Morbidity and disability in elderly Zimbabweans

Background: the population aged over 60 years in Zimbabwe is expanding. Despite the likely increased demand on medical services that this will bring, little is known about the health needs of this elderly population. Objective: to record the prevalence of disability (impairment of activities of daily living), subjective morbidity (symptoms), the social circumstances and the utilization of health services in a group of elderly Zimbabweans. Design: cross-sectional community survey Setting: a remote rural area in North Eastern Zimbabwe and two urban townships located approximately 80 km from Harare. Subjects: 278 subjects (154 women, 174 rural), aged > 60 years (range 60-92) living at home. Method: subjects were selected by random cluster sampling. They were assessed in a structured interview and underwent physical examination including visual acuity, inspection for cataracts and assessment of mobility. Results: less than 4% experienced difficulty with self-maintenance activities of daily living, but 30% had difficulty with instrumental activities. The former were all visually impaired and both visual and mobility problems contributed to the latter. Elderly people experienced many symptoms but had inadequate access to health services and used medication infrequently. Subjects were mainly self-sufficient for financial income and 60% still worked. They had declining resources with age and received little help from the social welfare department. Their health and functional abilities deteriorated with age but it was older subjects who had most difficulty getting to the clinic. Simple measures such as cataract surgery and analgesics were available only to the minority or not at all. Conclusions: this study highlights problem areas where simple, low-cost measures could make a difference to the morbidity and disability of elderly Zimbabweans.