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Midao L, Duarte M, Sampaio R, Almada M, Dias CC, Paúl C, Costa E. FRAILSURVEY-an mHealth App for Self-Assessment of Frailty Based on the Portuguese Version of the Groningen Frailty Indicator: Validation and Reliability Study. JMIR Form Res 2025; 9:e51975. [PMID: 40053720 PMCID: PMC11928775 DOI: 10.2196/51975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 03/09/2025] Open
Abstract
BACKGROUND Portugal is facing the challenge of population ageing, with a notable increase in the proportion of older individuals. This has positioned the country among those in Europe with a high prevalence of frailty. Frailty, a geriatric syndrome characterized by diminished physiological reserve and heightened vulnerability to stressors, imposes a substantial burden on public health. OBJECTIVE This study seeks to address two primary objectives: (1) translation and psychometric evaluation of the European Portuguese version of the Groningen Frailty Indicator (GFI); and (2) development and evaluation of the FRAILSURVEY app, a novel assessment tool for frailty based on the GFI. By achieving these objectives, the study aims to enhance the accuracy and reliability of frailty assessment in the Portuguese context, ultimately contributing to improved health care outcomes for older individuals in the region. METHODS To accomplish the objectives of the study, a comprehensive research methodology was used. The study comprised 2 major phases: the initial translation and validation of the GFI into European Portuguese and the development of the FRAILSURVEY app. Following this, an extensive examination of the app's validity and reliability was conducted compared with the conventional paper version of the GFI. A randomized repeated crossover design was used to ensure rigorous evaluation of both assessment methods, using both the paper form of the GFI and the smartphone-based app FRAILSURVEY. RESULTS The findings of the study revealed promising outcomes in line with the research objectives. The meticulous translation process yielded a final version of the GFI with robust psychometric properties, ensuring clarity and comprehensibility for participants. The study included 522 participants, predominantly women (367/522, 70.3%), with a mean age of 73.7 (SD 6.7) years. Psychometric evaluation of the European Portuguese GFI in paper form demonstrates good reliability (internal consistency: Cronbach a value of 0.759; temporal stability: intraclass correlation coefficient=0.974) and construct validity (revealing a 4D structure explaining 56% of variance). Evaluation of the app-based European Portuguese GFI indicates good reliability (interinstrument reliability: Cohen k=0.790; temporal stability: intraclass correlation coefficient=0.800) and concurrent validity (r=0.694; P<.001). CONCLUSIONS Both the smartphone-based app and the paper version of the GFI were feasible and acceptable for use. The findings supported that FRAILSURVEY exhibited comparable validity and reliability to its paper counterpart. FRAILSURVEY uses a standardized and validated assessment tool, offering objective and consistent measurements while eliminating subjective biases, enhancing accuracy, and ensuring reliability. This app holds promising potential for aiding health care professionals in identifying frailty in older individuals, enabling early intervention, and improving the management of adverse health outcomes associated with this syndrome. Its integration with electronic health records and other data may lead to personalized interventions, improving frailty management and health outcomes for at-risk individuals.
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Affiliation(s)
- Luis Midao
- RISE-Health, Biochemistry Lab, Faculty of Pharmacy, University of Porto, Porto, Portugal
- Porto4Ageing-Competences Centre on Active and Healthy Ageing, Faculty of Pharmacy, University of Porto, Porto, Portugal
- ICBAS-School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Mafalda Duarte
- RISE-Health, Department of Behavioural Sciences, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
- ISAVE-Superior Institute of Health, Amares, Braga, Portugal
| | - Rute Sampaio
- RISE-Health, Department of Biomedicine, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Marta Almada
- RISE-Health, Biochemistry Lab, Faculty of Pharmacy, University of Porto, Porto, Portugal
- Porto4Ageing-Competences Centre on Active and Healthy Ageing, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Cláudia Camila Dias
- Knowledge Management Unit, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
- CINTESIS@RISE, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| | - Constança Paúl
- ICBAS-School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
- RISE-Health, Department of Behavioural Sciences, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Elísio Costa
- RISE-Health, Biochemistry Lab, Faculty of Pharmacy, University of Porto, Porto, Portugal
- Porto4Ageing-Competences Centre on Active and Healthy Ageing, Faculty of Pharmacy, University of Porto, Porto, Portugal
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Avram L, Ungureanu MI, Crişan D, Donca V. Assessment of Frailty Scores Among Geriatric Patients Hospitalized in the North-Western Region of Romania: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1947. [PMID: 39768829 PMCID: PMC11678423 DOI: 10.3390/medicina60121947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Revised: 11/22/2024] [Accepted: 11/24/2024] [Indexed: 01/11/2025]
Abstract
