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A brief frailty screening tool in Tanzania: external validation and refinement of the B-FIT screen

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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.

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Data availability

The datasets generated and analysed during the current study are available from the corresponding author on reasonable request.


  1. Clegg A, Young J, Iliffe S et al (2013) Frailty in elderly people. Lancet 381:752–762.

    Article  PubMed  Google Scholar 

  2. Cesari M, Prince M, Thiyagarajan JA et al (2016) Frailty: an emerging public health priority. J Am Med Dir Assoc 17:188–192.

    Article  PubMed  Google Scholar 

  3. Adebusoye LA, Owolabi M, Ogunniyi A (2019) Predictors of mortality among older patients in the medical wards of a tertiary hospital in Nigeria. Aging Clin Exp Res 31:539–547.

    Article  PubMed  Google Scholar 

  4. Kakuma R, Minas H, van Ginneken N et al (2011) Human resources for mental health care: current situation and strategies for action. Lancet 378:1654–1663.

    Article  PubMed  Google Scholar 

  5. Morley JE, Vellas B, van Kan GA et al (2013) Frailty consensus: a call to action. J Am Med Dir Assoc 14:392–397.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Dotchin CL, Akinyemi RO, Gray WK et al (2013) Geriatric medicine: services and training in Africa. Age Ageing 42:124–128.

    Article  PubMed  Google Scholar 

  7. Gray WK, Richardson J, McGuire J et al (2016) Frailty screening in low- and middle-income countries: a systematic review. J Am Geriatr Soc 64:806–823.

    Article  PubMed  Google Scholar 

  8. Payne CF, Wade A, Kabudula CW et al (2017) Prevalence and correlates of frailty in an older rural African population: findings from the HAALSI cohort study. BMC Geriatr 17:293.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gray WK, Orega G, Kisoli A et al (2017) Identifying frailty and its outcomes in older people in rural Tanzania. Exp Aging Res 43:257–273.

    Article  PubMed  Google Scholar 

  10. Gray WK, Paddick SM, Kisoli A et al (2014) Development and validation of the identification and intervention for Dementia in Elderly Africans (IDEA) study dementia screening instrument. J Geriatr Psychiatry Neurol 27:110–118.

    Article  PubMed  Google Scholar 

  11. Dewhurst F, Dewhurst MJ, Gray WK et al (2012) The prevalence of disability in older people in Hai, Tanzania. Age Ageing 41:517–523.

    Article  PubMed  Google Scholar 

  12. Lewis EG, Wood G, Howorth K et al (2018) Prevalence of frailty in older community-dwelling Tanzanians according to comprehensive geriatric assessment. J Am Geriatr Soc 66:1484–1490.

    Article  PubMed  Google Scholar 

  13. Prince M (2000) Methodological issues for population-based research into dementia in developing countries. A position paper from the 10/66 Dementia Research Group. Int J Geriatr Psychiatry 15:21–30.;2-5

    Article  CAS  PubMed  Google Scholar 

  14. Lewis EG, Wood G, Howorth K et al (2018) Prevalence of frailty in older community-dwelling Tanzanians according to comprehensive geriatric assessment. J Am Geriatr Soc.

    Article  PubMed  Google Scholar 

  15. British Geriatrics Society, Age UK, Royal College of General Practitioners (2014) Fit for frailty: consensus best practice guidance for the care of older people living in community and outpatient settings. British Geriatrics Society in association with Age UK and the Royal College of General Practitioners, London

  16. Stone L, Heward J, Paddick SM et al (2018) Screening for Instrumental activities of daily living in sub-Saharan Africa: a balance between task shifting, simplicity, brevity, and training. J Geriatr Psychiatry Neurol 31:248–255.

    Article  PubMed  Google Scholar 

  17. Rockwood K, Song X, MacKnight C et al (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173:489–495.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Bouillon K, Kivimaki M, Hamer M et al (2013) Measures of frailty in population-based studies: an overview. BMC Geriatr 13:64.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Sullivan LM, Massaro JM, D’Agostino RB Sr (2004) Presentation of multivariate data for clinical use: the Framingham Study risk score functions. Stat Med 23:1631–1660.

    Article  PubMed  Google Scholar 

  20. Theou O, Rockwood MR, Mitnitski A et al (2012) Disability and co-morbidity in relation to frailty: how much do they overlap? Arch Gerontol Geriatr 55:e1–e8.

    Article  PubMed  Google Scholar 

  21. Cesari M (2019) There is much more than just diseases that underlies frailty in older persons. Aging Clin Exp Res 31:1349–1350.

    Article  PubMed  Google Scholar 

  22. Canevelli M, Raganato R, Remiddi F et al (2019) Counting deficits or diseases? The agreement between frailty and multimorbidity in subjects with cognitive disturbances. Aging Clin Exp Res.

    Article  PubMed  Google Scholar 

  23. Gray WK, Paddick SM, Collingwood C et al (2016) Community validation of the IDEA study cognitive screen in rural Tanzania. Int J Geriatr Psychiatry 31:1199–1207.

    Article  PubMed  Google Scholar 

  24. Dewhurst F, Dewhurst MJ, Gray WK et al (2012) Rates of diagnosis and treatment of neurological disorders within a prevalent population of community-dwelling elderly people in sub-Saharan Africa. J Epidemiol Glob Health 2:207–214.

    Article  PubMed  Google Scholar 

  25. Dewhurst MJ, Dewhurst F, Gray WK et al (2013) The high prevalence of hypertension in rural-dwelling Tanzanian older adults and the disparity between detection, treatment and control: a rule of sixths? J Hum Hypertens 27:374–380.

