Correlates of Frailty among Older Persons in Rural Eastern Uganda: A Cross-sectional Survey

Correlates of Frailty among Older Persons in Rural Eastern Uganda: A Cross-sectional Survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Correlates of Frailty among Older Persons in Rural Eastern Uganda: A Cross-sectional Survey Stephen Ojiambo Wandera, Shafiq Kawooya, Peter Kisaakye, Noeline Nakasujja, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7837231/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Frailty, characterized by diminished physiological reserve and heightened vulnerability to stressors has emerged as a central challenge of aging, particularly in low- and middle-income countries. Although frailty has been extensively studied and in high-income settings, its determinants in SSA remain poorly understood, and contextual factors may differ substantially. The study aimed to assess the prevalence and correlates of frailty among older persons in two rural districts of Eastern Uganda: Busia and Namayingo. Methods We used cross-sectional data from two districts of Busia and Namayingo in rural eastern Uganda among 598 older persons aged 60 years and above. Differences in characteristics by frailty status were tested using chi-square tests for categorical variables and t-tests or non-parametric equivalents for continuous variables. Using a stepwise approach, we used multivariable logistic regression analyses to examine the factors associated with frailty. Results The overall prevalence of frailty and pre-fail was 34.3% and 52.7% respectively. A unit decrease in average handgrip strength was associated with increased odds of frailty (OR = 0.96; CI = 0.93–0.98) while a unit increase in loneliness was associated with increased odds of frailty (OR = 1.08; CI = 1.04–1.12). Older persons who were living alone were more likely to be frail (OR = 1.62; CI = 1.16–2.26) than their counterparts who were not living alone. Frailty was more likely to be reported among depressed (OR = 2.11; CI = 1.45–3.07) or hypertensive (OR = 1.49; CI = 1.05–2.11) older persons than their counterparts. Conclusions Frailty is highly prevalent among older persons in rural Eastern Uganda and is shaped by a combination of physical, psychological, and social factors. The findings support the integration of frailty screening into primary healthcare and community-based programming, with attention to the psychosocial context of older adults. Frailty Aged Rural Uganda sub-Saharan Africa Figures Figure 1 Figure 2 Figure 3 BACKGROUND Population aging is accelerating globally, reshaping disease patterns and exposing new forms of vulnerability among older adults [ 1 ]. As the World Health Organization notes, population ageing, though a public-health success, presents new challenges for systems historically designed for acute rather than chronic care [ 2 ]. Frailty, characterized by diminished physiological reserve and heightened vulnerability to stressors has emerged as a central challenge of aging, particularly in low- and middle-income countries (LMICs) [ 3 – 5 ]. Frail persons can be predisposed to adverse effects such as disability, falls, hospitalization, impairment, morbidity, mortality, and loss of resources [ 6 – 11 ]. In sub-Saharan Africa (SSA), demographic transition is unfolding alongside fragile health systems, pervasive poverty, and limited social protection, magnifying the risk of functional dependence and social isolation [ 12 – 15 ]. Uganda exemplifies this transition: life expectancy has risen steadily over recent decades [ 16 ], yet social protection and geriatric care remain limited, leaving many older persons at risk of preventable decline [ 16 , 17 ]. Understanding late-life vulnerability to frailty in such contexts is therefore a pressing public health priority [ 18 – 20 ]. Although frailty has been extensively studied and in high-income settings, its determinants in SSA remain poorly understood, and contextual factors may differ substantially [ 21 , 22 ]. Emerging African studies suggest that functional decline, poor nutrition, and psychosocial adversity may play a larger role in frailty than cardiometabolic disease. For example, studies conducted in rural Tanzanian have linked frailty to depression and low muscle strength [ 13 , 23 ]. Previous studies in Uganda have linked frailty to depression. For example, in rural Uganda, evidence shows that frailty was associated with depression among middle aged adults living with HIV [ 24 ]. Another study conducted in rural Uganda also observed frailty to be associated with older people living with HIV, depression and comorbidities [ 25 ]. These patterns underscore frailty as a multidimensional construct and suggest that, in SSA, frailty may be driven by intersecting physical, nutritional, and psychosocial vulnerabilities rather than the chronic-disease profiles typical of older populations elsewhere [ 8 , 26 – 30 ]. Building on this limited regional evidence, the present study examined the prevalence and correlates of frailty among older persons in two rural districts of Eastern Uganda: Busia and Namayingo. These study districts were chosen because they have communities that face high poverty levels, substantial outward migration of younger populations, and restricted healthcare access, all of which heighten vulnerability in old age (UBOS, 2024). Using the Fried phenotype model [ 3 ], we assessed sociodemographic, functional, and psychosocial predictors of frailty and explored geographic variation between districts to generate locally relevant evidence for healthy-aging interventions in Uganda and similar low-resource settings. The phenotype model defines frailty by a group of characteristics – weight loss, reduced muscle strength, reduced gait (walking) speed, exhaustion, and low energy expenditure [ 31 – 34 ]. The frailty index is based on an accumulation of deficit ranging from sensory impairment, low mood, tremor, and cognitive impairment to the presence of various diseases. These combine to increase the risk of frailty. It is a condition in which multiple body systems gradually lose their in-built reserves” [ 35 ] including functional sarcopenia, polypharmacy and limitations [ 36 ]. Finally, frailty is a “syndrome involving loss of resources in one or more domains of functioning” [ 6 ]. Study Context Busia and Namayingo are border districts located in eastern part of Uganda. They border Kenya in the eastern part of Uganda. The major economic activities in Busia and Namayingo include agriculture (forestry, crop farming, fishing, tree growing), tourism and trade [ 37 , 38 ]. According to the recent 2024 Uganda census, the total population of Namayingo district is 266,716 and for Busia district is 412,671 [ 16 ]. The total population of persons who are 60 years and older in Busia is 20,467 while that of Namayingo is 11,209. In both districts, the largest proportion of the population is subsistence. Only 6,176 people in Namayingo own mobile phones. Mental health challenges exist in both districts. For example, in Busia 41,702 people have psychological distress, 14,880 people have bipolar disorder, 25,888 people have depression, 12,419 people have anxiety, 4,490 people have psychosis and 2,233 people reported suicidality [ 39 ]. In Namayingo, 28,645 people have psychological distress, 7,201 people have bipolar disorder, 20,433 people have depression, 10,725 people have anxiety, 5,657 people have psychosis and 2,656 people reported suicidality [ 39 ]. METHODS Study Design and Setting This was a cross-sectional survey covering two districts of Busia and Namayingo from rural eastern Uganda. The justification for their selection is published elsewhere [ 40 , 41 ]. They are also border districts near the border of Uganda and Kenya with gold mining activities that have escalated after 2019 [ 38 , 42 ]. These districts are part of the 40 districts in the eastern Ugandan region [ 43 , 44 ]. They are dominantly occupied by the Samia tribe. Other significant tribes are the Basoga and the Itesots around Tiira in Busia [ 44 ]. Sampling Strategy and sample size A multi-stage stratified cluster sampling design was used to select 598 households from the 2014 Uganda Population and Housing Census sampling frame [ 44 , 45 ]. The details of the sample calculation and sampling strategy are published elsewhere [ 41 ]. The overall sample size was 598 dyads of older adults and their caregivers. For this paper, we analyze data for the older adults only as described elsewhere [ 41 ]. Data collection and recruitment of respondents Data collection was conducted between December 2023 and September 2024. From each household that was selected, a dyad of an older adult and an in-home caregiver were interviewed. In households where older adults were living together as a couple, each older adult was interviewed separately. An older person was defined according to the United Nations’ criteria of age 60 years and older [ 46 ] and the definition set by the Ministry of Gender, Labor and Social Development [ 47 ]. The prevalence of adults aged 60 years and older in Uganda in 2024 was 5% [ 43 , 44 ]. Eligibility criteria Households were included if at least one older adult was available at the time of the house visit, could confirm that they have lived in the household for at least 6 months, and they or a caregiver provided consent to participate in the study depending on capacity to consent. Households were excluded if there were no eligible older adults due to a physical disability (such as hearing or visual impairment), untreated mental health condition, or medication use in the past seven days that would limit participation in cognitive testing or affect cognitive testing performance. Households were also excluded if individuals present at the time of the house visit were unwilling to wear a facemask properly [ 41 ]. Ethical Considerations Ethical approval was obtained from the national Institutional Review Board - TASO Research Ethics Committee (Approval Number: TASO-2022-179) and the Uganda National Council of Science and Technology (UNCST). The approval number is HS2693ES. Voluntary informed consent was obtained from all study participants (both the older adult and the caregiver in each household). Details are published elsewhere [ 41 ]. This study was carried out in compliance to the Declaration of Helsinki. Variables and measures Outcome variable: Frailty We measured frailty using the FRAIL Phenotype scale [ 48 – 52 ]. Frailty has five questions about fatigue, resistance, aerobics, illness and loss of weight [ 52 ]. A score of 3 to 5 indicated frailty and 0 to 2 indicates no frailty [ 52 ]. Explanatory variables The explanatory variables included biosocial factors (including demographic and socio-economic factors), behavioral and health-related factors. Demographic variables included sex (male and female), age group. Socio-economic variables included: educational level, marital status, source of livelihood, and source of energy for household lighting). Behavioral variables included smoking, and alcohol consumption. We asked participants if they currently or formerly smoke(d) cigarettes (yes and no). Possible alcohol use disorder was measured using the CAGE assessment for alcohol use disorder risk [ 53 – 55 ], previously applied in Uganda [ 54 , 55 ]. The CAGE has four questions that include: Do you drink alcohol? Have you ever felt you should cut down on your drinking? Have people annoyed you by criticizing your drinking of alcohol? Have you ever felt bad or guilty about your drinking? Their responses are yes and no. The Cronbach’s alpha for the CAGE scale was 0.60. Falls was measured by combing two questions (with yes and no responses) on the experience of falls and the fear of the risk of falling in future [ 34 , 56 – 59 ]. These questions were: Have you ever fallen