Background and Objectives: The global demographic trend of population aging is evident across all regions, with a notable increase in the proportion of elderly individuals. Romania exemplifies this phenomenon, as 17% of its population is currently aged 65 years or older-a figure projected to rise to 25% by 2050. This demographic shift underscores the pressing need for comprehensive measures to address the health and social requirements of this growing population segment. This study aims to assess the prevalence of frailty among older adults in Romania and explore its relationship with socioeconomic factors. Materials and Methods: We employed a quantitative approach, by using cross-sectional data from patients hospitalized at the geriatrics ward of the Municipal Clinical Hospital in Cluj-Napoca, Romania. Frailty scores were calculated through established frailty assessment tools, allowing for a comprehensive evaluation of frailty status. In addition, we compared the socioeconomic characteristics of frail and non-frail patients to identify potential disparities. Statistical analyses were performed to assess associations between frailty and socioeconomic factors, providing insight into the relationship between these variables within the patient population. Results: The prevalence of frailty in our sample is, depending on the frailty scale used, 55% to 79%, which is in line with figures from specialized geriatric wards in other studies. There is moderate to substantial agreement between the scales we compared, and all six scales seem to concurrently agree on the frailty diagnostic in 55% of cases. Additionally, frail patients are more likely to have a low socioeconomic status. Conclusions: A significant limitation in European frailty research has been the absence of comparative frailty prevalence data across several European countries, especially those with lower economic development. Our study fills this gap by providing data on frailty prevalence in the north-western region of Romania.
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Affiliation(s)
- Lucreția Avram
- Department of Geriatrics and Gerontology, Iuliu Haţieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (L.A.); (V.D.)
| | - Marius I. Ungureanu
- Department of Public Health, Babeș-Bolyai University, 400347 Cluj-Napoca, Romania
| | - Dana Crişan
- Department of Internal Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Valer Donca
- Department of Geriatrics and Gerontology, Iuliu Haţieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (L.A.); (V.D.)
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Atala-Acevedo C, McGrath R, Capurro D, Glenister K, Bourke L, Morgan M, Simmons D, Mariño R. Identifying Frailty in Older Adults in Rural Victoria, Australia: A Secondary Analysis of Population Health Data. J Aging Health 2024; 36:170-181. [PMID: 37260112 DOI: 10.1177/08982643231180045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Objectives: To determine the prevalence of frailty among community-dwelling older adults in regional Victoria, Australia. Methods: Frailty status of 376 participants from the Crossroads II cross-sectional study was assessed by selected markers of frailty. The selected variables were psychometrically tested. Associations between frailty and socio-demographic, environmental and health factors were analysed using chi-square, ANOVA and binary logistic regression (BLR). Results: Estimated prevalence of frailty was 39.4%. BLR indicated that frailty decreased with higher educational attainment, (OR = .23; 95% CI: .10-.51) increased for divorced/separated participants (OR = 2.68; 95% CI: 1.29-5.56) and when having three (OR = 3.27; 95% CI: 1.07-9.98), four (OR = 7.20; 95% CI: 2.22-23.31) or five or more chronic conditions (OR = 9.18; 95% CI: 2.83-29.72). Discussion: Frailty in this Australian regional community-dwelling sample was higher than other studies conducted in urban areas of Australia. Present results highlight the importance of exploring the multidimensionality of the frailty construct to have a better understanding which factors are associated with the development of this syndrome.
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Affiliation(s)
- Claudia Atala-Acevedo
- Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC Australia
| | - Roisin McGrath
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC Australia
| | - Daniel Capurro
- School of Computing and Information Systems, Centre for the Digital Transformation of Health, The University of Melbourne, Melbourne, VIC Australia
| | - Kristen Glenister
- Department of Rural Health, The University of Melbourne, Melbourne, VIC Australia
| | - Lisa Bourke
- Department of Rural Health, The University of Melbourne, Melbourne, VIC Australia
| | - Mike Morgan
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC Australia
| | - David Simmons
- Department of Rural Health, The University of Melbourne, Melbourne, VIC Australia
- Macarthur Clinical School, Western Sydney University, Sydney, Australia
| | - Rodrigo Mariño
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC Australia
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Güner M, Ceylan S, Okyar Baş A, Koca M, Doğu BB, Halil MG, Cankurtaran M, Balcı C. Turkish translation, cross-cultural adaptation and reliability of the Groningen Frailty Indicator. BMC Geriatr 2023; 23:753. [PMID: 37978450 PMCID: PMC10656956 DOI: 10.1186/s12877-023-04445-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Frailty is an important geriatric syndrome that can be seen as a way of recognizing and distinguishing the complex health conditions of older people. Due to the time limitation, short and simple instruments are most feasible in clinical practice, and several quick screening tools have been developed and validated, Groningen frailty indicator (GFI) is one of these scales. We aimed to validate and evaluate the reliability of the GFI in outpatient older adults in the Turkish population. METHODS A total of 101 older patients were enrolled to the study. GFI was scored by a geriatrician for every patient at first admission to the geriatric outpatient clinic. Fried Physical Frailty Phenotype (FPFP) was performed as a reference test. RESULTS The median age (IQR) was 72.0 (10.0) and 62.4% of the study population (n = 63) was female. Based on the GFI, 34 patients (33.7%) were defined as robust, and 67 patients (66.3%) were defined as living with frailty. There was a statistically significant concordance between GFI and FPFP (Cohen's kappa: 0.415 p < 0.001). GFI had excellent consistency in inter-rater reliability (Cronbach's alpha: 0.99, 95% CI 0.97-1.00) and in intra-rater reliability (Cronbach's alpha: 0.99, 95% CI 0.96-1.0). CONCLUSION Our study showed that GFI is a valid and reliable scale in the Turkish older population.
