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Association between frailty and activities of daily living disability in older adults residing in a high-altitude Peruvian Andean community: the Aunqui-Andes study

BMC Geriatrics volume 24, Article number: 792 (2024) Cite this article

Abstract

Background

The prevalence of frailty and activities of daily living (ADL) disability may be higher in high-altitude Andean regions, due to chronic hypoxia, malnutrition, and physical challenges. and their association is relevant. This study aimed to evaluate the association between frailty and ADL disability among older adults residing in the Totos district in Peru during the year 2022.

Methods

A cross-sectional study was conducted in Totos district (mean altitude: 3286 m above sea level), located in Ayacucho, Peru, during 2022. A complete census was employed including residents aged 60 and above. The exposure variable was frailty, defined by fulfilling 3 or more criteria of the Fried phenotype. The outcome variable was ADL disability, defined as a score below 95 on the Barthel index. Generalized linear models with a Poisson family, logarithmic link function, and robust variances were employed to estimate crude prevalence ratios and adjusted prevalence ratios (aPRs), along with their corresponding 95% confidence intervals (CIs).

Results

We evaluated 272 older adults with a mean age of 74 years, of whom 59.9% were female, 62.1% were cohabiting or married and 83.1% had not completed primary education. We found that 19.5% were frail, while 51.1% had ADL disability. In the adjusted regression model, we found frailty increased the prevalence of ADL disability (aPR = 1.77; 95%CI: 1.44–2.16; p < 0.001).

Conclusion

Frailty was associated with an increased prevalence of ADL disability. These findings could contribute to establishing government intervention plans to manage disability and frailty within the high-risk group comprising older adults living at high altitudes.

Peer Review reports

Introduction

The global population is rapidly aging, with the number of people aged over 60 projected to reach over 2 billion by 2050, comprising 22% of the total population [1]. In Latin America and the Caribbean (LAC), the proportion of individuals aged 65 and above is expected to double from 5.5% in 2000 to 11.6% by 2030 [2]. This demographic shift highlights the importance of geriatric medicine to identify individuals at risk of becoming frail, which is the most challenging manifestation of non-healthy population aging [3]. Frailty is characterized by increased vulnerability due to age-related declines in physiological reserves and functions across multiple organ systems, compromising the ability to manage daily or acute stressors and giving rise to adverse outcomes, including falls, delirium, increased care needs, admission to hospitals, long-term care, and disability of activities of daily living (ADL) [4]. The prevalence of frailty exhibits a significant variation worldwide when assessed using the Fried Phenotype. This phenotype defines frailty based on the presence of at least three of the following criteria: unintentional weight loss, self-reported exhaustion, weakness (measured by grip strength), slow walking speed, and low physical activity [5, 6]. Globally, the prevalence of frailty ranges from 4.0 to 17% [7]. In Latin America, this range is wider, being from 7.7 to 34.6%, with Central America notably exhibiting a higher prevalence compared to South America over the past two decades [8]. In the specific context of Perú, the prevalence ranges between 7.7% and 27.8% [6, 9].

ADL disability refers to the difficulty in performing day-to-day social role activities because of physical or health-related issues. There is a notable overlap between disability and frailty, which becomes more pronounced as frailty increases [10]. Fried et al.. estimated that the risk of worsening ADL disability over a span of 3 and 7 years is five and four times greater, respectively, among the frail population [5]. Similarly, Jang et al. estimated a ten-fold increase in the risk of disability over a 10-year period [11]. Furthermore, it has been observed that the probability of disability was two times higher in the frailty group of an urban zone in Brazil [12]. Previous studies have described a prevalence of frailty in sea-level areas in Europe of 7% [13], and in LAC it is 19.6% [8]. Additionally, research conducted at sea level has evaluated the association between frailty and ADL disability, revealing odds ratios ranging from 1.53 to 1.69 [14, 15].

From a healthcare standpoint, living with ADL disability entails an increased demand for services and resource utilization, with older adults experiencing disability incurring annual healthcare expenses ranging between $9,679 and $38,711 per person [16].Considering the sociocultural impairment on activities affected by disability, it is of particular interest that, as of 2020, Peru, a Latin American country, has an elderly population accounting for 12.7% of its total population [17]. In addition, it has one of the largest numbers of populations residing in high-altitude regions alongside Bolivia and China [18]. Despite the acknowledged association between frailty and ADL disability, limited research has been conducted in high-Andean urban and rural populations [19, 20]. Indeed, only a few studies have assessed the association of frailty and ADL disability in altitude settings. The higher prevalence of frailty and ADL disability in older adults living in high-altitude regions may be attributed to chronic hypoxia and malnutrition, which exacerbate age-related declines in physiological reserves, leading to impaired muscle function, increased sarcopenia, and greater vulnerability to disability [19, 21,22,23,24,25].

