A cross-sectional observational study of the psychometric properties of comprehensive health assessments of older adults in 14 African nations: The Pan-African Utilization of Lay Assessment Systems (PAULAS) Project.

INTRODUCTION: Many African countries face challenges in adapting their health systems to meet the needs of rapidly aging populations. Limited health human resources, inadequate geriatric expertise, and poor understanding of the aging process present barriers to effectively supporting older Africans.

METHODS: The Pan-African Utilization of Lay Assessment Systems (PAULAS) project is a cross-sectional observational study to examine the potential use of the interRAI Check-Up Self-Report (CUSR) assessment instrument in 14 African countries. The primary study aim was to determine whether the CUSR could be used to respond to the UN Decade of Healthy Aging recommendation that all older adults receive an annual health and social needs assessment. Psychometric performance is a major focus but other aspects of feasibility that were examined included time to complete the assessment, cultural acceptability, response rates, and completion rates.

RESULTS: 8,142 individuals aged 50 years or older were assessed in 14 African countries. The CUSR instrument displayed high reliability in this population with most of the 42 reported scale reliabilities having alpha values above 0.70. Similarly, the evidence of convergent validity was consistent with findings from high resource nations. Response rates were very high in all countries with few refusals, and median item non-response rates were below 2%. The mean time to complete was 21.6 minutes. Focus group feedback suggested modest revisions to the instrument for adaptation to the African context.

CONCLUSION: The interRAI CUSR can provide a psychometrically sound comprehensive assessment of older adults that may be used in African settings.