1
|
Vo NT, Tu YK, Lin KC, Chiu HY, Huang HC. Diagnostic Accuracy of the FRAIL Scale, Groningen Frailty Indicator, Tilburg Frailty Indicator, and PRISMA-7 for Frailty Screening Among Older Adults in Community Settings: A Systematic Review and Network Meta-Analysis. THE GERONTOLOGIST 2024; 64:gnae008. [PMID: 38332716 DOI: 10.1093/geront/gnae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND AND OBJECTIVES This study aimed to investigate the diagnostic accuracy of four questionnaire-based tools (i.e., the FRAIL scale, Groningen Frailty Indicator [GFI], Tilburg Frailty Indicator [TFI], and PRISMA-7) for screening frailty in older adults. RESEARCH DESIGN AND METHODS The 4 databases comprising the Cumulative Index to Nursing and Allied Health Literature, Embase, PubMed, and ProQuest were searched from inception to June 20, 2023. Study quality comprising risks of bias and applicability was assessed via a QUADAS-2 questionnaire. A bivariate network meta-analysis model and Youden's index were performed to identify the optimal tool and cutoff points. RESULTS In total, 20 studies comprising 13 for FRAIL, 7 for GFI, 6 for TFI, and 5 for PRISMA-7 were included. Regarding study quality appraisal, all studies had high risks of bias for study quality assessment domains. Values of the pooled sensitivity of the FRAIL scale, GFI, TFI, and PRISMA-7 were 0.58, 0.74, 0.66, and 0.73, respectively. Values of the pooled specificity of the FRAIL scale, GFI, TFI, and PRISMA-7 were 0.92, 0.77, 0.84, and 0.86, respectively. The Youden's index was obtained for the FRAIL scale with a cutoff of 2 points (Youden's index = 0.65), indicating that the FRAIL scale with a cutoff of 2 points was the optimal tool for frailty screening in older adults. DISCUSSION AND IMPLICATIONS The FRAIL scale comprising 5 self-assessed items is a suitable tool for interview older adults for early frailty detection in community settings; it has the advantages of being short, simple, and easy to respond to.
Collapse
Affiliation(s)
- Nhi Thi Vo
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, China
- Faculty of Nursing, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan, China
- Department of Dentistry, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan, China
| | - Kuan-Chia Lin
- Institute of Hospital and Health Care Administration, Community Medicine Research Center, Preventive Medicine Research Center, National Yang-Ming University, Taipei, Taiwan, China
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, China
- Department of Nursing, Taipei Medical University Hospital, Taipei City, Taiwan, China
| | - Hui-Chuan Huang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, China
| |
Collapse
|
2
|
Gobbens RJJ, Kuiper S, Dijkshoorn H, van Assen MALM. Associations of individual chronic diseases and multimorbidity with multidimensional frailty. Arch Gerontol Geriatr 2024; 117:105259. [PMID: 37952423 DOI: 10.1016/j.archger.2023.105259] [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: 09/08/2023] [Revised: 10/29/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE To examine the associations between individual chronic diseases and multidimensional frailty comprising physical, psychological, and social frailty. METHODS Dutch individuals (N = 47,768) age ≥ 65 years completed a general health questionnaire sent by the Public Health Services (response rate of 58.5 %), including data concerning self-reported chronic diseases, multidimensional frailty, and sociodemographic characteristics. Multidimensional frailty was assessed with the Tilburg Frailty Indicator (TFI). Total frailty and each frailty domain were regressed onto background characteristics and the six most prevalent chronic diseases: diabetes mellitus, cancer, hypertension, arthrosis, urinary incontinence, and severe back disorder. Multimorbidity was defined as the presence of combinations of these six diseases. RESULTS The six chronic diseases had medium and strong associations with total ((f2 = 0.122) and physical frailty (f2 = 0.170), respectively, and weak associations with psychological (f2 = 0.023) and social frailty (f2 = 0.008). The effects of the six diseases on the frailty variables differed strongly across diseases, with urinary incontinence and severe back disorder impairing frailty most. No synergetic effects were found; the effects of a disease on frailty did not get noteworthy stronger in the presence of another disease. CONCLUSIONS Chronic diseases, in particular urinary incontinence and severe back disorder, were associated with frailty. We thus recommend assigning different weights to individual chronic diseases in a measure of multimorbidity that aims to examine effects of multimorbidity on multidimensional frailty. Because there were no synergetic effects of chronic diseases, the measure does not need to include interactions between diseases.
Collapse
Affiliation(s)
- Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; Zonnehuisgroep Amstelland, Amstelveen, the Netherlands; Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Tranzo, Tilburg University, Tilburg, the Netherlands.
| | - Sandra Kuiper
- Tranzo, Tilburg University, Tilburg, the Netherlands; Department of Research, Public Health Service of West-Brabant, Breda, the Netherlands
| | - Henriëtte Dijkshoorn
- Department of Healthy Living, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Marcel A L M van Assen
- Faculty of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands; Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
3
|
Kim J, Chang H. Can tailored home-delivered meal services alleviate self-rated frailty of the low-income older adults in Korea? Nutr Res Pract 2023; 17:1007-1018. [PMID: 37780217 PMCID: PMC10522816 DOI: 10.4162/nrp.2023.17.5.1007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/05/2023] [Accepted: 05/01/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND/OBJECTIVES This study aimed to examine whether the tailored home-delivered meal (HDM) services included nutrition counseling impacts alleviating self-rated frailty among low-income older adults in Korea. SUBJECTS/METHODS Pre- and post-test were implemented on May 27 and on November 25 in 2019 during 3 weeks, respectively, before and after the 6 months intervention program. Participants completed a questionnaire measuring frailty, malnutrition, food security, depression, and underlying diseases. Initially, 136 older adults were selected as participants for this study, they were recipients of a free meal program from 2 senior welfare centers in Seoul, the final sample size of those who completed the intervention program was 117 (female 70.9%, male 29.1%). Statistical analyses were conducted with IBM SPSS package program, paired t-test and χ2 test to validate the test. RESULTS There were statistically significant differences in the score of the Tilburg Frailty Indicator (TFI) before and after receiving the tailored HDM services (pre-test 9.46, post-test 2.8, P < 0.01). The differences in the score of TFI by 3 risk groups at the pre-test decreased as a result of receiving these services. CONCLUSIONS The tailored HDM services alleviated the self-rated frailty of low-income older adults with limited mobility in a community setting. Based on the positive outcomes this study could be applied to developing social services for aging in place.
