Developing and evaluating a frailty index for older South Africans - Findings from the HAALSI study

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

Abstract

Background: 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. Methods: 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. Results: 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). Conclusion: 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.

Citation

Barker, F. J., Davies, J. I., Xavier Gomez-Olive, F., Kahn, K., Matthews, F. E., Payne, C. F., …Witham, M. D. (2021). Developing and evaluating a frailty index for older South Africans - Findings from the HAALSI study. Age and ageing, 50(6), 2167-2173. https://doi.org/10.1093/ageing/afab111

• Journal Article Type: Article
• Acceptance Date: Apr 19, 2021
• Online Publication Date: Jun 9, 2021
• Publication Date: Nov 1, 2021
• Deposit Date: Mar 31, 2024
• Publicly Available Date: Apr 3, 2024
• Journal: Age and Ageing
• Print ISSN: 0002-0729
• Electronic ISSN: 1468-2834
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 50
• Issue: 6
• Pages: 2167-2173
• DOI: https://doi.org/10.1093/ageing/afab111
• Keywords: Frailty index; Older people; Global health
• Public URL: https://hull-repository.worktribe.com/output/4451242