Review of frailty measurement of older people: Evaluation of the conceptualization, included domains, psychometric properties, and applicability

Abstract

The purposes of this review are to describe the existing research on frailty measurement of older people and to understand their characteristics, with a focus on conceptual definitions, psychometric properties, and diagnostic accuracies. We reviewed the published literature to explore if cross‐cultural studies of different types of frailty measurements have been conducted and to determine their applicability in the community setting. Narrative review with limited electronic database search and cross reference searching of included studies was performed. Studies published after year 2001 were searched for using MEDLINE and CINAHL Plus databases with keywords. A total of 5144 search results were obtained, but only 42 frailty measurements were identified in 68 studies. For the type, three different measurements were indicated, namely, self‐report instrument (n = 17), clinical observation assessment (n = 19), and mixed frailty assessment instrument (n = 6). Only 12 (29%) measurements examined reliability and validity. Nevertheless, over 35% did not perform any psychometric testing before applying. For diagnosis accuracies, 35 (83%) frailty measurements reported the cut‐off value(s) for determining level of the frailty. However, the sensitivity (56%‐89.5%) and specificity (52%‐91.3%) varied. The applicability was also diverse and some frailty instruments should be only used in some specific population and mode of administration. This review provides an overview of three major types of frailty measurements used in different settings with different purposes. For estimating the prevalence of frailty of older people in a community, the self‐report type may be appropriate. The psychometric properties of many reviewed instruments are reported insufficiently. The cut‐off value(s) are usually suggested with diverse sensitivity and specificity. Self‐report instruments, such as Groningen Frailty Indicator (GFI) and Tilburg Frailty Indicator (TFI), are the most extensively examined in terms of satisfactory psychometric properties. Thus, GFI and TFI, with the current evidence, are recommended to be used in the community setting for frailty screening tools.

Frailty, e-health and prevention of late-onset Alzheimer disease and related disorders: it is time to take action

“…An effective prevention of ADRD needs to not only consider each MRF individually, but also their accumulation. A significant adverse consequence of chronic morbidity accumulation is frailty [ 10 ]. Frailty is associated with an increased risk of ADRD [ 11 ].…”

“…Frailty is associated with an increased risk of ADRD [ 11 ]. Frailty may be reversed and, thus, assimilated as a MRF of ADRD [ 10 , 11 ]. Addressing frailty (i.e., assessing frailty level and proposing interventions to reverse it) might be a key intervention to prevent ADRD.…”

“…However, this study underscored uncertainty about this association. First, most studies used Fried’s criteria which defines frailty as a strictly physical impairment, whereas psychological, cognitive and social domains also contribute to frailty and, thus, should be considered in its definition and quantification [ 10 ]. The Rockwood’s deficit accumulation model considers this multidimensional aspect of frailty by counting deficits in various domains [ 11 ].…”

“…The Rockwood’s deficit accumulation model considers this multidimensional aspect of frailty by counting deficits in various domains [ 11 ]. Second, although cognitive impairment, like mild cognitive impairment, is an important risk factor for ADRD, its place in frailty models is absent or limited [ 10 , 11 ]. Fried’s model does not include it, while Rockwood’s model includes “poor cognition” as a deficit [ 10 ].…”

“…Second, although cognitive impairment, like mild cognitive impairment, is an important risk factor for ADRD, its place in frailty models is absent or limited [ 10 , 11 ]. Fried’s model does not include it, while Rockwood’s model includes “poor cognition” as a deficit [ 10 ]. To counter these issues, the concept of “cognitive frailty” has been created [ 12 ].…”