Frailty, multimorbidity and quality of life in an ageing population in Africa: a cross-sectional, population-based study in rural and urban Rwanda

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OBJECTIVE: As populations age, multimorbidity and frailty have emerged as major health challenges. While their associations with disability and mortality are well documented, their impact on quality of life (QoL) in sub-Saharan Africa remains underexplored. We examined the associations between frailty, multimorbidity and QoL among older adults in Rwanda. DESIGN: A cross-sectional population-based study. Multimorbidity was defined as having two or more chronic conditions, including hypertension, diabetes, heart disease and mental health conditions. Frailty scores were derived using the Fried phenotype, and QoL was measured using the European Health Instrument Survey-Quality of Life index (scaled 0%-100%). Sequential linear regression models were used to examine independent associations. SETTING: Rural and urban settings of Rwanda. PARTICIPANT: We analysed data from 4369 adults (≥40 years). RESULTS: The mean QoL score was 48.2% (±15.6). Frailty and multimorbidity prevalence were 14.5% (95% CI 13.5 to 15.6) and 55.2% (95% CI 53.7 to 56.6), respectively, while 55.0% (95% CI 53.3 to 56.3) were classified as prefrail. Frailty and multimorbidity are independently associated with poorer QoL. Compared with robust individuals, prefrail and frail individuals experienced a 3.66 (95% CI -4.63 to -2.70) and 7.30 (95% CI -8.76 to -5.83) percentage point reduction in QoL, respectively. Multimorbidity was associated with a 4.66% (95% CI -5.54 to -3.79) point decrease in QoL. Impairments in activities of daily living partly mediated these associations. CONCLUSIONS: Frailty and multimorbidity showed a strong negative association with QoL, with frailty having a stronger effect. These findings underscore the need for age-responsive healthcare strategies, including frailty screening and integrated chronic care, to enhance QoL among older adults in Rwanda.

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