Attributes Variables p value N=142 N=82 N=60 Consumption of addictive Yes 60 (42.25) 45 (54.88) 15 (25.00) <0.001* substances No 82 (57.75) 37 (45.12) 45 (75.00) On permanent/ Yes 83 (58.45) 58 (70.73) 25 (41.67) <0.001* semi-permanent drugs No 59 (41.55) 24 (29.27) 35 (58.33) Herbs 27 (19.01) 16 (19.51) 11 (18.33) 0.183 Traditional healers 5 (3.52) 2 (2.44) 3 (5.00) Primary health seeking Over-the-counter drugs 31 (21.83) 18 (21.95) 13 (21.67) behaviour Health facility 48 (33.80) 33 (40.24) 15 (25.00) Health facility when other options fail 31 (21.83) 13 (15.85) 18 (30.00) Lack of money 45 (31.69) 25 (30.49) 20 (33.33) 0.794 Health facilities are located far from 15 (10.56) 9 (10.98) 6 (10.00) home Reason for choice of health seeking behaviour (option) My disease condition is due to aging 2 (1.41) 2 (2.44) 0 (0) Believe God for healing 4 (2.82) 2 (2.44) 2 (3.33) Other reasons 76 (53.52) 44 (53.66) 32 (53.33) Vegetarian 0 (0) 0 (0) 0 (0) / Food habits Non-vegetarian 125 (88.03) 69 (84.15) 56 (93.33) Special diet 17 (11.97) 13 (15.85) 4 (6.67) Regular exercise 15 (10.56) 5 (6.10) 10 (16.67) 0.060 Physical exercise Exercise but not regular 94 (66.20) 60 (73.17) 34 (56.67) No exercise 33 (23.24) 17 (20.73) 16 (26.67) Maintain activities as when Yes 132 (92.96) 77 (93.90) 55 (91.67) 0.607 was <60 No 10 (7.04) 5 (6.10) 5 (8.33) Yes 59 (41.55) 39 (47.56) 20 (33.33) 0.089 Have children No 83 (58.45) 43 (52.44) 40 (66.67) Farming 10 (7.04) 7 (8.54) 2 (3.33) 0.392 Business 3 (2.11) 1 (1.22) 2 (3.33) Office works 1 (0.70) 0 (0) 1 (1.67) Main activity at this age Outdoor works 3 (2.11) 1 (1.22) 2 (3.33) (60 years +) Household works 39 (27.46) 27 (32.93) 12 (20.00) Nothing 5 (3.52) 3 (3.55) 2 (3.33) Others 81 (57.04) 43 (52.44) 38 (63.33) *Statistically significant relationships.

