Stanley Jack L, Hettle David, Chingono Rudo Ms, Mhino Fadzaishe, Bandason Tsitsi, Mpandaguta Chipo E, Madziva Karlos, Ferrand Rashida A, Chipanga Joseph, Vere Michael, Chonzi Prosper, Dixon Justin, Gregson Celia L, Kranzer Katharina, Olaru Ioana D
The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.
Elizabeth Blackwell Institute, Bristol Medical School, University of Bristol, Bristol, UK.
Glob Health Action. 2025 Dec;18(1):2547495. doi: 10.1080/16549716.2025.2547495. Epub 2025 Sep 2.
Over the coming decades Africa is projected to undergo a significant demographic shift towards an older population. Healthcare provision for older adults is made more complex by age-related multimorbidity and frailty, which contribute to older adults more frequently requiring intensive, hospital-based treatment than those in younger age groups. We investigate age and sex-stratified, diagnosis-specific hospital referral patterns in Harare, Zimbabwe to understand referral practices for older adults. This retrospective analysis of attendance records from primary health clinics ( = 8) over six years (2016 to 2021) investigated associations between age, sex and diagnosis and recommended hospital referral. Analysis compared the percentage referred between those aged ≥65 years and those younger than 65 years. The records contained 195,999 attendances. Median attendee age was 9 years (IQR 1.75-32); 52.5% were female; 5.4% were aged ≥65 years. Overall, 14.9% attendances resulted in hospital referral. The highest referral percentage by diagnosis was for trauma (47.8% referred overall, 40.5% of those aged ≥65 years referred). The overall percentage referred in those aged ≥65 years (18.5%) was the same as those aged 35-44 years (18.0%); this pattern was observed across diverse diagnoses including acute respiratory infections, hypertension and musculo-skeletal pain. Despite age-associated morbidity and theoretically free public healthcare to those aged ≥65 years in Zimbabwe, older adults are no more likely to be referred than young adults to higher level care, across multiple disease classes, including infective, musculoskeletal and cardiovascular diseases. This may reflect a healthcare system not yet orientated towards an ageing population's needs.
预计在未来几十年里，非洲将经历重大的人口结构转变，朝着老年人口占比更高的方向发展。与年龄相关的多种疾病并存和身体虚弱使老年人的医疗保健变得更加复杂，这导致老年人比年轻人群体更频繁地需要强化的、基于医院的治疗。我们调查了津巴布韦哈拉雷按年龄和性别分层的、特定诊断的医院转诊模式，以了解老年人的转诊情况。这项对8家初级保健诊所6年（2016年至2021年）就诊记录的回顾性分析，研究了年龄、性别与诊断之间的关联以及推荐的医院转诊情况。分析比较了65岁及以上人群和65岁以下人群的转诊百分比。记录包含195,999次就诊情况。就诊者的年龄中位数为9岁（四分位距1.75 - 32岁）；52.5%为女性；5.4%年龄在65岁及以上。总体而言，14.9%的就诊导致了医院转诊。按诊断分类，转诊百分比最高的是创伤（总体转诊率为47.8%，65岁及以上人群中转诊率为40.5%）。65岁及以上人群的总体转诊百分比（18.5%）与35 - 44岁人群（18.0%）相同；在包括急性呼吸道感染、高血压和肌肉骨骼疼痛在内的各种诊断中都观察到了这种模式。尽管存在与年龄相关的发病率，并且在津巴布韦理论上65岁及以上人群可享受免费公共医疗保健，但在包括感染性、肌肉骨骼和心血管疾病在内的多种疾病类别中，老年人被转诊到更高水平医疗的可能性并不比年轻人更高。这可能反映出医疗系统尚未适应老年人口的需求。
