Abstract：
BACKGROUND: Little is known about ageing and frailty progression in low-income settings. We aimed to describe frailty changes over time in individuals living in rural Burkina Faso and to assess which sociodemographic, disability, and multimorbidity factors are associated with frailty progression and mortality.
METHODS: This longitudinal, population-based study was conducted at the Nouna Health and Demographic Surveillance Systems (HDSS) site in northwestern Burkina Faso. Eligible participants were aged 40 years or older and had been primarily resident in a household within the HDSS area for at least the past 6 months before the baseline survey and were selected from the 2015 HDSS household census using a stratified random sample of adults living in unique households within the area. Participants were interviewed in their homes in 2018 (baseline), 2021 (follow-up), or both. We derived the Fried frailty score for each participant at each timepoint using data on grip strength, gait speed, self-reported weight loss, self-reported exhaustion, and physical activity, and described changes in frailty status (no frailty, pre-frailty, or frailty) between 2018 and 2021. We used multivariate regression models to assess factors (ie, sex, age, marital status, educational attainment, wealth quintile, WHO Disability Assessment Schedule (WHODAS) score, and multimorbidity) associated with frailty progression (either worsening frailty status or dying, compared with frailty status remaining the same or improving) and with mortality, and developed sequential models: unadjusted, adjusting for sociodemographic factors (sex, age, marital status, educational attainment, and wealth quintile), and adjusting for sociodemographic factors, disability, and multimorbidity.
RESULTS: Between May 25 and July 19, 2018, and between July 1 and Aug 22, 2021, 5952 individuals were invited to participate: 1709 (28·7%) did not consent, 1054 (17·8%) participated in 2018 only and were lost to follow-up, 1214 (20·4%) participated in 2021 only, and 1975 (33·2%) were included in both years or died between years. Of 1967 participants followed up with complete demographic data, 190 (9·7%) were frail or unable to complete the frailty assessment in 2018, compared with 77 (3·9%) in 2021. Between 2018 and 2021, frailty status improved in 567 (28·8%) participants and worsened in 327 (16·6%), and 101 (5·1%) participants died. The relative risk of frailty status worsening or of dying (compared with frailty impRoving or no change) increased with age and WHODAS score, whereas female sex appeared protective. After controlling for all sociodemographic factors, multimorbidity, and WHODAS score, odds of mortality were 1·07 (odds ratio 2·07, 95% CI 1·05-4·09) times higher among pre-frail individuals and 1·1 (2·21, 0·90-5·41) times higher among frail individuals than among non-frail individuals.
CONCLUSIONS: Frailty status was highly dynamic in this low-income setting and appears to be modifiable. Given the rapid increase in the numbers of older adults in low-income or middle-income countries, understanding the behaviour of frailty in these settings is of high importance for the development of policies and health systems to ensure the maintenance of health and wellbeing in ageing populations. Future work should focus on designing context-appropriate interventions to improve frailty status.
BACKGROUND: Alexander Von Humboldt Foundation, Institute for Global Innovation, University of Birmingham, and Wellcome Trust.
METHODS: This longitudinal, population-based study was conducted at the Nouna Health and Demographic Surveillance Systems (HDSS) site in northwestern Burkina Faso. Eligible participants were aged 40 years or older and had been primarily resident in a household within the HDSS area for at least the past 6 months before the baseline survey and were selected from the 2015 HDSS household census using a stratified random sample of adults living in unique households within the area. Participants were interviewed in their homes in 2018 (baseline), 2021 (follow-up), or both. We derived the Fried frailty score for each participant at each timepoint using data on grip strength, gait speed, self-reported weight loss, self-reported exhaustion, and physical activity, and described changes in frailty status (no frailty, pre-frailty, or frailty) between 2018 and 2021. We used multivariate regression models to assess factors (ie, sex, age, marital status, educational attainment, wealth quintile, WHO Disability Assessment Schedule (WHODAS) score, and multimorbidity) associated with frailty progression (either worsening frailty status or dying, compared with frailty status remaining the same or improving) and with mortality, and developed sequential models: unadjusted, adjusting for sociodemographic factors (sex, age, marital status, educational attainment, and wealth quintile), and adjusting for sociodemographic factors, disability, and multimorbidity.
