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The association between frailty and quality of life among rural community-dwelling older adults in Kegalle district of Sri Lanka: a cross-sectional study

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Abstract

Purpose

The objective of this study was to estimate the cross-sectional association of frailty status with overall and domain-specific quality of life (QoL) in rural community-dwelling older adults in Kegalle district of Sri Lanka.

Methods

A population-based cross-sectional study was conducted with 746 community-dwelling older adults aged ≥ 60 years living in the rural areas of Kegalle district of Sri Lanka in 2016. A three-stage probability sampling design was used to recruit participants. Frailty and QoL were assessed using the Fried phenotype and Older People’s Quality of Life Questionnaire, respectively. Multivariable linear regression was used to estimate the association of frailty with QoL after accounting for the complex sampling design.

Results

The median (IQR) age of the sample was 68 (64:75) years and comprised of 56.7% women. 15.2% (95% CI 12.4%, 18.7%) were frail and 48.5% (95% CI 43.9%, 53.2%) were pre-frail. The unadjusted means (SE) of the total QoL score for the robust, pre-frail and frail groups were 139.2 (0.64), 131.8 (1.04) and 119.2 (1.35), respectively. After adjusting for covariates in the final multivariable model, the estimated differences in mean QoL were lower for both frail and pre-frail groups versus robust. The estimated reduction in the total QoL score was 7.3% for those frail and 2.1% for those pre-frail. All QoL domains apart from ‘social relationships and participation’, ‘home and neighbourhood’ and ‘financial circumstances’ were associated with frailty.

Conclusions

Frailty was associated with a small but significant lower quality of life in this rural Sri Lankan population, which appears largely explained by ‘health’ and ‘independence, control over life and freedom’ QoL domains. Interventions aiming to improve quality of life in frail older adults should consider targeting these aspects.

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Acknowledgements

Authors acknowledge all the participants of this study who kindly gave their time and effort to respond the questionnaire. We also thank the assistance provided by the Director General of Health Services, Provincial Director of Health Services-Sabaragamuwa province, District Secretary and Regional Director of Health Services-Kegalle district, all the Divisional secretaries and the Grama Niladhari officers of the respective areas investigated in this study. We would also like to thank Mrs. Krishna Kurunathapillai for performing the Tamil translation of all the study instruments. We would like to thank the research assistants (H.P.M. Hewavitharane, P.G.I.P. Udayakumara, D.M.N. Kumara, A.P.A. Jayasinghe, M.V.J.D. Abeyrathna) and the field assistants (H.K.P. Ariyadasa, K.D.S.S. Dissanayaka, W.G.C. Pussallamada, G.R.K.M. Rathnasiri, W.S.T. Weerasinghe, R.J.S. Dharmawansha, W.R.P. Wijenayake, V.P.D.I. Danarathna, R.G.R.D. Anuruddha) for their invaluable support with data collection. We would also like to acknowledge Prof. A.R. Wickremasinghe, Department of Public Health, Faculty of Medicine, University of Kelaniya, Sri Lanka for his invaluable guidance on data cleaning process. We thank Department of Community Medicine, Faculty of Medicine, University of Colombo for handling finances and arranging logistics for the field study.

Funding

DDS (corresponding author) is a Commonwealth Scholar, funded by UK government (LKCS-2015-678). This funder had no role in study design, data collection, data analysis, interpretation, drafting the paper, or decision to publish.

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Authors and Affiliations

  1. Research Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF, UK

    Dhammika Deepani Siriwardhana, Greta Rait & Kate R. Walters

  2. Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Thalagolla Road, P.O. Box 6, 11010, Ragama, Sri Lanka

    Dhammika Deepani Siriwardhana

  3. Department of Community Medicine, Faculty of Medicine, University of Colombo, No. 25, Kynsey Road, Colombo 08, Sri Lanka

    Manuj Chrishantha Weerasinghe

  4. Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK

    Shaun Scholes

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Contributions

DDS, KW, MCW and GR conceived and designed the study. DDS and MCW collected the data. DDS and SS analysed the data. DDS drafted the manuscript. KW, MCW, GR and SS critically revised the manuscript.

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Correspondence to Dhammika Deepani Siriwardhana.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institution or practice at which the study was conducted. The ethical clearance for this study was obtained from two ethics review committees at University College London (Project ID: 8155/001) and Faculty of Medicine, University of Colombo, Sri Lanka (Protocol No. EC-16-071).

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Siriwardhana, D.D., Weerasinghe, M.C., Rait, G. et al. The association between frailty and quality of life among rural community-dwelling older adults in Kegalle district of Sri Lanka: a cross-sectional study. Qual Life Res 28, 2057–2068 (2019). https://doi.org/10.1007/s11136-019-02137-5

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