A study conducted in a Peruvian community reported a significant prevalence of frailty of 72.1%, while in a larger study in Colombia, the frequency of frailty was 12.2% [19, 20]. It is of note that the latter study focused on the Andean Coffee-Growing region, characterized by elevations ranging between 1,000 and 2,000 m above sea level (m.a.s.l) [19]. In contrast, in the study in Chaglla, Peru, the elevation exceeded 3,000 m.a.s.l [20]. Furthermore, although the Colombia study provided information about ADL disability, it did not specify the instrument used [20]. Conversely, the Colombian study explored the inverse relationship in which ADL disability is considered an associated factor for frailty (2.5-fold increased risk of frailty) [19]. Therefore, the objective of this study was to estimate the association between frailty and ADL disability among older adults residing in the Totos district in Peru during the year 2022.

Methods

Study design, population, and sample

We conducted an analytical cross-sectional study in the district of Totos, Cangallo province, Ayacucho department, Peru. The district of Totos is situated at mean altitude of 3,286 m.a.s.l. and has an average temperature of 9.2 °C. It is located 97 km from the Huamanga province. In 2017, the district had a population of approximately 3,009 inhabitants, and by 2023, it registered a poverty rate of 49.9%. Furthermore, approximately 11% of the population consists of older adults who have received support through Pensión 65, a social program in Peru designed to provide financial assistance to individuals aged 65 and older who are in extreme poverty and do not have access to any contributory pension. The district is served by a single health center, which offers outpatient services in general medicine, dentistry, and obstetrics, but lacks hospitalization facilities. The district is semi-rural, and its primary economic activity is agriculture. A complete census of 292 older adults aged 60 years and above, without severe cognitive impairment or mobility dependence, was conducted. For the current analysis, 20 older adults were excluded due to incomplete variables of interest (Fig. 1). We evaluated older adults residing in the populated villages of Totospampa (2,937 m.a.s.l.), Chacabamba (3,018 m.a.s.l.), Lloqllasqa (3,027 m.a.s.l.), Quiñasi (3,232 m.a.s.l.), Veracruz (3,307 m.a.s.l.), Totos (3,315 m.a.s.l.), Chuymay (3,368 m.a.s.l.), Huanupampa (3,395 m.a.s.l.), and Ramón Castilla (3,539 m.a.s.l.) (Figs. 2 and 3). The census achieved a 95% response rate, covering the majority of older adults in the district.

Fig. 1
figure 1

Flowchart of sample selection

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Fig. 2
figure 2

Map of Totos district

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Fig. 3
figure 3

Map of Totos district, including villages

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Procedures

The recruitment in the populated areas was carried out in coordination with the social development manager and community representatives of each municipality. The announcements were made through radio broadcasts. The health center staff and research team received advanced training on data execution and collection by the principal investigator of the study. Additionally, the necessary instruments and supplies for the assessments were transported to the locations several days before participant recruitment.

The assessments of older adults were conducted through scheduled visits to the populated areas of Totos. It should be noted that the assessments were administered individually to each participant. The assessments were carried out with the collaboration of Ayacuchan natives proficient in both Spanish and the Chanka variant of Quechua, spoken in the Totos district. Furthermore, the research team possessed expertise in Quechua Chanka.

All older adults who met the selection criteria and willingly agreed to participate in the study after reading the informed consent were surveyed. The assessments were carried out independently of the healthcare provided by the district health center, and this was communicated to the older adults during enrollment. The assessment results were provided to the study participants individually.

Variables

Outcome variable: ADL disability

To assess ADL disability, the Barthel Index was utilized. This index evaluates ten basic ADL: personal hygiene, eating, bathing, dressing, transfer from bed to chair, mobility, use of stairs, going to the bathroom, and urinary and fecal continence with a score ranging from 0 to 100. A score less than 95 defines a participant as having disability [26].

Exposure variable: frailty

Frailty was evaluated using the Fried phenotype criteria: (1) Weight loss was assessed by the question: “Have you noticed that you have lost weight to the point where your clothes feel looser?“; (2) Exhaustion was defined as an affirmative response to two or more questions from the Center for Epidemiological Studies Depression Scale, which include: “Do you feel full of energy?“, “Do you feel that you can’t get going?“, “Do you feel that everything you do is an effort?“; (3) Slowness was defined as a gait speed in the slowest 20%, adjusted for gender and height, or an inability to complete the Short Physical Performance Battery test; (4) Sedentary behavior was defined using the Physical Activity Scale for the Elderly, with a score below 64 for men and 52 for women; (5) Weakness was assessed by identifying the lowest 20% in grip strength within each gender and BMI quartile. Older adults who presented three or more affected criteria were defined as frail [5, 6].

Other variables

Sociodemographic characteristics

The following sociodemographic characteristics were collected through self-reporting: gender (male, female), age (60–70 years, 71–80 years, > 80 years), marital status (single, married or cohabiting, divorced or widowed), education level (no schooling/incomplete primary, complete primary/incomplete secondary, complete secondary, technical or university education), lives alone (yes, no), and employment status (yes, no).

