Tsion Yohannes

Objective As populations age, multimorbidity and frailty have emerged as major health challenges. While their associations with disability and mortality are well documented, their impact on quality of life (QoL) in sub-Saharan Africa remains underexplored. We examined the associations between frailty, multimorbidity and QoL among older adults in Rwanda. Design A cross-sectional population-based study. Multimorbidity was defined as having two or more chronic conditions, including hypertension, diabetes, heart disease and mental health conditions. Frailty scores were derived using the Fried phenotype, and QoL was measured using the European Health Instrument Survey-Quality of Life index (scaled 0%–100%). Sequential linear regression models were used to examine independent associations. Setting Rural and urban settings of Rwanda. Participant We analysed data from 4369 adults (≥40 years). Results The mean QoL score was 48.2% (±15.6). Frailty and multimorbidity prevalence were 14.5% (95% CI 13.5 to 15.6) and 55.2% (95% CI 53.7 to 56.6), respectively, while 55.0% (95% CI 53.3 to 56.3) were classified as prefrail. Frailty and multimorbidity are independently associated with poorer QoL. Compared with robust individuals, prefrail and frail individuals experienced a 3.66 (95% CI −4.63 to –2.70) and 7.30 (95% CI −8.76 to –5.83) percentage point reduction in QoL, respectively. Multimorbidity was associated with a 4.66% (95% CI −5.54 to –3.79) point decrease in QoL. Impairments in activities of daily living partly mediated these associations. Conclusions Frailty and multimorbidity showed a strong negative association with QoL, with frailty having a stronger effect. These findings underscore the need for age-responsive healthcare strategies, including frailty screening and integrated chronic care, to enhance QoL among older adults in Rwanda.

By 2030, an estimated 80% of the world's older population (aged ≥60 years) will reside in low- and middle-income countries (LMICs). Ageing well in these regions requires addressing complex financial, health, and social care needs through evidence-based policy and practice. However, data collection in LMICs remains limited and often unrepresentative, as seen in Brazil, where nearly 70% of geriatrics and gerontology publications (2014–2019) originated from the south or southeast regions. Recognizing the diverse needs of ageing populations, it is crucial to prioritize locally informed research and targeted interventions. Urgent action is needed to expand research efforts, inform policy development, and strengthen systems that address the medical and psychosocial challenges faced by older individuals in LMICs.