Collapse
Affiliation(s)
- Junghyun Kim
- Policy Research Department, Seoul Welfare Foundation, Seoul 04147, Korea
| | - Hyeja Chang
- Department of Food Science and Nutrition, Dankook University, Cheonan 31116, Korea
| |
Collapse
|
4
|
Mazya AL, Boström AM, Bujacz A, Ekdahl AW, Kowalski L, Sandberg M, Gobbens RJJ. Translation and Validation of the Swedish Version of the Tilburg Frailty Indicator. Healthcare (Basel) 2023; 11:2309. [PMID: 37628509 PMCID: PMC10454910 DOI: 10.3390/healthcare11162309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
The Tilburg Frailty Indicator (TFI) is a questionnaire with 15 questions designed for screening for frailty in community-dwelling older people. TFI has a multidimensional approach to frailty, including physical, psychological, and social dimensions. The aim of this study was to translate TFI into Swedish and study its psychometric properties in community-dwelling older people with multimorbidity. A cross-sectional study of individuals 75 years and older, with ≥3 diagnoses of the ICD-10 and ≥3 visits to the Emergency Department in the past 18 months. International guidelines for back-translation were followed. Psychometric properties of the TFI were examined by determining the reliability (inter-item correlations, internal consistency, test-retest) and validity (concurrent, construct, structural). A total of 315 participants (57.8% women) were included, and the mean age was 83.3 years. The reliability coefficient KR-20 was 0.69 for the total sum. A total of 39 individuals were re-tested, and the weighted kappa was 0.7. TFI correlated moderately with other frailty measures. The individual items correlated with alternative measures mostly as expected. In the confirmatory factor analysis (CFA), a three-factor model fitted the data better than a one-factor model. We found evidence for adequate reliability and validity of the Swedish TFI and potential for improvements.
Collapse
Affiliation(s)
- Amelie Lindh Mazya
- Division of Clinical Geriatrics, Department NVS, Karolinska Institutet, 141 83 Huddinge, Sweden
- Department of Geriatric Medicine of Danderyd Hospital, 182 88 Danderyd, Sweden
| | - Anne-Marie Boström
- Theme Inflammation and Aging, Nursing Unit Aging, Karolinska University Hospital, 141 86 Huddinge, Sweden
- Division of Nursing, Department NVS, Karolinska Institutet, 141 83 Huddinge, Sweden
- R&D Unit, Stockholms Sjukhem, 112 19 Stockholm, Sweden
| | - Aleksandra Bujacz
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Anne W. Ekdahl
- Division of Clinical Geriatrics, Department NVS, Karolinska Institutet, 141 83 Huddinge, Sweden
- Department of Clinical Sciences Helsingborg, Lund University, 251 87 Helsingborg, Sweden
| | - Leo Kowalski
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Magnus Sandberg
- Department of Health Sciences, Lund University, 221 00 Lund, Sweden
| | - Robbert J. J. Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, 1081 HV Amsterdam, The Netherlands
- Zonnehuisgroep Amstelland, 1180 HV Amstelveen, The Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium
- Tranzo, Tilburg University, 5037 AB Tilburg, The Netherlands
| |
Collapse
|
5
|
Kasa AS, Drury P, Chang HCR, Lee SC, Traynor V. Cross-Cultural Adaptation, Validity, and Reliability Testing of the Tilburg Frailty Indicator (TFI) Amharic Version for Screening Frailty in Community-Dwelling Ethiopian Older People. Clin Interv Aging 2023; 18:1115-1127. [PMID: 37522070 PMCID: PMC10377638 DOI: 10.2147/cia.s416942] [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: 04/13/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Frailty is a global health problem, including in African countries. Despite this, no reliable or valid frailty instruments incorporate any African language, and no research exists to cross-culturally adapt and test the validity and reliability of instruments commonly used in other countries for use within African countries. The Tilburg Frailty Indicator (TFI) is a reliable and validated instrument with the potential to be relevant for older populations living in Africa. This study aimed to develop the TFI Amharic (TFI-AM) version for use within Ethiopia. METHODS This study employed psychometric testing and the evaluation of a translated and adapted instrument. The original English language version of the TFI was translated and culturally adapted into Amharic using the World Health Organization process of translation and adaptation of an instrument. A convenience sample of ninety-six community-dwelling older people 60 years and over was recruited. Cronbach's alpha was used for the analysis of the internal consistency of the TFI Amharic (TFI-AM) version using IBM SPSS 26.0 (IBM Corp., Armonk, NY, USA). Face and content validities of the TFI-AM were determined. RESULTS The TFI-AM total mean score was 5.76 (±2.89). The internal consistency of the TFI-AM was very good with an overall Cronbach alpha value of 0.82. The physical domain showed the highest reliability with a 0.75 Cronbach's alpha value while the social domain was the lowest with a 0.68 Cronbach's alpha value. The Cronbach's alpha reliability coefficients of the instrument ranged from 0.68 to 0.75. The item content validity index value ranged from 0.83 to 1.0 and the total content validity index average for the instrument was 0.91. CONCLUSION The TFI-AM is reliable, valid, and reproducible for the assessment of frailty among community-dwelling older populations in Ethiopia. TFI-AM proved an easy-to-administer, applicable and fast instrument for assessing frailty in community-dwelling older populations.
Collapse
Affiliation(s)
- Ayele Semachew Kasa
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong (UOW), New South Wales, Australia
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Peta Drury
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong (UOW), New South Wales, Australia
| | - Hui-Chen Rita Chang
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong (UOW), New South Wales, Australia
- School of Nursing and Midwifery, Western Sydney University, Parramatta South Campus, Parramatta, New South Wales, Australia
| | - Shu-Chun Lee
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Victoria Traynor
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong (UOW), New South Wales, Australia
| |
Collapse
|
6
|
Balasch-Bernat M, Sentandreu-Mañó T, Tomás JM, Cebrià I Iranzo MA, Tortosa-Chuliá MA, Arnal-Gómez A, Cezón-Serrano N. Deepening the understanding of the structural validity of the Tilburg Frailty Indicator. Aging Clin Exp Res 2023; 35:1263-1271. [PMID: 37085651 DOI: 10.1007/s40520-023-02407-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/02/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Psychometric properties of the Tilburg Frailty Indicator (TFI) have shown low internal consistency for psychological and social domains, and evidence for its structure validity is controversial. Moreover, research on TFI is frequently limited to community dwellings. AIMS To evaluate structural validity, reliability, and convergent and divergent validity of the Spanish version of the Tilburg Frailty Indicator (TFI) in both community-dwelling and institutionalized older people. MATERIALS AND METHODS A cross-sectional study was conducted on Spanish older adults (n = 457) recruited from both community settings (n = 322) and nursing homes (n = 135). Participants completed the TFI and other frailty instruments: Fried's Frailty Phenotype, Edmonton Frailty Scale, FRAIL Scale, and Kihon Checklist (KCL). Confirmatory Factor Analysis (CFA), and reliability and validity coefficients were estimated. RESULTS AND DISCUSSION Some items from physical and social domains showed low factor loadings (< 0.40). The three-factor CFA model showed better fit indices after depurating these items. Reliability estimates were good (CRI ≥ 0.70) for physical and psychological domains in the institutionalized sample, while in the community dwellings, only physical domain reliability was adequate. Convergent and divergent validity of physical and psychological domains was good, except for some alternative psychological measures highly correlating with the TFI physical component (KCL-depressive mood and Edmonton mood). However, the social domain showed low correlations with some social indicators. CONCLUSION The findings of this study clarify some of the controversial validation results of the TFI structure and provide evidence to improve its use in psychometric terms. CLINICAL TRIAL REGISTRATION NUMBER NCT03832608.