Medical and personal history

Through self-reporting, variables such as a history of falls in the last year (no, at least one), polypharmacy (consumption of three or more concurrently prescribed medications), tobacco use (yes, no), and alcohol consumption (yes, no) were also collected. Additionally, it was assessed whether the older adult had visited the emergency department in the last year and whether they had been hospitalized during this period. A variable considering multimorbidity was compiled including the following comorbidities: high blood pressure, type 2 diabetes mellitus, chronic obstructive pulmonary disease, osteoarthritis, arthritis, hypercholesterolemia, gastritis, low back pain, and osteoporosis. Subsequently, a variable was created grouping these comorbidities into 0, 1, and ≥ 2 categories. The body mass index (BMI) was evaluated in kg/m2.

Depressive symptoms were assessed using the Geriatric Depression Scale with five questions. A score of 2 or more indicated the presence of depressive symptoms in an older adult [27].

The Edmonton Frail Scale was employed to evaluate social support, utilizing the question “When you need help, do you have someone who meets your needs?” (never, sometimes/always)”. This question is part of the Edmonton Frail Scale, which serves as a tool for assessing social support among other frailty components [28].

Cognitive impairment in older adults was assessed using the Short Portable Mental State Questionnaire which is comprised of 10 questions, and the score is based on the number of errors. A score of 0 to 2 errors indicates no cognitive impairment, 3 to 4 errors indicate mild cognitive impairment, and 5 to 7 errors indicate moderate cognitive impairment [29]. We adjusted the Short Portable Mental State Questionnaire scores according to the participants’ educational levels. We allowed one less error for those with higher education and discounted one error for those with incomplete primary education or no formal education.

Statistical analysis

The database was collected using REDCap and then exported in “.dta” format for analysis in the statistical package Stata v17.0 (StataCorp, College Station, TX, USA). Descriptive analysis utilized absolute and relative frequencies for categorical variables, as well as measures of central tendency and dispersion for quantitative variables. Bivariate analysis was conducted using the chi-square test to compare proportions among categorical variables. In cases in which statistical assumptions were not met, the Fisher’s exact test was employed. The independent samples t-test was used to compare means between two groups. If the assumptions for this test were not met, the non-parametric Mann-Whitney U test was chosen.

Regarding multivariate analysis, a generalized linear model of the Poisson family with a logarithmic link function and robust variances was employed for dichotomous outcomes. Crude prevalence ratios (cPR) and adjusted prevalence ratios (aPR) were reported with their respective 95% confidence intervals (95% CI). The adjusted model for analysis followed an epidemiological approach, including confounders described in the literature such as gender, age, marital status, employment, comorbidities, BMI, tobacco use, living alone, and neurocognitive disorder.

Results

Descriptive and bivariate analysis according to the prevalence of frailty in the study sample

We evaluated 272 older adults with a median age of 75 years, among whom 59.9% (n = 163) were female and 62.1% (n = 169) were cohabiting or married. Furthermore, 83.1% (n = 226) had no education or had not completed primary education, and 48.9% (n = 133) were employed. Additionally, 63.2% (n = 172) had visited the emergency department in the last year, 45.6% (n = 124) had moderate neurocognitive disorder, and 57.4% (n = 156) presented symptoms of depression. We found that 19.5% (n = 53) had frailty, while 51.1% (n = 139) had ADL disability. There was a higher prevalence of frailty among older adults with disability (33.1% vs. 5.3%; p < 0.001). The descriptive and bivariate analyses according to frailty are shown in Table 1.

Table 1 Descriptive and bivariate analysis of the variables of interest according to the prevalence of frailty in older adults in a high Andean district of Ayacucho, Peru (n = 272)
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Descriptive and bivariate analyses according to the prevalence of ADL disability in the study sample

Descriptive and bivariate analyses showed that the presence of ADL disability was significantly associated with several factors. Specifically, frailty was more prevalent among those with ADL disability (86.8% vs. 13.2%, p < 0.001), and a higher percentage of females (58.9% vs. 41.1%, p = 0.002) exhibited ADL disability compared to males. Additionally, older age was associated with greater ADL disability, with those aged over 80 years showing the highest prevalence (64.4%, p < 0.001). Employment status also differed significantly, as those not working were more likely to have ADL disability (64.7% vs. 35.3%, p < 0.001). Comorbidities, particularly hypercholesterolemia (76.9% vs. 23.1%, p < 0.001) and the presence of two or more comorbid conditions (61.4% vs. 38.6%, p = 0.034), were associated with higher ADL disability. Furthermore, lower social support (68.1% vs. 31.9%, p = 0.010), presence of neurocognitive disorders (58.9% in moderate cases, p = 0.003), history of falls in the last year (62.6% vs. 37.4%, p < 0.001), and depressive symptoms (60.9% vs. 39.1%, p < 0.001) were also more common among those with ADL disability (Table 2).

