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

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

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18 Citations (Scopus)
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BACKGROUND: Frailty 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.

METHODS: We 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+).

RESULTS: Five 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).

CONCLUSIONS: Phenotypic frailty could be measured in this older South African population, and was associated with worse health, wellbeing and earlier death.

Original languageEnglish
Article number293
JournalBMC Geriatrics
Publication statusPublished - 28 Dec 2017


  • Africa South of the Sahara/epidemiology
  • Aged
  • Aged, 80 and over
  • Aging/physiology
  • Body Mass Index
  • Cohort Studies
  • Female
  • Frail Elderly
  • Frailty/diagnosis
  • Health Status
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Prevalence
  • Rural Population/trends
  • Self Report


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