<p>Simultaneous Employment of the FRAIL Scale and the Tilburg Frailty Indicator May Identify Elderly People Who Require Different Interventional Strategies</p>

Abstract

Purpose: Frailty is a geriatric syndrome that is usually considered as a set of physical deficits (unidimensional concept); however, it can also concern the psychological and social domains of human functioning (multidimensional concept). The FRAIL scale is a diagnostic tool which ascertains only physical frailty, whereas the Tilburg Frailty Indicator (TFI) is a diagnostic instrument for multidimensional frailty. The study investigates if non-robust physical status and multidimensional frailty affect the same individuals and whether simultaneous employment of the FRAIL scale and TFI identifies specific subgroups of elderly people which require different interventions. Patients and Methods: In this cross-sectional study, 1024 community dwelling elderly individuals at the age of 65 years or older (mean age 72.6 ± 6.3 years; range 65-93 years) were evaluated with the FRAIL scale and TFI. Results: According to the FRAIL scale, 52.9% of the subjects were physically non-robust, but according to TFI, 54.6% presented multidimensional frailty. These two diagnostic tools were concordant in their outcomes in 77.1% (ie, 42.3% of individuals were physically and multidimensionally frail but 34.8% were robust according to both two instruments); however, in 22.9% the outcomes were discordant. Consequently, by simultaneous employment of the FRAIL scale and TFI, four distinct functional categories have been distinguished: (i) nonrobust physical status with multidimensional frailty, (ii) exclusive non-robust physical status, (iii) exclusive multidimensional frailty, and (iv) full robust status. Conclusion: By applying simple physical and multidimensional frailty diagnostic tools, subgroups of elderly people may be identified that require specific management strategies to improve their functional status.

Multidimensional and Physical Frailty in Elderly People: Participation in Senior Organizations Does Not Prevent Social Frailty and Most Prevalent Psychological Deficits

“…In fact, the approach to seniors should be individualized to their needs. Recently, it has been shown that simultaneous employment of TFI and the FRAIL scale may identify elderly people who require different managements, i.e., subgroups presenting predominantly social and psychological frailty and those with mainly physical deficits (10). These simple tools can be used by both seniors themselves or professionals in senior organizations to detect particular needs and plan an individualized management strategy.…”

“…These open-access meetings were dedicated to all elderly people living in a region (not only to the organizations members) and they were advertised by appropriate posters. Details on the data collection have been described elsewhere (10).…”

“…Therefore, an approach to frailty should be multidimensional (i.e., physical, psychological, and social) because such a concept more adequately reflects a complexity of the decrease in physiological reserves associated with aging (6,8,9). Moreover, the elderly people may present different types of functional deterioration and hence require an individualized approach to ensure their independence and good functioning (10).…”

Determinants of Multidimensional and Physical Frailty and Their Individual Components: Interactions between Frailty Deficits

“…Many risk factors for frailty development have been determined; yet, frailty as an accumulation of impairments combines conditions which certainly constitute risk factors for each other and their interplay most likely amplify their effects. Moreover, since frailty is a multidimensional entity, the interaction between impairments in various dimensions presumably accelerates the overall functional degradation associated with aging [ 6 , 7 ].…”

“…Combination of unidimensional (i.e., physical) and multidimensional frailty diagnostic tools may yield more information about the character of functional disturbances associated with age than either of these tools employed exclusively. Indeed, it has been recently shown that a simultaneous employment of TFI and the FRAIL scale, may identify subgroups of the elderly people that present different functional profiles—i.e., those presenting predominantly social and psychological frailty or those with mainly physical deficits [ 7 ]. Such subgroups potentially require different management and, therefore, the approach to frail people should be individualized according to their functional state.…”