DEPRESSION AND MEDICATION ADHERENCE AMONG ALDER ADULTS WITH SELECTED CHRONIC MEDICAL CONDITIONS IN MAIDUGURI, NIGERIA

Introduction

Older adults constitute a rapidly growing population whose healthcare needs are unique, with a higher prevalence of physical and psychiatric morbidities. A knowledge gap exists regarding the association of chronic medical conditions with Depression and how they affect medication adherence. This may be linked to their chronic nature and impacts on the mood of older adults. This study assessed Depression among older adults with Hypertension, Diabetes Mellitus, and Arthritis; and compared its relationship with medication adherence in the speciality clinics of UMTH, Maiduguri.

Methods

A comparative cross-sectional analytic study was employed to recruit 327 older adults aged≥60years for six months. They were proportionally distributed into groups of Hypertension only (140), Diabetes only (85), Arthritis only (43), hypertension and diabetes (59). The socio- clinical proforma, Geriatric Depression Scale (GDS-30), and Morisky Medication Adherence Scale (MMAS-8) were administered. Data were analysed using SPSS version 26.0. The mean adherence scores for those with depression were compared with the mean scores of those without depression using a t-test.

Results

The study found that the mean medication adherence score was lower in those with depression than those without depression. The difference is significant among the group with arthritis only (t = 1.943 and p-value = 0.049) where those with depression had an adherence score (2.299 ± 0.500) while those without depression scored (3.177 ± 1.267); and also, among the group with HTN + DM (t = 2.769, p-value = 0.006) where those with depression had an adherence score (2.000 ± 0.001) while those without depression scored (4.299 ±2.026).

Conclusion

Depression is associated with low medication adherence in older adults with chronic medical conditions. This underscores the need for consultation-liaison practice and proactivity in assessing for depression in older adults with chronic conditions to improve their adherence.

AN X-RAY OF THE NATIONAL MENTAL HEALTH ACT 2021 OF NIGERIA: OPPORTUNITIES, LIMITATIONS AND THE WAY FORWARD

The Nigerian Mental Health Law originated as a Lunacy ordinance in 1916 and matured into Lunacy Act CAP 524 of the law of Nigeria, 1964. This review of the National Mental Health Act (NMHA) 2021 of Nigeria examines the prospects, challenges, and possible ways forward. This act has a schedule, five parts, fifty-eight sections, and many subsections. It was compared with the WHO Checklist while the limitations were examined with a view to recommending solutions and identifying the tasks ahead. The NMHA 2021 provides for enhancing and regulating Mental Health Services through a Mental health Services Department. Also, a Mental Health Assessment committee is set up as a tribunal to protect the rights of persons with intellectual, cognitive and psychosocial disabilities, including the rights to a legal representative, employment, and housing. Persons with mental health conditions are to enjoy standard services and participate in formulating their medical plans devoid of coercion. The Presidential gazetting of the act is a good starting point in a positive direction. It should be adequately implemented with the coordinated efforts of all stakeholders and domesticated by the state governments. Finally, more advocacy by the Association of Psychiatrists in Nigeria and other key players. A key limitation is the access to the health care facility given the rural-urban access challenges and owing to the wide treatment gap and the low Doctor-patient ratio worsened by the brain drain.