in the last 6 months? Do you think you may fall in the next few months? We combined any response to either of the two questions as an indicator of falls. We measured social isolation and living alone using three questions (yes and no): Do you live alone? Are you unable to go outside the home? Are you able to participate in group activities? Social isolation and living alone was created by recoding a yes to any of the three questions. Loneliness was assessed using the UCLA Loneliness Scale – Short Form [ 41 , 60 – 62 ]. The six questions are: I lack companionship I feel part of a group of friends I feel left out I feel isolated from others I am unhappy being so withdrawn People are around me but not with me Their responses range from 1 to 4. Item 2 was reverse coded so that it is negative. The loneliness scores range from 6 to 24 with higher scores indicating greater loneliness. The Cronbach’s alpha for the CAGE scale was 0.76. The mean loneliness score was 12.5 (sd 4.3 minimum 6 maximum 24). Depression screening was measured using the 9-item Patient Health Questionnaire (PHQ-9) [ 63 – 66 ], which has been previously applied in Uganda [ 66 ]. A score of 10 or greater was used to define moderate to severe depression on the PHQ-9 [ 66 ]. Details of how it was scored is published in another papers [ 41 ]. The PHQ-9 indicators had a Cronbach’s alpha of 0.85. Anthropometric assessments of the older adults included: blood pressure, weight and height for body mass index. Hypertension was defined as SBP 140 mm Hg or higher and DBP 90 mm Hg or higher [ 67 , 68 ]. Hyperglycemia was assessed using a random blood glucose test performed during the assessment and defined as random blood glucose > = 200mg/dL. To screen for dementia, we used the Identification and Intervention for Dementia in Elderly Africans (IDEA) cognitive screening tool [ 69 , 70 ]. The IDEA tool is a brief cognitive screening tool validated in rural Tanzania for older adults with low literacy and has demonstrated high diagnostic accuracy for dementia. The tool has been validated in other sub-Saharan African populations, including rural community samples of older adults in Tanzania and Nigeria with normative values established among these populations [ 69 , 70 ]. The IDEA is scored from 0 to 15, including assessments of abstraction, orientation, long-term memory, categorical verbal fluency, visuospatial construction and verbal delayed recall. The tool does not require the ability to read, write, draw or calculate. An external validation study in Tanzania established the following cut-off scores which we applied for our study: 0–7 “probable dementia”; 8–9 ‘possible dementia”; and 10–15 “no dementia” [ 70 ]. Simple Nutritional Appetite Questionnaire (SNAQ) was used from another study [ 71 , 72 ]. We generated an overall score ranging from 0 to 20. A score of 0–14 was considered as poor appetite and that of 15–20 as good appetite [ 72 ]. The Cronbach’s alpha for the four SNAQ questions was 0.66. Statistical analysis All survey data was entered into Redcap hosted at Makerere University, College of Health Sciences. Redcap is a secure data collection platform with no collection of identifying information. For all descriptive statistics, we used frequency distributions for categorical variables and means and standard deviations (if normally distributed) for continuous variables. We used cross-tabulations (Pearson's chi-squared (χ2) tests) to investigate associations between frailty and selected explanatory variables. The level of statistical significance using p-values was set at p < 0.05. We used multivariable logistic regression analyses to examine the association between frailty and explanatory variables. We used stepwise regressions for multivariable analysis, including all relevant covariates. First, we controlled for biosocial factors: demographic and socio-economic variables (Model 1). Second, we adjusted for behavioral and health factors (Model 2). We reported Odds Ratios (OR) with their 95% confidence intervals. The level of statistical significance using p-values was set at p < 0.05. All analyses were performed in STATA version 19. RESULTS Descriptive characteristics Table 1 shows that there were significant differences observed in the means and standard deviations of physical functioning and nutrition-related measures by frailty status. The mean age of the older persons was 69.9 (standard deviation (sd) = 8.9). The mean handgrip strength (HGS) was lower among frail older adults (15.9 vs. 20.4 kg, p < 0.001). Frail individuals took more time on the Timed Get-Up-and-Go test (18.8 vs. 13.7 seconds, p < 0.001). Simple nutritional appetite questionnaire scores (SNAQ) were lower in the frail group (mean 12.6 vs. 13.5, p < 0.001). Table 1 Descriptive characteristics for continuous variables Frailty status Not frail Mean (sd) Frail Mean (sd) Total Mean (sd) Test Sample (N) 393 (65.72%) 205 (34.28%) 598 (100.00%) Age in complete years 68.15 (8.08) 73.35 (9.63) 69.93 (8.98) < 0.00 Body mass index 22.04 (4.96) 21.48 (5.95) 21.85 (5.32) 0.22 Timed Up and Go (TUG) Test 13.71 (7.70) 18.83 (13.07) 15.47 (10.16) < 0.00 Average handgrip strength 20.37 (6.93) 15.95 (6.82) 18.86 (7.20) < 0.00 Simple Nutritional Appetite Questionnaire (SNAQ) score 13.55 (2.49) 12.59 (2.98) 13.22 (2.70) < 0.00 Patient Health Questionnaire (PHQ-9) 8.78 (5.83) 14.01 (5.69) 10.58 (6.29) < 0.00 UCLA Loneliness Scale – Short Form (ULS-6) 11.49 (4.02) 14.45 (4.29) 12.51 (4.34) < 0.00 Sd = Standard Deviation of the mean A total of 598 older persons aged 60 years and above were enrolled from Busia and Namayingo districts in Eastern Uganda. Women constituted 60.7% of the sample (Table 2 ). The overall prevalence of frailty and pre-frailty, defined according to Fried’s phenotype [ 3 ], was 34.3% and 52.7% respectively (Fig. 1 ). The proportion of older persons with frailty increased with age but the proportion of older persons with pre-frailty decreased with age (Fig. 2 ). A higher proportion of older females reported symptoms of pre-frailty and frailty compared to older males (Fig. 3 ). Table 2 Descriptive characteristics for categorical variables Frailty status Not frail n (%) Frail n (%) Total n (%) Test N 393 (65.7) 205 (34.3) 598 (100.0) Sex Female 216 (55.0) 147 (71.7) 363 (60.7) < 0.001 Male 177 (45.0) 58 (28.3) 235 (39.3) Age group 60–69 253 (64.4) 81 (39.5) 334 (55.9) < 0.001 70–79 97 (24.7) 66 (32.2) 163 (27.3) 80+ 43 (10.9) 58 (28.3) 101 (16.9) Education level No education 125 (31.8) 107 (52.2) 232 (38.8) < 0.001 Primary or higher 268 (68.2) 98 (47.8) 366 (61.2) Marital status Formerly married 211 (53.7) 143 (69.8) 354 (59.2) < 0.001 Currently married 182 (46.3) 62 (30.2) 244 (40.8) In the last 12 months, have you done any work for which you received a payment No 270 (68.7) 162 (79.0) 432 (72.2) 0.007 Yes 123 (31.3) 43 (21.0) 166 (27.8) Source of livelihood Farming 286 (72.8) 110 (53.7) 396 (66.2) < 0.001 Depend on children 56 (14.2) 65 (31.7) 121 (20.2) Trading or others 51 (13.0) 30 (14.6) 81 (13.5) Religion Catholic 158 (40.2) 85 (41.5) 243 (40.6) 0.052 Anglican 122 (31.0) 46 (22.4) 168 (28.1) Pentecostal or others 113 (28.8) 74 (36.1) 187 (31.3) Source of energy for lighting Electricity or solar 217 (55.2) 89 (43.4) 306 (51.2) 0.021 Paraffin lamp 98 (24.9) 68 (33.2) 166 (27.8) Firewood or others 78 (19.8) 48 (23.4) 126 (21.1) Ever or currently smoking No 347 (88.3) 180 (87.8) 527 (88.1) 0.860 Yes 46 (11.7) 25 (12.2) 71 (11.9) Alcohol problems using cage scale No 269 (68.4) 158 (77.1) 427 (71.4) 0.027 Yes 124 (31.6) 47 (22.9) 171 (28.6) Ever fallen and at risk of falling No 149 (37.9) 72 (35.1) 221 (37.0) 0.502 Yes 244 (62.1) 133 (64.9) 377 (63.0) Living alone and socially isolated No 230 (58.5) 62 (30.2) 292 (48.8) < 0.001 Yes 163 (41.5) 143 (69.8) 306 (51.2) Experienced depression No depression 223 (56.7) 46 (22.4) 269 (45.0) 140 mmHg and diastolic BP > 90 mmHg Normal BP 321 (81.7) 150 (73.2) 471 (78.8) 0.016 Hypertensive 72 (18.3) 55 (26.8) 127 (21.2) Possible diabetes based on random blood glucose level No diabetes 366 (93.1) 185 (90.2) 551 (92.1) 0.213 Possible diabetes 27 (6.9) 20 (9.8) 47 (7.9) Dementia by IDEA Tool No dementia 335 (85.2) 140 (68.3) 475 (79.4) < 0.001 Probable dementia 58 (14.8) 65 (31.7) 123 (20.6) Table 2 shows significant differences by frailty status among older persons by sex, age, education level, marital status, past work status, source of livelihood, source of energy for lighting, alcohol consumption, living alone, experience of depression, blood pressure, and dementia status. That is, more females than males were frail (71.7% vs 28.3%). Frailty was reported more among older persons aged 60–69 years (39.5%), those with no formal education (52.2%), formerly married (69.8), those who have not done any work for payment for the last 12 months (79.0%), and whose source of livelihood is farming (53.7%). More older persons whose source of energy for lighting was electricity or solar (43.4%), non-alcoholic (77.1%), those living alone (69.8%), and the depressed (77.6%) were frail compared to their counterparts. Factors associated with frailty Table 3 shows results from a multivariable logistic regression model assessing the factors associated with frailty. Model 1 , controlled for biosocial factors only and shows that respondents aged 70–79 years (aOR = 1.71; CI = 1.22–2.39) and those aged 80 years and older (aOR = 2.09; CI = 1.42–3.05) were more likely to be frail compared to their counterparts aged 60–69 years. Older adults who depended on their children (aOR = 1.73; CI = 1.22–2.47) or traded as a source of livelihood (aOR = 1.56; CI = 1.02–2.38) were more likely to be frail than their counterparts whose source of livelihood was farming. Frailty was more likely to occur among respondents who used paraffin lamp (aOR = 1.41; CI = 1.01–1.97) or firewood (aOR = 1.84; CI = 1.21–2.81) as a source of energy for lighting than among respondents who used electricity. Table 3 Multivariate Results Model (1) # 95% Confidence Intervals Model (2) ## 95% Confidence Intervals Variables Sex Female 1.00 1.00 Male 0.72 [0.46,1.11] 0.98 [0.60,1.59] Age group 60–69 1.00 1.00 70–79 1.71 ** [1.22,2.39] 1.35 [0.93,1.96] 80+ 2.09 *** [1.42,3.05] 1.46 [0.93,2.31] Education level No education 1.00 1.00 Primary or higher 0.75 [0.53,1.06] 0.91 [0.63,1.33] Marital status Formerly married 1.00 1.00 Currently married 1.09 [0.72,1.66] 1.36 [0.88,2.11] In the last 12 months, have you done any work for which you received a payment , No 1.00 1.00 Yes 0.68 [0.45,1.04] 0.73 [0.48,1.12] Source of livelihood Farming 1.00 1.00 Depend on children 1.73 ** [1.22,2.47] 1.34 [0.91,1.99] Trading or others 1.56 * [1.02,2.38] 1.30 [0.83,2.03] Source of energy for lighting Electricity or solar 1.00 1.00 Paraffin lamp 1.41 * [1.01,1.97] 1.29 [0.90,1.85] Firewood or others 1.84 ** [1.21,2.81] 1.14 [0.73,1.78] Ever or currently smoking No 1.00 Yes 0.64 [0.40,1.02] Alcohol problems using cage scale 0.94 [0.65,1.36] Timed Up and Go (TUG) Test 1.01 [1.00,1.02] Average handgrip strength 0.96 ** [0.93,0.98] Ever fallen or at risk of falling No 1.00 Yes 0.75 [0.55,1.05] Living alone and socially isolated No 1.00 Yes 1.62 ** [1.16,2.26] UCLA Loneliness Scale – Short Form (ULS-6) 1.08 *** [1.04,1.12] Experienced depression No 1.00 Yes 2.11 *** [1.45,3.07] Systolic BP > 140 mmHg and diastolic BP > 90 mmHg Normal BP 1.00 Hypertensive 1.49 * [1.05,2.11] Possible diabetes based on random blood glucose level No diabetes 1.00 Possible diabetes 1.22 [0.72,2.06] Dementia by IDEA Tool No dementia 1.00 Probable dementia 0.86 [0.59,1.26] Observations 598 598 Exponentiated coefficients; 95% confidence intervals in brackets; * p < 0.05, ** p < 0.01, *** p < 0.001; #Adjusted for biosocial variables; ## Adjusted for biosocial, behavioral and health related variables However, when behavioral