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Background Older adults with lower levels of activity can be at risk of poor health outcomes. Wearable technology has improved the acceptability and objectivity of measuring activity for older adults in high-income countries. Nevertheless, the technology is under-utilized in low-to-middle income countries. The aim was to explore feasibility, acceptability and utility of wearable technology to measure walking activity in rural-dwelling, older Tanzanians. Methods A total of 65 participants (73.9 ± 11.2 years), 36 non-frail and 29 frail, were assessed. Free-living data were recorded for 7 days with an accelerometer on the lower back. Data were analyzed via an automatic cloud-based pipeline: volume, pattern and variability of walking were extracted. Acceptability questionnaires were completed. T-tests were used for comparison between the groups. Results 59/65 datasets were analyzed. Questionnaires indicated that 15/65 (23.0%) experienced some therapeutic benefit from the accelerometer, 15/65 (23.0%) expected diagnostic benefit; 16/65 (24.6%) experienced symptoms while wearing the accelerometer (e.g. itching). Frail adults walked significantly less, had less variable walking patterns, and had a greater proportion of shorter walking bouts compared to the non-frail. Conclusion This study suggests that important contextual and practical limitations withstanding wearable technology may be feasible for measuring walking activity in older rural-dwelling adults in low-income settings, identifying those with frailty.

Background Social vulnerability correlates with frailty and is associated with mortality and disability. However, few studies have investigated this relationship outside of high-income country settings. This study aimed to produce and analyze a culturally adapted social vulnerability index (SVI) to investigate the relationship between social vulnerability, frailty, and mortality in older adults in Tanzania. Methods An SVI was produced using data from a cohort study investigating frailty in older adults in Tanzania. Variables were selected based on previous SVI studies using the categories established by Andrew et al. from the Canadian Study of Health and Aging, and National Population Health Survey. The SVI distribution was examined and compared with a frailty index (FI) produced from the same sample, using mutually exclusive variables. Cox regression survival analysis was used to investigate the association between social vulnerability, frailty, and mortality. Results A stratified cohort of 235 individuals were included in the study at baseline, with a mean age of 75.2 (SD 11.5). Twenty-six participants died within the follow-up period, with a mean of 503 days (range: 405–568) following the initial assessment. The SVI had a median score of 0.47 (interquartile range: 0.23, range: 0.14–0.86). Social vulnerability significantly predicted mortality when adjusting for age and gender, but not when also adjusting for frailty. Conclusions Social vulnerability can be successfully operationalized and culturally adapted in Tanzania. Social vulnerability is associated with mortality in Tanzania, but not independently of frailty.

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. To validate and further refine a frailty screening tool for SSA. 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. 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%. The inclusion of items assessing nutrition, social support and sensory impairment improved the performance of the B-FIT. The B-FIT 2 should be externally validated.