    Article  CAS  PubMed  Google Scholar 

  26. Hindley G, Kissima J, Oates L et al (2016) The role of traditional and faith healers in the treatment of dementia in Tanzania and the potential for collaboration with allopathic healthcare services. Age Ageing.

    Article  Google Scholar 

  27. Hunter E, Rogathi J, Chigudu S et al (2016) The epilepsy treatment gap in rural Tanzania: a community-based study in adults. Seizure 36:49–56.

    Article  PubMed  Google Scholar 

  28. Comoro C, Nsimba SED, Warsame M et al (2003) Local understanding, perceptions and reported practices of mothers/guardians and health workers on childhood malaria in a Tanzania district-implications for malaria control. Acta Trop 87:305–313

    Article  CAS  PubMed  Google Scholar 

  29. Dotchin C, Walker R (2012) The management of Parkinson’s disease in sub-Saharan Africa. Expert Rev Neurother 12:661–666.

    Article  CAS  PubMed  Google Scholar 

  30. Mshana G, Hampshire K, Panter-Brick C et al (2008) Urban-rural contrasts in explanatory models and treatment-seeking behaviours for stroke in Tanzania. J Biosoc Sci 40:35–52

    Article  CAS  PubMed  Google Scholar 

  31. Fabricio-Wehbe SC, Cruz IR, Haas VJ et al (2013) Reproducibility of the Brazilian version of the Edmonton Frail Scale for elderly living in the community. Rev Lat Am Enferm 21:1330–1336.

    Article  Google Scholar 

  32. Fabricio-Wehbe SC, Schiaveto FV, Vendrusculo TR et al (2009) Cross-cultural adaptation and validity of the ‘Edmonton Frail Scale—EFS’ in a Brazilian elderly sample. Rev Lat Am Enferm 17:1043–1049

    Article  Google Scholar 

  33. Sanchez-Garcia S, Sanchez-Arenas R, Garcia-Pena C et al (2014) Frailty among community-dwelling elderly Mexican people: prevalence and association with sociodemographic characteristics, health state and the use of health services. Geriatr Gerontol Int 14:395–402.

    Article  PubMed  Google Scholar 

  34. Runzer-Colmenares FM, Samper-Ternent R, Al Snih S et al (2014) Prevalence and factors associated with frailty among Peruvian older adults. Arch Gerontol Geriatr 58:69–73.

    Article  PubMed  Google Scholar 

  35. Lewis EG, Coles S, Howorth K et al (2018) The prevalence and characteristics of frailty by frailty phenotype in rural Tanzania. BMC Geriatr 18:283.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Paddick SM, Gray WK, Ogunjimi L et al (2015) Validation of the Identification and Intervention for Dementia in Elderly Africans (IDEA) cognitive screen in Nigeria and Tanzania. BMC Geriatr 15:53.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Paddick SM, Mkenda S, Mbowe G et al (2017) Cognitive stimulation therapy as a sustainable intervention for dementia in sub-Saharan Africa: feasibility and clinical efficacy using a stepped-wedge design. Int Psychogeriatr.

    Article  PubMed  Google Scholar 

  38. Economic and Social Research Foundation (2015) Tanzania human development report 2014. Economic and Social Research Foundation, United Nations Development Programme and Government of the United Republic of Tanzania, Dar-es-Salaam, Tanzania

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We thank Greta Wood, Selina Coles, Aloyce Kisoli, Paulina Tukay, John Kissima, and Antusa Kissima who participated in data collection. We acknowledge all the help we have received from the healthcare workers, translators, village enumerators, carers, family members and participants in Hai district, who helped with or participated in data collection. We would like to thank staff from the Research and Development Department at Northumbria Healthcare NHS Foundation Trust for administrative and logistical support.


The study received no funding external to the organisations conducting this study. Salaries for EGL and KH were funded by a Teaching and Research Fellow position sponsored by Northumbria Healthcare NHS Foundation Trust. LW and HC completed this work in part fulfilment of the requirements of a Master’s in Research (MRes) degree at Newcastle University, UK.

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Authors and Affiliations



Design/conception: RW, WKG, CD, EGL, SU. Literature search: LW, EGL, WKG. Data collection: LW, HC, EGL, KH, BS, LM, AM, DM, JM, FZ. Data analysis: LW, WKG. Interpretation of results: LW, WKG, CD, EGL, RW. Writing of paper and review: All authors.

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Correspondence to William K. Gray.

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All other authors report no conflicts of interest.

Ethical approval

The study was approved by the National Institute for Medical Research, Dar-es-Salaam, Tanzania (Ref: 2403), Kilimanjaro Christian Medical University College Research Ethics and Review Committee, Moshi, Tanzania (Ref: 998) and Newcastle University Research Ethics Committee, Newcastle upon Tyne, UK (Ref: 01229/10058/2016).

Informed consent

For each participant, verbal information was given on the aims of the study and the implications of taking part and a consent form was read aloud. Participants were also given the opportunity to ask questions. Consent was then obtained by signature or thumbprint, depending on literacy status. Where the participant was felt to lack capacity to give consent, assent was obtained instead from a close relation.

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Lewis, E.G., Whitton, L.A., Collin, H. et al. A brief frailty screening tool in Tanzania: external validation and refinement of the B-FIT screen. Aging Clin Exp Res 32, 1959–1967 (2020).

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