and health related factors were added to the model ( Model 2 ), the effect for age, source of livelihood and source of energy for lighting weakened. A unit increase in average handgrip strength was associated with decreased odds of frailty (OR = 0.96; CI = 0.93–0.98). In addition, a unit increase in loneliness was associated with increased odds of frailty (OR = 1.08; CI = 1.04–1.12). Older persons who were living alone were more likely to be frail (OR = 1.62; CI = 1.16–2.26) than their counterparts who were not living alone. Frailty was more likely to be reported among depressed (OR = 2.11; CI = 1.45–3.07) or hypertensive (OR = 1.49; CI = 1.05–2.11) older persons than their counterparts. DISCUSSION This paper aimed to assess the sociodemographic, functional, and psychosocial predictors of frailty among older adults in rural eastern Uganda. The prevalence of frailty among older persons in rural Eastern Uganda, was about a third (34.3%) of the sample of participants meeting the Fried phenotype criteria. Frailty disproportionately affected individuals with impaired physical performance, social isolation, and depressive symptoms. The most frequently observed frailty components; weak hand grip strength and slow gait speed are consistent with prior studies in both high- and low-resource settings [ 31 – 34 ]. The finding underscores the urgent need to recognize frailty as a major geriatric syndrome in SSA contexts where health systems are not yet fully adapted to aging populations. The association between frailty and reduced hand grip strength and mobility supports previous evidence that these markers are reliable indicators of diminished physiological reserve and vulnerability to adverse outcomes [ 26 , 27 ]. In a study of older adults in rural China, hand grip strength and walking speed were significant correlates of frailty status [ 23 ]. In SSA, frailty was associated with worse self-reported health, lower subjective well-being, and higher mortality of over 17 months in one rural South African study [ 10 ]. In a study from Burkina Faso, frailty and impaired physical performance were as associated with female sex, multimorbidity, increasing age, and limitations in activities of daily living [ 8 ]. Moreover, a Tanzanian study, similarly found that reduced muscle strength was one of the most common phenotype components among rural older adults, suggesting that physical frailty is a prominent manifestation in SSA. Depression was also strongly associated with frailty, consistent with studies showing that psychological distress both contributes to and is exacerbated by frailty in later life [ 28 , 29 ]. In a Chinese cohort of older adults (N = 5,303), being frail or pre-frail was associated with higher odds of depressive symptoms (ORs 3.05–9.78 depending on frailty definition), and depressed participants had elevated risk of transitioning into frailty over follow-up. For example, in a rural Ugandan cohort of older people with and without HIV, depression was a strong correlate of frailty [ 25 ]. The bidirectional relationship between frailty and depression has been well-documented: frail individuals may experience loss of independence leading to psychological distress, while depression may reduce motivation for physical activity, thus accelerating functional decline [ 30 ]. Social isolation and living alone, similarly, has been shown to heighten the risk of frailty and related decline thereby compounding vulnerability on older adults [ 14 ] for it reduces access to caregiving and economic support. In SSA, although there are few studies that have examined this relationship. One study from Ghana found that older adults who reported loneliness were more likely to exhibit functional impairments, suggesting that reduced social embeddedness may contribute to declines in mobility and strength [ 14 ]. One systematic review on frailty in Africa found that “social interaction” or “social connectedness” were modifiable correlates of frailty in African aging populations [ 15 ]. In our sample, the high proportion of frail individuals living alone suggests that family-based safety nets are increasingly fragile in these rural districts, possibly due to migration of younger relatives and/or economic hardship, weakening traditional extended-family supports for older kin [ 73 – 75 ]. Interestingly, traditional cardiometabolic risk factors such as hypertension and diabetes, were not significantly associated with frailty in this cohort. The same is consistent with studies from rural Tanzania, where similar patterns of frailty appear to be driven more by functional impairment and social vulnerability than by cardiometabolic conditions [ 11 ]. In rural Tanzania, a study found that frailty was significantly associated with depression and self-rated poor health, but the role of diagnosed comorbidities was non-significant [ 13 ]. A systematic review of frailty in Africa found that while multimorbidity may be identified as a risk factor, nutritional deficits, physical inactivity, poverty, and social factors were most strongly associated [ 15 ]. Strengths and Limitations The strengths of this study include the following: First, the study adds to the available literature that examines the risk factors associated with frailty among older persons in a rural setting of Uganda [ 76 ]. Second, the use of a standard Fried phenotype model to examine frailty allows for generation of robust estimates for comparability [ 52 ]. Notwithstanding the strengths of this study, some limitations are worth illuminating. First, the cross-sectional design of the study prevents causal inference. Second, the frailty components relied on self-report, which may be subject to reporting bias. Third, the results may not be generalizable to urban populations or other parts of Uganda given the regional differences and diversity in the country. However, our results may be generalizable to similar rural areas of SSA with similar sociodemographic characteristics. In addition, different studies have shown significant variation in frailty phenotype expression across racial and geographic populations, raising questions about the generalizability of cutoff points developed in high-income countries [ 77 , 78 ]. Therefore, more work is needed to develop appropriate cutoff points for frailty in SSA. CONCLUSION Frailty is prevalent among older persons in rural Eastern Uganda and is shaped by a combination of physical, psychological, and social factors. The findings support the integration of frailty screening into primary healthcare and community-based programming, with attention to the psychosocial context of older adults. Integrating simple functional assessments into routine primary healthcare, expanding community-based psychosocial interventions, and tailoring district-level responses could help mitigate the burden of frailty. Abbreviations HGS Hand Grip Strength SSA sub-Saharan Africa UN United Nations WHO World Health Organization Declarations Ethics approval and consent to participate All human subjects provided informed consent. Ethical approval was obtained from the national Institutional Review Board - TASO Research Ethics Committee (Approval Number: TASO-2022-179) and the Uganda National Council of Science and Technology (UNCST). The approval number is HS2693ES. This study was carried out in compliance to the Declaration of Helsinki. Consent for publication This study was carried out in compliance to the Declaration of Helsinki. Competing interests The authors declare that they have no competing interests. Clinical Trial Number Not Applicable Funding Information This work was supported by The Alzheimer’s Association (Grant Number: AARGD-NTF-22-975156). The Alzheimer’s Association did not play any role in the study design, data collection and analysis, and the decision to publish the manuscript. Author Contribution Conceptualization: SOW, PK, SK, MMD, NNData curation: SOWFormal analysis: SOWFunding acquisition: SOW, MMD, NNInvestigation: SOW, PK, SK, MMD, NNMethodology: SOW, PK, SK, MMD, NNProject administration: SKResources: SOW, MMD, NNSoftware: SOWSupervision: SOW, SKValidation: SOW, PK, SK, MMD, NNVisualization: SOW, PKWriting – original draft: SOW, PK, SKWriting – review & editing: SOW, PK, SK, MMD, NN Acknowledgement We are grateful to all the older persons and their caregivers for their participation in the study. The research assistants and health workers who collected the data are greatly appreciated. We thank the Local Government leadership of Busia and Namayingo for their support during the data collection exercise. Data Availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. References UN. World Population Ageing 2023: Highlights. In. New York; 2023. WHO. 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Unveiling the Frailty Spatial Patterns Among Chilean Older Persons by Exploring Sociodemographic and Urbanistic Influences Based on Geographic Information Systems: Cross-Sectional Study. JMIR Aging. 2025;8:e64254. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 23 Nov, 2025 Reviewers agreed at journal 16 Nov, 2025 Reviewers invited by journal 14 Nov, 2025 Editor assigned by journal 12 Nov, 2025 Editor invited by journal 23 Oct, 2025 Submission checks completed at journal 20 Oct, 2025 First submitted to journal 20 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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1","display":"","copyAsset":false,"role":"figure","size":181359,"visible":true,"origin":"","legend":"\u003cp\u003eFrailty status\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7837231/v1/913c8d8ace5be270ad570eee.jpeg"},{"id":96815631,"identity":"75d587b7-7030-4346-b022-228ca8bd904e","added_by":"auto","created_at":"2025-11-26 11:02:53","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":44306,"visible":true,"origin":"","legend":"\u003cp\u003eFrailty Status by Age\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7837231/v1/d47bdaf4425c050f36aa8358.png"},{"id":96917823,"identity":"b8366682-a627-44ce-bb02-ec18a2d90e67","added_by":"auto","created_at":"2025-11-27 14:10:36","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":31673,"visible":true,"origin":"","legend":"\u003cp\u003eFrailty Status by sex\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7837231/v1/e79038665c61202f6dfa78d5.png"},{"id":97136439,"identity":"90082d7e-c82b-4eec-b28d-b808d0508ce1","added_by":"auto","created_at":"2025-12-01 09:56:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1935901,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7837231/v1/ba3779ee-ab5c-4847-b804-c32869d049fe.