Frailty in older people admitted to hospital in northern Tanzania : A longitudinal mixed methods study

Abstract

Background Hospitals in low- and middle-income countries are admitting larger numbers of older people with disability, multimorbidity and geriatric syndromes. Tanzania – the setting for this research – has experienced a dramatic increase in life expectancy in recent decades. Despite this, older people in Tanzania often spend their later years in ill health. Frailty is an age-related state of multiple health deficits and increased vulnerability. While frailty is known to be prevalent in the community in northern Tanzania, little is known about its impact in hospital settings in this context. Aim This research aimed to explore the extent, impact and experience of frailty amongst older people admitted to hospital in northern Tanzania. Methods This aim demanded a mixed methods approach. In the quantitative strand, consecutive people aged 60 years, admitted to four hospitals, were assessed for frailty using multiple instruments, with exploration of demographic and clinical characteristics. Outcomes, including mortality, were assessed at 12 months follow-up. Qualitative interviews with a purposive sample of service users, their caregivers and healthcare providers were conducted to explore the context of frailty, its outcomes and hospital care experiences. Results Regardless of the instrument used, frailty was prevalent and associated with a twofold increase in mortality. Themes – identified in the analysis of transcribed and translated qualitative interviews – highlighted the contributors to health in old age in Tanzania, the needs of hospitalised older people, caregiver roles during admission, and the impacts of resource limitations on the patient journey. Discussion This study was the first to assess frailty amongst hospitalised older people in Tanzania and demonstrates that frailty instruments can identify those with the greatest risk of adverse outcomes. Findings are critically discussed with reference to barriers and facilitators to effective care, and the implications for healthcare services striving to align with the needs of older people.