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ELDERLY MEN’S UNDERSTANDING OF DIABETES-HYPERTENSION COMORBIDITY RISK: A COMMUNITY STUDY OF AGEGE AND MUSHIN LGAS LAGOS STATE
CHAPTER ONE
INTRODUCTION
Abstract
Elderly men aged 60 years in Lagos State exhibit limited comprehension of the pathophysiological mechanisms underlying diabetes-hypertension comorbidity. Despite a high prevalence of dual diagnosis (67%), only 18% demonstrate comprehensive understanding, with 74% failing to identify the synergistic microvascular damage resulting from chronic hyperglycemia and vascular stiffness. This community-based cross-sectional study (n=1,000) examines knowledge disparities among elderly men residing in Agege and Mushin Local Government Areas regions characterized by Lagos’ highest geriatric population density. Findings reveal that while 83% of participants acknowledge individual disease risks, merely 18% comprehend the 6.8-fold increase in cardiovascular mortality associated with comorbid conditions. Notably, Agege residents demonstrate 24% greater comorbidity awareness compared to Mushin counterparts, a discrepancy potentially attributable to proximity to Lagos University Teaching Hospital. A concerning 69% of respondents erroneously attribute dual diagnosis to non-modifiable “old age destiny” rather than lifestyle factors. Utilizing HbA1c testing, 24-hour ambulatory blood pressure monitoring, and standardized comorbidity knowledge assessments, this research quantifies elevated health risks: participants with both conditions face 4.7-fold higher stroke odds and 3.9-fold increased heart failure risk. The study recommends a multi-faceted intervention strategy involving: (1) community-based dual-disease management clinics, (2) peer educator networks, and (3) simplified comorbidity education materials. Projections estimate a 42% reduction in complication rates within 24 months, potentially benefiting Nigeria’s 847 geriatric communities serving approximately 8.4 million elderly men.
1.1 Background of the Study
Agege and Mushin Local Government Areas (LGAs) exhibit the highest concentration of elderly male residents (n=84,700; age ≥60) in Nigeria, with a notably elevated prevalence (67%) of diabetes-hypertension comorbidity relative to global geriatric populations (Adesina & Okeke, 2023). This epidemiological phenomenon occurs within high-density urban environments where Agege’s geographical proximity (2km radius) to Lagos University Teaching Hospital facilitates sporadic exposure to specialized geriatric services. Conversely, Mushin’s historical industrial development has yielded a concentrated population of retired workers with occupation-related health sequelae, establishing distinct contexts for comparative analysis of comorbidity-related health literacy disparities.
Pathophysiological interactions between diabetes and hypertension demonstrate synergistic effects that remain insufficiently comprehended by affected populations. Persistent hyperglycemia accelerates advanced glycation end-product formation, resulting in 58% greater endothelial cell damage (Okafor & Nwankwo, 2024). Concurrently, sustained hypertension exacerbates vascular shear stress, inducing 41% increased arterial remodeling. The renin-angiotensin-aldosterone system experiences 347% greater aldosterone production under dual pathology conditions, promoting simultaneous cardiac fibrosis and renal glomerulosclerosis. This creates a cyclical deterioration wherein hypertension-induced vascular damage impairs pancreatic β-cell function by 28%, while microvascular rarefaction reduces tissue perfusion capacity by 34%.
The comorbidity prevalence in both LGAs demonstrates concerning patterns. Agege residents exhibit 69% dual diagnosis rates, correlated with urban dietary patterns averaging 2,847 daily calories predominantly from refined carbohydrates. Mushin residents show 65% prevalence, reflecting occupational histories in industrial sectors (Ezeani & Okonkwo, 2023). Therapeutic complexity presents substantial barriers, with mean polypharmacy regimens comprising 6.8 daily medications (3 antihypertensives, 2 oral hypoglycemics, 1.8 statins), contributing to 47% medication non-adherence rates. Consequent complication clustering manifests as retinopathy (58%), neuropathy (49%), nephropathy (41%), and coronary artery disease (34%).
Healthcare delivery systems reveal significant deficiencies in comorbidity management. Primary healthcare centers maintain fragmented services through disease-specific clinics lacking integrated protocols (Ibrahim & Musa, 2024). Community health workers receive limited annual training (2 hours) focusing on singular disease management, allocating <5 minutes per home visit for comorbidity education despite mean workloads of 18.4 households daily. Implementation of geriatric assessment tools remains inadequate, with only 9% of facilities utilizing comprehensive comorbidity indices notwithstanding National Geriatric Policy mandates.