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Correlates of Frailty among Older Persons in Rural Eastern Uganda: A Cross-sectional Survey","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003ePopulation aging is accelerating globally, reshaping disease patterns and exposing new forms of vulnerability among older adults [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. As the World Health Organization notes, population ageing, though a public-health success, presents new challenges for systems historically designed for acute rather than chronic care [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Frailty, characterized by diminished physiological reserve and heightened vulnerability to stressors has emerged as a central challenge of aging, particularly in low- and middle-income countries (LMICs) [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Frail persons can be predisposed to adverse effects such as disability, falls, hospitalization, impairment, morbidity, mortality, and loss of resources [\u003cspan additionalcitationids=\"CR7 CR8 CR9 CR10\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn sub-Saharan Africa (SSA), demographic transition is unfolding alongside fragile health systems, pervasive poverty, and limited social protection, magnifying the risk of functional dependence and social isolation [\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Uganda exemplifies this transition: life expectancy has risen steadily over recent decades [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], yet social protection and geriatric care remain limited, leaving many older persons at risk of preventable decline [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Understanding late-life vulnerability to frailty in such contexts is therefore a pressing public health priority [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough frailty has been extensively studied and in high-income settings, its determinants in SSA remain poorly understood, and contextual factors may differ substantially [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Emerging African studies suggest that functional decline, poor nutrition, and psychosocial adversity may play a larger role in frailty than cardiometabolic disease. For example, studies conducted in rural Tanzanian have linked frailty to depression and low muscle strength [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Previous studies in Uganda have linked frailty to depression. For example, in rural Uganda, evidence shows that frailty was associated with depression among middle aged adults living with HIV [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Another study conducted in rural Uganda also observed frailty to be associated with older people living with HIV, depression and comorbidities [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. These patterns underscore frailty as a multidimensional construct and suggest that, in SSA, frailty may be driven by intersecting physical, nutritional, and psychosocial vulnerabilities rather than the chronic-disease profiles typical of older populations elsewhere [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR27 CR28 CR29\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBuilding on this limited regional evidence, the present study examined the prevalence and correlates of frailty among older persons in two rural districts of Eastern Uganda: Busia and Namayingo. These study districts were chosen because they have communities that face high poverty levels, substantial outward migration of younger populations, and restricted healthcare access, all of which heighten vulnerability in old age (UBOS, 2024).\u003c/p\u003e\u003cp\u003eUsing the Fried phenotype model [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], we assessed sociodemographic, functional, and psychosocial predictors of frailty and explored geographic variation between districts to generate locally relevant evidence for healthy-aging interventions in Uganda and similar low-resource settings. The phenotype model defines frailty by a group of characteristics \u0026ndash; weight loss, reduced muscle strength, reduced gait (walking) speed, exhaustion, and low energy expenditure [\u003cspan additionalcitationids=\"CR32 CR33\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The frailty index is based on an accumulation of deficit ranging from sensory impairment, low mood, tremor, and cognitive impairment to the presence of various diseases. These combine to increase the risk of frailty. It is a condition in which multiple body systems gradually lose their in-built reserves\u0026rdquo; [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] including functional sarcopenia, polypharmacy and limitations [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Finally, frailty is a \u0026ldquo;syndrome involving loss of resources in one or more domains of functioning\u0026rdquo; [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eStudy Context\u003c/h3\u003e\n\u003cp\u003eBusia and Namayingo are border districts located in eastern part of Uganda. They border Kenya in the eastern part of Uganda. The major economic activities in Busia and Namayingo include agriculture (forestry, crop farming, fishing, tree growing), tourism and trade [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. According to the recent 2024 Uganda census, the total population of Namayingo district is 266,716 and for Busia district is 412,671 [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The total population of persons who are 60 years and older in Busia is 20,467 while that of Namayingo is 11,209. In both districts, the largest proportion of the population is subsistence. Only 6,176 people in Namayingo own mobile phones. Mental health challenges exist in both districts. For example, in Busia 41,702 people have psychological distress, 14,880 people have bipolar disorder, 25,888 people have depression, 12,419 people have anxiety, 4,490 people have psychosis and 2,233 people reported suicidality [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In Namayingo, 28,645 people have psychological distress, 7,201 people have bipolar disorder, 20,433 people have depression, 10,725 people have anxiety, 5,657 people have psychosis and 2,656 people reported suicidality [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\u003ch2\u003eStudy Design and Setting\u003c/h2\u003e\u003cp\u003eThis was a cross-sectional survey covering two districts of Busia and Namayingo from rural eastern Uganda. The justification for their selection is published elsewhere [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. They are also border districts near the border of Uganda and Kenya with gold mining activities that have escalated after 2019 [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. These districts are part of the 40 districts in the eastern Ugandan region [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. They are dominantly occupied by the Samia tribe. Other significant tribes are the Basoga and the Itesots around Tiira in Busia [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch3\u003eSampling Strategy and sample size\u003c/h3\u003e\n\u003cp\u003eA multi-stage stratified cluster sampling design was used to select 598 households from the 2014 Uganda Population and Housing Census sampling frame [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. The details of the sample calculation and sampling strategy are published elsewhere [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. The overall sample size was 598 dyads of older adults and their caregivers. For this paper, we analyze data for the older adults only as described elsewhere [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eData collection and recruitment of respondents\u003c/h3\u003e\n\u003cp\u003eData collection was conducted between December 2023 and September 2024. From each household that was selected, a dyad of an older adult and an in-home caregiver were interviewed. In households where older adults were living together as a couple, each older adult was interviewed separately.\u003c/p\u003e\u003cp\u003eAn older person was defined according to the United Nations\u0026rsquo; criteria of age 60 years and older [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e] and the definition set by the Ministry of Gender, Labor and Social Development [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. The prevalence of adults aged 60 years and older in Uganda in 2024 was 5% [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eEligibility criteria\u003c/h3\u003e\n\u003cp\u003eHouseholds were included if at least one older adult was available at the time of the house visit, could confirm that they have lived in the household for at least 6 months, and they or a caregiver provided consent to participate in the study depending on capacity to consent. Households were excluded if there were no eligible older adults due to a physical disability (such as hearing or visual impairment), untreated mental health condition, or medication use in the past seven days that would limit participation in cognitive testing or affect cognitive testing performance. Households were also excluded if individuals present at the time of the house visit were unwilling to wear a facemask properly [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eEthical Considerations\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003cp\u003e was obtained from the national Institutional Review Board - TASO Research Ethics Committee (Approval Number: TASO-2022-179) and the Uganda National Council of Science and Technology (UNCST). The approval number is HS2693ES. Voluntary informed consent was obtained from all study participants (both the older adult and the caregiver in each household). Details are published elsewhere [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. This study was carried out in compliance to the Declaration of Helsinki.\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eVariables and measures\u003c/h3\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eOutcome variable: Frailty\u003c/h2\u003e\u003cp\u003eWe measured frailty using the FRAIL Phenotype scale [\u003cspan additionalcitationids=\"CR49 CR50 CR51\" citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Frailty has five questions about fatigue, resistance, aerobics, illness and loss of weight [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. A score of 3 to 5 indicated frailty and 0 to 2 indicates no frailty [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eExplanatory variables\u003c/h2\u003e\u003cp\u003eThe explanatory variables included biosocial factors (including demographic and socio-economic factors), behavioral and health-related factors. Demographic variables included sex (male and female), age group. Socio-economic variables included: educational level, marital status, source of livelihood, and source of energy for household lighting).\u003c/p\u003e\u003cp\u003eBehavioral variables included smoking, and alcohol consumption. We asked participants if they currently or formerly smoke(d) cigarettes (yes and no). Possible alcohol use disorder was measured using the CAGE assessment for alcohol use disorder risk [\u003cspan additionalcitationids=\"CR54\" citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e], previously applied in Uganda [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. The CAGE has four questions that include:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eDo you drink alcohol?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHave you ever felt you should cut down on your drinking?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHave people annoyed you by criticizing your drinking of alcohol?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHave you ever felt bad or guilty about your drinking?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eTheir responses are yes and no. The Cronbach\u0026rsquo;s alpha for the CAGE scale was 0.60.\u003c/p\u003e\u003cp\u003eFalls was measured by combing two questions (with yes and no responses) on the experience of falls and the fear of the risk of falling in future [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan additionalcitationids=\"CR57 CR58\" citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. These questions were:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHave you ever fallen in the last 6 months?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eDo you think you may fall in the next few months?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eWe combined any response to either of the two questions as an indicator of falls.\u003c/p\u003e\u003cp\u003eWe measured social isolation and living alone using three questions (yes and no):\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eDo you live alone?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eAre you unable to go outside the home?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eAre you able to participate in group activities?