Determining frailty index thresholds for older people across multiple countries in sub-Saharan Africa.

BACKGROUND

Despite the increasing attention on frailty as a global public health concern, frailty screening among older people in Sub-Saharan Africa (SSA) continues to rely on instruments and thresholds from high-income countries. These instruments and thresholds may not be useful in SSA due to contextual differences. We explored the development of a frailty threshold for older people in SSA.

METHODS

We utilized pooled cross-sectional data from four SSA countries (Kenya, Ghana, Uganda and Côte d'Ivoire) to determine a frailty index threshold for 5527 older people (50 years and above) using a two-step approach. The mean ages of the participants ranged from 62.13 (SD: 9.60) to 74.00 (SD: 9.40) years. The participants were mostly females across the four countries, ranging from 50.1% in Côte d'Ivoire to 65.3% in Kenya. Country-specific frailty thresholds were developed using the Receiver Operating Characteristics (ROC) method. The primary thresholds were further combined into a single threshold using random effects meta-analysis. Subgroup analyses and meta-regression were conducted to explore potential sources of heterogeneity in the pooled frailty threshold.

RESULTS

Here we show the Area Under the Curves from the ROC analyses ranging between 0.91 (CI: 0.89, 0.93) and 0.94 (CI: 0.92, 0.97), with sensitivities ranging from 0.83 to 0.94 and specificities from 0.72 to 0.87. An overall threshold of 0.29 (95% CI: 0.25, 0.33) was obtained after pooled analysis of the country-specific thresholds.

CONCLUSIONS

This work demonstrates that using context-specific data can yield valuable insights into frailty thresholds among older people in SSA, enabling more culturally relevant interventions. Effective frailty screening must account for population-level differences, including demographic, health, and socio-cultural factors.