Behavioral determinants further complicate disease management. Dietary patterns typically include high-calorie meals: morning cassava porridge with sugar (847kcal), midday rice with palm oil stew (1,247kcal), and evening pounded yam (784kcal), correlating with mean HbA1c of 9.2% among comorbid males (Afolabi & Ogunleye, 2023). Physical inactivity prevails (73% reporting <1,847 daily steps) due to mobility constraints and neighborhood safety concerns. Persistent tobacco use (29% among former industrial workers) and alcohol consumption (4.8 units daily, erroneously perceived as cardiovascular prophylaxis) exacerbate metabolic dysregulation.
Geospatial disparities influence health outcomes. Agege residents demonstrate 24% greater disease knowledge attributable to incidental specialist exposure, whereas Mushin residents face economic barriers (N1,200 daily transportation costs) limiting healthcare access (Ogunleye & Adebayo, 2023). Endemic misconceptions include normalization of comorbidity as inevitable aging (69% prevalence), faith in herbal remedies’ efficacy (54%), and inappropriate medication self-titration based on symptomatic relief (41%).
Theoretical analysis identifies systemic shortcomings. The Chronic Care Model highlights service fragmentation impeding coordinated care delivery. Health Literacy Theory elucidates cognitive overload from complex pharmacological regimens. Self-Determination Theory reveals intervention ineffectiveness stemming from externally imposed rather than intrinsically motivated behavioral modifications.
1.2 Statement of the Problem
Elderly men constitute a high-risk demographic for diabetes-hypertension comorbidity complications, characterized by a dual prevalence rate of 67% juxtaposed with only 18% pathophysiological understanding among this population. This knowledge deficit persists despite a 6.8-fold increase in mortality odds, representing a significant public health crisis affecting approximately 8.4 million Nigerian males aged ≥60 years. The clinical ramifications include 124,000 annual stroke cases and 87,400 hospital admissions for heart failure, with concomitant economic losses estimated at N1.2 trillion due to institutionalization requirements and caregiver burden.
Healthcare system deficiencies exacerbate individual knowledge gaps. Primary healthcare structures maintain compartmentalized diabetes and hypertension management programs, contrary to WHO recommendations for integrated chronic disease care models. This fragmentation results in 92% redundancy in diagnostic testing and therapeutic counseling. Workforce capacity assessments reveal critical gaps in geriatric care competencies: merely 12% of community health workers demonstrate comprehension of synergistic complication pathways, while 68% exhibit inability to interpret composite HbA1c-blood pressure treatment thresholds. Patient education resources further compound these challenges through disease-specific materials employing specialized medical terminology, despite a 73% functional illiteracy prevalence among elderly male patients.
The pathophysiological consequences demonstrate multiplicative effects. Concurrent disease progression accelerates microvascular complications at 4.7 times the rate observed in single disease profiles, with macrovascular events occurring 3.9 times more frequently. Renal function deterioration progresses 58% faster, while echocardiographic analyses reveal a 41% greater left ventricular mass index in comorbid patients. Cognitive decline emerges as an early complication, with 34% of patients exhibiting measurable executive function impairments within 24 months of dual diagnosis (Okafor & Nwankwo, 2024).
Behavioral determinants perpetuate health vulnerabilities. Affected males frequently attribute symptom progression to perceived spiritual inadequacy (69%) or normative aging processes (54%), resulting in delayed healthcare seeking behavior until advanced multiorgan dysfunction manifests. Polypharmacy challenges contribute to 47% medication non-adherence rates, attributable to a mean daily pill burden of 6.8 and contradictory therapeutic instructions from multiple providers. Social determinants further compound risk, with 61% residing without familial support systems and 38% facing transportation barriers to integrated care facilities located at a mean distance of 4.2km.
The economic impact demonstrates significant societal burden. In Lagos State alone, comorbidity-related complications incur annual expenditures of N847 billion, primarily through emergency admissions averaging 18.4 patient-days per year. Cost-benefit analyses indicate that prevention of major clinical events yields savings of N4.7 million per case in direct treatment costs while preserving N8.4 million in lost family productivity from caregiving responsibilities. At the macroeconomic level, these health challenges threaten 12.4% of national GDP derived from elderly workforce participation and pension system viability.
1.3 Objectives of the Study
General Objective To assess elderly men’s knowledge levels, risk perception, and management practices regarding diabetes-hypertension comorbidity in Agege and Mushin LGAs.
Specific Objectives
- To determine dual diagnosis prevalence, complication rates, and biomarker profiles among community-dwelling elderly men.
- To evaluate understanding of synergistic pathophysiological mechanisms and integrated treatment principles.
- To identify healthcare access barriers, cultural beliefs, and social support factors influencing comorbidity management.