Table 2 Descriptive and bivariate analysis of the variables of interest according to the prevalence of ADL disability in older adults in a high Andean district of Ayacucho, Peru (n = 272)
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Descriptive and bivariate analysis of the Fried phenotype components according to the prevalence of ADL disability in the study sample

Descriptive and bivariate analyses revealed significant associations between the components of the Fried phenotype and the prevalence of ADL disability. Weight loss was more prevalent among those with ADL disability (59.5% vs. 37.5%, p < 0.001). Similarly, exhaustion was significantly associated with ADL disability, with a higher prevalence among those reporting exhaustion (61.2% vs. 34.3%, p < 0.001). Slowness was also more common in individuals with ADL disability (77.4% vs. 22.6%, p < 0.001). Sedentary behavior was strongly associated with ADL disability, with 88.9% of those exhibiting sedentary behavior having ADL disability compared to 11.1% without (p = 0.001). Finally, weakness was more prevalent among those with ADL disability (73.9% vs. 26.1%, p = 0.001) (Supplementary Table 1).

Crude and adjusted prevalence ratios to estimate the association between frailty and ADL disability in the study sample

The crude regression model showed that the prevalence of ADL disability was 104% higher among older adults with frailty (cPR = 2.04; 95%CI: 1.70–2.46; p < 0.001). Similarly, in the adjusted regression model, the prevalence of ADL disability was 77% higher among individuals with frailty (aPR = 1.77; 95%CI: 1.44–2.16; p < 0.001) (Table 3 and supplementary Table 2).

Table 3 Crude and adjusted regression models to estimate the association between frailty and ADL disability in older adults in a high Andean district of Ayacucho, Peru
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Discussion

Main findings

In this study including 272 older adults, we found that approximately two out of ten exhibited frailty, while one in every two had ADL disability. Moreover, the presence of frailty was associated with an increased prevalence of disability in the study sample. To our knowledge, this is the first study to assess the association of interest among older adults residing in a high-altitude district. This finding is significant due to the high prevalences of both geriatric conditions compared to frequencies reported in studies at sea level. Therefore, our results could be valuable for the implementation of interventions aimed at preventing adverse outcomes stemming from both conditions.

Comparison with previous studies

The prevalence of frailty in Europe is 7% [13], while in Asia (Japan and China) it ranges from 7.4 to 10% [30, 31], and in LAC it is 19.6% (7.7–42.6%) [8]. Furthermore, we identified studies in Latin America that assessed the prevalence of frailty, such as those conducted in Ecuador (21%) [32] and Brazil (15.8%) [33], with prevalence rates comparable to those reported in the present study. Systematic reviews and meta-analyses have assessed the association between frailty and ADL disability, reporting effect sizes greater than those found in our study, both in cross-sectional [31] and longitudinal studies [31, 34,35,36]. Additionally, only one systematic review with a meta-analysis evaluated the association of interest among older adults residing in rural areas. However, this analysis focused on the inverse association between the variables of interest [37]. It is important to note that these studies did not include older adults from rural high-altitude communities. Previous studies in rural Andean populations in Colombia [19] and Peru [20] have examined the association between frailty and ADL disability. Nevertheless, one study analyzed the inverse relationship [19], while the other did not compute an association measure due to limited statistical analysis [20]. To the best of our knowledge, this is the first study to identify that frailty increases the prevalence of developing ADL disability in older adults from a rural high-altitude community. Meanwhile, previous studies in LAC countries [38, 39] have assessed the association of interest. However, these studies only conducted bivariate analyses without estimating the magnitude of the association by regression analysis between frailty and disability.

Results interpretation

In this study, we found a strong association between frailty and disability in older adults living in high-altitude regions, although this association has been understudied and poorly understood. Frailty and ADL disability are common and independent geriatric conditions [40] that share associated factors, such as female gender, recurrent falls, greater cognitive impairment, mood disorders, and an increased incidence of mortality [41]. Similarly, they share pathophysiological mechanisms related to inflammation associated with aging [40]. We can hypothesize explanations for this association between frailty and ADL disability in older adults living in high-altitude regions. First, the aging process leads to a decrease in physiological reserves and dysregulation of multiple systems [21]. Additionally, as altitude increases, there is a progressive decrease in barometric pressure, both in inspired oxygen pressure and arterial oxygen partial pressure, leading to chronic hypobaric hypoxemia and sympathetic-mediated vasoconstriction [22]. Second, the decrease in tissue oxygen due to chronic hypobaric hypoxia and aging affects the oxidation of essential biochemical components responsible for energy production, leading to deterioration of physical health [23, 24]. Furthermore, the high prevalence of malnutrition in high-altitude regions in Peru could lead to a reduction in muscle function and mass, thereby increasing the risk of sarcopenia, frailty, falls, and ADL disability [19, 25]. Additionally, while older adults with higher levels of physical activity typically have a lower probability of frailty and ADL disability, the unique geographical characteristics of high-altitude regions might still contribute to an increased incidence of falls. In the Peruvian Andes, streets in highland villages are often stony, narrow, steeply sloping, and slippery, similar to the conditions described in previous studies, where uneven, unpaved streets were associated with a higher risk of falls [42, 43]. These challenging environmental conditions may offset the protective effects of physical activity on frailty and disability. Coupled with limited access to health services, individuals in these regions may face an elevated risk of ADL disability [44]. Third, from a social standpoint, marked gender roles in rural communities could explain the higher frequency of frailty and ADL disability in women. Women often take on roles as homemakers, caring for their children, with less social contact, greater economic dependence, and stress [20]. Identifying older adults at risk of frailty and disability in high-altitude regions is crucial for proposing prevention programs and exercise-based interventions, along with improved protein nutrition to enhance strength and muscle mass. One noteworthy aspect is the low educational attainment among older adults residing in high-altitude regions, given its association with diminished healthy aging [45].