RESULTS: Between May 25 and July 19, 2018, and between July 1 and Aug 22, 2021, 5952 individuals were invited to participate: 1709 (28·7%) did not consent, 1054 (17·8%) participated in 2018 only and were lost to follow-up, 1214 (20·4%) participated in 2021 only, and 1975 (33·2%) were included in both years or died between years. Of 1967 participants followed up with complete demographic data, 190 (9·7%) were frail or unable to complete the frailty assessment in 2018, compared with 77 (3·9%) in 2021. Between 2018 and 2021, frailty status improved in 567 (28·8%) participants and worsened in 327 (16·6%), and 101 (5·1%) participants died. The relative risk of frailty status worsening or of dying (compared with frailty impRoving or no change) increased with age and WHODAS score, whereas female sex appeared protective. After controlling for all sociodemographic factors, multimorbidity, and WHODAS score, odds of mortality were 1·07 (odds ratio 2·07, 95% CI 1·05-4·09) times higher among pre-frail individuals and 1·1 (2·21, 0·90-5·41) times higher among frail individuals than among non-frail individuals.
CONCLUSIONS: Frailty status was highly dynamic in this low-income setting and appears to be modifiable. Given the rapid increase in the numbers of older adults in low-income or middle-income countries, understanding the behaviour of frailty in these settings is of high importance for the development of policies and health systems to ensure the maintenance of health and wellbeing in ageing populations. Future work should focus on designing context-appropriate interventions to improve frailty status.
BACKGROUND: Alexander Von Humboldt Foundation, Institute for Global Innovation, University of Birmingham, and Wellcome Trust.
摘要：
背景：关于低收入环境中的衰老和虚弱进展知之甚少。我们的目的是描述生活在布基纳法索农村的个人随着时间的推移的脆弱变化，并评估哪些社会人口统计学，残疾,多发病因素与虚弱进展和死亡率相关。