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Affiliation(s)
- Merve Güner
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University, 06230, Sıhhıye, Ankara, Türkiye.
| | - Serdar Ceylan
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University, 06230, Sıhhıye, Ankara, Türkiye
| | - Arzu Okyar Baş
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University, 06230, Sıhhıye, Ankara, Türkiye
| | - Meltem Koca
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University, 06230, Sıhhıye, Ankara, Türkiye
| | - Burcu Balam Doğu
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University, 06230, Sıhhıye, Ankara, Türkiye
| | - Meltem Gülhan Halil
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University, 06230, Sıhhıye, Ankara, Türkiye
| | - Mustafa Cankurtaran
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University, 06230, Sıhhıye, Ankara, Türkiye
| | - Cafer Balcı
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University, 06230, Sıhhıye, Ankara, Türkiye
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Huang EYZ, Cheung J, Liu JYW, Kwan RYC, Lam SC. Groningen Frailty Indicator-Chinese (GFI-C) for pre-frailty and frailty assessment among older people living in communities: psychometric properties and diagnostic accuracy. BMC Geriatr 2022; 22:788. [PMID: 36207703 PMCID: PMC9540721 DOI: 10.1186/s12877-022-03437-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 09/05/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The early identification of pre-frailty and frailty among older people is a global priority because of the increasing incidence of frailty and associated adverse health outcomes. This study aimed to validate the Groningen Frailty Indicator-Chinese (GFI-C), a widely used screening instrument, and determine the optimal cut-off value in Chinese communities to facilitate pre-frailty and frailty screening. METHODS This methodological study employed a cross-sectional and correlational design to examine the psychometric properties of GFI-C, namely, internal consistency, stability, and concurrent and construct validities. The appropriate cut-off values for pre-frailty and frailty screening in the receiver-operating characteristic (ROC) curve were determined through sensitivity and specificity analysis. RESULTS A total of 350 community older people had been assessed and interviewed by a nurse. The GFI-C showed satisfactory internal consistency (Cronbach's α = 0.87) and two-week test-retest reliability (intra-class correlation coefficient = 0.87). Concurrent validity (r = 0.76, p < 0.001) showed a moderate correlation with Fried's frailty phenotype. The known-groups method, hypothesis testing and confirmatory factory analysis (three-factor model; χ2/df = 2.87, TLI = 0.92, CFI = 0.93, GFI = 0.92, RMR = 0.014; RMSEA = 0.073) were suitable for the establishment of construct validity. Based on the ROC and Youden's index, the optimal cut-off GFI-C values were 2 (sensitivity, 71.5%; specificity, 84.7%) for pre-frailty and 3 for frailty (sensitivity, 88.2%; specificity, 79.6%). CONCLUSIONS The result indicated that GFI-C is a reliable and valid instrument for pre-frailty and frailty screening among older Chinese people in communities. For optimal diagnostic accuracy, the cut-off values of 3 for frailty and 2 for pre-frailty are recommended.