Collapse
Affiliation(s)
- Mercè Balasch-Bernat
- Department of Physiotherapy, University of Valencia, C/Gascó Oliag, 5, 46010, Valencia, Spain
- Physiotherapy in Motion. Multi-Speciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010, Valencia, Spain
| | - Trinidad Sentandreu-Mañó
- Department of Physiotherapy, University of Valencia, C/Gascó Oliag, 5, 46010, Valencia, Spain.
- Advanced Research Methods Applied to Quality of Life Promotion (ARMAQoL), University of Valencia, 46010, Valencia, Spain.
| | - José M Tomás
- Advanced Research Methods Applied to Quality of Life Promotion (ARMAQoL), University of Valencia, 46010, Valencia, Spain
- Department of Methodology for the Behavioral Sciences, University of Valencia, 46010, Valencia, Spain
| | - Maria A Cebrià I Iranzo
- Department of Physiotherapy, University of Valencia, C/Gascó Oliag, 5, 46010, Valencia, Spain
- Physiotherapy in Motion. Multi-Speciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010, Valencia, Spain
- Physical Medicine and Rehabilitation Service, La Fe Hospital in Valencia, La Fe Health Research Institute (IISLAFE), 46026, Valencia, Spain
| | - Maria A Tortosa-Chuliá
- Department of Applied Economics, University of Valencia, 46022, Valencia, Spain
- Public Economic Evaluation Research Group (EVALPUB), Department of Applied Economics, Faculty of Economics, University of Valencia, 46022, Valencia, Spain
| | - Anna Arnal-Gómez
- Department of Physiotherapy, University of Valencia, C/Gascó Oliag, 5, 46010, Valencia, Spain
- Physiotherapy in Motion. Multi-Speciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010, Valencia, Spain
| | - Natalia Cezón-Serrano
- Department of Physiotherapy, University of Valencia, C/Gascó Oliag, 5, 46010, Valencia, Spain
- Physiotherapy in Motion. Multi-Speciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010, Valencia, Spain
| |
Collapse
|
7
|
Mavragani A, Dixe MDA, Gonçalves Pereira S, Meyer-Massetti C, Verloo H. An Intervention Program to Reduce Medication-Related Problems Among Polymedicated Home-Dwelling Older Adults (OptiMed): Protocol for a Pre-Post, Multisite, Pilot, and Feasibility Study. JMIR Res Protoc 2023; 12:e39130. [PMID: 36696165 PMCID: PMC9909524 DOI: 10.2196/39130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 11/20/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Effective medication management is one of the essential preconditions for enabling polymedicated home-dwelling older adults with multiple chronic conditions to remain at home and preserve their quality of life and autonomy. Lack of effective medication management predisposes older adults to medication-related problems (MRPs) and adverse health outcomes, which can lead to the degradation of a patient's acute clinical condition, physical and cognitive decline, exacerbation of chronic medical conditions, and avoidable health care costs. Nonetheless, it has been shown that MRPs can be prevented or reduced by using well-coordinated, patient-centered, interprofessional primary care interventions. OBJECTIVE This study aimed to explore the feasibility and acceptability of an evidence-based, multicomponent, interprofessional intervention program supported by informal caregivers to decrease MRPs among polymedicated home-dwelling older adults with multiple chronic conditions. METHODS This quasi-experimental, pre-post, multisite pilot, and feasibility study will use an open-label design, with participants knowing the study's objectives and relevant information, and it will take place in primary health care settings in Portugal and Switzerland. The research population will comprise 30 polymedicated, home-dwelling adults, aged ≥65 years at risk of MRPs and receiving community-based health care, along with their informal caregivers and health care professionals. RESULTS Before a projected full-scale study, this pilot and feasibility study will focus on recruiting and ensuring the active collaboration of its participants and on the feasibility of expanding this evidence-based, multicomponent, interprofessional intervention program throughout both study regions. This study will also be essential to projected follow-up research programs on informal caregivers' multiple roles, enhancing their coordination tasks and their own needs. Results are expected at the end of 2024. CONCLUSIONS Designing, establishing, and exploring the feasibility and acceptability of an intervention program to reduce the risks of MRPs among home-dwelling older adults is an underinvestigated issue. Doing so in collaboration with all the different actors involved in that population's medication management and recording the first effects of the intervention will make this pilot and feasibility study's findings very valuable as home care becomes an ever more common solution. TRIAL REGISTRATION Swiss National Clinical Trials Portal 000004654; https://tinyurl.com/mr3yz8t4.
Collapse
Affiliation(s)
| | - Maria Dos Anjos Dixe
- Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal
| | | | - Carla Meyer-Massetti
- Institute for Primary Health Care BIHAM, University of Bern, Bern, Switzerland.,Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Henk Verloo
- School of Health Sciences, University of Applied Sciences (HES-SO) Valais/Wallis, Sion, Switzerland.,Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
8
|
Dixe MDA, Pinho J, Pereira F, Verloo H, Meyer-Massetti C, Pereira SG. Patterns of Medication Management and Associated Medical and Clinical Features among Home-Dwelling Older Adults: A Cross-Sectional Study in Central Portugal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1701. [PMID: 36767067 PMCID: PMC9914088 DOI: 10.3390/ijerph20031701] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 06/18/2023]
Abstract
Ageing is frequently associated with multimorbidity and polypharmacy. The present study aimed to identify the current medication management patterns and the profiles of home-dwelling older adults and to find any association with their conditions, including frailty and cognitive impairment. Within the scope of this cross-sectional study, 112 older adults living in the community were assessed via face-to-face structured interviews. Frailty, cognitive status, medication management and clinical and sociodemographic variables were evaluated. Descriptive and inferential statistics were calculated. The mean participant age was 76.6 ± 7.1 years, 53.6% of participants were women, and 40.2% of participants lived alone. More than half were classified as having frailty (58.9%), almost one-fifth (19.6%) presented with a moderate cognitive impairment had more than one disease, and 60.7% were polymedicated. No associations were found between polymedication and medication self-management, the use of over-the-counter medications, living alone, having a poor understanding of pharmacological therapy and/or pathology, or having more than one prescriber. Self-management was associated with age, the number of medications, frailty and cognitive status. Binary logistic regressions showed that cognitive impairment had statistically significant differences with medication management, having a poor understanding of pharmacological therapy and/or pathology, having one prescriber and the use of medications not prescribed by physicians. Interventions to prevent medication-related problems in home-dwelling older adults are recommended.
