Hospital referral patterns amongst older adults in Zimbabwe: a cross-sectional study

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 (n = 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.