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Affiliation(s)
- Emma Yun Zhi Huang
- Division of Social Worker, Zhongshan Polytechnic, No.25 Bo’ai 7th Road, East District, Zhongshan City, Guangdong Province People’s Republic of China
| | - Jasmine Cheung
- School of Nursing, Tung Wah College, Ma Kam Chan Memorial Building, 31 Wylie Road, Hong Kong SAR, China
| | - Justina Yat Wa Liu
- School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong SAR, China
| | - Rick Yiu Cho Kwan
- School of Nursing, Tung Wah College, Ma Kam Chan Memorial Building, 31 Wylie Road, Hong Kong SAR, China
| | - Simon Ching Lam
- School of Nursing, Tung Wah College, Ma Kam Chan Memorial Building, 31 Wylie Road, Hong Kong SAR, China
- Integrative Health Centre, Tung Wah College, Cheung Chin Lan Hong Building, 98 Shantung Street, Hong Kong SAR, China
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Si H, Jin Y, Qiao X, Tian X, Liu X, Wang C. Predictive performance of 7 frailty instruments for short-term disability, falls and hospitalization among Chinese community-dwelling older adults: A prospective cohort study. Int J Nurs Stud 2021; 117:103875. [PMID: 33621721 DOI: 10.1016/j.ijnurstu.2021.103875] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 12/26/2020] [Accepted: 01/01/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Frailty becomes a great challenge with population aging. The proactive identification of frailty is considered as a rational solution in the community. Previous studies found that frailty instruments had insufficient predictive accuracy for adverse outcomes, but they mainly focused on long-term outcomes and constructed frailty instruments based on available data not original forms. The predictive performance of original frailty instruments for short-term outcomes in community-dwelling older adults remains unknown. OBJECTIVE To examine the predictive performance of seven frailty instruments in their original forms for 1-year incident outcomes among community-dwelling older adults. DESIGN A prospective cohort study. SETTINGS A total of 22 communities were selected by a stratified sampling method from one Chinese city. PARTICIPANTS A total of 749 older adults aged ≥ 60 years (mean age of 69.2 years, 69.8% female) were followed up after 1 year. METHODS Baseline frailty was assessed by three purely physical dimensional instruments (i.e. Frailty Phenotype, the Study of Osteoporotic Fracture and FRAIL Scale) and four multidimensional instruments (i.e. Frailty Index, Groningen Frailty Indicator, Tilburg Frailty Indicator and Comprehensive Frailty Assessment Instrument), respectively. Outcomes included incident disability, falls, hospitalization and the combined outcome at 1-year follow-up. The receiver operating characteristic curves were plotted to assess the predictive performance of frailty instruments. RESULTS The areas under the curves of seven frailty instruments in predicting incident outcomes ranged from 0.55 [95% confidence interval (CI): 0.51-0.60] to 0.67 (95% CI: 0.61-0.72), with high specificity (72.3-99.2%) and low sensitivity (4.0-49.6%). Four multidimensional instruments had much higher sensitivity (20.9-49.6% versus 4.0-11.7%) than three purely physical dimensional instruments. Overall, the Frailty Index was more accurate than some instruments in predicting incident outcomes, while several self-report instruments had comparable predictive accuracy to the Frailty Index for all (FRAIL Scale) or some (Groningen Frailty Indicator and Tilburg Frailty Indicator) of the incident outcomes. CONCLUSIONS All frailty instruments have inadequate predictive accuracy for short-term outcomes among community-dwelling older adults. The Frailty Index roughly performs better but self-report instruments are comparable to the Frailty Index for all or some of the outcomes. An accurate frailty instrument needs to be developed, and the simple self-report instruments could be used temporarily as practical and efficient tools in primary care.
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Affiliation(s)
- Huaxin Si
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yaru Jin
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Xiaoxia Qiao
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Xiaoyu Tian
- School of Nursing, Shandong University, No. 44 Wenhuaxi Road, Lixia District, Jinan 250012, China
| | - Xinyi Liu
- School of Nursing, Shandong University, No. 44 Wenhuaxi Road, Lixia District, Jinan 250012, China
| | - Cuili Wang
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China.
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Zupo R, Castellana F, Bortone I, Griseta C, Sardone R, Lampignano L, Lozupone M, Solfrizzi V, Castellana M, Giannelli G, De Pergola G, Boeing H, Panza F. Nutritional domains in frailty tools: Working towards an operational definition of nutritional frailty. Ageing Res Rev 2020; 64:101148. [PMID: 32827687 DOI: 10.1016/j.arr.2020.101148] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/11/2022]
Abstract
Different methods have been proposed for the assessment of the nutritional status in frailty phenotypes. In the present narrative review article, we have summarized the number and specifications of nutritional items in existing frailty tools, in order to develop a possible means of assessment and operational definition of the nutritional frailty phenotype. In six different databases until December 2019, we searched for original articles regarding frailty tools (i.e., scales, indexes, scores, questionnaires, instruments, evaluations, screening, indicators), analyzing each tool regarding nutritional items. We identified 160 articles describing 71 frailty tools. Among the selected frailty tools, 54 were community-based (70 %), 17 hospital-based (22 %), 4 validated in long-term care institutions for older adults (LTCIOA) (5.1 %) and 2 validated in both community- and hospital-based settings, including LTCIOA (2.5 %). Fifty-two of these tools (73 %) included at least one nutritional item. Twenty-two (42 %) reported two or more nutritional items. The items were grouped in the following categories: A) anthropometric measurements, B) laboratory measurements, and C) other nutritional-related measurements. Anthropometric measurements stood out compared to all other items. Nutritional items are included in the majority of frailty tools, strengthening the concept that they may have a direct implication on an increased risk of adverse health-related outcomes in frail subjects. This supports the development of the concept of nutritional frailty as an independent frailty phenotype. Subsequent steps will be to assess the contribution of each nutritional item to a possible operational definition of nutritional frailty and define the items that may best identify this new frailty phenotype.