Collapse
Affiliation(s)
- Maria dos Anjos Dixe
- Center for Innovative Care and Health Technology, Polytechnic of Leiria, 2411-901 Leiria, Portugal
- School of Health Sciences, Polytechnic of Leiria, 2411-901 Leiria, Portugal
| | - Joana Pinho
- Center for Innovative Care and Health Technology, Polytechnic of Leiria, 2411-901 Leiria, Portugal
- School of Health Sciences, Polytechnic of Leiria, 2411-901 Leiria, Portugal
| | - Filipa Pereira
- School of Health Sciences, HES-SO Valais-Wallis, 2800 Sion, Switzerland
- Institute of Biomedical Sciences Abel Salazar, University of Porto, 4099-002 Porto, Portugal
| | - Henk Verloo
- School of Health Sciences, HES-SO Valais-Wallis, 2800 Sion, Switzerland
- Service of Old Age Psychiatry, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacology and Toxicology Unit, General Internal Medicine Clinic, University Hospital of Bern (Inselspital), 3010 Bern, Switzerland
- Institute for Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
| | - Sónia Gonçalves Pereira
- Center for Innovative Care and Health Technology, Polytechnic of Leiria, 2411-901 Leiria, Portugal
| |
Collapse
|
9
|
Faria ADCA, Martins MMFPS, Ribeiro OMPL, Ventura-Silva JMA, Fonseca EF, Ferreira LJM, Laredo-Aguilera JA. Effect of the Active Aging-in-Place-Rehabilitation Nursing Program: A Randomized Controlled Trial. Healthcare (Basel) 2023; 11:276. [PMID: 36673644 PMCID: PMC9859571 DOI: 10.3390/healthcare11020276] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
(1) Background: It is of great importance to promote functional capacity and positive lifestyles, since they contribute to preventing the progression of frailty among the older adults. The aim of this study was to evaluate the effect of active aging-in-place−rehabilitation nursing program (AAP-RNP) on the functional capacity and lifestyles of frail older adults. (2) Methods: This was a single-blinded, two-group, randomized, controlled trial of 30 frail older people enrolled at a Health-care unit in Portugal between 2021 and 2022. The duration of the program was 12 weeks, and the sessions took place at the participants’ homes. We used as instruments the Tilburg Frailty Indicator; Fried frailty phenotype; Senior Fitness Test battery; Barthel Index; Lawton Index; handgrip strength measurement; Tinetti Index; Individual lifestyle profile; and Borg’s perception of effort. (3) Results: Post-program, there was an improvement in multidimensional and physical frailty, functional capacity, balance, and perceived exertion (p < 0.05) in the experimental group. Among the older adults’ lifestyles, we observed significant improvements in physical activity habits, relational behavior, and stress management. (4) Conclusions: Rehabilitation nurses have a relevant role, and the AAP-RNP seems to be effective in improving functional capacity and lifestyles in frail older adults.
Collapse
Affiliation(s)
- Ana da Conceição Alves Faria
- Abel Salazar Biomedical Sciences Institute, University of Porto, 4050-313 Porto, Portugal
- Aces Ave/Famalicão, North Region Health Administration, 4000-447 Porto, Portugal
| | | | | | - João Miguel Almeida Ventura-Silva
- Abel Salazar Biomedical Sciences Institute, University of Porto, 4050-313 Porto, Portugal
- Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
| | | | | | - José Alberto Laredo-Aguilera
- Facultad de Fisioterapia y Enfermería, Campus de Fábrica de Armas, Universidad de Castilla-La Mancha, 45071 Toledo, Spain
- Multidisciplinary Research Group in Care (IMCU), University of Castilla-La Mancha, 45005 Toledo, Spain
| |
Collapse
|
10
|
Gobbens RJJ, Uchmanowicz I. Frailty Viewed From a Nursing Perspective. SAGE Open Nurs 2023; 9:23779608221150598. [PMID: 36636626 PMCID: PMC9829991 DOI: 10.1177/23779608221150598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/18/2022] [Accepted: 12/24/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction More and more researchers are convinced that frailty should refer not only to physical limitations but also to psychological and social limitations that older people may have. Such a broad, or multidimensional, definition of frailty fits better with nursing, in which a holistic view of human beings, and thus their total functioning, is the starting point. Purpose In this article, which should be considered a Practice Update, we aim at emphasizing the importance of the inclusion of other domains of human functioning in the definition and measurement of frailty. In addition, we provide a description of how district nurses view frailty in older people. Finally, we present interventions that nurses can perform to prevent or delay frailty or its adverse outcomes. We present, in particular, results from studies in which the Tilburg Frailty Indicator, a multidimensional frailty instrument, was used. Conclusion The importance of a multidimensional assessment of frailty was demonstrated by usually satisfactory results concerning adverse outcomes of mortality, disability, an increase in healthcare utilization, and lower quality of life. Not many studies have been performed on nurses' opinions about frailty. Starting from a multidimensional definition of frailty, encompassing physical, psychological, and social domains, nurses are able to assess and diagnose frailty and conduct a variety of interventions to prevent or reduce frailty and its adverse effects. Because nurses come into frequent contact with frail older people, we recommend future studies on opinions of nurses about frailty (e.g., screening, prevention, and addressing).
Collapse
Affiliation(s)
- Robbert J. J. Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of
Applied Sciences, Amsterdam, the Netherlands,Zonnehuisgroep Amstelland, Amstelveen, the Netherlands,Department of Family Medicine and Population Health, Faculty of
Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium,Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg
University, Tilburg, the Netherlands,Robbert J. J. Gobbens, Faculty of Health,
Sports and Social Work, Inholland University of Applied Sciences, De Boelelaan
1109, 1081 HV Amsterdam, the Netherlands.
| | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences,
Wroclaw
Medical University, Wroclaw, Poland,Institute of Heart Diseases, University Hospital, Wroclaw,
Poland
| |
Collapse
|
11
|
Faria ADCA, Martins MMFPS, Ribeiro OMPL, Ventura-Silva JMA, Fonseca EF, Ferreira LJM, Teles PJFC, Laredo-Aguilera JA. Multidimensional Frailty and Lifestyles of Community-Dwelling Older Portuguese Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14723. [PMID: 36429441 PMCID: PMC9691079 DOI: 10.3390/ijerph192214723] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Lifestyles are referred to as conditioning factors for the frailty of older adults. However, there are few studies that explore its association. The objective of the present study is to analyze the association between sociodemographic, clinical, and lifestyle factors of older adults people with multidimensional frailty. (2) Methods: Descriptive and correlational study carried out with older adults people registered in a Health Unit in Portugal. Data were collected through a sociodemographic and clinical questionnaire and application of the Individual Lifestyle Profile and Tilburg Frailty Index to assess the lifestyles and multidimensional frailty of older adults, respectively. This last instrument, being of a multidimensional nature, assesses not only physical, but also psychological and social frailty, with a cut-off point of 6. (3) Results: Of the 300 older adults who participated, most were female (60.3%) and had a mean age of 81.34 ± 6.75 years. Moreover, 60.3% of the sample were frail older adults. Gender, marital status, number of household members, number of chronic diseases, number of daily medications, self-perception of health status and lifestyle and use of a walking device were associated with multidimensional frailty (p ≤ 0.001). Healthy eating habits, physical activity, relational behaviour, preventive behaviour, and stress management were significantly associated with lower physical, psychological, and social frailty (p ≤ 0.001). (4) Conclusions: When community health workers are aware of multidimensional frailty predictors and their components, they can intervene early and, consequently, delay the onset and progression of frailty in older adults.
