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. Change, F. Xavier Gomez-Olive, Kathleen Kahn, Lisa F. Berkman, Stephen Tollman, Joshua A. Salomon, Miles Witham (Lead / Corresponding author)

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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: 5059 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
    Pages (from-to)1-10
    Number of pages10
    JournalBMC Geriatrics
    Publication statusPublished - 28 Dec 2017


    • Fried frailty score
    • mortality
    • multimorbidity
    • activities of daily living
    • rural South Africa


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