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Xiang W, Cheng Y, Li Z, Han J, Li K. Cross-cultural adaptation and validation of the Groningen Frailty Indicator in Chinese nursing home residents. Aging Clin Exp Res 2020; 32:1035-1042. [PMID: 30900215 DOI: 10.1007/s40520-019-01178-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/14/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Frail older people are more likely to develop negative health outcomes. Previous studies have indicated that the Groningen Frailty Indicator is a practical frailty screening instrument with good psychometric properties; however, it has never been implemented in Chinese nursing homes. AIMS To cross-culturally adapt and validate the Groningen Frailty Indicator in Chinese nursing home residents. METHODS The participants were 192 residents from nursing homes. Reliability was analyzed by internal consistency and test-retest methods. Convergent validity was assessed using Spearman rank correlations between the GFI domains and activities of daily living, the mini nutritional assessment, the Mini-mental state examination, the Social Support Rating Scale, the 20-item Epidemiologic Studies Depression Scale and the Short Form 36 mental component summary. Criterion validity was investigated by performing a receiver operating characteristics curve analysis. RESULTS The Chinese GFI achieved semantic, idiomatic, and experiential equivalence. It had a high response rate among nursing home elders. It also showed good internal consistency (ICC = 0.712) and excellent test-retest reliability. Regarding construct validity, it presented good known-group divergent validity based on age. The correlations between the GFI domains and their corresponding measures were consistent as hypothesized, demonstrating convergent validity of the GFI. Using the Fried frailty phenotypes as reference criteria, the Chinese GFI showed satisfactory diagnostic accuracy for frailty (AUC = 0.823) and prefrailty (AUC = 0.791). The optimal cutoff point was 4 for frailty and 3 for prefrailty. CONCLUSIONS The GFI was successfully adapted for Chinese nursing home residents and presented acceptable validity and reliability.
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Tian X, Qiao X, Dong L, Liu N, Si H, Jin Y, Liu X, Wang C. Cross-cultural adaptation and psychometric properties of the Groningen Frailty Indicator (GFI) among Chinese community-dwelling older adults. Geriatr Nurs 2020; 41:236-241. [DOI: 10.1016/j.gerinurse.2019.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 12/15/2022]
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Khamis R, Sabbah H, Sabbah S, Peters L, Droubi N, Sabbah I. Evaluating the psychometric properties of the Arabic version of the Groningen Frailty Indicator among Lebanese elderly people. J Egypt Public Health Assoc 2019; 94:28. [PMID: 32813111 PMCID: PMC7364700 DOI: 10.1186/s42506-019-0028-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 10/03/2019] [Indexed: 12/03/2022]
Abstract
Background The levels of frailty are anticipated to increase as a result of population aging. A valid instrument is required to detect individuals at high risk of frailty. The present research aimed to assess feasibility, reliability, and construct validity of the Arabic version of Groningen Frailty Indicator (GFI) in urban and rural populations in South Lebanon. Methods During 2015, a cross-sectional study, which enrolled 390 community-dwelling individuals aged 65 years and above, was conducted in urban and rural areas in Nabatieh in South Lebanon. The survey included questions on sociodemographic and health-related characteristics, GFI, and Vulnerable Elders Survey-13 (VES-13). The translation and cultural adaptation of the GFI followed a standardized protocol. After that, the psychometric properties of the scale (i.e., feasibility, reliability, and validity) were evaluated. Results A total of 390 elderly filled out the questionnaire, of whom 51% were women and 70% lived in rural areas. 81.3% of elderly were identified as frail. The internal consistency of the GFI scale was high for all subscales (Cronbach’s alpha > 0.70), except the social scale (0.56). The GFI yielded statistically significant scores for subgroup analysis (known-groups validity) as higher levels of frailty were seen in older people, women, those with morbidities, and those reported poor financial status. The construct validity of the scale was supported by the significant correlation with the VES-13 (r = 0.73; p = 0.001), quality of life (r = − 0.22; p = 0.001), and self-reported health status (r = − 0.66; p = 0.001). Conclusion This study supports the feasibility, reliability, and validity of the GFI Arabic version as a screening tool for frailty among community-dwelling elderly in South Lebanon.
