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.
Highlights
Frailty is highly prevalent in older people
Older people were identified between November 2008 and April 2009 from the panels of three general practitioners (GPs)
From the present study we may conclude that: (1) prevalence estimates of frailty ranged between 40.2% (TFI), 46.3% (GFI) and 59.1% (SPQ); (2) the agreement in identifying frailty between the Groningen Frailty Indicator (GFI) and the Tilburg Frailty Indicator (TFI) was satisfactory and the agreements between the Sherbrooke Postal Questionnaire (SPQ) and the GFI and the TFI, respectively, were much lower; (3) both the GFI and the TFI had high internal consistency in contrast to the SPQ; (4) the GFI and the TFI had better construct validity in comparison with the SPQ
Summary
Frailty is highly prevalent in older people. Its serious adverse consequences, such as disability, are considered to be a public health problem. 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. To its high prevalence, frailty is characterized by its seriousness as it is related to an increased risk of adverse health outcomes such as disability [2,3,4]. Disability is defined as difficulty or dependency in the execution of activities of daily living and it is associated with increased health service utilization and Several authors emphasize a two-step approach in preventive interventions for community-dwelling frail older people, in which screening is followed by extensive. With valid (screening) instruments to identify frail older people this approach may avoid costs and the unnecessary assessment of healthy people [7,8]. More insight into the psychometric properties of frailty instruments is relevant for geriatric care and research in this area [4]
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