16 Aging Medicine and Healthcare 2020;11(1):10-19. doi:10.33879/AMH.2020.033-1904.010

5. CONCLUSION 5. Kinsella K, Taebur CM. An ageing world-US Government Washington DC 1992, UNDP; 1990. The health status of elderly people in Cameroon 6. Word Health Organization. Definition of an older or elderly has for long been neglected. In the present study person. Word Health Organization 2013. Accessed on aimed at assessing the socio-clinical profile of elderly 22 May 2013 at: http://www.who.int/healthinfo/survey/ ageingdefnolder/en/ people in the Buea Health District, it was revealed that musculo-skeletal system was the most affected 7. Grandjour A. Aging diseases--do they prevent preventive health care from saving costs? Health Econ. 2009; (3):355-62. body system at old age and that the musculo-skeletal 18 system is more affected in elderly women than men. 8. World Health Organization. Towards policy for health and ageing. World Health Organization 2013. Accessed on 23 Secondly, conditions of the skin were reported to have May 2013 at: http://www.who.int/ageing/publications/alc_fs_ the greatest subjective severity. It was statistically ageing_policy.pdf. significant that more elderly women than men 9. Boutayeb A, Boutayeb S. The burden of non-communicable consumed addictive substances and that more women diseases in developing countries. Int J Equity Health. than men were on permanent/semi-permanent drugs 2005;4(1):2. for their chronic conditions. However, we recommend 10. Sandra M, Scheila MG, Ariana B, Karina K, Lilian B. The that more studies on this subject be conducted in prevalence of major ENT symptoms in ambulatory geriatric other parts of the country to assess the risk factors for patients. Int Arch Otorhinolaryngol. 2008;12(1). these conditions among the elderlies in Came roon. 11. Lal S. Text book of community medicine, 1st ed. New Delhi, India: CBS Publishers and Distributors; 2007. CONFLICTS OF INTEREST STATEMENT 12. Shankar R, Tondon J. Health status of elderly population in rural area of Varanasi District. Indian J Public Health. 2007;51(1):56- The authors declare that they have no competing 8. interest. 13. Jaul E, Barron J. Age-Related Diseases and Clinical and Public Health Implications for the 85 Years Old and Over Population. Front Ethics Approval and Consent to Pparticipate Public Health. 2017;5:335. 14. Onzotto G, Koffi-Aka V, Yotio A, Ehouo F, Adjoua B, Bamaba Ethical clearance was obtained from the Institutional M. Oto-rhino-laryngology and geriatrics in the Ivory Coast. Rev Review Board of the Faculty of Health Science, Laryngol Otol Rhinol (Bord). 2002;123(2):119-23. University of Buea (Reference No. 2012/0034/UB/FHS/ 15. Park K. Parks Text book of Preventive and Social Medicine. IRB of 29 June 2012). Administrative clearance was Banarsidas Bhanot Publishers: Jabalpur, India; 2009, p. 512-4. obtained from the Regional Delegation of Public Health 16. Waweru LM, Kabiru EW, Mbithi JN, Some ES. Health Status and for South and the Buea District Health Health Seeking Behaviour of the Elderly Persons in Dagoretti Division, Nairobi. East Afr Med J. 2003; (2):63-7. Service. 80 17. World Health Organization. Preventing chronic disease–A vital investment. Geneva, Switzerland: World Health Organizatio; 2005. Authors’ Contribution 18. Bhatia SPS, Swami HM. A study on health problems and ANE conceived the idea, carried out the study and loneliness among the elderly in Chandigarh. Indian J Community Med. 2007; (4):255-7. wrote the first draft of the study. All authors planned 32 the statistics and presentation of the study results. 19. Moss C. Selection of topics and questions for the 2001 census. Popul Trends. 1999; (9):28-36. ANE, FCL, TNG and AAH edited, comment and 97 approved the final manuscript. 20. Miilunpalo S, Vuori I, Oja P, Pasanen M, Urponene H. Self-rated health status as a health measure: the predictive value of self- reported health status on the use of physician services and Acknowledgements on mortality in the working-age population. J Clin Epidemiol. 1997;50(5):517-28. Special thanks to the Faculty of Health Science, 21. McLeod CB, Lavis JN, Mustard CA, Stoddart GL. Income University of Buea for hosting this research work. inequality, household income, and health status in Canada: a prospective cohort study. Am J Public Health. 2003;93(8):1287-93. REFERENCES 22. Goldberg P, Gueguen A, Nakache JP, Goldberg M. Longitudinal study of associations between perceived health status and self- 1. Shrivastava SR, Shrivastava PS, Ramasamy J. Health-care of reported diseases in the French Gazel cohort. J Epidemiol Elderly: Determinants, Needs and Services. Int J Prev Med. Community Health. 2001;55(4):233-8. 2013; (10):1224-5. 4 23. Damian J, Valderrama-Gama E, Rodriguez-Artalejo F, Martin- 2. United Nations. Report of the Second World Assembly on Moreno JM. Health and functional status among elderly Ageing. New York: United Nations; 2002. individuals living in nursing homes in Madrid. Gac Saint. 2005;18(4):268-74. 3. Rechel B, Doyle Y, Grundy E, McKee M. How can health systems respond to population aging? Denmark: WHO Regional Office 24. Zizza CA, Ellison KJ, Wernette CM. Total Water Intakes of for Europe; 2009. Community-Living Middle-Old and Oldest-Old Adults. J Gerontol A Biol Sci Med Sci. 2009;64(4):481-6. 4. Besdine R, Boult C, Brangman S, Coleman E, Fried L, American geriatric society task force on the future of geriatric medicine. 25. Charan J, Biswas T. How to calculate sample size for different Caring for older Americans: the future of geriatric medicine. J study designs in medical research? Indian J Psychol Med. Am Geriatr Soc. 2005;53(6 suppl):S245-56. 2013;35(2):121-6.