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Affiliation(s)
- Rania Khamis
- Institute of Social Science, Lebanese University, Saida, Lebanon
| | - Hala Sabbah
- Faculty of Economic Sciences and Business Administration, Lebanese University, Nabatieh, Lebanon
| | - Sanaa Sabbah
- Institute of Social Science, Lebanese University, Saida, Lebanon.,Doctoral School of Literature, Humanities & Social Sciences, Lebanese University, Beirut, Lebanon
| | - Lilian Peters
- VU University Medical Center Amsterdam, Department of Midwifery Science AVAG, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Nabil Droubi
- Faculty of Public Health, Lebanese University, Saida, Lebanon
| | - Ibtissam Sabbah
- Faculty of Public Health, Lebanese University, Saida, Lebanon.
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Faller JW, Pereira DDN, de Souza S, Nampo FK, Orlandi FDS, Matumoto S. Instruments for the detection of frailty syndrome in older adults: A systematic review. PLoS One 2019; 14:e0216166. [PMID: 31034516 PMCID: PMC6488093 DOI: 10.1371/journal.pone.0216166] [Citation(s) in RCA: 195] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/15/2019] [Indexed: 12/15/2022] Open
Abstract
Frailty is a dynamic process in which there is a reduction in the physical, psychological and/or social function associated with aging. The aim of this study was to identify instruments for the detection of frailty in older adults, characterizing their components, application scenarios, ability to identify pre-frailty and clinimetric properties evaluated. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), under registration number CRD42017039318. A total of 14 electronic sources were searched to identify studies that investigated instruments for the detection of frailty or that presented the construction and/or clinimetric evaluation of the instrument, according to criteria established by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). 96 studies were included in the qualitative synthesis: 51 instruments for the detection of frailty were identified, with predominantly physical domains; 40 were constructed and/or validated for use in the older adult community population, 28 only highlighted the distinction between frail and non-frail individuals and 23 presented three or more levels of frailty. The FRAGIRE, FRAIL Scale, Edmonton Frail Scale and IVCF-20 instruments were the most frequently analyzed in relation to clinimetric properties. It was concluded that: (I) there is a large number of instruments for measuring the same construct, which makes it difficult for researchers and clinicians to choose the most appropriate; (II) the FRAGIRE and CFAI stand out due to their multidimensional aspects, including an environmental assessment; however, (III) the need for standardization of the scales was identified, since the use of different instruments in clinical trials may prevent the comparability of the results in systematic reviews and; (IV) considering the different instruments identified in this review, the choice of researchers/clinicians should be guided by the issues related to the translation and validation for their location and the suitability for their context.
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Affiliation(s)
- Jossiana Wilke Faller
- Department of Maternal and Child Health and Public Health, University of São Paulo, PAHO/WHO Collaborating Center for Nursing Research Development, Ribeirão Preto School of Nursing, Ribeirão Preto, Brazil
- * E-mail:
| | - David do Nascimento Pereira
- Program in Health Promotion and Care in Hospital Care of the Medical School of the University of São Paulo, São Paulo, Brazil
| | - Suzana de Souza
- Latin-American Institute of Life and Natural Sciences, Federal University of Latin-American Integration, Foz do Iguassu, Paraná, Brazil
| | - Fernando Kenji Nampo
- Latin-American Institute of Life and Natural Sciences, Federal University of Latin-American Integration, Foz do Iguassu, Paraná, Brazil
| | - Fabiana de Souza Orlandi
- Department of Gerontology of the Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Silvia Matumoto
- Department of Maternal and Child Health and Public Health, University of São Paulo, PAHO/WHO Collaborating Center for Nursing Research Development, Ribeirão Preto School of Nursing, Ribeirão Preto, Brazil
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Lewis EG, Wood G, Howorth K, Shah B, Mulligan L, Kissima J, Dotchin C, Gray W, Urasa S, Walker R. Prevalence of Frailty in Older Community-Dwelling Tanzanians According to Comprehensive Geriatric Assessment. J Am Geriatr Soc 2018; 66:1484-1490. [DOI: 10.1111/jgs.15433] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/06/2018] [Accepted: 04/10/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Emma G. Lewis
- Institute of Health and Society, Faculty of Medical Sciences; Newcastle University; Newcastle upon Tyne United Kingdom
- Northumbria Healthcare National Health Service Foundation Trust; North Tyneside General Hospital; North Shields United Kingdom
| | - Greta Wood
- Faculty of Medical Sciences; Newcastle University; Newcastle upon Tyne United Kingdom
| | - Kate Howorth
- Northumbria Healthcare National Health Service Foundation Trust; North Tyneside General Hospital; North Shields United Kingdom
| | - Bhavini Shah
