The prevalence and characteristics of frailty by frailty phenotype in rural Tanzania

Abstract

BackgroundThe frailty phenotype is defined by the presence of three from the following five clinical features: weakness, slow walking speed, unintentional weight loss, exhaustion, and low physical activity. It has been widely applied in different research and clinical contexts, including across many low and middle-income countries. However, there is evidence that the operationalisation of each component of the frailty phenotype significantly alters its characteristics and predictive validity, and care is needed when applying the phenotype across settings. The study’s objective was to operationalise the frailty phenotype in a rural Tanzanian population of older community-dwelling adults.MethodsConsenting adults aged ≥60 years, and resident in five randomly selected villages of Hai district Demographic Surveillance Site, were eligible to participate in this cross-sectional study. From a screened sample of 1207 older adults, 235 were randomised and consented to an assessment of their frailty status by the frailty phenotype. Trained research fieldworkers (Tanzanian medical doctors and nurses) carried out measurements and questionnaires at local village centres or at participants’ homes.ResultsThe prevalence of the frailty phenotype, calculated from complete data for 196 participants, was 9.25% (95% CI 4.39–14.12) When missing data were counted as meeting frailty criterion (i.e. missing due to inability to perform an assessment), the prevalence increased to 11.22% (95% CI 7.11–15.32). Frailty by phenotype criteria was more common in older age groups, and was associated with self-assessed poor health and depression symptoms.ConclusionsFrailty can be successfully estimated using the frailty phenotype, however there are challenges in its operationalisation cross-culturally. Further work is needed to explore the potential clinical application of the frailty phenotype in such settings.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0967-0) contains supplementary material, which is available to authorized users.

Examining Frailty Phenotype Dimensions in the Oldest Old

“…In accordance with previous studies (Lewis et al, 2018), our findings revealed a high number of women and widow(ed) participants. The education level among this group is very low (or inexistent), which is why we considered participants who were illiterate versus those who attended school for 1 year or more.…”

“…Frail individuals represented more than two-thirds of the total sample (71.8 vs. 24.6% of prefrail). These results are in accordance with other studies (Duarte and Paúl, 2015;Lewis et al, 2018), which also had a great number of frail oldest old individuals in their samples, highlighting the low differentiation (almost all frail persons) provided by the frailty phenotype of Fried among oldest old individuals and emphasizing the need to better understand its components.…”

“…Previous research has shown that there is a significant association between increased age and frailty, revealing that the majority of frail individuals are the oldest ones (e.g., Fried et al, 2001;Duarte and Paúl, 2015;Carey et al, 2018;Lewis et al, 2018). Fried's original study in particular showed that individuals aged 80+ years old represented 34.8% of the frail sample.…”

<p>Frailty syndrome: implications and challenges for health care policy</p>

“…The population-based lowest 20% of the handgrip strength, gait speed, and physical activity need to be calculated based on the population distributions. Calculation of the Frailty Index requires the recording of various types of deficits (typically more than [30][31][32][33][34][35][36][37][38][39][40] and dividing the number of deficits present by the number of deficits considered, which may take ~20-30 minutes, 19 Kojima et al…”

“…28 A higher prevalence of frailty is also observed in selected populations with specific diseases or conditions, such as patients with cancer (42%), 29 end-stage renal disease (37%), 30 heart failure (45%), 31 Alzheimer disease (32%), 32 and nursing home residents (52%). 33 Although the mean prevalence of frailty gradually increases with age, 28,[34][35][36][37] the individual course of frailty varies and the level of frailty can be reduced even in old age. 4,38 Several longitudinal population-based studies have showed that 8.3%-17.9% of older adults actually improved their frailty status [39][40][41][42][43][44] and that some of them made frequent and dynamic transitions over time.…”