ObjectiveTo systematically review the research conducted on prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries (LMICs) and to estimate the pooled prevalence of frailty and prefrailty in community-dwelling older adults in LMICs.DesignSystematic review and meta-analysis. PROSPERO registration number is CRD42016036083.Data sourcesMEDLINE, EMBASE, AMED, Web of Science, CINAHL and WHO Global Health Library were searched from their inception to 12 September 2017.SettingLow-income and middle-income countries.ParticipantsCommunity-dwelling older adults aged ≥60 years.ResultsWe screened 7057 citations and 56 studies were included. Forty-seven and 42 studies were included in the frailty and prefrailty meta-analysis, respectively. The majority of studies were from upper middle-income countries. One study was available from low-income countries. The prevalence of frailty varied from 3.9% (China) to 51.4% (Cuba) and prevalence of prefrailty ranged from 13.4% (Tanzania) to 71.6% (Brazil). The pooled prevalence of frailty was 17.4% (95% CI 14.4% to 20.7%, I2=99.2%) and prefrailty was 49.3% (95% CI 46.4% to 52.2%, I2=97.5%). The wide variation in prevalence rates across studies was largely explained by differences in frailty assessment method and the geographic region. These findings are for the studies with a minimum recruitment age 60, 65 and 70 years.ConclusionThe prevalence of frailty and prefrailty appears higher in community-dwelling older adults in upper middle-income countries compared with high-income countries, which has important implications for healthcare planning. There is limited evidence on frailty prevalence in lower middle-income and low-income countries.PROSPERO registration numberCRD42016036083.

The COVID‐19 pandemic has caused increased rates of perinatal anxiety and depression in pregnant women with no known COVID‐19 infection in Sri Lanka.

ObjectiveOur main objective was to describe the prevalence and associated sociodemographic factors of frailty and pre-frailty in rural community-dwelling older adults in Kegalle district of Sri Lanka.DesignCommunity-based cross-sectional study.SettingThe study was conducted in rural areas of Kegalle district in Sri Lanka.ParticipantsA total of 746 community-dwelling older adults aged ≥60 years were included in the study.ResultsThe prevalence of frailty and pre-frailty in rural Kegalle district was 15.2% (95% CI 12.3% to 18.6%) and 48.5% (95% CI 43.8% to 53.2%), respectively. We found a strong association between age and both frailty and pre-frailty. There were strong associations between longest-held occupation and frailty and education level and pre-frailty.ConclusionsThe prevalence of frailty in this rural Sri Lankan older population was high compared with high-income and upper middle-income countries. The profile of health and social care services in Sri Lanka needs to address frailty and its consequences.

BackgroundPeripheral arterial disease (PAD), a slowly progressive atherosclerotic disease affecting vital organs of the body, is increasingly recognized as a health burden worldwide. Epidemiological information on peripheral arterial disease is scarce in Sri Lanka. The present study intended to estimate the prevalence and associated factors of PAD among adults aged 40–74 years in Gampaha district, Sri Lanka.MethodsA cross-sectional study was carried out to estimate the prevalence of PAD among adults aged 40–74 years in four randomly selected divisional secretariat areas in Gampaha district in 2012–2013. The sample size of 2912 adults was obtained from 104 clusters using multistage probability proportionate to size sampling. The number of individuals to be included in the 5-year age groups between 40 and 74 years was determined based on the population proportion of the respective age groups in the district. Cluster size was 28, and equal numbers of males and females were selected for each age group per cluster. PAD was defined as having an ankle-brachial pressure index ≤ 0.89.ResultsThe age-and sex-standardized prevalence of PAD, adjusted for the sensitivity of the ankle-brachial pressure index was 3.6 % (95 % CI 2.9–4.3 %), and no significant difference was found between males (3.7 %) and females (3.6 %) (p = 0.08). Eighty-eight individuals were newly identified as having PAD, and a significant trend of prevalence with increasing age was observed (p < 0.001). Histories of diabetes mellitus, hypertension, dyslipidemia, coronary artery disease, cerebrovascular accident, smoking, and erectile dysfunction among males were significantly associated with PAD (p <0.001). Only one third of those with PAD experienced claudication symptoms.ConclusionsPAD was found to be a hidden disease in the Gampaha district population. Although there is minimal attention on PAD at present, the disease is likely to become a problematic public health concern in Sri Lanka, particularly with its aging population. Primary prevention measures to modify risk factors of PAD, including screening activities for early identification, should be a priority.

IntroductionInstrumental activities of daily living (IADL) are cognitively complex activities related to independent living in the community. Robust IADL scales are needed, however the psychometric properties of instruments have been little evaluated. There is no validated instrument for Sri Lankan older populations. Sri Lanka has the highest proportion of older people in South Asia with rapid population ageing. Therefore, it is essential to have standard instruments to assess activity limitations. We aimed to cross-culturally adapt the original Lawton Instrumental Activities of Daily Living Scale from English to Sinhala and evaluate the psychometric properties of the Sinhala version.MethodsCross-cultural adaptation of the instrument was performed. The instrument was validated in a sample of 702 community-dwelling older adults aged 60 years and above in Sri Lanka. Reliability (internal consistency and inter-rater reliability) was assessed. Construct validity of the scale was evaluated by performing exploratory and confirmatory factor analysis and testing convergent and divergent validity.ResultsThe Lawton IADL scale was successfully adapted to Sri Lankan context. Internal consistency of the scale was very high (Cronbach’s alpha = 0.91). Very good inter-rater reliability was observed with very good agreement for all items. Inter-class correlations for overall IADL score ranged from 0.57 to 0.91. Results of the exploratory and confirmatory factor analyses supported the unidimensionality of the scale. Goodness of fit indices in confirmatory factor analysis were in acceptable range (CFI = 0.98, SRMR = 0.06, NNFI = 0.97). Strength of associations were significant and in the expected direction. Results of the known group validity were also significant, confirming the convergent and divergent validity.ConclusionThe Lawton IADL scale was successfully translated and culturally adapted to Sinhala language. The Sinhala version demonstrated excellent reliability and construct validity. Given good psychometric properties, this scale would be recommended for use in future research.