Relevance in public health

Frailty is defined as a decline in intrinsic capacity, encompassing both physical and mental abilities, without necessarily implying a loss in the performance of ADL and is potentially reversible [40]. Our findings are valuable for implementing interventions that promote healthy aging and frailty prevention in older adults from high-altitude regions.

However, in Peru, systematic identification of frailty is not commonly conducted using validated instruments [46]. Furthermore, in resource-limited settings such as rural areas, access to healthcare services is often limited [47]. Additionally, healthcare workers may lack sufficient training to address common problems of aging, such as frailty or dementia, leading to missed opportunities for early diagnosis [47]. Simultaneously, the number of specialized medical positions corresponds to approximately 0.006% of the number of licensed physicians per year in Peru [48, 49]. It is worth noting that only 1.4% of medical specialization positions are allocated to geriatrics [48]. This is significant because it creates greater healthcare disparities, due to the limited capacity to screen, evaluate, and manage geriatric syndromes in older adults in Peru.

Furthermore, the proportion of households with at least one older adult is higher in rural areas than in urban areas (42.8% vs. 36.2%) [50], of which 16% are indigenous or native to the Peruvian Andes [51], increasing the need for specialists to evaluate older adults in the country, particularly in rural, Andean, and high-altitude regions. It is essential to design a national long-term care system, particularly in the geriatric context of the Andes, where implementing targeted measures is crucial to ensuring the well-being and quality of life of older adults.

Strengths and limitations

The strengths of this study include the diversity of variables examined and the unique altitude setting for the assessment. To the best of our knowledge, this is the first Peruvian study to measure the association between frailty and ADL disability in older adults living at high altitudes. However, the study has inherent limitations. Firstly, the cross-sectional design prevents establishing causality for our main variables, frailty, and disability. We recommend the implementation of cohort studies to better explore potential associations, as these studies allow for the examination of temporal relationships, which helps in understanding the directionality of associations. Secondly, the findings should not be generalized to the entire population of older adults living at high altitudes in Peru, as our study was limited to older adults residing in the Totos district of the Ayacucho department. Third, some variables were collected through self-reporting, which may be susceptible to memory bias. Lastly, there could have been cultural and linguistic barriers impeding data collection; however, we had bilingual native speakers, and the research team was proficient in both languages.

Conclusions

In conclusion, our findings provide information on the prevalence and relationship between frailty and ADL disability in a Peruvian population of older adults living at high altitudes. These findings can contribute to designing governmental intervention plans specifically tailored to address the concurrent management of ADL disability and frailty among the older adult population residing at high altitudes, aimed at enhancing healthy aging and preserving dignity. This would enable early detection for preventive efforts, ultimately reducing costs associated with the complications that arise from these conditions.

Data availability

The datasets utilized and analyzed in the present study are accessible upon reasonable request to the corresponding author.

Abbreviations

LAC:

Latin America and the Caribbean

ADL:

Activities of Daily Living

M.a.s.l:

Meters above sea level

BMI:

Body Mass Index

cPR:

Crude Prevalence Ratios

aPR:

Adjusted Prevalence Ratios

95% CI:

95% Confidence Intervals

References

  1. Newgard CB, Sharpless NE. Coming of age: molecular drivers of aging and therapeutic opportunities. J Clin Invest. 2013;123:946.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Centers for Disease Control and Prevention. Trends in aging–United States and worldwide. MMWR Morb Mortal Wkly Rep. 2003;52:101–4.

    Google Scholar 

  3. Song X, Mitnitski A, Rockwood K. Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation. J Am Geriatr Soc. 2010;58:681–7.

    Article  PubMed  Google Scholar 

  4. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in Older people. Lancet. 2013;381:752–62.

