A brief frailty screening tool in Tanzania: external validation and refinement of the B-FIT screen.

BACKGROUND: Identifying older people who are most vulnerable to adverse outcomes is important. This is particularly so in low-resource settings, such as those in sub-Saharan Africa (SSA), where access to social and healthcare services is often limited. AIM: To validate and further refine a frailty screening tool for SSA. METHODS: Phase I screening of people aged 60 years and over was conducted using the Brief Frailty Instrument for Tanzania (B-FIT). In phase II, a stratified, frailty-weighed sample was assessed across a range of variables covering cognition, physical function (including continence, mobility, weakness and exhaustion) nutrition, mood, co-morbidity, sensory impairment, polypharmacy, social support and self-rated health. The frailty-weighted sample was also assessed for frailty according to the comprehensive geriatric assessment (CGA), which we used as our 'gold standard' diagnosis. RESULTS: Of 235 people in the frailty-weighted sample, 91 (38.7%) were frail according to CGA, the median age was 73 years and 136 (57.9%) were female. In multivariable modelling, physical disability (Barthel index), cognitive impairment (IDEA cognitive screen), calf circumference, poor distance vision and problems engaging in social activities were found to be associated with frailty. After developing a scoring system, based on regression coefficients, a modified B-FIT screen (B-FIT 2) had an area under the receiver operating characteristic curve of 0.925, a sensitivity of 86.2% and a specificity of 88.8%. DISCUSSION: The inclusion of items assessing nutrition, social support and sensory impairment improved the performance of the B-FIT. CONCLUSIONS: The B-FIT 2 should be externally validated.

Prevalence of Frailty in Older Community-Dwelling Tanzanians According to Comprehensive Geriatric Assessment.

OBJECTIVES: To investigate the prevalence of frailty using a Comprehensive Geriatric Assessment (CGA) in older community-dwelling adults living in rural northern Tanzania. DESIGN: Cross-sectional survey. SETTING: Five randomly selected villages in Hai District, Kilimanjaro region, Tanzania. PARTICIPANTS: All adults aged 60 and older living in the selected villages were eligible to participate, including older adults with cognitive impairment provided a close relative was able to assent on their behalf. All participants were community dwelling because institutionalization is very rare. MEASUREMENTS: Participants were screened using a short frailty screening tool, the Brief Frailty Instrument for Tanzania (B-FIT), comprising an abbreviated test of cognitive function and the Barthel Index, which assesses functional independence. Based on B-FIT score, a frailty-weighted, stratified sample was selected for in-depth assessment using CGA and characterized as frail or not frail. RESULTS: Two hundred thirty-six CGAs were performed in 1,207 people screened, 91 of whom were deemed frail. After adjusting for stratification, the prevalence of frailty was 19.1% (95% confidence interval=15.2-23.1). CONCLUSION: This is the first study in sub-Saharan Africa to report the prevalence of frailty in community-dwelling older adults according to a CGA. The strengths of reporting frailty according to a CGA include the ability to consider likely medical diagnoses based on clinical assessment and to assess individuals' social circumstances and environment.