Collapse
Affiliation(s)
- Ana da Conceição Alves Faria
- Abel Salazar Biomedical Sciences Institute, University of Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
- North Region Health Administration, 4000-447 Porto, Portugal
- CINTESIS@RISE, 4050-313 Porto, Portugal
| | | | | | - João Miguel Almeida Ventura-Silva
- Abel Salazar Biomedical Sciences Institute, University of Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
- Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
| | | | | | - Paulo João Figueiredo Cabral Teles
- School of Economics, University of Porto, 4200-465 Porto, Portugal
- Laboratory of Artificial Intelligence and Decision Support—INESC Porto LA, 4200-465 Porto, Portugal
| | - José Alberto Laredo-Aguilera
- Facultad de Fisioterapia y Enfermería, Campus de Fábrica de Armas, Universidad de Castilla-La Mancha, Av de Carlos III, nº 21, 45071 Toledo, Spain
- Multidisciplinary Research Group in Care (IMCU), University of Castilla-La Mancha, 45005 Toledo, Spain
| |
Collapse
|
12
|
Oviedo-Briones M, Rodríguez-Laso Á, Carnicero JA, Gryglewska B, Sinclair AJ, Landi F, Vellas B, Rodríguez Artalejo F, Checa-López M, Rodriguez-Mañas L. The ability of eight frailty instruments to identify adverse outcomes across different settings: the FRAILTOOLS project. J Cachexia Sarcopenia Muscle 2022; 13:1487-1501. [PMID: 35429109 PMCID: PMC9178160 DOI: 10.1002/jcsm.12990] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/04/2022] [Accepted: 03/07/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND To compare the performance of eight frailty instruments to identify relevant adverse outcomes for older people across different settings over a 12 month follow-up. METHODS Observational longitudinal prospective study of people aged 75 + years enrolled in different settings (acute geriatric wards, geriatric clinic, primary care clinics, and nursing homes) across five European cities. Frailty was assessed using the following: Frailty Phenotype, SHARE-FI, 5-item Frailty Trait Scale (FTS-5), 3-item FTS (FTS-3), FRAIL scale, 35-item Frailty Index (FI-35), Gérontopôle Frailty Screening Tool, and Clinical Frailty Scale. Adverse outcomes ascertained at follow-up were as follows: falls, hospitalization, increase in limitation in basic (BADL) and instrumental activities of daily living (IADL), and mortality. Sensitivity, specificity, and capacity to predict adverse outcomes in logistic regressions by each instrument above age, gender, and multimorbidity were calculated. RESULTS A total of 996 individuals were followed (mean age 82.2 SD 5.5 years, 61.3% female). In geriatric wards, the FI-35 (69.1%) and the FTS-5 (67.9%) showed good sensitivity to predict death and good specificity to predict BADL worsening (70.3% and 69.8%, respectively). The FI-35 also showed good sensitivity to predict BADL worsening (74.6%). In nursing homes, the FI-35 and the FTSs predicted mortality and BADL worsening with a sensitivity > 73.9%. In geriatric clinic, the FI-35, the FTS-5, and the FRAIL scale obtained specificities > 85% to predict BADL worsening. No instrument achieved high enough sensitivity nor specificity in primary care. All the instruments predict the risk for all the outcomes in the whole sample after adjusting for age, gender, and multimorbidity. The associations of these instruments that remained significant by setting were for BADL worsening in geriatric wards [FI-35 OR = 5.94 (2.69-13.14), FTS-3 = 3.87 (1.76-8.48)], nursing homes [FI-35 = 4.88 (1.54-15.44), FTS-5 = 3.20 (1.61-6.38), FTS-3 = 2.31 (1.27-4.21), FRAIL scale = 1.91 (1.05-3.48)], and geriatric clinic [FRAIL scale = 4.48 (1.73-11.58), FI-35 = 3.30 (1.55-7.00)]; for IADL worsening in primary care [FTS-5 = 3.99 (1.14-13.89)] and geriatric clinic [FI-35 = 3.42 (1.56-7.49), FRAIL scale = 3.27 (1.21-8.86)]; for hospitalizations in primary care [FI-35 = 3.04 (1.25-7.39)]; and for falls in geriatric clinic [FI-35 = 2.21 (1.01-4.84)]. CONCLUSIONS No single assessment instrument performs the best for all settings and outcomes. While in inpatients several commonly used frailty instruments showed good sensitivities (mainly for mortality and BADL worsening) but usually poor specificities, the contrary happened in geriatric clinic. None of the instruments showed a good performance in primary care. The FI-35 and the FTS-5 showed the best profile among the instruments assessed.
Collapse
Affiliation(s)
- Myriam Oviedo-Briones
- Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Madrid, Spain.,Facultad de Medicina, Universidad de las Américas, Quito, Ecuador
| | - Ángel Rodríguez-Laso
- CIBERFES: CIBER (Centers of the Network of Biomedical Research) thematic area of Frailty and Healthy Ageing, Instituto de Salud Carlos III, Madrid, Spain
| | - José Antonio Carnicero
- Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Madrid, Spain
| | - Barbara Gryglewska
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical Collegium Medicum, Cracow, Poland
| | | | - Francesco Landi
- Hospital Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Bruno Vellas
- Gerontopole, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | | - Marta Checa-López
- Jefe de Servicio de Geriatría, Hospital Universitario de Getafe, Madrid, Spain
| | - Leocadio Rodriguez-Mañas
- CIBERFES: CIBER (Centers of the Network of Biomedical Research) thematic area of Frailty and Healthy Ageing, Instituto de Salud Carlos III, Madrid, Spain.,Jefe de Servicio de Geriatría, Hospital Universitario de Getafe, Madrid, Spain
| |
Collapse
|
13
|
Gil I, Santos-Costa P, Bobrowicz-Campos E, Silva R, de Lurdes Almeida M, Apóstolo J. Effectiveness of Reminiscence Therapy versus Cognitive Stimulation Therapy in Older Adults with Cognitive Decline: A Quasi-Experimental Pilot Study. NURSING REPORTS 2022; 12:339-347. [PMID: 35645359 PMCID: PMC9150000 DOI: 10.3390/nursrep12020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022] Open
Abstract
Cognitive impairment can represent a predecessor to neuro-degenerative processes; however, evidence suggests that non-pharmacologic interventions such as reminiscence therapy (RT) and cognitive stimulation therapy (CST) can potentially stabilize or reverse this trend. Community-based settings are widely regarded as the key area of intervention by healthcare professionals in this field. Thus, this study aimed to assess the effects of an RT and a CST program in the cognition, depressive symptomatology, and quality of life (QoL) of older adults with cognitive decline who attend community support structures (CSS) in central Portugal. A quasi-experimental study with two arms (RT and CST program) was conducted for seven weeks. Participants were allocated to each arm based on the CSS they attended. Of the 109 older adults initially screened, 76 completed the intervention (50 in the RT program and 26 in the CST program). A pre- and post-intervention analysis showed statistically significant differences in older adults’ cognition, especially in their delayed recall ability, in both groups. Older adults in the RT program evidence improved QoL scores post-intervention. Both the RT and CST programs implemented throughout the study are beneficial to older adults’ cognitive performance, although results are more pronounced in the earlier stages of cognitive decline. Participation in the RT program was associated with improvements in older adults’ QoL scores.
Collapse
Affiliation(s)
- Isabel Gil
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3046-851 Coimbra, Portugal; (P.S.-C.); (R.S.); (M.d.L.A.); (J.A.)
- Instituto Ciências da Saúde, Universidade Católica Portuguesa, 4169-005 Porto, Portugal
- Correspondence:
| | - Paulo Santos-Costa
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3046-851 Coimbra, Portugal; (P.S.-C.); (R.S.); (M.d.L.A.); (J.A.)