    Article  PubMed  Google Scholar 

  5. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J et al. Frailty in older adults: evidence for a phenotype. J Gerontol Biol Sci Med Sci. 2001;56.

  6. Runzer-Colmenares FM, Samper-Ternent R, Al Snih S, Ottenbacher KJ, Parodi JF, Wong R. Prevalence and Factors Associated with Frailty among Peruvian older adults. Arch Gerontol Geriatr. 2014;58:69–73.

    Article  PubMed  Google Scholar 

  7. Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012;60:1487–92.

    Article  PubMed  Google Scholar 

  8. Araújo F, Perez P, Cordeiro KR, Morais AC, Tolentino M, Gomes M. Prevalence of Frailty in Latin America and the Caribbean: a systematic review and Meta-analysis. PLoS ONE. 2016;11.

  9. Varela Pinedo L, Ortiz Saavedra PJ, Chávez Jimeno H. Velocidad De La marcha como indicador de fragilidad en adultos mayores de la comunidad en Lima, Perú. Rev Esp Geriatr Gerontol. 2010;45:22–5.

    Article  PubMed  Google Scholar 

  10. Theou O, Rockwood MRH, Mitnitski A, Rockwood K. Disability and co-morbidity in relation to frailty: how much do they overlap? Arch Gerontol Geriatr. 2012;55:e1.

    Article  PubMed  Google Scholar 

  11. Jang J, Jung H, Shin J, Kim DH. Assessment of Frailty Index at 66 years of Age and Association with Age-Related diseases, disability, and Death over 10 years in Korea. JAMA Netw Open. 2023;6:E2248995.

    Article  PubMed  PubMed Central  Google Scholar 

  12. de Albuquerque Sousa ACP, Correa Dias R, Campos Cavalcanti Maciel Á, Oliveira Guerra R. Frailty syndrome and associated factors in community-dwelling elderly in Northeast Brazil. Arch Gerontol Geriatr. 2012;54.

  13. Manfredi G, Midão L, Paúl C, Cena C, Duarte M, Costa E. Prevalence of frailty status among the European elderly population: findings from the Survey of Health, Aging and Retirement in Europe. Geriatr Gerontol Int. 2019;19:723–9.

    Article  PubMed  Google Scholar 

  14. Forti P, Maioli F, Lega MV, Montanari L, Coraini F, Zoli M. Combination of the clock drawing test with the physical phenotype of frailty for the prediction of mortality and other adverse outcomes in older community dwellers without dementia. Gerontology. 2014;60:204–11.

    Article  PubMed  Google Scholar 

  15. Aguilar-Navarro SG, Amieva H, Gutiérrez-Robledo LM, Avila-Funes JA. Frailty among Mexican community-dwelling elderly: a story told 11 years later. The Mexican Health and Aging Study. Salud Publica Mex. 2015;57:s62–9.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Falck RS, Percival AG, Tai D, Davis JC. International depiction of the cost of functional independence limitations among older adults living in the community: a systematic review and cost-of-impairment study. BMC Geriatr. 2022;22:1–11.

    Article  Google Scholar 

  17. Instituto Nacional de Estadistica e Informatica. En el Perú existen más de cuatro millones de adultos mayores. Lima:INEI. https://m.inei.gob.pe/prensa/noticias/en-el-peru-existen-mas-de-cuatro-millones-de-adultos-mayores-12356/. Accessed 6 Jun 2023.

  18. Tremblay JC, Ainslie PN. Global and country-level estimates of human population at high altitude. Proc Natl Acad Sci U S A. 2021;118.

  19. Curcio CL, Henao GM, Gomez F. Frailty among rural elderly adults. BMC Geriatr. 2014;14:2.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Acosta-Illatopa E, Lama-Valdivia J, García-Solórzano F, Cruz-Vargas J. Síndrome De fragilidad en adultos mayores de una comunidad rural de Los andes peruanos. Rev Fac Med Hum. 2021;21:309–15.

    Google Scholar 

  21. Borges LL, Menezes RL. Definitions and markers of frailty: a systematic review of literature. Rev Clin Gerontol. 2011;21:67–77.

    Article  Google Scholar 

  22. Parati G, Agostoni P, Basnyat B, Bilo G, Brugger H, Coca A, et al. Clinical recommendations for high altitude exposure of individuals with pre-existing cardiovascular conditions: a joint statement by the European Society of Cardiology, the Council on Hypertension of the European Society of Cardiology, the European Society of Hypertension, the International Society of Mountain Medicine, the Italian Society of Hypertension and the Italian society of Mountain Medicine. Eur Heart J. 2018;39:1546–54.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Burtscher M. Effects of living at higher altitudes on mortality: a narrative review. Aging Dis. 2014;5:274.

    PubMed  Google Scholar 

  24. Bagnato S, Cavallo M, Li Y, Wang Y. Effects of Long-Term exposure to high Altitude Hypoxia on cognitive function and its mechanism: a narrative review. Brain Sci. 2022;12:808.