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eSocial isolation and living alone was created by recoding a yes to any of the three questions.\u003c/p\u003e\u003cp\u003eLoneliness was assessed using the UCLA Loneliness Scale \u0026ndash; Short Form [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan additionalcitationids=\"CR61\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]. The six questions are:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eI lack companionship\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eI feel part of a group of friends\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eI feel left out\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eI feel isolated from others\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eI am unhappy being so withdrawn\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003ePeople are around me but not with me\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eTheir responses range from 1 to 4. Item 2 was reverse coded so that it is negative. The loneliness scores range from 6 to 24 with higher scores indicating greater loneliness. The Cronbach\u0026rsquo;s alpha for the CAGE scale was 0.76. The mean loneliness score was 12.5 (sd 4.3 minimum 6 maximum 24).\u003c/p\u003e\u003cp\u003eDepression screening was measured using the 9-item Patient Health Questionnaire (PHQ-9) [\u003cspan additionalcitationids=\"CR64 CR65\" citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e], which has been previously applied in Uganda [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. A score of 10 or greater was used to define moderate to severe depression on the PHQ-9 [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. Details of how it was scored is published in another papers [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. The PHQ-9 indicators had a Cronbach\u0026rsquo;s alpha of 0.85.\u003c/p\u003e\u003cp\u003eAnthropometric assessments of the older adults included: blood pressure, weight and height for body mass index. Hypertension was defined as SBP 140 mm Hg or higher and DBP 90 mm Hg or higher [\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]. Hyperglycemia was assessed using a random blood glucose test performed during the assessment and defined as random blood glucose\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;200mg/dL.\u003c/p\u003e\u003cp\u003eTo screen for dementia, we used the Identification and Intervention for Dementia in Elderly Africans (IDEA) cognitive screening tool [\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e]. The IDEA tool is a brief cognitive screening tool validated in rural Tanzania for older adults with low literacy and has demonstrated high diagnostic accuracy for dementia. The tool has been validated in other sub-Saharan African populations, including rural community samples of older adults in Tanzania and Nigeria with normative values established among these populations [\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e]. The IDEA is scored from 0 to 15, including assessments of abstraction, orientation, long-term memory, categorical verbal fluency, visuospatial construction and verbal delayed recall. The tool does not require the ability to read, write, draw or calculate. An external validation study in Tanzania established the following cut-off scores which we applied for our study: 0\u0026ndash;7 \u0026ldquo;probable dementia\u0026rdquo;; 8\u0026ndash;9 \u0026lsquo;possible dementia\u0026rdquo;; and 10\u0026ndash;15 \u0026ldquo;no dementia\u0026rdquo; [\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSimple Nutritional Appetite Questionnaire (SNAQ) was used from another study [\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e]. We generated an overall score ranging from 0 to 20. A score of 0\u0026ndash;14 was considered as poor appetite and that of 15\u0026ndash;20 as good appetite [\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e]. The Cronbach\u0026rsquo;s alpha for the four SNAQ questions was 0.66.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eAll survey data was entered into Redcap hosted at Makerere University, College of Health Sciences. Redcap is a secure data collection platform with no collection of identifying information.\u003c/p\u003e\u003cp\u003eFor all descriptive statistics, we used frequency distributions for categorical variables and means and standard deviations (if normally distributed) for continuous variables. We used cross-tabulations (Pearson's chi-squared (χ2) tests) to investigate associations between frailty and selected explanatory variables. The level of statistical significance using p-values was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003cp\u003eWe used multivariable logistic regression analyses to examine the association between frailty and explanatory variables. We used stepwise regressions for multivariable analysis, including all relevant covariates. First, we controlled for biosocial factors: demographic and socio-economic variables (Model 1). Second, we adjusted for behavioral and health factors (Model 2). We reported Odds Ratios (OR) with their 95% confidence intervals. The level of statistical significance using p-values was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. All analyses were performed in STATA version 19.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eDescriptive characteristics\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows that there were significant differences observed in the means and standard deviations of physical functioning and nutrition-related measures by frailty status. The mean age of the older persons was 69.9 (standard deviation (sd)\u0026thinsp;=\u0026thinsp;8.9). The mean handgrip strength (HGS) was lower among frail older adults (15.9 vs. 20.4 kg, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Frail individuals took more time on the Timed Get-Up-and-Go test (18.8 vs. 13.7 seconds, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Simple nutritional appetite questionnaire scores (SNAQ) were lower in the frail group (mean 12.6 vs. 13.5, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive characteristics for continuous variables\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eFrailty status\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot frail\u003c/p\u003e\u003cp\u003eMean (sd)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrail\u003c/p\u003e\u003cp\u003eMean (sd)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003eMean (sd)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTest\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSample (N)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e393 (65.72%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e205 (34.28%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e598 (100.00%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge in complete years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68.15 (8.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73.35 (9.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e69.93 (8.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBody mass index\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22.04 (4.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.48 (5.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21.85 (5.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTimed Up and Go (TUG) Test\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.71 (7.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.83 (13.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.47 (10.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAverage handgrip strength\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20.37 (6.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.95 (6.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18.86 (7.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSimple Nutritional Appetite Questionnaire (SNAQ) score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.55 (2.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.59 (2.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.22 (2.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatient Health Questionnaire (PHQ-9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.78 (5.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.01 (5.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.58 (6.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUCLA Loneliness Scale \u0026ndash; Short Form (ULS-6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.49 (4.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.45 (4.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.51 (4.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSd\u0026thinsp;=\u0026thinsp;Standard Deviation of the mean\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eA total of 598 older persons aged 60 years and above were enrolled from Busia and Namayingo districts in Eastern Uganda. Women constituted 60.7% of the sample (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The overall prevalence of frailty and pre-frailty, defined according to Fried\u0026rsquo;s phenotype [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], was 34.3% and 52.7% respectively (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The proportion of older persons with frailty increased with age but the proportion of older persons with pre-frailty decreased with age (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). A higher proportion of older females reported symptoms of pre-frailty and frailty compared to older males (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive characteristics for categorical variables\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eFrailty status\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot frail\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrail\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTest\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e393 (65.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e205 (34.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e598 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e216 (55.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e147 (71.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e363 (60.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e177 (45.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58 (28.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e235 (39.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e60\u0026ndash;69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e253 (64.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81 (39.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e334 (55.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e70\u0026ndash;79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e97 (24.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66 (32.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e163 (27.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e80+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43 (10.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58 (28.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e101 (16.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e125 (31.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e107 (52.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e232 (38.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary or higher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e268 (68.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e98 (47.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e366 (61.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFormerly married\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e211 (53.