ArticleBMC public health2026
The mediating role of social networks and safety perceptions in the frailty-quality of life relationship among older people in rural and urban regions of Ghana.
Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundFrailty is a major public health concern among older people, particularly in resource-limited settings where it significantly reduces Quality of Life (QoL) and increases vulnerability to poor health outcomes. While social and environmental factors influencing frailty have been studied in high-income countries, evidence from Sub-Saharan Africa remains scarce. This study examined the relationship between frailty and QoL in Ghana, focusing on the mediating roles of social networks and perceptions of safety across rural and urban settings.
methodsWe analysed nationally representative data from the World Health Organisation’s Study on Global Ageing and Adult Health (SAGE) in Ghana. The data included older people (N = 2077), aged 60 years and above. Frailty was measured using a 30-item Frailty Index, and QoL was assessed using a composite score from the WHOQOL-BREF. We conducted bootstrapped parallel mediation analysis to examine the indirect effects of social networks and perception of safety on the frailty–QoL relationship, with subgroup analyses comparing urban and rural settings.
resultsThe overall frailty prevalence was 39.7%, with slightly higher rates in rural (43.1%) than urban areas (35.8%). Frailty was significantly associated with lower QoL across both rural and urban settings. The total effect of frailty on QoL was strong and significant in both rural (effect = − 5.44, 95% CI: − 6.00, − 4.88) and urban areas (effect = − 5.97, 95% CI: − 6.65, − 5.29). In rural areas, perception of safety was found to be a significant mediator in the association between frailty and QoL (indirect effect = 0.08, 95% CI: 0.02, 0.15), while in urban areas, social networks were the key mediator (indirect effect = − 0.22, 95% CI: − 0.45, − 0.02). The combined total indirect effect was not significant in both urban (–0.24, 95% CI: − 0.48, 0.00) and rural (–0.05, 95% CI: − 0.24, 0.15) areas.
conclusionContext specific interventions are required to improve the well-being of older people in rural and urban regions of Ghana. Strengthening community safety and cohesion in rural areas and enhancing social connectedness in urban settings may help reduce the impact of frailty, as well as improve QoL among older people in Ghana.
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