- Instituto Ciências da Saúde, Universidade Católica Portuguesa, 4169-005 Porto, Portugal
| | | | - Rosa Silva
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3046-851 Coimbra, Portugal; (P.S.-C.); (R.S.); (M.d.L.A.); (J.A.)
| | - Maria de Lurdes Almeida
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3046-851 Coimbra, Portugal; (P.S.-C.); (R.S.); (M.d.L.A.); (J.A.)
| | - João Apóstolo
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3046-851 Coimbra, Portugal; (P.S.-C.); (R.S.); (M.d.L.A.); (J.A.)
| |
Collapse
|
14
|
Zamora-Sánchez JJ, Urpí-Fernández AM, Sastre-Rus M, Lumillo-Gutiérrez I, Gea-Caballero V, Jodar-Fernández L, Julián-Rochina I, Zabaleta-Del-Olmo E. The Tilburg Frailty Indicator: A psychometric systematic review. Ageing Res Rev 2022; 76:101588. [PMID: 35150901 DOI: 10.1016/j.arr.2022.101588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/11/2022] [Accepted: 02/07/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The Tilburg Frailty Indicator (TFI) is one of the most prominent multidimensional frailty assessment instruments. This review aimed to critically appraise and summarise its measurement properties. METHODS Reports were eligible if they included results of studies aimed at developing the TFI or evaluating its measurement properties. We performed a literature search in MEDLINE, CINAHL, and PsycINFO databases from their inception until December 8, 2021. We also searched grey literature databases. We assessed the methodological quality of the included studies using the "COSMIN Risk of Bias". The measurement properties were evaluated using specific criteria. We graded the quality of the evidence using a GRADE approach. RESULTS Sixty-three studies were included. We found moderate sufficient evidence for TFI content validity, although it is still insufficient for the comprehensiveness of its items. TFI construct validity was based on sufficient evidence from two studies of its structural validity as well as multiple hypothesis-testing for construct validity studies with inconsistent results. We did not find any studies that assessed cross-cultural validity. Only one of TFI's three dimensions showed sufficient evidence for the internal consistency of its scores, and results in test-retest reliability were inconsistent. The TFI showed high sufficient concurrent validity with the comprehensive geriatric assessment. We identified several studies assessing its predictive validity for adverse frailty-related outcomes, although most of the evidence from these studies was insufficient. We did not find any studies that assessed the responsiveness of TFI scores. CONCLUSIONS The TFI had evidence gaps in several relevant measurement properties. Further research is needed to strengthen its usefulness as a clinical decision-making tool.
Collapse
Affiliation(s)
- Juan-José Zamora-Sánchez
- Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain; School of Nursing, Universitat de Barcelona, Barcelona, Spain.
| | | | - Meritxell Sastre-Rus
- Escola Universitària d'Infermeria Gimbernat, Universitat Autònoma de Barcelona, Sant Cugat del Vallès, Barcelona, Spain.
| | - Iris Lumillo-Gutiérrez
- School of Nursing, Universitat de Barcelona, Barcelona, Spain; Chronic Disease Management Team, Baix Llobregat Centre Primary Care Service, Costa de Ponent Primary Care Directorate, Gerència Territorial Metropolitana Sud, Institut Català de la Salut, Cornellà de Llobregat, Spain.
| | - Vicente Gea-Caballero
- Deanery, Faculty of Health Sciences, Valencian International University, Valencia, Spain; Nursing School "La Fe", University of Valencia, Valencia, Spain; Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain.
| | - Lina Jodar-Fernández
- Montbaig Primary Care Centre, Delta Primary Care Service, Costa de Ponent Primary Care Directorate, Gerència Territorial Metropolitana Sud, Institut Català de la Salut, Viladecans, Spain.
| | - Iván Julián-Rochina
- Nursing Department, Universitat de València, Valencia, Spain; Frailty and Cognitive Impairment Group (FROG), Universitat de València, Valencia, Spain.
| | - Edurne Zabaleta-Del-Olmo
- Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain; Nursing Department, Faculty of Nursing, Universitat de Girona, Girona, Spain; Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
| |
Collapse
|
15
|
Teixeira-Gomes A, Laffon B, Valdiglesias V, Gostner JM, Felder T, Costa C, Madureira J, Fuchs D, Teixeira JP, Costa S. Exploring Early Detection of Frailty Syndrome in Older Adults: Evaluation of Oxi-Immune Markers, Clinical Parameters and Modifiable Risk Factors. Antioxidants (Basel) 2021; 10:antiox10121975. [PMID: 34943076 PMCID: PMC8750623 DOI: 10.3390/antiox10121975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/22/2021] [Accepted: 12/02/2021] [Indexed: 12/15/2022] Open
Abstract
Ageing is accompanied with a decline in several physiological systems. Frailty is an age-related syndrome correlated to the loss of homeostasis and increased vulnerability to stressors, which is associated with increase in the risk of disability, comorbidity, hospitalisation, and death in older adults. The aim of this study was to understand the relationship between frailty syndrome, immune activation, and oxidative stress. Serum concentrations of vitamins A and E were also evaluated, as well as inflammatory biomarkers (CRP and IL-6) and oxidative DNA levels. A group of Portuguese older adults (≥65 years old) was engaged in this study and classified according to Fried’s frailty phenotype. Significant increases in the inflammatory mediators (CRP and IL-6), neopterin levels, kynurenine to tryptophan ratio (Kyn/Trp), and phenylalanine to tyrosine ratio (Phe/Tyr), and significant decreases in Trp and Tyr concentrations were observed in the presence of frailty. IL-6, neopterin, and Kyn/Trp showed potential as predictable biomarkers of frailty syndrome. Several clinical parameters such as nutrition, dependency scales, and polypharmacy were related to frailty and, consequently, may influence the associations observed. Results obtained show a progressive immune activation and production of pro-inflammatory molecules in the presence of frailty, agreeing with the inflammageing model. Future research should include different dimensions of frailty, including psychological, social, biological, and environmental factors.
Collapse
Affiliation(s)
- Armanda Teixeira-Gomes
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; (A.T.-G.); (C.C.); (J.M.); (S.C.)
- Environmental Health Department, National Institute of Health Doutor Ricardo Jorge, Rua Alexandre Herculano 321, 4000-055 Porto, Portugal
- School of Medicine and Biomedical Sciences (ICBAS), University of Porto, Rua de Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Rua das Taipas 135, 4050-600 Porto, Portugal
| | - Blanca Laffon
- Centro de Investigaciones Científicas Avanzadas (CICA), Grupo DICOMOSA, Departamento de Psicología, Facultad de Ciencias de la Educación, Campus Elviña s/n, Universidade da Coruña, 15071 A Coruña, Spain;
- Instituto de Investigación Biomédica de A Coruña (INIBIC), AE CICA-INIBIC. Oza, 15071 A Coruña, Spain;
| | - Vanessa Valdiglesias
- Instituto de Investigación Biomédica de A Coruña (INIBIC), AE CICA-INIBIC. Oza, 15071 A Coruña, Spain;
- Centro de Investigaciones Científicas Avanzadas (CICA), Grupo NanoToxGen, Departamento de Biología, Facultad de Ciencias, Campus A Zapateira s/n, Universidade da Coruña, 15071 A Coruña, Spain
| | - Johanna M. Gostner
- Institute of Medical Biochemistry, Biocenter, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Thomas Felder
- Department of Laboratory Medicine, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Carla Costa
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; (A.T.-G.); (C.C.); (J.M.); (S.C.)
