Developing and evaluating a Frailty Index for older South Africans – findings from the HAALSI study

Fred J Barker, Justine Davies, F Xavier Gomez-Olive, Kathleen Kahn, Fiona E Matthews, Collin F Payne, Joshua A Salomon, Stephen M Tollman, Alisha N Wade, Richard W Walker, Miles D Witham

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despite rapid population ageing, few studies have investigated frailty in older people in sub-Saharan Africa. We tested a cumulative deficit frailty index in a population of older people from rural South Africa.

analysis of cross-sectional data from the Health and Ageing in Africa: Longitudinal Studies of an INDEPTH Community (HAALSI) study. We used self-reported diagnoses, symptoms, activities of daily living, objective physiological indices and blood tests to calculate a 32-variable cumulative deficit frailty index. We fitted Cox proportional hazards models to test associations between frailty category and all-cause mortality. We tested the discriminant ability of the frailty index to predict one-year mortality alone and in addition to age and sex.

in total 3,989 participants were included in the analysis, mean age 61 years (standard deviation 13); 2,175 (54.5%) were women. The median frailty index was 0.13 (interquartile range 0.09–0.19); Using population-specific cutoffs, 557 (14.0%) had moderate frailty and 263 (6.6%) had severe frailty. All-cause mortality risk was related to frailty severity independent of age and sex (hazard ratio per 0.01 increase in frailty index: 1.06 [95% confidence interval 1.04–1.07]). The frailty index alone showed moderate discrimination for one-year mortality: c-statistic 0.68–0.76; combining the frailty index with age and sex improved performance (c-statistic 0.77–0.81).

frailty measured by cumulative deficits is common and predicts mortality in a rural population of older South Africans. The number of measures needed may limit utility in resource-poor settings.
Original languageEnglish
Article numberafab111
Pages (from-to)2167-2173
JournalAge and Ageing
Issue number6
Early online date9 Jun 2021
Publication statusE-pub ahead of print - 9 Jun 2021


  • frailty index
  • global health
  • older people


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