Developing and evaluating a frailty index for older South Africans—findings from the HAALSI study


Fred J Barker, Justine I Davies, Xavier F Gomez-Olive, Kathleen Kahn, Fiona E Matthews, Collin F Payne, Joshua A. Salomon, Stephen M Tollman, Alisha N Wade, Richard W Walker, and Miles D Witham. 2021. “Developing and evaluating a frailty index for older South Africans—findings from the HAALSI study.” Age and Ageing, 50, 6, Pp. 2167-2173. Publisher's Version


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.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 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).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.
Last updated on 12/02/2021