Prevalence and outcomes of intrinsic capacity impairments assessed using the WHO Integrated Care for Older People (ICOPE) framework in The Gambia, South Africa, and Zimbabwe: a cross-sectional study

Background:

Despite rising longevity across Africa, the epidemiology of intrinsic capacity (combination of mental and physical capacities) impairments (ICIs) is understudied. We aimed to determine the prevalence of ICIs and associated sociodemographic and lifestyle factors, pain, functional limitations, and health-related quality of life (HRQoL) across three African countries.

Methods:

This population-based cross-sectional study recruited adults aged 40 years and older in five settings: rural (n=1052) and urban (n=1218) Gambia, rural (n=948) and urban (n=968) South Africa, and urban Zimbabwe (n=1110). Researcher-administered questionnaires and physical assessments quantified ICIs. Pain was assessed using the Brief Pain Inventory, functional limitations using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and HRQoL using the 5-level EQ-5D. Setting-specific associations between sociodemographic and lifestyle factors and ICIs were meta-analysed. Differences in pain, function, and HRQoL scores were computed according to ICI number.

Findings:

The 5296 adults had a mean age of 61·0 (SD 12·9) years; 2823 (53·3%) were female and 2473 (46·7%) were male. Prevalence of two or more ICIs was 62·4% (59·4–65·3) in rural Gambia, 57·6% (54·8–60·4) in urban Gambia, 67·6% (64·5–70·6) in rural South Africa, 72·1% (69·2–74·9) in urban South Africa, and 64·8% (61·9–67·6) in urban Zimbabwe. Having two or more ICIs was more common in those aged 55–69 years (pooled sex-adjusted odds ratio [OR] 1·79 [95% CI 1·51–2·11]) and 70 years and older (7·21 [5·01–10·37]), female individuals (pooled age-adjusted OR 1·73 [95% CI 1·35–2·22]), those who were underweight (pooled age-adjusted and sex-adjusted OR 4·72 [3·41–6·54]), those with lower wealth index (1·38 [1·20–1·58]), those with food insecurity (1·92 [1·17–3·17]), and those who reported current or former tobacco use (1·47 [1·18–1·83]). Overall mean values were 3·95 (SD 10·64) for pain score, 14·17 (18·36) for WOMAC score, and 0·83 (0·11) for HRQoL. Compared with no impairment (n=554 [10·5%]), having two or more ICIs was associated with 2·34-fold (95% CI 1·92–2·84) greater functional limitation, 2·44-fold more pain (1·86–3·20), and lower HRQoL (mean difference –0·06 [–0·07 to –0·05]).

Interpretation:

In both rural and urban African settings, common ICIs necessitate urgent interventions to maximise functional ability and reduce the effect on quality of life. Individuals most at risk include women, those aged ≥55 years, and people with low socioeconomic status.

Funding:

National Institute for Health Research (NIHR), NIHR–Wellcome Partnership for Global Health Research, and Medical Research Council Musculoskeletal Functional Ability in sub-Saharan Africa.

Translations:

For the Shona and isiZulu translations of the abstract see Supplementary Materials section.