Introduction

In the world, old age has gained attention because of both physiological and pathological effects leading to an impaired health condition¹. The concept applies to people >60 years of age². It is estimated that by 2050 such population will virtually double from 12% to 22%, reaching approximately 2 billion people^3-5. Aging may be associated with an increase in pathologies resulting from mobility restrictions, physical and psychological problems characterizing the frail state⁶. Thus, frailty is a clinical syndrome affecting >10% of the elderly in the world and its prevalence increases at advanced ages. It is related to a dynamic process based on the downward path of physical function during aging, which may lead to functional loss and is associated with adverse outcomes ranging including falls⁷, from disability and hospitalization requirement to death^8,9 and multimorbidity¹⁰.

As a result of the different approaches and measurement methods, there is no standard definition for frailty. Prevalence of the frail condition in older people in the community varies greatly (between 4% and 59%)¹¹, which makes it difficult to adopt preventive measures to minimize its occurrence and adverse outcomes¹². This situation is more evident in developing countries such as Colombia, due to the large inequality gap in the provision of health services in preventive care¹³, which adds to various socioeconomic components, barriers to access and mobilization, and the difficulties for a timely diagnosis^14,15. According to the National Study on Health, Wellbeing and Aging (SABE), frailty reaches up to 17.9%¹⁶, with pre-frail state ranging between 18.7% and 53.1%¹⁷.

On the other hand, geographic information systems are an important tool for epidemiological investigation and surveillance as they integrate medical information with geographic data, environmental and socioeconomic variables, among other data¹⁸. The process requires knowing information needs, information sources, their organization and storage, use and distribution, all of which is the basis for knowledge creation¹⁹. This technique allows both early detection and decision-making in any geographical context¹⁸, and distributes health-related states or disease determinants for their control¹⁹. Consequently, improved access implies the absence of physical or geographical barriers preventing people from using health services²⁰. This study was aimed to analyze the spatial distribution of frailty in people aged >60 years in Pereira, Colombia in 2021.

Methods

Results

There were 505 elderly people from the city of Pereira surveyed. Mean age was 69.6 (SD ±7.8) years (range 60-98 years). Approximately 52% were males and more than 45% of both men and women were pre-frail and frail (Table 1). Three quarters of the elderly were 60 to 74 years old, of whom 69.3% were pre-frail vs 4.7% who were frail. Regarding educational level, >50% had attended primary school (55.4% pre-frail vs. 5.0% frail). As about household SES, more than three quarters were from low SES (67.2% pre-frail vs 5.0 frail), and 20% of the sample were from middle SES (74.0 pre-frail vs 1.9 frail). About 56% were either on poor or fair health condition. In addition, it was found that approximately 37% of the elderly had >2 diseases. Over 55% were taking >1 medication, were physically inactive, reported having depressive symptoms and having experienced falls. However, according to the ADLs 61.4% were independent.

Frailty prevalence was 4.4% (Table 1); components are presented in Table 2. As assessed by means of the FRAIL scale, about 49% of the population reported fatigue and <15% impairment of endurance, ambulation, and balance. It was found that about 45% were hypertensive and <15% suffered diabetes, cancer, chronic obstructive pulmonary disease (COPD), heart disease/failure, angina, asthma, arthritis, stroke or kidney disease. This reflects approximately half of elderly people are affected by cardiovascular diseases, while respiratory diseases affect 8.7% and metabolic disorders about 29%.

In the study, the prevalence of frailty in both old men and women was similar among pre-frail subjects aged 70-74 years and 75-89 years, while three quarters of those aged >90 years were males. On the other hand, its prevalence was lower among the frail, equally affecting both genders (Figure 1).

According to the map of Pereira communes, frailty is most common in El Triunfo and La Esperanza neighborhoods (Figure 2), where its prevalence exceeds 25%.

Figure 1 Prevalence of frailty according to gender and age of elderly people in Pereira Colombia 2021. 

Source: the autor

Figure 2 Prevalence of frailty in elderly subjects in Pereira, 2021 

Discussion

The prevalence of frailty in elderly people in Pereira is lower than that reported in the SABE for Colombia¹⁶, because this study was carried out in both urban and rural areas and with an instrument for measuring frailty. However, there is similarity to a study reported in Peru, in which it was identified that female gender and low SES are associated risk factors³⁰, along with the presence of chronic diseases, which add to progressive physical capacity deterioration^10,31. Therefore, primary health care detection of factors involved in frailty at a community level is important because this may offer an opportunity to identify any changes in elderly people and could also result in delaying progression of the condition.

According to a 2017 Australian geospatial modeling report, the growth of fragile populations in peripheral metropolitan, regional and remote areas can be reduced by targeting health interventions in these areas and improving access to support services³².

In addition, a relationship with disability is reported, which is similar to what was reported in another study in which it is associated with negative health outcomes³³. It is associated as it can be marked by loss of independence in a multidimensional process resulting from the interaction between health condition and other individual factors such as age, gender, educational level, social and environmental factors^9,33. Also, a relationship between fragility and falls was reported, which as mentioned in other research, may be due to weakness in the lower limbs⁷. Likewise, the study identified an association with nutritional status, probably due to inadequate nutrient intake and has also been shown in previous publications^34,35. As this leads to muscle weakness and physical impairment impacting health condition, timely frailty identification could prevent deficiencies and limitations occurring in the elderly at different times.

Neighborhoods with the highest number of elderly people with frailty (i.e., El Triunfo and La Esperanza) belong to the Rio Otún commune, where the highest concentrations of frail people >60 years were seen according to the 2021 DANE report. Frailty was also found among those for whom carrying out any activity was most difficult; consequently, this reflects the need to undertake actions that allow early identification of this pathological condition leading to physical impairment in the elderly³⁶, and also to implement plans focused on health promotion and disease prevention in the two mentioned neighborhoods. Future implementation of a notification and georeferencing system in the community to establish when a person is at risk of a fragile state in order to facilitate pertaining interventions was proposed.

For frail older people, there are different challenges related to their timely identification, which is why it is recommended to carry out new research on this topic, for the evaluation of the planning and implementation of public policies in this population group. Furthermore, the exploration of frailty is not part of the general medical consultation, and it is important to identify the conditions that are associated in the community, due to their growing interest as part of a continuous accumulation of deficits. The main limitation of the study consists of the type of instrument used to measure frailty, since it presents several phenotypes, which makes comparison between regions difficult.

Conclusions

Georeferencing implementation allows mapping location of vulnerable sectors with older people, which is important for data surveillance and control. It also highlights the need to recognize the changes occurring in the elderly, as in Pereira there is a large number of pre-frail women aged 60-74 years, so that decision makers may make proposals for improving this population health condition.