- West Middlesex University Hospital; Chelsea and Westminster Hospital National Health Service Foundation Trust; Middlesex United Kingdom
| | - Louise Mulligan
- Fiona Stanley Hospital; South Metropolitan Health Service; Murdoch Western Australia Australia
| | - John Kissima
- Hai District Hospital, Boma Ng'ombe, Hai; Kilimanjaro Tanzania
| | - Catherine Dotchin
- Institute of Health and Society, Faculty of Medical Sciences; Newcastle University; Newcastle upon Tyne United Kingdom
- Northumbria Healthcare National Health Service Foundation Trust; North Tyneside General Hospital; North Shields United Kingdom
| | - William Gray
- Northumbria Healthcare National Health Service Foundation Trust; North Tyneside General Hospital; North Shields United Kingdom
| | - Sarah Urasa
- Kilimanjaro Christian Medical Centre, Moshi; Kilimanjaro Tanzania
| | - Richard Walker
- Institute of Health and Society, Faculty of Medical Sciences; Newcastle University; Newcastle upon Tyne United Kingdom
- Northumbria Healthcare National Health Service Foundation Trust; North Tyneside General Hospital; North Shields United Kingdom
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Frailty in end-stage hip or knee osteoarthritis: validation of the Groningen Frailty Indicator (GFI) questionnaire. Rheumatol Int 2017; 38:917-924. [PMID: 29147763 PMCID: PMC5910491 DOI: 10.1007/s00296-017-3868-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 10/26/2017] [Indexed: 01/25/2023]
Abstract
Frailty is highly prevalent in the elderly, increasing the risk of poor health outcomes. The Groningen Frailty Indicator (GFI) is a 15-item validated questionnaire for the elderly. Its value in patients with end-stage hip or knee osteoarthritis (OA) has not yet been determined. This study assesses the validity of the GFI in this patient group. End-stage hip or knee OA patients completed the GFI (range 0-15, ≥ 4 = frail) before arthroplasty surgery. Convergent validity was determined by Spearman-rank correlation between the SF-12 physical (PCS) and mental (MCS) component scores and the physical and mental GFI-domains, respectively. Discriminant validity was assessed by means of overall GFI-score and the pain-domain of the Hip/Knee Osteoarthritis Outcome Score (HOOS/KOOS). Altogether 3275 patients were included of whom 2957 (90.3%) completed the GFI. Mean GFI-scores were 2.78 (2.41) and 2.28 (1.99) in hip and knee OA-patients, respectively, with 570 (35.9%) of hip and 344 (24.1%) of knee patients considered frail. The convergent validity was moderate to strong (physical domain R = - 0.4, mental domain R = - 0.6) and discriminant validity low (R HOOS/KOOS-pain domain = - 0.2), confirming the validity of the GFI-questionnaire in this population. With 90% of participants completing the GFI, it is a feasible and valid questionnaire to assess frailty in end-stage hip and knee OA-patients. One-third (33.3%) of the patients undergoing hip arthroplasty and a quarter (24.1%) of those undergoing knee arthroplasty are frail. Whether this is associated with worse outcomes and can thus be used as a pre-operative predictor needs to be explored.
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de Rossi Figueiredo D, Paes LG, Warmling AM, Erdmann AL, de Mello ALSF. Multidimensional measures validated for home health needs of older persons: A systematic review. Int J Nurs Stud 2017; 77:130-137. [PMID: 29080438 DOI: 10.1016/j.ijnurstu.2017.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 08/19/2017] [Accepted: 08/23/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To conduct a systematic review of the literature on valid and reliable multidimensional instruments to assess home health needs of older persons. DESIGN Systematic review. DATA SOURCE Electronic databases, PubMed/Medline, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, Scientific Electronic Library Online and the Latin American and Caribbean Health Sciences Information. REVIEW METHODS All English, Portuguese and Spanish literature which included studies of reliability and validity of instruments that assessed at least two dimensions: physical, psychological, social support and functional independence, self-rated health behaviors and contextual environment and if such instruments proposed interventions after evaluation and/or monitoring changes over a period of time. PARTICIPANTS Older persons aged 60 years or older. RESULTS Of the 2397 studies identified, 32 were considered eligible. Two-thirds of the instruments proposed the physical, psychological, social support and functional independence dimensions. Inter-observer and intra-observer reliability and internal consistency values were 0.7 or above. More than two-thirds of the studies included validity (n=26) and more than one validity was tested in 15% (n=4) of these. Only 7% (n=2) proposed interventions after evaluation and/or monitoring changes over a period of time. CONCLUSION Although the multidimensional assessment was performed, and the reliability values of the reviewed studies were satisfactory, different validity tests were not present in several studies. A gap at the instrument conception was observed related to interventions after evaluation and/or monitoring changes over a period of time. Further studies with this purpose are necessary for home health needs of the older persons.
