The Validity of the Sunfrail Tool: A Cross-Sectional Study Among Dutch Community-Dwelling Older People

Abstract

Background: Early detection of frail older people is important. Timely intervention may allow health care professionals to prevent or delay the occurrence of adverse outcomes such as disability, increases in health care utilization, and premature death. Objectives: We assessed the construct and criterion validity of the SUNFRAIL tool, a questionnaire for measuring frailty among older people. Design, Setting and Participants: This cross-sectional study was carried out in a sample of Dutch citizens. A total of 195 community-dwelling persons aged 71 years and older completed the questionnaire. Measurements: Construct validity was examined by determining the correlation between the SUNFRAIL tool and the Tilburg Frailty Indicator (TFI). Criterion validity for the SUNFRAIL tool was determined by establishing the correlations with chronic diseases and adverse outcomes of frailty (disability, falls, indicators of health care utilization). Disability was measured using the Groningen Activity Restriction Scale. Participants also answered questions regarding falls and health care utilization. Results: The construct validity of this tool was good and showed significant correlations with the TFI. The correlation between SUNFRAIL total and TFI total was 0.624. The criterion validity of the SUNFRAIL tool was good for chronic diseases and good-to-excellent for adverse outcomes disability, receiving nursing care, and falls. The area under the curve for these outcomes was 0.840 (95% CI 0.781–0.899), 0.782 (95% CI 0.696–0.868), and 0.769 (95% CI 0.686–0.859), respectively. Conclusions: The results of our study suggest that the SUNFRAIL tool is a valid instrument for assessing frailty in community-dwelling older people. It is an attractive instrument for use in practice because it takes little time for health care professionals and older people to complete the questionnaire, and it expresses the integral functioning of human beings.

Validation and Screening Capacity of the European Portuguese Version of the SUNFRAIL Tool for Community-Dwelling Older Adults

“…One of the strengths of the European Portuguese version [15] is its ability to discriminate between robust, pre-frail, and frail older adults. These results are in line with another study [13]. The differences between groups were predominantly higher in the biological domain and lower in the other domains, which may reinforce the idea that the biological domain is overrated in comparison with the psychological and the social domains, which is also similar to the results found by Gobbens et al (2012) [7].…”

“…Other authors [25] also argue that a mean number of chronic diseases is a relevant determinant of frailty, with overlap rates of frailty and multimorbidity reaching 25%. We are able to determine two-thirds for the cutoff point, with score 2 indicating a robust health status and score 3 or more indicating pre-frailty or frailty, which is consistent with a previous study [13]. The sensitivity and specificity values for a pilot study are satisfactory, but more studies are needed.…”

“…The total explained variance of the SUNFRAIL was higher for the interaction between frailty status and cognitive status than when the cognitive status or the frailty status were analyzed per se, which, in our opinion, may reinforce the multidimensionality of frailty [13]. As regards concurrent validity, the SUNFRAIL was significantly correlated with multimorbidity.…”

“…On the other hand, significant moderate (psychological and social) to strong (biological) correlations were found between domain scores and total score, proving that the instrument may collect relevant data for defining the follow-up care plan. The correlations between different SUNFRAIL domains showed more satisfactory results than those found in the study conducted in the Netherlands [13]. In the latter study, no significant correlations were found between the physical and the social domains in the SUNFRAIL tool; the internal consistency value was also not reported.…”

“…This nine-question tool assesses the presence of difficulties or problems in biological (items 1-5), psychological (items 6 and 7), and social domains (items 8 and 9). However, a recent study proposed a different categorization of this tool's items [13]. SUNFRAIL items are scored 1 for "yes" and 0 for "no", except for items 4 and 8, which are scored inversely.…”