Project 1: Social and Economic Predictors of Physical and Cognitive Function Functional outcomes such as disability and cognitive impairment critically affect independence and productivity in old age, especially in low-income countries where medical assistance and access to adaptive equipment are limited. However, current surveillance data of disability are extremely limited, and evidence on determinants of functional outcomes in older Africans is heavily dependent on the very few population-based cohorts. There is an urgent need for high-quality data on functional outcomes in adults in sub-Saharan Africa, including both performance-based and self-reported outcomes. Our long term goal is to enrich the INDEPTH cohort studies so they can be used to plan health and social services through the identification of specific, modifiable factors that promote physical and cognitive health of elderly. The overall objective of this project is to introduce validated performance-based and self-reported assessments of physical and cognitive function into three INDEPTH cohorts (in Ghana, Tanzania, and South Africa) and use these data to test whether selected risk factors predict physical or cognitive impairments. This project is tightly integrated with other projects. Functional outcomes and chronic diseases, including cardiometabolic disorders and HIV, are related to Projects 2 and 3 where these disease outcomes are identified. Project 4 uses functional data in analyses of well-being &productivity. Project 1 draws on two waves three years apart for South Africa, and one wave in Ghana and Tanzania;these new surveys will enroll 4000 men and women 50+ in three INDEPTH communities (n=12,000) including all surviving participants from the 2006 SAGE short and long studies.
The aims of this project are:
AIM 1. To compare the prevalence of physical disability and cognitive impairment using harmonized methods across the three INDEPTH countries.
AIM 2. To describe trajectories of mobility and activities of daily living (ADLs) for older adults in South Africa and compare these trajectories to available data on cohorts in Ghana and Tanzania. Here we draw on data from several sources to obtain longitudinal data over a period of 3-7 years.
AIM 3. To evaluate social isolation, socioeconomic status, and adult vascular risk factors and HIV as predictors of physical and cognitive impairments and mortality.

Public Health Relevance

The relevance of this project is that it will focus for virtually the first time on a longitudinal study of a large random sample of older adults in three countries undergoing this demographic transition. In Project 1, we will: 1. obtain accurate estimates of functional ability in terms of prevalence and change;2.identify factors that determine and shape the prevalence at multiple levels including individual, family and geographic areas, and 3.further our understanding of the consequences of population level functional ability for both the formal and informal care sectors.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Program Projects (P01)
Project #
Application #
Study Section
Special Emphasis Panel (ZAG1-ZIJ-1)
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Harvard University
United States
Zip Code
Reniers, Georges; Blom, Sylvia; Calvert, Clara et al. (2017) Trends in the burden of HIV mortality after roll-out of antiretroviral therapy in KwaZulu-Natal, South Africa: an observational community cohort study. Lancet HIV 4:e113-e121
Reniers, Georges; Blom, Sylvia; Lieber, Judith et al. (2017) Tuberculosis mortality and the male survival deficit in rural South Africa: An observational community cohort study. PLoS One 12:e0185692
GBD 2016 Disease and Injury Incidence and Prevalence Collaborators (2017) Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390:1211-1259
GBD 2016 Mortality Collaborators (2017) Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390:1084-1150
Gaziano, Thomas A; Abrahams-Gessel, Shafika; Gomez-Olive, F Xavier et al. (2017) Cardiometabolic risk in a population of older adults with multiple co-morbidities in rural south africa: the HAALSI (Health and Aging in Africa: longitudinal studies of INDEPTH communities) study. BMC Public Health 17:206
Harling, Guy; Gumede, Dumile; Mutevedzi, Tinofa et al. (2017) The impact of self-interviews on response patterns for sensitive topics: a randomized trial of electronic delivery methods for a sexual behaviour questionnaire in rural South Africa. BMC Med Res Methodol 17:125
Alcalde-Rabanal, Jacqueline Elizabeth; Nigenda, Gustavo; Bärnighausen, Till et al. (2017) The gap in human resources to deliver the guaranteed package of prevention and health promotion services at urban and rural primary care facilities in Mexico. Hum Resour Health 15:49
Jardim, Thiago Veiga; Reiger, Sheridan; Abrahams-Gessel, Shafika et al. (2017) Hypertension management in a population of older adults in rural South Africa. J Hypertens 35:1283-1289
GBD 2016 DALYs and HALE Collaborators (2017) Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390:1260-1344
Rosenberg, Molly S; Gómez-Olivé, Francesc X; Rohr, Julia K et al. (2017) Sexual Behaviors and HIV Status: A Population-Based Study Among Older Adults in Rural South Africa. J Acquir Immune Defic Syndr 74:e9-e17

Showing the most recent 10 out of 19 publications