Developing a feasible frailty screening instrument for older people in Sub-Saharan Africa: Exploratory and confirmatory factor analysis.

Abstract

Aim: Frailty screening is gaining significant attention in Sub-Saharan Africa. However, the frailty screening instruments used are developed and validated in high-income countries and may not capture the cultural nuances that are associated with frailty in this region. This study aimed to develop a feasible frailty screening instrument for older people in Sub-Saharan Africa.

Methods: A cross-sectional secondary data analysis was conducted on a sample of 2860 community-dwelling older people aged 60 years and above from Kenya and Ghana. A 33-item Frailty Index was developed in each dataset using similar age-related deficits. Item-total correlation and exploratory factor analysis were performed on the Kenyan dataset to identify the underlying dimensions. Confirmatory factor analysis was conducted on the Ghanaian dataset to validate the factor structure identified in the exploratory factor analysis.

Results: The initial 33 health deficits were reduced to 17 deficits after excluding items with poor correlation and factor loadings. The final 17-item frailty instrument yielded a robust five-factor structure, including social and emotional relationships, physical mobility and functional independence, psychological well-being, hearing ability, and vision. Confirmatory factor analysis confirmed the factor structure with good model fit indices. Reliability was excellent (>0.70) across the factors in both datasets, highlighting the instrument's suitability for frailty screening in Sub-Saharan Africa.

Conclusion: The new frailty instrument has a clear multidimensional structure that captures key aspects of aging in Sub-Saharan Africa. The tool offers a feasible and efficient means of identifying older people at risk for frailty to aid prompt interventions. Geriatr Gerontol Int 2025; ••: ••-••.