Prevalence and correlates of frailty in an older rural African population: findings from the HAALSI cohort study

Collin F Payne,Chodziwadziwa W Kabudula,F Xavier Gomez-Olive,Joshua A Salomon,Alisha Wade,Kathleen Kahn,Stephen M Tollman,Lisa F Berkman,Angela Y Chang,Miles D Witham,Justine I Davies

doi:10.1186/s12877-017-0694-y

Abstract

BackgroundFrailty is a key predictor of death and dependency, yet little is known about frailty in sub-Saharan Africa despite rapid population ageing. We describe the prevalence and correlates of phenotypic frailty using data from the Health and Aging in Africa: Longitudinal Studies of an INDEPTH Community cohort.MethodsWe analysed data from rural South Africans aged 40 and over. We used low grip strength, slow gait speed, low body mass index, and combinations of self-reported exhaustion, decline in health, low physical activity and high self-reported sedentariness to derive nine variants of a phenotypic frailty score. Each frailty category was compared with self-reported health, subjective wellbeing, impairment in activities of daily living and the presence of multimorbidity. Cox regression analyses were used to compare subsequent all-cause mortality for non-frail (score 0), pre-frail (score 1–2) and frail participants (score 3+).ResultsFive thousand fifty nine individuals (mean age 61.7 years, 2714 female) were included in the analyses. The nine frailty score variants yielded a range of frailty prevalences (5.4% to 13.2%). For all variants, rates were higher in women than in men, and rose steeply with age. Frailty was associated with worse subjective wellbeing, and worse self-reported health. Both prefrailty and frailty were associated with a higher risk of death during a mean 17 month follow up for all score variants (hazard ratios 1.29 to 2.41 for pre-frail vs non-frail; hazard ratios 2.65 to 8.91 for frail vs non-frail).ConclusionsPhenotypic frailty could be measured in this older South African population, and was associated with worse health, wellbeing and earlier death.

Highlights

Frailty is a key predictor of death and dependency, yet little is known about frailty in sub-Saharan Africa despite rapid population ageing
Our objectives were to ascertain the prevalence of phenotypic frailty in a rural South African population of older people using a range of different ways of constructing a frailty phenotype score, to test whether phenotypic frailty was a distinct construct from disability and multimorbidity in this population, and to test whether frailty associated with earlier death and worse health and wellbeing in this population
The prevalence of frailty was similar for most frailty score variants, but was markedly higher for those variants (6 and 7) using an unadjusted walk speed cutpoint of 0.8 m/s

Summary

Introduction

Frailty is a key predictor of death and dependency, yet little is known about frailty in sub-Saharan Africa despite rapid population ageing. Frailty identifies the group of older people in higher-income countries most likely to benefit from. Comprehensive Geriatric Assessment – a major healthcare intervention shown to improve outcomes in older people [6]. Frailty indices have the potential to assist with identification of those at highest risk of these adverse outcomes, and target interventions to those most likely to benefit. Population-based studies on frailty can aid in identifying people at risk of frailty and the development of strategies for altering the trajectory towards frailty. As population ageing reaches across the world, preventive strategies to limit frailty and maximize healthy life expectancy will become increasingly important

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