    Article  Google Scholar 

  25. Tramontano A, Veronese N, Giantin V, Manzato E, Rodriguez-Hurtado D, Trevisan C, et al. Nutritional status, physical performance and disability in the elderly of the Peruvian Andes. Aging Clin Exp Res. 2016;28:1195–201.

    Article  PubMed  Google Scholar 

  26. Collin C, Wade DT, Davies S, Horne V. The Barthel ADL Index: a reliability study. Int Disabil Stud. 1988;10:61–3.

    Article  CAS  PubMed  Google Scholar 

  27. Sheikh JI, Yesavage JA. 9/Geriatric Depression Scale (GDS). Clin Gerontol. 1986;5:165–73.

    Article  Google Scholar 

  28. Rolfson DB, Majumdar SR, Tsuyuki RT, Tahir A, Rockwood K. Validity and reliability of the Edmonton Frail Scale. Age Ageing. 2006;35:526–9.

    Article  PubMed  PubMed Central  Google Scholar 

  29. De La Martínez J, Herrero RD, Vilches MCO, Taberné CA, Colomer CA, Luque RL. Adaptación Y validación Al Castellano Del Cuestionario De Pfeiffer (SPMSQ) para detectar la existencia de deterioro cognitivo en personas mayores e 65 años. Med Clin (Barc). 2001;117:129–34.

    Article  Google Scholar 

  30. Kojima G, Iliffe S, Taniguchi Y, Shimada H, Rakugi H, Walters K. Prevalence of frailty in Japan: a systematic review and meta-analysis. J Epidemiol. 2017;27:347–53.

    Article  PubMed  Google Scholar 

  31. He B, Ma Y, Wang C, Jiang M, Geng C, Chang X, et al. Prevalence and risk factors for Frailty among Community-Dwelling Older people in China: a systematic review and Meta-analysis. J Nutr Health Aging. 2019;23:442–50.

    Article  CAS  PubMed  Google Scholar 

  32. Del Brutto OH, Mera RM, Peinado CD, Zambrano M, Sedler MJ. Frailty and risk of falls in community-dwelling older adults living in a rural setting. The Atahualpa project. J Frailty Aging. 2020;9:150–4.

    PubMed  Google Scholar 

  33. Melo Filho J, Moreira NB, Vojciechowski AS, Biesek S, Bento PCB, Gomes ARS. Frailty prevalence and related factors in older adults from southern Brazil: a cross-sectional observational study. Clinics. 2020;75:e1694.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Chang SF, Cheng CL, Lin HC. Frail phenotype and disability prediction in Community-Dwelling Older people: a systematic review and Meta-analysis of prospective cohort studies. J Nurs Res. 2019;27:e28.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Kojima G. Frailty as a predictor of disabilities among community-dwelling older people: a systematic review and meta-analysis. Disabil Rehabil. 2017;39:1897–908.

    Article  PubMed  Google Scholar 

  36. Kojima G, Quick, Simple FRAIL. Scale Predicts Incident activities of Daily Living (ADL) and instrumental ADL (IADL) disabilities: a systematic review and Meta-analysis. J Am Med Dir Assoc. 2018;19:1063–8.

    Article  PubMed  Google Scholar 

  37. Xu R, Li Q, Guo F, Zhao M, Zhang L. Prevalence and risk factors of frailty among people in rural areas: a systematic review and meta-analysis. BMJ Open. 2021;11:e043494.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Quevedo-Tejero E, del Zavala-González C, Alonso-Benites MA. Síndrome De fragilidad en adultos mayores no institucionalizados de Emiliano Zapata, Tabasco, México. Universitas Med. 2011;52:255–68.

    Google Scholar 

  39. Bustamante-Chavez RX, Peña Sánchez ER, Leguía-Cerna JA. Fragilidad Y factores asociados en adultos mayores de Los Consultorios De geriatría De Dos hospitales Nivel III De Lambayeque. Rev Cuerpo Med HNAAA. 2016;9:231–41.

    Google Scholar 

  40. Zamudio-Rodríguez A, Letenneur L, Féart C, Avila-Funes JA, Amieva H, Pérès K. The disability process: is there a place for frailty? Age Ageing. 2020;49:764–70.

    Article  PubMed  Google Scholar 

  41. Vetrano DL, Palmer KM, Galluzzo L, Giampaoli S, Marengoni A, Bernabei R, et al. Hypertension and frailty: a systematic review and meta-analysis. BMJ Open. 2018;8:24406.

    Article  Google Scholar 

  42. Del Brutto OH, Mera RM, Peinado CD, Sedler MJ. Prevalence, severity, and risk of future falls in community-dwelling older adults living in a rural community: the Atahualpa Project. J Community Health. 2019;44:487–91.

