Miss Deepani Siriwardhana is currently reading for her PhD in Epidemiology and Public Health at University College London. She received the prestigious Commonwealth Scholarship in 2015 to pursue her doctoral studies at University College London. She is also involving with teaching activities at UCL as a part time PhD teaching assistant. By profession, Ms. Deepani is a Lecturer in Public Health in the Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Sri Lanka. She holds a BSc honors degree in Health Promotion with a first class (2011) and Master of Public Health in Epidemiology with a merit pass (2014). Before joined to the Lecturer position, she had been working as a Demonstrator and Assistant Lecturer at the Department of Primary Care, Eastern University, Sri Lanka facilitating the teaching of undergraduate medical students. Her PhD focuses on the frailty syndrome of older adults in low and middle income countries with special attention to Sri Lanka.
Burden of Frailty Syndrome in Low and Middle Income Countries: A Systematic Review and Meta-Analysis
Globally the population is ageing. The pace of population ageing is faster in low and middle income countries (LMICs) compared to high income countries (HICs). Frailty syndrome is a health problem of old age that has several negative outcomes. It is defined as a clinically identifiable state which increases vulnerability to adverse outcomes due to decline in reserve and functions in multiple physiologic systems associated with ageing. Frailty has a rich research base in HICs. The objective of this study was to systematically review the research conducted on prevalence of frailty and pre-frailty among community dwelling older adults in low and middle income countries (LMICs) and to estimate the pooled prevalence of frailty and pre-frailty in community dwelling older adults in LMICs.
The MEDLINE, EMBASE, AMED, Web of Science, CINAHL and WHO Global Health Library were searched from their inception to 12, September 2017. Two search terms, “Frailty” and “low and middle income countries” were used to develop the electronic search strategy. The World Bank Country Classification for the 2018 fiscal year which is based on the 2016 economic data was used to identify the transitions of the countries. In addition to the electronic search, reference lists of the selected articles were scanned and citation searches were performed. Cross sectional and prospective studies measuring prevalence of frailty in LMICs were included. Eligible participants were community dwelling adults aged 60 years+. Two independent reviewers reviewed articles assessing methodological rigor. No language limit was imposed on the search. PROSPERO registration number is CRD42016036083.
We screened 7057 citations and 56 studies were included. Forty seven and 42 studies were included in the frailty and pre-frailty meta-analysis respectively. The majority of studies were from upper middle income countries. One study was available from low income countries. The prevalence of frailty varied from 3.9% (China) to 51.4% (Cuba) and prevalence of pre-frailty ranged from 13.4% (Tanzania) to 71.6% (Brazil). The pooled prevalence of frailty was 17.4% (95% CI=14.4-20.7%, I2 =99.2) and pre-frailty was 49.3% (95% CI= 46.4-52.2%, I2 =97.5). The wide variation in prevalence rates across studies was largely explained by differences in frailty assessment method and the geographic region.
The prevalence of frailty and pre-frailty appears higher in community dwelling older adults in upper middle income countries compared to HICs, which has important implications for healthcare planning. There is limited evidence on frailty prevalence in lower middle and low income countries. Although there is evidence on change of demographics in LMICs leading to rapid ageing populations, scarcity of data on frailty has become a barrier for policy development and planning of social services for elderly. With the limited resource in LMICs, hard data on vulnerabilities of elderly population becomes a prerequisite for advocacy. Hence, there is a great need for studies on elderly health particularly on debilitating illnesses in LMICs.