- Environmental Health Department, National Institute of Health Doutor Ricardo Jorge, Rua Alexandre Herculano 321, 4000-055 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Rua das Taipas 135, 4050-600 Porto, Portugal
| | - Joana Madureira
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; (A.T.-G.); (C.C.); (J.M.); (S.C.)
- Environmental Health Department, National Institute of Health Doutor Ricardo Jorge, Rua Alexandre Herculano 321, 4000-055 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Rua das Taipas 135, 4050-600 Porto, Portugal
| | - Dietmar Fuchs
- Institute of Biological Chemistry, Biocenter, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - João Paulo Teixeira
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; (A.T.-G.); (C.C.); (J.M.); (S.C.)
- Environmental Health Department, National Institute of Health Doutor Ricardo Jorge, Rua Alexandre Herculano 321, 4000-055 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Rua das Taipas 135, 4050-600 Porto, Portugal
- Correspondence: or
| | - Solange Costa
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; (A.T.-G.); (C.C.); (J.M.); (S.C.)
- Environmental Health Department, National Institute of Health Doutor Ricardo Jorge, Rua Alexandre Herculano 321, 4000-055 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Rua das Taipas 135, 4050-600 Porto, Portugal
| |
Collapse
|
16
|
Ozsoy G, Ates Bulut E, Gurpinar B, Ilcin N, Isik AT. Determination of an optimal frailty cut-off score of Tilburg Frailty Indicator and frailty associated factors in community-dwelling Turkish older adults. Ann Geriatr Med Res 2021; 25:294-300. [PMID: 34773934 PMCID: PMC8749031 DOI: 10.4235/agmr.21.0086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/06/2021] [Indexed: 11/01/2022] Open
Abstract
Background Frailty is a multidimensional and dynamic state that has adverse physical, psychological, and social outcomes. The Tilburg Frailty Indicator (TFI) has the most robust evidence of reliability and validity for assessing frailty. However, the characteristics of TFI have not been investigated in detail. This study aimed to set a cut-off score for frailty and evaluate frailty-associated factors in community-dwelling older adults. Methods This cross-sectional study assessed frailty according to both the TFI and Fried criteria. The Geriatric Depression Scale, basic and instrumental activities of daily living, and Hospital Anxiety and Depression Scale-Anxiety subscale were also implemented. Results This study included 166 older adults. The area under the receiver operating characteristic curve was 0.735 (95% confidence interval [CI]: 0.648-0.823). A TFI cut-off point of 8, showed a sensitivity of 60% and specificity of 72.5% for the prediction of frailty (p<0.05). Frailty according to the TFI was more associated with the physical and psychological parameters, while frailty according to the Fried score was more closely related to the physical parameters (p<0.05). Conclusion The results of this study suggested an optimal TFI cut-off score of 8 as a frailty instrument in community-dwelling older adults. Additionally, the TFI included physical, psychological, and social aspects, thereby providing a multidimensional evaluation of frailty.
Collapse
Affiliation(s)
- Gulsah Ozsoy
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Selcuk University, Konya, TR
| | - Esra Ates Bulut
- Department of Geriatric Medicine, Adana City Training and Research Hospital, Adana, TR
| | - Baris Gurpinar
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, TR
| | - Nursen Ilcin
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, TR
| | - Ahmet Turan Isik
- Department of Geriatric Medicine, Dokuz Eylul University, Faculty of Medicine, Izmir, TR
| |
Collapse
|
17
|
Lin CH, Liu CY, Rong JR. Psychometric Properties of the Taiwanese Version of the Tilburg Frailty Indicator for Community-Dwelling Older Adults. Healthcare (Basel) 2021; 9:healthcare9091193. [PMID: 34574967 PMCID: PMC8472410 DOI: 10.3390/healthcare9091193] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022] Open
Abstract
Screening the frailty level of older adults is essential to avoid morbidity, prevent falls and disability, and maintain quality of life. The Tilburg Frailty Indicator (TFI) is a self-report instrument developed to assess frailty for community-dwelling older adults. The aim of this study was to explore the psychometric properties of the Taiwanese version of TFI (TFI-T). The sample consisted of 210 elderly participants living in the community. The scale was implemented to conduct a confirmatory factor analysis (CFA) test for validity. The models were evaluated through sensitivity, specificity, area under the curve, and receiving operating characteristic (ROC) curve. CFA was performed to evaluate construct validity, and the TFI-T has a goodness of fit with the three-factor structure of the TFI. Totally, the 15 items of TFI-T have acceptable internal consistency (Cronbach’s alpha = 0.78), and test–retest reliability (r = 0.88, p < 0.001). The criterion-related validity was examined, the TFI-T correlation with the Kihon Checklist (KCL) score (r = 0.74; p < 0.001). The cutoff of 5.5 based on the Youden index was considered optimal. The area under the ROC curve analysis indicated that the TFI-T has good accuracy in frailty screening. The TFI-T exhibits good reliability and validity and can be used as a sensitive and accurate instrument, which is highly applicable to screen frailty in Taiwan among older adults.
Collapse
Affiliation(s)
- Chia-Hui Lin
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan;
- School of Long-Term Care and Management, Wufeng University, Chiayi 621303, Taiwan
| | - Chieh-Yu Liu
- Biostatistical Consultant Laboratory, Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan;
| | - Jiin-Ru Rong
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan;
- Correspondence: ; Tel.: +886-228-227-101 (ext. 3187)
| |
Collapse
|
18
|
Gobbens RJ, Uchmanowicz I. Assessing Frailty with the Tilburg Frailty Indicator (TFI): A Review of Reliability and Validity. Clin Interv Aging 2021; 16:863-875. [PMID: 34040363 PMCID: PMC8140902 DOI: 10.2147/cia.s298191] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 01/19/2021] [Indexed: 11/23/2022] Open
Abstract
Objective The Tilburg Frailty Instrument (TFI) is an instrument for assessing frailty in community-dwelling older people. Since its development, many studies have been carried out examining the psychometric properties. The aim of this study was to provide a review of the main findings with regard to the reliability and validity of the TFI. Methods We conducted a literature search in the PubMed and CINAHL databases on May 30, 2020. An inclusion criterion was the use of the entire TFI, part B, referring to the 15 components. No restrictions were placed on language or year of publication. Results In total, 27 studies reported about the psychometric properties of the TFI. By far, most of the studies (n = 25) were focused on community-dwelling older people. Many studies showed that the internal consistency and test–retest reliability are good, which also applies for the criterion and construct validity. In many studies, adverse outcomes of interest were disability, increased health-care utilization, lower quality of life, and mortality. Regarding disability, studies predominantly show results that are excellent, with an area under the curve (AUC) >0.80. In addition, the TFI showed good associations with lower quality of life and the findings concerning mortality were at least acceptable. However, the association of the TFI with some indicators of health-care utilization can be indicated as poor (eg, visits to a general practitioner, hospitalization). Conclusion Since population aging is occurring all over the world, it is important that the TFI is available and well known that it is a user-friendly instrument for assessing frailty and its psychometric properties being qualified as good. The findings of this assessment can support health-care professionals in selecting interventions to reduce frailty and delay its adverse outcomes, such as disability and lower quality of life.