    Article  PubMed  Google Scholar 

  43. Meucci RD, Runzer-Colmenares FM, Parodi JF, De Mola CL. Falls among the elderly in Peruvian Andean communities and the rural far South of Brazil: prevalence and associated factors. J Community Health. 2020;45:363–9.

    Article  PubMed  Google Scholar 

  44. Tramontano A, Veronese N, Sergi G, Manzato E, Rodriguez-Hurtado D, Maggi S, et al. Prevalence of Sarcopenia and associated factors in the healthy older adults of the Peruvian Andes. Arch Gerontol Geriatr. 2017;68:49–54.

    Article  PubMed  Google Scholar 

  45. White CM, St. John PD, Cheverie MR, Iraniparast M, Tyas SL. The role of income and occupation in the association of education with healthy aging: results from a population-based, prospective cohort study Health behavior, health promotion and society. BMC Public Health. 2015;15:1–11.

    Article  Google Scholar 

  46. Ministerio de Salud del Perú. NTS N° 043-MINSA/DGSP-V.01 Norma técnica De salud para la atención integral de salud de las personas adultas mayores. Lima; 2010.

  47. World Health Organization. Informe mundial de la salud 2015. El envejecimiento y la salud. Geneva: WHO. 2015. https://dds.cepal.org/redesoc/publicacion?id=4165. Accessed 5 Aug 2022.

  48. Ministerio de Salud. Aprueban el listado y la distribución de plazas de especialidades o subespecialidades priorizadas para la formación de médicos especialistas en la modalidad vacante libre, a ser financiadas por el Ministerio de Salud, en el Concurso Nacional de Admisión al Residentado Médico - RESOLUCION MINISTERIAL - No 045-2022/MINSA - PODER EJECUTIVO - SALUD. El Peruano. 2022;:20–1.

  49. Instituto Nacional de Estadística e Informática. Número de Médicos Colegiados, Según departamento, 2011–2020. Lima: INEI. 2021. https://m.inei.gob.pe/estadisticas/indice-tematico/health-human-resources/. Accessed 19 Apr 2023.

  50. Instituto Nacional de Estadística e Informática. Situación De La Población Adulta Mayor: Octubre-Noviembre-Diciembre 2022. Lima; 2022.

  51. Instituto Nacional de Estadística e Informática. Población Indígena u Originaria De Los Andes. Resultados Definitivos Del III Censo De comunidades Nativas 2017. Lima: Gobierno del Peru: INEI; 2018. pp. 34–73.

    Google Scholar 

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Acknowledgements

We thank the Universidad Científica del Sur for English editing support.

Funding

The study was funded by the “Semilla – Docente 2022” grant provided by Universidad Científica del Sur and approved through the document “RESOLUCIÓN DIRECTORAL No. 001-DGIDI-CIENTIFICA-2022”.

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Authors and Affiliations

  1. CHANGE Research Working Group, Carrera de Medicina Humana, Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Peru

    Diego Urrunaga-Pastor, Ana L. Alcantara-Diaz, Kiara Camacho-Caballero & Fernando M. Runzer-Colmenares

  2. Grupo Estudiantil de Investigación en Salud Mental (GISAM), Sociedad Científica de Estudiantes de Medicina de la Universidad de San Martin de Porres, Lima, Peru

    Leslie Salazar-Talla

  3. Facultad de Medicina Humana, Universidad de San Martin de Porres, Lima, Peru

    Sofia Cuba-Ruiz

  4. Facultad de Medicina Humana, Centro de Investigación del Envejecimiento (CIEN), Universidad de San Martin de Porres, Lima, Peru

    José F. Parodi

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  1. Diego Urrunaga-Pastor
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  2. Leslie Salazar-Talla
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  3. Ana L. Alcantara-Diaz
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  4. Kiara Camacho-Caballero
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  6. Fernando M. Runzer-Colmenares
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  7. José F. Parodi
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Contributions

DUP and FMRC conceived the research idea. All authors participated in the statistical analysis and interpretation of data. All authors participated in data curation, drafting of the manuscript, and all participated in the review and approval of the final manuscript.

Corresponding author

Correspondence to Diego Urrunaga-Pastor.

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Ethical approval and consent to participate

This study was approved by the Internal Review Board (IRB) of the Universidad Científica del Sur (005-2022-PRO99). Participants enrolled previously provided informed consent. During the participant recruitment process, any questions about their participation in the study were addressed, and they were informed about the strict confidentiality of the data, along with their right to withdraw from the study at any time they deemed necessary.

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Informed consent was obtained from a legal/guardian/legally authorized representative in participants with no formal education.

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Urrunaga-Pastor, D., Salazar-Talla, L., Alcantara-Diaz, A.L. et al. Association between frailty and activities of daily living disability in older adults residing in a high-altitude Peruvian Andean community: the Aunqui-Andes study. BMC Geriatr 24, 792 (2024). https://doi.org/10.1186/s12877-024-05381-8

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Keywords

BMC Geriatrics

ISSN: 1471-2318

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