Abstract
Background
There have been few cross-national studies of the prevalence of the frailty phenotype
conducted among low or middle income countries. We aimed to study the variation in
prevalence and correlates of frailty in rural and urban sites in Latin America, India,
and China.
Methods
Cross-sectional population-based catchment area surveys conducted in 8 urban and 4
rural catchment areas in 8 countries; Cuba, Dominican Republic, Puerto Rico, Venezuela,
Peru, Mexico, China, and India. We assessed weight loss, exhaustion, slow walking
speed, and low energy consumption, but not hand grip strength. Therefore, frailty
phenotype was defined on 2 or more of 4 of the usual 5 criteria.
Results
We surveyed 17,031 adults aged 65 years and over. Overall frailty prevalence was 15.2%
(95% confidence inteval 14.6%–15.7%). Prevalence was low in rural (5.4%) and urban
China (9.1%) and varied between 12.6% and 21.5% in other sites. A similar pattern
of variation was apparent after direct standardization for age and sex. Cross-site
variation in prevalence of frailty indicators varied across the 4 indicators. Controlling
for age, sex, and education, frailty was positively associated with older age, female
sex, lower socioeconomic status, physical impairments, stroke, depression, dementia,
disability and dependence, and high healthcare costs.
Discussion
There was substantial variation in the prevalence of frailty and its indicators across
sites in Latin America, India, and China. Culture and other contextual factors may
impact significantly on the assessment of frailty using questionnaire and physical
performance-based measures, and achieving cross-cultural measurement invariance remains
a challenge.
Conclusions
A consistent pattern of correlates was identified, suggesting that in all sites, the
frailty screen could identify older adults with multiple physical, mental, and cognitive
morbidities, disability and needs for care, compounded by socioeconomic disadvantage
and catastrophic healthcare spending.
Keywords
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Article info
Publication history
Published online: January 03, 2018
Footnotes
The 10/66 Dementia Research Group population-based surveys were funded by The Wellcome Trust (UK) (GR066133); the World Health Organization; the US Alzheimer's Association (IIRG -04-1286); and the Fondo Nacional de Ciencia Y Tecnologia, Consejo de Desarrollo Cientifico Y Humanistico, Universidad Central de Venezuela (Venezuela). The analysis reported here was carried out with funding support from the European Research Council (ERC-2013-ADG 340755 LIFE2YEARS1066). Matthew Prina was supported by the MRC (MR/K021907/1). The funding bodies had no role in the design of the study, in the collection, analysis, and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication.
The authors declare no conflicts of interest.
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© 2017 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
