The psychometric properties of three self-report screening instruments for identifying frail older people in the community

Abstract

BackgroundFrailty is highly prevalent in older people. Its serious adverse consequences, such as disability, are considered to be a public health problem. Therefore, disability prevention in community-dwelling frail older people is considered to be a priority for research and clinical practice in geriatric care. With regard to disability prevention, valid screening instruments are needed to identify frail older people in time. The aim of this study was to evaluate and compare the psychometric properties of three screening instruments: the Groningen Frailty Indicator (GFI), the Tilburg Frailty Indicator (TFI) and the Sherbrooke Postal Questionnaire (SPQ). For validation purposes the Groningen Activity Restriction Scale (GARS) was added.MethodsA questionnaire was sent to 687 community-dwelling older people (≥ 70 years). Agreement between instruments, internal consistency, and construct validity of instruments were evaluated and compared.ResultsThe response rate was 77%. Prevalence estimates of frailty ranged from 40% to 59%. The highest agreement was found between the GFI and the TFI (Cohen's kappa = 0.74). Cronbach's alpha for the GFI, the TFI and the SPQ was 0.73, 0.79 and 0.26, respectively. Scores on the three instruments correlated significantly with each other (GFI - TFI, r = 0.87; GFI - SPQ, r = 0.47; TFI - SPQ, r = 0.42) and with the GARS (GFI - GARS, r = 0.57; TFI - GARS, r = 0.61; SPQ - GARS, r = 0.46). The GFI and the TFI scores were, as expected, significantly related to age, sex, education and income.ConclusionsThe GFI and the TFI showed high internal consistency and construct validity in contrast to the SPQ. Based on these findings it is not yet possible to conclude whether the GFI or the TFI should be preferred; data on the predictive values of both instruments are needed. The SPQ seems less appropriate for postal screening of frailty among community-dwelling older people.

Association of brain pathology with the progression of frailty in older adults

“…[1][2][3][4][5] Frailty may occur in up to 50% or more of adults by the age of 85, making it essential to understand its underlying biology. 6,7 We used data from 791 persons participating in 1 of 2 cohort studies of common chronic conditions of aging that include brain donation at death: the Religious Orders Study (ROS) and the Rush Memory and Aging Project (MAP). 8,9 Prior work in one of these cohorts showed that the level of frailty proximate to death was associated with postmortem indices of AD pathology even in individuals without dementia, suggesting that brain pathology may contribute to frailty.…”

“…First, we examined person-specific differences in the annual rate of change in frailty using a mixed-effect model controlling for age, sex, and education and their interactions with time. Average follow-up was 6.4 years (SD 5 2.80; range [2][3][4][5][6][7][8][9][10][11][12][13][14]. The rate of change in frailty ranged from 20.04 to 0.27 unit/year, but on average, frailty increased by approximately 0.12 unit per year (estimate 0.117, SE 0.035, p , 0.001).…”

Changes in the Household Structures of the Elderly: Household Projections for Turkey, 2016-2050

“…In studies that set the TFI cutoff point for frailty at 5, the ratio of frailty was 44.6% in the Italian sample with an average age of 73.4 years, 47.1% in the Dutch sample with an average age of 80.3 years, 40% in the Polish sample with an average age of 68.2 years, 35.6% and 31.7% in two Brazilian samples with average ages of 69.8 and 71.3 years, and 41.4% in the German sample with an average age of 75.3 years (13,17,(20)(21)(22)(23). In the Portuguese sample that set the cutoff point for frailty at 6, the average age was 79.2 years, and frailty was identified in 54.8% of the sample population (5).…”

“…In a study conducted in Holland that included 532 people, the average age was 77.2 years, the ratio of frailty based on the TFI was 40.2%, and the total Cronbach's alpha value was 0.73 (21). The corrected item total correlations varied between 0.18 and 0.58 (21).…”

A disability prevention programme for community-dwelling frail older persons

“…The instrument has shown high internal consistency and construct validity. 41,42 In our feasibility study 13 among 41 elderly persons, nearly all participating elderly were willing to return the Groningen Frailty Indicator by post (90% response), and the number of missing items was low. The study into predictive values of three postal screening instruments 15 showed that all three instruments, including the Groningen Frailty Indicator, do have potential to identify older persons at risk, but their predictive power is not yet sufficient.…”