17 Aging Medicine and Healthcare 2020;11(1):10-19. doi:10.33879/AMH.2020.033-1904.010

26. Henderson RH, Sundaresan T. Cluster sampling to assess immunization coverage: a review of experience with a simplified sampling method. Bull World Health Organ. 1982;60(2):253-60. 27. Cameroon Sex Ratio [Updated on January 20, 2018]. IndexMundi. Accessed on 14 March 2019 at: https://www. indexmundi.com/Cameroon/sex_ratio.html 28. Moharana PR, Sahani NC, Sahu T. Heath Status of Geriatric Population Attending the Preventive Geriatrics Clinic of a Tertiary Health Facility. J Community Med. 2008;4(2):85-7. 29. Ghosh A, Singh A. Health status of elderly in a rural area of North Of India. Natl J Community Med. 2014; 5(2):236-9. 30. Sugiura H, Demura S. Effect of Mild and Severe Unilateral Knee Joint Pain on Gait in Elderly Females. J Geriatr. 2014;2014:ID 820428. 31. Rachel D, Roger MF, Joanna C, Karen D, Carol J, Andrew K, et al. Prevalence of arthritis and joint pain in the oldest old: findings from the Newcastle 85+ Study. Age Ageing. 2011;40(6):752-5. 32. Singh JP, Kasturwar NB, Hassan A. Geriatric morbidity profile in an urban slum, Central India. Indian J Community Med. 2013;25(2):164-70. . 33. Hassan MA, Razia AA, Awad SA, Safar A, Mohamed ASA, Abdullah A, et al. The prevalence of symptoms experienced during menopause, influence of socio-demographic variables on symptoms and quality of life among women at Abha, Saudi Arabia. Biomed Res. 2017;28(6):2587-95. 34. Zakir H, Saswata G. Is health status of elderly worsening in India: A comparison of successive rounds of National Sample Survey data. MPRA Paper No.25747. Munich Personal RePEc Archive 2010. Accessed on 19 October 2010 at: https://mpra. ub.uni-muenchen.de/25747/ 35. Hambleton IR, Clarke K, Broome HL, Fraser HS, Brathwaite F, Hennis AJ. Historical and current predictors of self-reported health status among elderly persons in Barbados. Rev Panam Salud Publica. 2005;17(5/6):342-52. 36. Grime J, Richardson JC, Ong BN. Perceptions of joint pain and feeling well in older people who reported being healthy: a qualitative study. Br J Gen Pract. 2010;60(577):597-603. 37. Gignac MA, Davis AM, Hawker G, Wright JG, Mahomed N, Fortin PR, et al. What do you expect? you’re just getting older’: a comparison of perceived osteoarthritis-related and aging- related health experiences in middle-and older-age adults. Arthritis Rheum. 2006;55(6):905-12. 38. Chappel LNA, Laurel S, Blandford AA. A perspective Holt, Rinchart. Canada. Aging Health Care.1986;33-42. 39. Kimani V. African traditional health care: the place of indigenous resources in the delivery of primary health care in four Kenyan communities. PHD thesis, University of Nairobi, 1995. 40. Laping J. "Traditional medicine" in India decline and future perspectives. Anc Sci Life. 1987;7(1):6-11. 41. Macwangi M, Cliggett L, Alter S. Consequences of rural-urban migration on support for the elderly in Zambia. New Orleans, LS: Population Association of America, Annual Meeting; 1996. 42. Lautenschlager NT, Almeida OP, Flicker L, Janca A. Can physical activity improve the mental health of older adults? Ann Gen Hosp Psychiatry. 2004;3(1):12.