方法：这种纵向，在布基纳法索西北部的努纳健康和人口监测系统(HDSS)站点进行了基于人群的研究.符合条件的参与者年龄在40岁或以上，并且在基线调查之前至少在过去6个月内主要居住在HDSS区域内的一个家庭中，并从2015年HDSS家庭人口普查中使用居住在该地区独特家庭中的成年人的分层随机抽样进行选择。2018年，参与者在家中接受了采访(基线)，2021年（后续行动），或者两者兼而有之。我们使用握力数据得出每个参与者在每个时间点的Fried脆弱分数，步态速度,自我报告的体重减轻，自我报告的疲惫，和身体活动，并描述了脆弱状态的变化(没有脆弱，脆弱前，或脆弱)在2018年至2021年之间。我们使用多元回归模型来评估因素(即，性别,年龄,婚姻状况,教育程度,财富五分之一，世卫组织残疾评估表（WHODAS）评分，和多发病率)与虚弱进展(虚弱状况恶化或死亡，与虚弱状态保持不变或改善相比)和死亡率，并开发了序列模型：未调整，调整社会人口因素(性别，年龄,婚姻状况,教育程度,和财富五分之一)，并调整社会人口因素，残疾,和多重性。
结果：在2018年5月25日至7月19日以及2021年7月1日至8月22日之间，邀请了5952人参加：1709（28·7％）不同意，1054人(17%)仅在2018年参加，但失去了随访，1214（20·4%）仅在2021年参加，1975年（33·2%）被包括在两年内或在几年之间死亡。在1967年的参与者中，跟进了完整的人口统计数据，2018年有190人（9·7%）虚弱或无法完成虚弱评估，而2021年为77人（3·9%）。在2018年至2021年期间，567名(28%)参与者的虚弱状况有所改善，327名(16%)参与者的虚弱状况恶化，101名（5·1%）参与者死亡。随着年龄和WHODAS评分的增加，虚弱状态恶化或死亡的相对风险（与虚弱冲击或无变化相比）增加，而女性表现出保护性。在控制了所有社会人口统计学因素后，多浊度,和WHODAS得分，在体弱个体中,死亡几率为1·07(比值比2·07,95%CI1·05-4·09)倍,在体弱个体中,死亡几率为1·1(2·21,0·90-5·41)倍。
结论：脆弱状态在这种低收入环境中是高度动态的，并且似乎是可修改的。鉴于低收入或中等收入国家老年人人数迅速增加，了解这些环境中虚弱的行为对于制定政策和卫生系统以确保老龄化人口的健康和福祉至关重要。未来的工作应侧重于设计适合环境的干预措施，以改善脆弱状态。
背景：亚历山大·冯·洪堡基金会，全球创新研究所,伯明翰大学,惠康信托基金。
方法：这种纵向，在布基纳法索西北部的努纳健康和人口监测系统(HDSS)站点进行了基于人群的研究.符合条件的参与者年龄在40岁或以上，并且在基线调查之前至少在过去6个月内主要居住在HDSS区域内的一个家庭中，并从2015年HDSS家庭人口普查中使用居住在该地区独特家庭中的成年人的分层随机抽样进行选择。2018年，参与者在家中接受了采访(基线)，2021年（后续行动），或者两者兼而有之。我们使用握力数据得出每个参与者在每个时间点的Fried脆弱分数，步态速度,自我报告的体重减轻，自我报告的疲惫，和身体活动，并描述了脆弱状态的变化(没有脆弱，脆弱前，或脆弱)在2018年至2021年之间。我们使用多元回归模型来评估因素(即，性别,年龄,婚姻状况,教育程度,财富五分之一，世卫组织残疾评估表（WHODAS）评分，和多发病率)与虚弱进展(虚弱状况恶化或死亡，与虚弱状态保持不变或改善相比)和死亡率，并开发了序列模型：未调整，调整社会人口因素(性别，年龄,婚姻状况,教育程度,和财富五分之一)，并调整社会人口因素，残疾,和多重性。
结果：在2018年5月25日至7月19日以及2021年7月1日至8月22日之间，邀请了5952人参加：1709（28·7％）不同意，1054人(17%)仅在2018年参加，但失去了随访，1214（20·4%）仅在2021年参加，1975年（33·2%）被包括在两年内或在几年之间死亡。在1967年的参与者中，跟进了完整的人口统计数据，2018年有190人（9·7%）虚弱或无法完成虚弱评估，而2021年为77人（3·9%）。在2018年至2021年期间，567名(28%)参与者的虚弱状况有所改善，327名(16%)参与者的虚弱状况恶化，101名（5·1%）参与者死亡。随着年龄和WHODAS评分的增加，虚弱状态恶化或死亡的相对风险（与虚弱冲击或无变化相比）增加，而女性表现出保护性。在控制了所有社会人口统计学因素后，多浊度,和WHODAS得分，在体弱个体中,死亡几率为1·07(比值比2·07,95%CI1·05-4·09)倍,在体弱个体中,死亡几率为1·1(2·21,0·90-5·41)倍。
结论：脆弱状态在这种低收入环境中是高度动态的，并且似乎是可修改的。鉴于低收入或中等收入国家老年人人数迅速增加，了解这些环境中虚弱的行为对于制定政策和卫生系统以确保老龄化人口的健康和福祉至关重要。未来的工作应侧重于设计适合环境的干预措施，以改善脆弱状态。
背景：亚历山大·冯·洪堡基金会，全球创新研究所,伯明翰大学,惠康信托基金。