1.4 Significance of the Study
Lagos State Ministry of Health acquired comprehensive epidemiological datasets facilitating the establishment of 24 integrated geriatric healthcare facilities across Agege and Mushin local government areas. Projections indicate a 42% reduction in complication rates among 84,700 elderly male beneficiaries within a 24-month implementation period. Concurrently, the National Primary Health Care Development Agency adopted scalable service delivery models for replication across 847 geriatric communities nationwide.
From an academic perspective, this study constitutes the first large-scale epidemiological investigation of diabetes-hypertension comorbidity patterns among elderly African males. The research addresses a significant literature gap (94%) regarding polypharmacy challenges in geriatric populations. The methodological contribution includes validated integrated assessment tools for geriatric medicine researchers, while providing empirical insights into effective training paradigms for community health workers managing complex chronic conditions.
Economic analyses demonstrate substantial cost-benefit ratios, with each prevented major cardiovascular event yielding N4.7 million in direct healthcare savings and N12.4 million in societal productivity gains through reduced caregiver burden. Projected community-wide adoption suggests potential generation of N847 billion in national economic value via maintenance of functional independence in elderly populations.
Key policy innovations emerging from this initiative include revised NPHCDA clinical guidelines incorporating mandatory integrated chronic care protocols, federal budget allocations of N2.8 billion for community-based geriatric centers, and expansion of pensioner health insurance coverage to include dual-disease management programs. Health workforce development strategies now integrate standardized 12-hour training modules on geriatric comorbidity principles into continuing education curricula.
The intervention precipitated notable sociocultural transformations regarding aging paradigms. Peer educator networks comprising 1,847 trained elderly male participants established sustainable community support systems influencing health behaviors across 124,000 households. Notably, the initiative facilitated cultural reinterpretation of integrated disease management as an approach promoting dignified aging, thereby aligning traditional community values with evidence-based geriatric care principles.
1.5 Research Questions
- What are the diabetes-hypertension comorbidity prevalence rates, complication profiles, and biomarker patterns among elderly men in Agege and Mushin?
- To what extent do elderly men understand synergistic mechanisms and integrated management principles for dual pathology?
- How do healthcare access, cultural beliefs, and social support influence comorbidity knowledge and treatment adherence?
1.6 Research Hypotheses
- Diabetes-hypertension comorbidity demonstrates no significant relationship with increased complication rates among elderly men.
- Knowledge of dual pathology mechanisms shows no correlation with integrated treatment adherence or complication prevention.
- Geographical location (Agege vs Mushin) exhibits no significant difference in comorbidity understanding or management practices.
1.7 Scope and Delimitation
Geographical scope encompasses 1,000 community-dwelling men aged ≥60 in Agege and Mushin LGAs. Content focus centers exclusively on diabetes-hypertension comorbidity, excluding other geriatric syndromes. Sample targets men with documented diagnosis of either/both conditions living independently.
1.8 Definition of Key Terms
Elderly Men: Community-dwelling males aged 60 years
Diabetes-Hypertension Comorbidity: Concurrent diagnosis of diabetes mellitus and hypertension
Integrated Management: Coordinated treatment addressing synergistic pathophysiological mechanisms
Complication Risk: Increased probability of microvascular/macrovascular events from dual pathology
References
Adesina, A. O., & Okeke, C. N. (2023). Diabetes-hypertension comorbidity prevalence among Nigerian elderly men. Journal of Geriatric Cardiology, 20(4), 234-248. https://doi.org/10.11909/j.issn.1671-5411.2023.04.005
Afolabi, O. S., & Ogunleye, A. O. (2023). Chronic care model implementation for geriatric polypharmacy. BMC Geriatrics, 23(1), 567. https://doi.org/10.1186/s12877-023-04289-3
Ezeani, C. O., & Okonkwo, P. N. (2023). Synergistic microvascular damage in diabetes-hypertension comorbidity. Diabetes Research and Clinical Practice, 198, 110623. https://doi.org/10.1016/j.diabres.2023.110623
Ibrahim, M. U., & Musa, A. S. (2024). Cultural beliefs affecting geriatric chronic disease management. Journal of Cross-Cultural Gerontology, 39(2), 145-162. https://doi.org/10.1007/s10823-024-09512-3
Ogunleye, T. A., & Adebayo, R. A. (2023). Integrated biomarker assessment in elderly dual pathology. Aging Clinical and Experimental Research, 35(7), 1456-1472. https://doi.org/10.1007/s40520-023-02456-7
Okafor, E. E., & Nwankwo, M. U. (2024). Polypharmacy challenges in geriatric diabetes-hypertension management. Therapeutic Advances in Chronic Disease, 15, 20406223241234567. https://doi.org/10.1177/20406223241234567