Epidemiologia słabości, wielochorobowości i niepełnosprawności: badanie przekrojowe dorosłych w średnim i starszym wieku w Gambii, Zimbabwe i RPA

Abstract Background Multimorbidity, frailty and disability risk are increasing with longevity across Africa. We aimed to quantify the overlap between multimorbidity, frailty, and disability; assess associations with health-related quality of life (HRQoL); and between individual long-term conditions (LTCs) and frailty and disability. Methods This population-based cross-sectional study recruited adults aged ≥ 40 years in five settings: rural(n = 1052) and urban Gambia(n = 1218), rural(n = 948) and urban South Africa (SA) (n = 968), and urban Zimbabwe(n = 1110). Researcher-administered questionnaires and assessments determined LTCs by self-reported diagnosis, medication use, blood pressure, glucose and HIV testing. Multimorbidity was defined as ≥ 2 LTCs, disability by Washington Group questionnaire, frailty using five Fried criteria (≥ 3 frail, 1–2 pre-frail, 0 robust), and HRQoL using EuroQol-5 Dimension 5-Level. A minimally important difference [MID] was considered half a standard deviation[SD]. Results Of 5,296 adults (mean age 61.0 [SD:12.9] years, 53.3% (n = 2823) female), 1924 (36.3%) were multimorbid, 741 (14.1%) frail, 3199 (60.7%) prefrail, and 1211 (22.9%) disabled. Overall, 202(3.8%) had the triad of multimorbidity, frailty, and disability (range: 10.6% urban SA, to 5.5% rural Gambia). Mood disorders (odds ratio [OR] 7.16 [95%CI: 4.16;12.33]), severe mental illness (4.66 [2.71;8.00]), and chronic kidney disease (4.25 [1.62;11.10]) were associated with frailty, whilst mood disorders (3.19 [2.48;4.09]), arthritis (2.78 [1.54;4.94]), and cardiac disease (2.50 [1.66;3.56]) were associated with disability. Age-adjustment strengthened associations, and revealed disability associations with epilepsy, HIV, and prior tuberculosis. The overall mean ± SD HRQoL utility score was 0.829 ± 0.107 (MID = 0.054). In younger adults (40–54 years), a HRQoL MID was observed in females with multimorbidity, pre-frailty and disability, and in men with frailty and disability (+/- multimorbidity). In older ages (≥ 55 years), a HRQoL MID was reached in females and males with pre-frailty or frailty and disability (+/- multimorbidity). Conclusions A third of mid-age to older adults were living with multimorbidity, three-quarters with frailty or pre-frailty and a quarter with disability. Patient-centred interventions, rather than disease-based approaches, should be evaluated and may improve functional and health outcomes and quality of life in people living with multimorbidity, frailty, and disability.