Frailty in Tanzania: a longitudinal mixed methods study

Abstract

Background Population ageing is occurring globally and sub-Saharan Africa has the most rapidly growing older population. Frailty in old age is likely to become of increasing importance therefore. Several biomedical models of frailty have been proposed, including the frailty phenotype which defines frailty as a syndrome of age-related physical changes meeting a standard criteria. An alternative model is the frailty index, which conceptualises frailty as the product of accumulating age-related “deficits”, these being diseases, disabilities, signs or symptoms. Aims The quantitative aspect of this study sought to operationalise both of these frailty models, comparing them with expert consensus, applied through the Comprehensive Geriatric Assessment. The aim was to investigate the prevalence characteristics and outcomes of frailty in rural Tanzania. The qualitative aspect of the study aimed to investigate how frailty is understood in the study’s setting, as well as the lived-experience of frailty from the perspectives of older people and their communities. Methods Quantitative methods included screening adults aged ≥60 years from five randomly selected villages in rural Hai District, Northern Tanzania. Survey questionnaires and anthropometric measurements were conducted, alongside comprehensive geriatric assessments on a frailty-weighted cohort. Qualitative methods involved semi-structured interviews and focus group discussions with a purposive sample of older people, their family members, and community representatives. Transcripts were transcribed, translated and analysed thematically. Results Results showed that frailty by biomedical models detected frailty, and replicated the expected epidemiological patterns. Six qualitative themes were developed that demonstrated frailty to be experienced and understood as either a natural conclusion to a long life, or an aberrant form of ageing due to a scarcity of resources and care. Discussion Findings were synthesised dialectically in order to arrive at a deeper understanding of frailty, its characteristics and outcomes in this rural African context.