Abstract
BackgroundMany instruments to identify frail older people have been developed. One of the consequences is that the prevalence rates of frailty vary widely dependent on the instrument selected. The aims of this study were 1) to examine the concordances and differences between a unidimensional and multidimensional assessment of frailty, 2) to assess to what extent the characteristics of a ‘frail sample’ differ depending on the selected frailty measurement because ‘being frail’ is used in many studies as an inclusion criterion.MethodA cross-sectional study was conducted among 196 community-dwelling older adults (≥60 years), which were selected from the census records. Unidimensional frailty was operationalized according to the Fried Phenotype (FP) and multidimensional frailty was measured with the Comprehensive Frailty Assessment Instrument (CFAI). The concordances and differences were examined by prevalence, correlations, observed agreement and Kappa values. Differences between sample characteristics (e.g., age, physical activity, life satisfaction) were investigated with ANOVA and Kruskall-Wallis test.ResultsThe mean age was 72.74 (SD 8.04) and 48.98% was male. According to the FP 23.59% was not-frail, 56.92% pre-frail and 19.49% frail. According to the CFAI, 44.33% was no-to-low frail, 37.63% was mild frail and 18.04% was high frail. The correlation between FP and the CFAI was r = 0.46 and the observed agreement was 52.85%. The Kappa value was κ = 0.35 (quadratic κ = 0.45). In total, 11.92% of the participants were frail according to both measurements, 7.77% was solely frail according to the FP and 6.21% was solely frail according to the CFAI. The ‘frail sample respondents’ according to the FP had higher levels of life satisfaction and net income, but performed less physical activities in comparison to high frail people according to the CFAI.ConclusionThe present study shows that the FP and CFAI partly measure the same ‘frailty-construct’, although differences were found for instance in the prevalence of frailty and the composition of the ‘frail participants’. Since ‘being frail’ is an inclusion criterion in many studies, researchers must be aware that the choice of the frailty measurement has an impact on both the estimates of frailty prevalence and the characteristics of the selected sample.
Highlights
Many instruments to identify frail older people have been developed
11.92% of the participants were frail according to both measurements, 7.77% was solely frail according to the Fried Phenotype (FP) and 6.21% was solely frail according to the Comprehensive Frailty Assessment Instrument (CFAI)
The present study shows that the FP and CFAI partly measure the same ‘frailty-construct’, differences were found for instance in the prevalence of frailty and the composition of the ‘frail participants’
Summary
Many instruments to identify frail older people have been developed. One of the consequences is that the prevalence rates of frailty vary widely dependent on the instrument selected. Frailty was often designated as a unidimensional construct, defined as “a medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual’s vulnerability for developing increased dependency and/ or death” [4]. An example of such a (bio)medical, unidimensional approach to operationalize frailty is the Fried Phenotype (FP) [5]. The Comprehensive Frailty Assessment Instrument (CFAI) for instance, is an assessment with a multidimensional perspective on frailty [9]
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