Background:

As African populations age rapidly, countries across the continent are witnessing a growing burden of impairments in activities of daily living (ADL) and instrumental activities of daily living (IADL), which are closely linked to poor health outcomes and increased care needs. Despite this, reliable and context-sensitive data remain scarce, limiting evidence-based care planning and policymaking.

 

Objective:

This study aimed to assess the prevalence and hierarchical distribution of ADL and IADL impairments among community-dwelling older adults across 11 African countries, using a low-cost, standardized assessment approach.

 

Methods:

The Pan African Utilization of Lay Assessment System (PAULAS) study was a collaborative initiative between local and international ageing researchers. In each participating country, approximately 300 individuals aged 50 years or older were recruited using purposive sampling. Trained laypersons from the communities administered the interRAI CheckUp Self-report (CUSR) instrument—either electronically via tablets or using paper-based forms. The interRAI ADL and IADL Hierarchy Scales were used to analyze patterns of functional impairment.

 

Results:

Data from 7,052 older adults (mean age: 71.6 ± 8.7 years; 63.8% female) were analyzed. Overall, 23.2% of participants reported impairment in at least one ADL item, while 45.9% reported IADL impairment. Ethiopia recorded the highest prevalence of both ADL (63.1%) and IADL (91.0%) impairments; Tanzania had the lowest (9%). South Africa reported the lowest IADL impairment prevalence overall.

Gender differences were minimal for ADL impairment (22.9% for males vs. 23.2% for females; p = 0.65), but significantly higher IADL impairment was observed among males (50.2% vs. 43.4%; p < 0.0001). Country-level sex disparities were also evident. For example, male participants reported higher ADL impairment in Ethiopia, Nigeria, and Uganda, while female participants had higher prevalence in the remaining countries. Males in Nigeria, Benin, Ethiopia, and Egypt more frequently reported IADL difficulties with meal preparation and housework, while no significant sex differences were found in managing finances, medication, or grocery shopping.

In terms of severity, 7.2% had mild ADL impairment (ADLH scale 1–2), and 11.1% had moderate-to-severe impairment (ADLH scale 3–6). Egypt (28.7%) and Ethiopia (21.7%) had the highest levels of moderate-to-severe impairment, while Tanzania (4.2%) and South Africa (6.7%) had the lowest. Unexpectedly, impairments in eating (a late-loss ADL item) were more prevalent than locomotion or toileting (mid-loss items) in several countries.

 

Conclusion:

This pilot study reveals complex and heterogeneous patterns of functional decline among older adults across Africa, with significant differences by country and gender. The use of a standardized instrument across diverse settings highlights the feasibility of lay person-administered community-based geriatric assessments and the importance of nuanced, regionally relevant data for care planning. These findings emphasize the need for expanded, longitudinal research to better inform ageing policies and service delivery in Africa.

Dr. Bon Egbujie is a physician and public health scientist with over 15 years of international experience spanning clinical care, research, and health systems innovation. Trained in medicine in Nigeria and holding a PhD in Public Health from the University of Waterloo, he has led research and implementation projects across Africa and Canada, working with organizations including PEPFAR, USAID, and the CDC.

 

Currently an Implementation and Research Scientist at Toronto Grace Health Centre and Adjunct Assistant Professor at the University of Waterloo, Dr. Bon Egbujie specializes in data-driven health solutions, program evaluation, and real-world evidence analytics. His work bridges clinical practice and policy, with a focus on improving outcomes for aging populations and underserved communities.

He has interests and skills in the use of artificial intelligence for evidence generation.