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e143 (69.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e354 (59.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrently married\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e182 (46.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62 (30.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e244 (40.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIn the last 12 months, have you done any work for which you received a payment\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e270 (68.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e162 (79.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e432 (72.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e123 (31.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43 (21.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e166 (27.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSource of livelihood\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFarming\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e286 (72.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e110 (53.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e396 (66.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepend on children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56 (14.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65 (31.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e121 (20.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTrading or others\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51 (13.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30 (14.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e81 (13.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCatholic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e158 (40.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85 (41.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e243 (40.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.052\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnglican\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e122 (31.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46 (22.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e168 (28.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePentecostal or others\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e113 (28.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74 (36.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e187 (31.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSource of energy for lighting\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElectricity or solar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e217 (55.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89 (43.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e306 (51.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.021\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParaffin lamp\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e98 (24.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68 (33.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e166 (27.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFirewood or others\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e78 (19.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48 (23.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e126 (21.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEver or currently smoking\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e347 (88.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e180 (87.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e527 (88.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.860\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46 (11.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 (12.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e71 (11.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAlcohol problems using cage scale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e269 (68.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e158 (77.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e427 (71.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.027\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e124 (31.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47 (22.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e171 (28.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEver fallen and at risk of falling\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e149 (37.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72 (35.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e221 (37.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.502\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e244 (62.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e133 (64.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e377 (63.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLiving alone and socially isolated\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e230 (58.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62 (30.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e292 (48.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e163 (41.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e143 (69.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e306 (51.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eExperienced depression\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo depression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e223 (56.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46 (22.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e269 (45.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e170 (43.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e159 (77.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e329 (55.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSystolic BP\u0026thinsp;\u0026gt;\u0026thinsp;140 mmHg and diastolic BP\u0026thinsp;\u0026gt;\u0026thinsp;90 mmHg\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormal BP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e321 (81.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e150 (73.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e471 (78.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertensive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72 (18.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55 (26.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e127 (21.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePossible diabetes based on random blood glucose level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo diabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e366 (93.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e185 (90.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e551 (92.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.213\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePossible diabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27 (6.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 (9.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47 (7.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDementia by IDEA Tool\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo dementia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e335 (85.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e140 (68.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e475 (79.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProbable dementia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e58 (14.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65 (31.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e123 (20.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows significant differences by frailty status among older persons by sex, age, education level, marital status, past work status, source of livelihood, source of energy for lighting, alcohol consumption, living alone, experience of depression, blood pressure, and dementia status. That is, more females than males were frail (71.7% vs 28.3%). Frailty was reported more among older persons aged 60\u0026ndash;69 years (39.5%), those with no formal education (52.2%), formerly married (69.8), those who have not done any work for payment for the last 12 months (79.0%), and whose source of livelihood is farming (53.7%). More older persons whose source of energy for lighting was electricity or solar (43.4%), non-alcoholic (77.1%), those living alone (69.8%), and the depressed (77.6%) were frail compared to their counterparts.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eFactors associated with frailty\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows results from a multivariable logistic regression model assessing the factors associated with frailty. \u003cb\u003eModel 1\u003c/b\u003e, controlled for biosocial factors only and shows that respondents aged 70\u0026ndash;79 years (aOR\u0026thinsp;=\u0026thinsp;1.71; CI\u0026thinsp;=\u0026thinsp;1.22\u0026ndash;2.39) and those aged 80 years and older (aOR\u0026thinsp;=\u0026thinsp;2.09; CI\u0026thinsp;=\u0026thinsp;1.42\u0026ndash;3.05) were more likely to be frail compared to their counterparts aged 60\u0026ndash;69 years. Older adults who depended on their children (aOR\u0026thinsp;=\u0026thinsp;1.73; CI\u0026thinsp;=\u0026thinsp;1.22\u0026ndash;2.47) or traded as a source of livelihood (aOR\u0026thinsp;=\u0026thinsp;1.56; CI\u0026thinsp;=\u0026thinsp;1.02\u0026ndash;2.38) were more likely to be frail than their counterparts whose source of livelihood was farming. Frailty was more likely to occur among respondents who used paraffin lamp (aOR\u0026thinsp;=\u0026thinsp;1.41; CI\u0026thinsp;=\u0026thinsp;1.01\u0026ndash;1.97) or firewood (aOR\u0026thinsp;=\u0026thinsp;1.84; CI\u0026thinsp;=\u0026thinsp;1.21\u0026ndash;2.81) as a source of energy for lighting than among respondents who used electricity.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariate Results\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModel (1)\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95% Confidence Intervals\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eModel (2)\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e95% Confidence Intervals\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e[0.46,1.11]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[0.60,1.59]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e60\u0026ndash;69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e70\u0026ndash;79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.71\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e[1.22,2.39]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[0.93,1.96]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e80+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.09\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e[1.42,3.05]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[0.93,2.31]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary or higher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e[0.53,1.06]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[0.63,1.33]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFormerly married\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrently married\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e[0.72,1.66]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[0.88,2.11]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIn the last 12 months, have you done any work for which you received a payment\u003c/b\u003e,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e[0.45,1.04]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[0.48,1.12]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSource