Developing and evaluating a frailty index for older South Africans—findings from the HAALSI study
Date
2021-06-09
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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.
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Keywords
frailty index, older people, global health