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Affiliation(s)
- Daniela de Rossi Figueiredo
- Post-Graduate Program in Nursing,Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Florianopolis, SC 88040-900, Brazil; Post-Graduate Program in Dentistry, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Florianopolis, SC 88040-900, Brazil.
| | - Lucilene Gama Paes
- Post-Graduate Program in Nursing,Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Florianopolis, SC 88040-900, Brazil
| | - Alessandra Martins Warmling
- Post-Graduate Program in Dentistry, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Florianopolis, SC 88040-900, Brazil
| | - Alacoque Lorenzini Erdmann
- Post-Graduate Program in Nursing,Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Florianopolis, SC 88040-900, Brazil
| | - Ana Lúcia Schaefer Ferreira de Mello
- Post-Graduate Program in Nursing,Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Florianopolis, SC 88040-900, Brazil; Post-Graduate Program in Dentistry, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Florianopolis, SC 88040-900, Brazil
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Gray WK, Richardson J, McGuire J, Dewhurst F, Elder V, Weeks J, Walker RW, Dotchin CL. Frailty Screening in Low- and Middle-Income Countries: A Systematic Review. J Am Geriatr Soc 2016; 64:806-23. [PMID: 27100577 DOI: 10.1111/jgs.14069] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To conduct a systematic review of frailty screening tools used in low- and middle-income countries (LMICs). DESIGN Systematic review. SETTING LMICs, as defined by the World Bank on June 30, 2014. PARTICIPANTS Elderly adults (as defined by the authors) living in LMICs. MEASUREMENTS Studies were included if the population under consideration lived in a LMIC, the study involved an assessment of frailty, the study population was elderly adults, and the full text of the study was available in English. The Medline, Embase, CINAHL and PsychINFO databases were searched up to June 30, 2014. RESULTS Seventy studies with data from 22 LMICs were included in the review. Brazil, Mexico, and China provided data for 60 of the 70 studies (85.7%), and 15 countries contributed data to only one study. Thirty-six studies used the Fried criteria to assess frailty, 20 used a Frailty Index, and eight used the Edmonton Frailty Scale; none of the assessment tools used had been fully validated for use in a LMIC. CONCLUSION There has been a rapid increase in the number of published studies of frailty in LMICs over the last 5 years. Further validation of the assessment tools used to identify frail elderly people in LMICs is needed if they are to be efficient in identifying those most in need of health care in such settings.
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Affiliation(s)
- William K Gray
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Jenny Richardson
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Jackie McGuire
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | | | - Vasanthi Elder
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Julie Weeks
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Richard W Walker
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom.,Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Catherine L Dotchin
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom.,Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom
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Olaroiu M, Ghinescu M, Naumov V, Brinza I, van den Heuvel W. Does Frailty Predict Health Care Utilization in Community-Living Older Romanians? Curr Gerontol Geriatr Res 2016; 2016:6851768. [PMID: 27493663 PMCID: PMC4967440 DOI: 10.1155/2016/6851768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 06/16/2016] [Indexed: 11/17/2022] Open
Abstract
Background. The predictive value of frailty assessment is still debated. We analyzed the predictive value of frailty of independent living elderly. The outcomes variables were visits to the general practitioner, hospital admission, and occurrence of new health problems. Methods. A one-year follow-up study was executed among 215 community-living old Romanians. General practitioners reported the outcome variables of patients, whose frailty was assessed one year before, using the Groningen Frailty Indicator. The predictive validity is analyzed by descriptive and regression analysis. Results. Three-quarters of all participants visited their general practitioner three times more last year and one-third were at least once admitted to a hospital. Patients who scored frail one year before were more often admitted to a hospital. Visits to the general practitioner and occurrence of new health problems were not statistically significant related to frailty scores. The frailty items polypharmacy, social support, and activities in daily living were associated with adverse outcomes. Conclusions. The predictive value of frailty instruments as the Groningen Frailty Indicator is still limited. More research is needed to predict health outcomes, health care utilization, and quality of life of frailty self-assessment instruments. Validation research on frailty in different "environments" is recommended to answer the question to what extent contextual characteristics influence the predictive value.
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Affiliation(s)
- Marinela Olaroiu
- Foundation Research and Advice on Elderly, Heggerweg 2a, 6176 RB Spaubeek, Netherlands
| | - Minerva Ghinescu
- Department of Family Medicine, University Titu Maiorescu, Street Pictor Petraşcu 67A, Sector 3, Bucharest, Romania
| | - Viorica Naumov
- Office General Practitioner, Boulevard Dorobantilor, No. 15, Bloc A14, Braila, Romania
| | - Ileana Brinza
- College of Physicians, Street Scolilor, No. 42, Bloc BPP, Sector 5, Braila, Romania
| | - Wim van den Heuvel
- Research School SHARE, University of Groningen, Heggerweg 2a, 6176 RB Spaubeek, Netherlands
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