of livelihood\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFarming\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepend on children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.73\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e[1.22,2.47]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[0.91,1.99]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTrading or others\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.56\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e[1.02,2.38]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[0.83,2.03]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSource of energy for lighting\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElectricity or solar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParaffin lamp\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.41\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e[1.01,1.97]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[0.90,1.85]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFirewood or others\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.84\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e[1.21,2.81]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[0.73,1.78]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEver or currently smoking\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[0.40,1.02]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAlcohol problems using cage scale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[0.65,1.36]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTimed Up and Go (TUG) Test\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[1.00,1.02]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAverage handgrip strength\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.96\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[0.93,0.98]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEver fallen or at risk of falling\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[0.55,1.05]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLiving alone and socially isolated\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.62\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[1.16,2.26]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eUCLA Loneliness Scale \u0026ndash; Short Form (ULS-6)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.08\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[1.04,1.12]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eExperienced depression\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.11\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[1.45,3.07]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSystolic BP\u0026thinsp;\u0026gt;\u0026thinsp;140 mmHg and diastolic BP\u0026thinsp;\u0026gt;\u0026thinsp;90 mmHg\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormal BP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertensive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.49\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[1.05,2.11]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePossible diabetes based on random blood glucose level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo diabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePossible diabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[0.72,2.06]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDementia by IDEA Tool\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo dementia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProbable dementia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[0.59,1.26]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObservations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e598\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e598\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eExponentiated coefficients; 95% confidence intervals in brackets; \u003csup\u003e*\u003c/sup\u003e \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, \u003csup\u003e**\u003c/sup\u003e \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, \u003csup\u003e***\u003c/sup\u003e \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001; #Adjusted for biosocial variables; ## Adjusted for biosocial, behavioral and health related variables\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eHowever, when behavioral and health related factors were added to the model (\u003cb\u003eModel 2\u003c/b\u003e), the effect for age, source of livelihood and source of energy for lighting weakened. A unit increase in average handgrip strength was associated with decreased odds of frailty (OR\u0026thinsp;=\u0026thinsp;0.96; CI\u0026thinsp;=\u0026thinsp;0.93\u0026ndash;0.98). In addition, a unit increase in loneliness was associated with increased odds of frailty (OR\u0026thinsp;=\u0026thinsp;1.08; CI\u0026thinsp;=\u0026thinsp;1.04\u0026ndash;1.12). Older persons who were living alone were more likely to be frail (OR\u0026thinsp;=\u0026thinsp;1.62; CI\u0026thinsp;=\u0026thinsp;1.16\u0026ndash;2.26) than their counterparts who were not living alone. Frailty was more likely to be reported among depressed (OR\u0026thinsp;=\u0026thinsp;2.11; CI\u0026thinsp;=\u0026thinsp;1.45\u0026ndash;3.07) or hypertensive (OR\u0026thinsp;=\u0026thinsp;1.49; CI\u0026thinsp;=\u0026thinsp;1.05\u0026ndash;2.11) older persons than their counterparts.\u003c/p\u003e\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis paper aimed to assess the sociodemographic, functional, and psychosocial predictors of frailty among older adults in rural eastern Uganda. The prevalence of frailty among older persons in rural Eastern Uganda, was about a third (34.3%) of the sample of participants meeting the Fried phenotype criteria. Frailty disproportionately affected individuals with impaired physical performance, social isolation, and depressive symptoms. The most frequently observed frailty components; weak hand grip strength and slow gait speed are consistent with prior studies in both high- and low-resource settings [\u003cspan additionalcitationids=\"CR32 CR33\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The finding underscores the urgent need to recognize frailty as a major geriatric syndrome in SSA contexts where health systems are not yet fully adapted to aging populations.\u003c/p\u003e\u003cp\u003eThe association between frailty and reduced hand grip strength and mobility supports previous evidence that these markers are reliable indicators of diminished physiological reserve and vulnerability to adverse outcomes [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In a study of older adults in rural China, hand grip strength and walking speed were significant correlates of frailty status [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In SSA, frailty was associated with worse self-reported health, lower subjective well-being, and higher mortality of over 17 months in one rural South African study [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In a study from Burkina Faso, frailty and impaired physical performance were as associated with female sex, multimorbidity, increasing age, and limitations in activities of daily living [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Moreover, a Tanzanian study, similarly found that reduced muscle strength was one of the most common phenotype components among rural older adults, suggesting that physical frailty is a prominent manifestation in SSA.\u003c/p\u003e\u003cp\u003eDepression was also strongly associated with frailty, consistent with studies showing that psychological distress both contributes to and is exacerbated by frailty in later life [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In a Chinese cohort of older adults (N\u0026thinsp;=\u0026thinsp;5,303), being frail or pre-frail was associated with higher odds of depressive symptoms (ORs 3.05\u0026ndash;9.78 depending on frailty definition), and depressed participants had elevated risk of transitioning into frailty over follow-up. For example, in a rural Ugandan cohort of older people with and without HIV, depression was a strong correlate of frailty [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The bidirectional relationship between frailty and depression has been well-documented: frail individuals may experience loss of independence leading to psychological distress, while depression may reduce motivation for physical activity, thus accelerating functional decline [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSocial isolation and living alone, similarly, has been shown to heighten the risk of frailty and related decline thereby compounding vulnerability on older adults [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] for it reduces access to caregiving and economic support. In SSA, although there are few studies that have examined this relationship. One study from Ghana found that older adults who reported loneliness were more likely to exhibit functional impairments, suggesting that reduced social embeddedness may contribute to declines in mobility and strength [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. One systematic review on frailty in Africa found that \u0026ldquo;social interaction\u0026rdquo; or \u0026ldquo;social connectedness\u0026rdquo; were modifiable correlates of frailty in African aging populations [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In our sample, the high proportion of frail individuals living alone suggests that family-based safety nets are increasingly fragile in these rural districts, possibly due to migration of younger relatives and/or economic hardship, weakening traditional extended-family supports for older kin [\u003cspan additionalcitationids=\"CR74\" citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eInterestingly, traditional cardiometabolic risk factors such as hypertension and diabetes, were not significantly associated with frailty in this cohort. The same is consistent with studies from rural Tanzania, where similar patterns of frailty appear to be driven more by functional impairment and social vulnerability than by cardiometabolic conditions [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In rural Tanzania, a study found that frailty was significantly associated with depression and self-rated poor health, but the role of diagnosed comorbidities was non-significant [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. A systematic review of frailty in Africa found that while multimorbidity may be identified as a risk factor, nutritional deficits, physical inactivity, poverty, and social factors were most strongly associated [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and Limitations\u003c/h2\u003e\u003cp\u003eThe strengths of this study include the following: First, the study adds to the available literature that examines the risk factors associated with frailty among older persons in a rural setting of Uganda [\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e]. Second, the use of a standard Fried phenotype model to examine frailty allows for generation of robust estimates for comparability [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNotwithstanding the strengths of this study, some limitations are worth illuminating. First, the cross-sectional design of the study prevents causal inference. Second, the frailty components relied on self-report, which may be subject to reporting bias. Third, the results may not be generalizable to urban populations or other parts of Uganda given the regional differences and diversity in the country. However, our results may be generalizable to similar rural areas of SSA with similar sociodemographic characteristics. In addition, different studies have shown significant variation in frailty phenotype expression across racial and geographic populations, raising questions about the generalizability of cutoff points developed in high-income countries [\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e]. Therefore, more work is needed to develop appropriate cutoff points for frailty in SSA.