Background: African populations are rapidly ageing yet care of older people remains a nascent field. Country-level Standard Treatment Guidelines and Essential Medicines Lists (STG/EMLs), often developed based on the World Health Organization model EML [1], reflect national priorities of ageing care within health systems. This study reviews the geriatric medicine content within STG/EMLs across Africa.
Methods: Using the ‘EMLs Around the World’ database [2] and search engines we obtained the latest versions of African STG/EMLs. Each STG/EML was examined for a geriatrics 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. Ecological analyses determined associations between country-level finance metrics and geriatric medicine content.
Results: Thirty countries (63%) had an STG/EML published in English or French available online. Five contained a geriatrics chapter (all English language). An older age-dependency ratio (ADR) of 5.5+ (cf. ADR<5.5) was associated with presence of a geriatrics chapter (5[100%] vs.0[0%];p=0.03), as well as guidance on falls (10[91%] vs.1[9%];p=0.004), delirium (13[81%] vs.3[19%];p=0.004), and dementia (13[72%] vs.5[28%];p=0.04). Guidance on parkinsonism was most common (25/30; 83%) and on frailty least common (3/30;10%). STG/EMLs updated since the COVID-19 pandemic (pre- vs. post-2020) were more likely to contain palliative care guidance (6[33%] vs.12[67%];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 STG/EML. There is significant scope for expansion of guidance on management of common geriatric conditions, particularly frailty.