18 Aging Medicine and Healthcare 2020;11(1):10-19. doi:10.33879/AMH.2020.033-1904.010

APPENDIX 1. Gastrointestinal (GIT) System GIT Signs and Symptoms Number of Mean Severity Buea Health District Communities % (N=142) Respondents Score 66 communities of the BHD include Bokoko, Bokova, Bokulu, Bokwai, Other GIT problems 4 2.80 2.250 Bokwaongo, Bolikawo, Bomaka, Bonakanda, Bonalyonga, Bonduma, Bonganjo, Bonjoku, Boteva, Bova 1, Bova 2, Buea Station, Buea Town Diarrheal problems 13 9.20 1.539 Stranger 1, Buea Town Stranger 2, Buea Town Stranger 3, Bwassa, constipation 24 16.90 2.167 Bweteva, Bwitingi, Bwuyuku 1, Bwuyuku 2, Bwuyuku 3, Camp Sic, Check point, Clerks Quarter, Ewonda, Fereral Quarters, GRA, Great Soppo Chronic abdominal pain 42 29.60 1.977 Native, Great Suppo Street, Likoko, Likombe, Lysoka, Malingo, Mamu, Total GIT problems 83 58.50 1.983 Mevio/Sasse, Mile 14/15, Mile 16, Muea, Mukinda, Mussaka, Naanga, Ndongo, New Camp Main Camp, Paramount, Railway1,2, Sandpit, Ear-Nose-Throat (ENT) System Saxenholf, Tole Wedding, UB 1, UB 2, Upper Bolimfamba, Upper Farms, ENT Signs and Number of Mean Severity % Vasingi, Warders Barracks, Wojoke, Wojomba, Wondongo, Wonganga, Symptoms (N=142) Respondents Score Wonyamavio, Woteke, Wotolo, Wovilla. Recurrent tonsillitis 1 0.70 2.000 Thirty communities that were selected through random systematic sampling include Bokwai, Bolikawo, Bonalyonga, Bonganjo, Boteva, Ear pain 8 5.60 2.125 Bova 2, Buea Town Stranger 1, Bwassa, Bwitingi, Bwuyuku 2, Camp Recurrent catarrh 14 9.90 2.286 Sic, Clerks Quarter, GRA, Great Suppo Street, Likombe, Malingo, Mevio/ Other ENT problems 14 9.90 2.286 Sasse, Muea, Mussaka, Ndongo, Paramount, Sandpit, UB 1, Upper Bolimfamba, Vasingi, Wojoke, Wondongo, Woteke, Wovilla and Bokulu. Ringing ear sensation 32 22.50 1.906 Dental pain 42 29.60 2.429 APPENDIX 2. Major health complaints grouped into respective body Total ENT problems 111 78.20 2.172 systems. NB: A single participant may present more Eye than one health complaint. Signs and Symptoms of Number of Mean Severity % Eyes (N=142) Respondents Score Musculoskeletal (MS) System Other eye problems 2 1.40 2.000 MS Signs and Symptoms Number of Mean Severity % (N=142) Respondents Score Chronic eye pain 13 9.20 2.308 Other MS problems 3 2.10 3.000 Itchy eyes 44 31.00 2.205 Joint swelling 14 9.90 1.643 Visual disturbance 100 70.40 2.170 Muscle ache 38 26.80 2.053 Total ENT problems 159 112.00 2.171 Joint stiffness 70 49.30 2.486 Integumentary system Skin Signs and Number of Mean Severity Joint pains 120 84.50 2.650 % Symptoms (N=142) Respondents Score Total MS problems 245 172.60 2.366 Chronic ulcer 1 0.70 3.000 Nervous System (NS) Recurrent lacerations 5 3.50 2.200 NS Signs and Symptoms Number of Mean Severity % (N=142) Respondents Score Other skin lesions 5 3.50 2.600 Other NS problems 1 0.70 3.000 Skin rashes 22 15.50 1.955 Action tremors 2 1.40 2.500 Skin itches 50 35.20 2.320 stroke 3 2.10 2.667 Total ENT problems 83 58.40 2.415 Seizures 4 2.80 1.500 Genito-urinary (GUS) system GU Signs and Symptoms Number of Mean Severity Rest tremors 5 3.50 1.000 % (N=142) Respondents Score Acute confusion 49 34.50 2.245 Recurrent UTI 1 0.70 2.000 Memory disturbances 63 44.40 2.222 Hematuria 2 1.40 2.00 Insomnia 70 49.30 2.229 Bladder outflow Chronic headache 77 54.20 2.129 4 2.80 2.250 obstruction Total MS problems 274 192.90 2.366 Sexual weakness 4 2.80 2.750 Cardiorespiratory (CR) System Urinary incontinence 6 4.20 2.167 CR Signs and Symptoms Number of Mean Severity % Painful urination 7 4.90 2.571 (N=142) Respondents Score Other GU problems 10 7.00 2.444 Other CR problems 1 0.70 3.000 Total GU problems 34 23.80 2.312 Breathing difficulties 8 5.60 2.375 Physical Traumas Palpitation 19 13.40 2.158 Health Problems Number of Mean Severity Chronic chest pain 22 15.50 1.955 % (N=142) Respondents Score Unusual fatigue 35 24.60 2.000 Falls 19 13.40 2.000 Chronic cough 38 26.80 2.245 Total CR problems 123 86.60 2.105

19