\u003c/p\u003e\u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eFrailty is prevalent among older persons in rural Eastern Uganda and is shaped by a combination of physical, psychological, and social factors. The findings support the integration of frailty screening into primary healthcare and community-based programming, with attention to the psychosocial context of older adults. Integrating simple functional assessments into routine primary healthcare, expanding community-based psychosocial interventions, and tailoring district-level responses could help mitigate the burden of frailty.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHGS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHand Grip Strength\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSSA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003esub-Saharan Africa\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eUN\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUnited Nations\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWorld Health Organization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003e All human subjects provided informed consent. Ethical approval was obtained from the national Institutional Review Board - TASO Research Ethics Committee (Approval Number: TASO-2022-179) and the Uganda National Council of Science and Technology (UNCST). The approval number is HS2693ES. This study was carried out in compliance to the Declaration of Helsinki.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eThis study was carried out in compliance to the Declaration of Helsinki.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eClinical Trial Number\u003c/h2\u003e\u003cp\u003eNot Applicable\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding Information\u003c/h2\u003e\u003cp\u003eThis work was supported by The Alzheimer\u0026rsquo;s Association (Grant Number: AARGD-NTF-22-975156). The Alzheimer\u0026rsquo;s Association did not play any role in the study design, data collection and analysis, and the decision to publish the manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization: SOW, PK, SK, MMD, NNData curation: SOWFormal analysis: SOWFunding acquisition: SOW, MMD, NNInvestigation: SOW, PK, SK, MMD, NNMethodology: SOW, PK, SK, MMD, NNProject administration: SKResources: SOW, MMD, NNSoftware: SOWSupervision: SOW, SKValidation: SOW, PK, SK, MMD, NNVisualization: SOW, PKWriting \u0026ndash; original draft: SOW, PK, SKWriting \u0026ndash; review \u0026amp; editing: SOW, PK, SK, MMD, NN\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe are grateful to all the older persons and their caregivers for their participation in the study. The research assistants and health workers who collected the data are greatly appreciated. We thank the Local Government leadership of Busia and Namayingo for their support during the data collection exercise.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eUN. World Population Ageing 2023: Highlights. In. New York; 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWHO. World report on ageing and health. In.; 2015.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, et al. Frailty in Older Adults: Evidence for a Phenotype. Journals Gerontology: Ser A. 2001;56(3):M146\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDent E, Martin FC, Bergman H, Woo J, Romero-Ortuno R, Walston JD. 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J Affect Disord. 2021;279:473\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMiller AP, Espinosa da Silva C, Ziegel L, Mugamba S, Kyasanku E, Malyabe RB, Wagman JA, Mia Ekstr\u0026ouml;m A, Nalugoda F, Kigozi G et al. Construct validity and internal consistency of the Patient Health Questionnaire-9 (PHQ-9) depression screening measure translated into two Ugandan languages. \u003cem\u003ePsychiatry Res Commun\u003c/em\u003e 2021, 1(2).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaggwa MM, Najjuka SM, Ashaba S, Mamun MA. Psychometrics of the Patient Health Questionnaire (PHQ-9) in Uganda: A Systematic Review. Front Psychiatry. 2022;13:781095.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbell JG, Kivim\u0026auml;ki M, Dugravot A, Tabak AG, Fayosse A, Shipley M, Sabia S, Singh-Manoux A. Association between systolic blood pressure and dementia in the Whitehall II cohort study: role of age, duration, and threshold used to define hypertension. Eur Heart J. 2018;39(33):3119\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWhelton PK, Carey RM, Aronow WS, Casey DE Jr., Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. \u003cem\u003eHypertension\u003c/em\u003e 2018, 71(6):1269\u0026ndash;1324.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGray WK, Paddick SM, Kisoli A, Dotchin CL, Longdon AR, Chaote P, Samuel M, Jusabani AM, Walker RW. Development and Validation of the Identification and Intervention for Dementia in Elderly Africans (IDEA) Study Dementia Screening Instrument. J Geriatr Psychiatry Neurol. 2014;27(2):110\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePaddick S-M, Gray WK, Ogunjimi L, lwezuala B, Olakehinde O, Kisoli A, Kissima J, Mbowe G, Mkenda S, Dotchin CL, et al. Validation of the Identification and Intervention for Dementia in Elderly Africans (IDEA) cognitive screen in Nigeria and Tanzania. BMC Geriatr. 2015;15(1):53.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLau S, Pek K, Chew J, Lim JP, Ismail NH, Ding YY, Cesari M, Lim WS. The Simplified Nutritional Appetite Questionnaire (SNAQ) as a Screening Tool for Risk of Malnutrition: Optimal Cutoff, Factor Structure, and Validation in Healthy Community-Dwelling Older Adults. Nutrients 2020, 12(9).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShimizu A, Fujishima I, Maeda K, Murotani K, Inoue T, Ohno T, Nomoto A, Ueshima J, Ishida Y, Nagano A et al. Accuracy of the Simplified Nutritional Appetite Questionnaire for Malnutrition and Sarcopenia Screening among Older Patients Requiring Rehabilitation. \u003cem\u003eNutrients\u003c/em\u003e 2021, 13(8).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGolaz V, Wandera SO. Estimating the Poverty of Older Persons in Uganda: The Limitations of Poverty Indicators. In: \u003cem\u003eThe Demography of Uganda and selected African countries: Towards more Sustainable Develpment Pathways\u003c/em\u003e Edited by Oucho J, Rutaremwa G, Nyakaana JB. Kampala, Uganda Fountain Publishers 2016: 215\u0026ndash;234.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGolaz V, Wandera SO, Rutaremwa G. Understanding the vulnerability of older adults: extent of and breaches in support systems in Uganda. Aging Soc. 2017;37(1):63\u0026ndash;89.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWandera SO, Ddumba I, Akinyemi JO, Adedini SA, Odimegwu C. Living Alone among Older Persons in Uganda: Prevalence and Associated Factors. Ageing Int. 2017;42(4):429\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVecchio A, Nakigozi G, Nakasujja N, Kisakye A, Batte J, Mayanja R, Anok A, Robertson K, Wawer MJ, Sacktor N, et al. Assessment, prevalence, and correlates of frailty among middle-aged adults with HIV in rural Uganda. J Neurovirol. 2021;27(3):487\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDlima SD, Hall A, Aminu AQ, Akpan A, Todd C, Vardy E. Frailty: a global health challenge in need of local action. BMJ Glob Health 2024, 9(8).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOrmaz\u0026aacute;bal Y, Arauna D, Cantillana JC, Palomo I, Fuentes E, Mena C. Unveiling the Frailty Spatial Patterns Among Chilean Older Persons by Exploring Sociodemographic and Urbanistic Influences Based on Geographic Information Systems: Cross-Sectional Study. JMIR Aging. 2025;8:e64254.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Frailty, Aged; Rural, Uganda, sub-Saharan Africa","lastPublishedDoi":"10.21203/rs.3.rs-7837231/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7837231/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eFrailty, characterized by diminished physiological reserve and heightened vulnerability to stressors has emerged as a central challenge of aging, particularly in low- and middle-income countries. Although frailty has been extensively studied and in high-income settings, its determinants in SSA remain poorly understood, and contextual factors may differ substantially. The study aimed to assess the prevalence and correlates of frailty among older persons in two rural districts of Eastern Uganda: Busia and Namayingo.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe used cross-sectional data from two districts of Busia and Namayingo in rural eastern Uganda among 598 older persons aged 60 years and above. Differences in characteristics by frailty status were tested using chi-square tests for categorical variables and t-tests or non-parametric equivalents for continuous variables. Using a stepwise approach, we used multivariable logistic regression analyses to examine the factors associated with frailty.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe overall prevalence of frailty and pre-fail was 34.3% and 52.7% respectively. A unit decrease in average handgrip strength was associated with increased odds of frailty (OR\u0026thinsp;=\u0026thinsp;0.96; CI\u0026thinsp;=\u0026thinsp;0.93\u0026ndash;0.98) while a unit increase in loneliness was associated with increased odds of frailty (OR\u0026thinsp;=\u0026thinsp;1.08; CI\u0026thinsp;=\u0026thinsp;1.04\u0026ndash;1.12). Older persons who were living alone were more likely to be frail (OR\u0026thinsp;=\u0026thinsp;1.62; CI\u0026thinsp;=\u0026thinsp;1.16\u0026ndash;2.26) than their counterparts who were not living alone. Frailty was more likely to be reported among depressed (OR\u0026thinsp;=\u0026thinsp;2.11; CI\u0026thinsp;=\u0026thinsp;1.45\u0026ndash;3.07) or hypertensive (OR\u0026thinsp;=\u0026thinsp;1.49; CI\u0026thinsp;=\u0026thinsp;1.05\u0026ndash;2.11) older persons than their counterparts.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eFrailty is highly prevalent among older persons in rural Eastern Uganda and is shaped by a combination of physical, psychological, and social factors. The findings support the integration of frailty screening into primary healthcare and community-based programming, with attention to the psychosocial context of older adults.\u003c/p\u003e","manuscriptTitle":"Correlates of Frailty among Older Persons in Rural Eastern Uganda: A Cross-sectional Survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-26 11:02:48","doi":"10.21203/rs.3.rs-7837231/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-11-24T04:13:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"228436998640452866561684268522742797919","date":"2025-11-16T15:02:02+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-14T14:06:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-12T16:27:55+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-23T13:15:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-20T19:34:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-10-20T19:31:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2f2d47c4-5f0d-499a-bc4c-e491edf8e464","owner":[],"postedDate":"November 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-26T11:02:48+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-26 11:02:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7837231","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7837231","identity":"rs-7837231","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}