Medicines for treatment of older people in guidelines and essential medicines lists, WHO African Region

Aims:
African populations are rapidly ageing yet care of older people remains a nascent field. Country-level Standard Treatment Guidelines (STG) and Essential Medicines Lists (EML), often developed based on the World Health Organization (WHO) Model EML, reflect national priorities of ageing care within health systems. This study reviews the geriatric medicine content within STG and EMLs across Africa.

Methods:
Using the ‘EMLs Around the World’ database and the WHO ‘Repository of National Essential Medicines Lists’ we obtained the latest versions of African STG and EMLs. Each STG and EML was examined for a geriatric medicine chapter and guidance on management of frailty, falls, palliative care, osteoporosis, parkinsonism, incontinence, delirium, dementia, and polypharmacy. Country-level demographic data were obtained from the World Bank and WHO. Ecological analyses determined associations between country-level metrics and geriatric medicine content.

Results:
We obtained an STG or EML from all 48 countries. Six (13%) contained a geriatric medicine chapter (5 English language, 1 French language). An age-dependency ratio (old) of ≥5.5% was associated with presence of a geriatric medicine chapter (6 [13%] vs 0 [0%]; p=0.04), as well as guidance on falls (10 [21%] vs 1 [2%]; p=0.03) and dementia (17 [35%] vs 5 [10%]; p=0.05). Guidance on parkinsonism was most common (42 [88%]) and on frailty least common (3 [6%]) STGs and EMLs published after the COVID-19 pandemic were more likely to contain guidance on parkinsonism (27 [56%] vs 15 [31%]; p=0.03).

Conclusions:
African countries with a higher proportion of older people (65+years) were more likely to include geriatric medicine content in their STGs and EMLs. There is significant potential for expansion of guidance on management of common geriatric conditions such as frailty, incontinence, and polypharmacy.