A cross-cultural investigation of the conceptualisation of frailty in northern Tanzania

Emma G Lewis,Matthew Breckons,Jane Rogathi,Richard Lee,Sarah Urasa,John Kissima

doi:10.1017/s0144686x21000520

Abstract

AbstractFrailty prevalence is higher in low- and middle-income countries (LMICs) compared with high-income countries when measured by biomedical frailty models, the most widely used being the frailty phenotype. Frailty in older people is becoming of global public health interest as a means of promoting health in old age in LMICs. As yet, little work has been done to establish to what extent the concept of frailty, as conceived according to ‘western’ biomedicine, has cross-cultural resonance for a low-income rural African setting. This study aimed to investigate the meaning of frailty contextually, using the biomedical concept of the frailty phenotype as a framework. Qualitative interviews were conducted with a purposive sample of older adults, their care-givers and community representatives in rural northern Tanzania. Thirty interview transcripts were transcribed, translated from Kiswahili to English and thematically analysed. Results reveal that despite superficial similarities in the understanding of frailty, to a great extent the physical changes highlighted by the frailty phenotype were naturalised, except when these were felt to be due to a scarcity of resources. Frailty was conceptualised as less of a physical problem of the individual, but rather, as a social problem of the community, suggesting that the frailty construct may be usefully applied cross-culturally when taking a social equity focus to the health of older people in LMICs.

Highlights

The proportion and number of older people is increasing worldwide, and this rise in the older population is occurring most rapidly in sub-Saharan Africa (SSA) (World Health Organization, 2015)
While there may have been some circularity of meaning, this younger ten-cell leader ‘Mzee Godfrey’ described his understanding of frailty based on his knowledge of the older people he knew in his locality
It was often implied that frailty consisted of both physical weakening and a loss of financial power, both being intimately associated in this context

Summary

Introduction

The proportion and number of older people is increasing worldwide, and this rise in the older population is occurring most rapidly in sub-Saharan Africa (SSA) (World Health Organization, 2015). The concept of frailty is described in high-income country (HIC) biomedical literature by two major models; the phenotype and deficit accumulation models, thought to be distinct, yet complimentary concepts (Cesari et al, 2014). The deficit accumulation model quantifies frailty as a ratio of the number of health- and age- associated “deficits” from those counted (Rockwood and Mitnitski, 2007). These “deficits” are loosely defined as any symptom, sign, disability or diagnosis across a range of modalities, often including cognitive impairment and mood (Rockwood and Mitnitski, 2007; Searle et al, 2008). This paper will concentrate on the frailty phenotype: While the frailty phenotype has been critiqued for its narrow focus on physical components (Gobbens et al, 2010), perhaps due to its relative simplicity, it has been widely adapted and is the most commonly applied frailty measure globally (Gray, 2016; Nguyen, Cumming and Hilmer 2015; Siriwardhana et al, 2018)

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