Collapse
Affiliation(s)
- Robbert J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, the Netherlands.,Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Izabella Uchmanowicz
- Division of Nursing in Internal Medicine Procedures, Department of Clinical Nursing, The Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| |
Collapse
|
19
|
Gobbens RJJ, van der Ploeg T. The Development of Multidimensional Frailty Over Seven Years A longitudinal study among Dutch community-dwelling older people using the Tilburg Frailty Indicator. Arch Gerontol Geriatr 2021; 95:104393. [PMID: 33752100 DOI: 10.1016/j.archger.2021.104393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To examine the development of multidimensional frailty, including physical, psychological and social components, over a period of seven years. To determine the effects of sociodemographic factors (gender, age, marital status, education, income) on the development of frailty. METHODS This longitudinal study was conducted in sample of 479 community-dwelling people aged ≥ 75 years living in the municipality of Roosendaal, the Netherlands. The Tilburg Frailty Indicator (TFI), a self-report questionnaire, was used to collect data about frailty. Frailty was assessed annually. RESULTS Frailty increased significantly over seven years among the people who completed the entire TFI all years (n = 121), the average score was 3.75 (SD 2.80) at baseline and 5.05 (SD 3.18) after seven years. Regarding frailty transitions, most participants remained unchanged from their baseline status. The transition from non-frail to frail was present in 8.3% to 12.6% of the participants and 5.1% to 10.7% made a transition from frail to non-frail. Gender (woman), age (≥80 years), marital status (not married/cohabiting), high level of education, and incomes from €601-€1800 were significantly associated with a higher frailty score. CONCLUSION This study showed that multidimensional frailty, assessed with the TFI, increased among Dutch community-dwelling people aged ≥75 years using a follow-up of seven years. Gender, age, marital status, education, and income were associated with frailty transitions. These findings provide healthcare professionals clues to identify people at increased risk of frailty, and target interventions which aim to prevent or delay frailty and its adverse outcomes, such as disability and mortality.
Collapse
Affiliation(s)
- Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; Zonnehuisgroep Amstelland, Amstelveen, the Netherlands; Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Tjeerd van der Ploeg
- Engineering, Design and Computer technology, Inholland University of Applied Sciences, Alkmaar, the Netherlands
| |
Collapse
|
20
|
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: 18] [Impact Index Per Article: 6.0] [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.
Collapse
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.
| |
Collapse
|
21
|
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: 9.8] [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.
Collapse
|
22
|
Mazoochi F, Gobbens RJJ, Lotfi MS, Fadayevatan R. Diagnostic accuracy of the Tilburg Frailty Indicator (TFI) for early frailty detection in elderly people in Iran. Arch Gerontol Geriatr 2020; 91:104187. [PMID: 32777633 DOI: 10.1016/j.archger.2020.104187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/16/2020] [Accepted: 07/13/2020] [Indexed: 11/20/2022]
Abstract
AIM Screening is one of the most important ways for early frailty detection that contributes to its prevention and timely treatment. The aim of this study was to determine the diagnostic value of the Persian version of the Tilburg Frailty Indicator (P-TFI) in the frailty screening. METHOD This is a diagnostic test accuracy study that uses known group method. It was designed based on a STARD statement and performed on 175 elderly people in the City of Kashan, Iran. The subjects were selected among older people available in health centers affiliated to Kashan University of Medical Sciences using purposive sampling. Data analysis was carried out using SPSS v16. Descriptive statistics were used to describe the characteristics of the research subjects. Independent t-test was used to determine the ability of the P-TFI to discriminate frail and non-frail individuals, and to evaluate the cut-off point and instrument accuracy, the receiver operating characteristic (ROC) curve was used. The best cut-off point was determined among the proposed points using Youden index. At the determined cut-off point, the diagnostic value parameters of the P-TFI (sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, accuracy, and diagnostic odds ratio) were calculated and their range was estimated with 95 % confidence interval. FINDINGS A total of 74.3 % of the sample was male and their mean age was 68.6 ± 54.44 years. The area under the ROC curve was calculated 0.922, indicating high accuracy of the instrument. The sensitivity and specificity of this instrument at the cut-off point of 4.5 were 0.95 and 0.86, respectively. Positive and negative predictive values were calculated 0.68 and 0.98, respectively, and the accuracy of the instrument was reported to be 0.88. CONCLUSION The P-TFI can be used as a sensitive and accurate instrument, which is highly applicable to screen frailty in older people.
Collapse
Affiliation(s)
- Faezeh Mazoochi
- Iranian Research Center on Ageing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Robbert J J Gobbens
- Rotterdam University of Applied Sciences, Museumpark 40, 3015 CX, Rotterdam, the Netherlands; Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands.; Zonnehuisgroep Amstelland, Amstelveen, the Netherlands.; Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Mohammad-Sajjad Lotfi
- Iranian Research Center on Ageing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Reza Fadayevatan
- Iranian Research Center on Ageing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| |
Collapse
|
23
|
Zhang X, Tan SS, Bilajac L, Alhambra-Borrás T, Garcés-Ferrer J, Verma A, Koppelaar E, Markaki A, Mattace-Raso F, Franse CB, Raat H. Reliability and Validity of the Tilburg Frailty Indicator in 5 European Countries. J Am Med Dir Assoc 2020; 21:772-779.e6. [PMID: 32387112 DOI: 10.1016/j.jamda.2020.03.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To assess the internal consistency, convergent and divergent validity, and concurrent validity of the Tilburg Frailty Indicator (TFI) within community-dwelling older people in Spain, Greece, Croatia, the Netherlands, and the United Kingdom. DESIGN Cross-sectional study. SETTING Primary care and community settings. PARTICIPANTS In total, 2250 community-dwelling older people (60.3% women; mean age = 79.7 years; standard deviation = 5.7). METHODS We assessed the reliability and validity of the full TFI as well as its physical, psychological, and social domains. Baseline data of the Urban Health Centers Europe project were used. The internal consistency was assessed with the Cronbach alpha. The convergent and divergent validity were assessed using Pearson correlation coefficients between the domains and alternative measures: the 12-item short-form, Groningen activity restriction scale, 5-item mental well-being scale of the 36-Item Short Form Survey, and the De Jong Gierveld loneliness scale. The concurrent validity was assessed by the area under the receiver operating characteristic curve with physically frail (Survey of Health, Ageing and Retirement in Europe-Frailty Instrument), loss of independence (Groningen activity restriction scale), limited function (Global Activity Limitation Index), poor mental health (5-item mental well-being scale of the 36-Item Short Form Survey), and feeling lonely (De Jong Gierveld loneliness scale) as criteria. RESULTS The internal consistency of the full TFI was satisfactory with the Cronbach alpha ≥0.70 in the total population and in each country. The internal consistency of the psychological and social domains was not satisfactory. The convergent and divergent validity of the physical, psychological, and social domains was supported by all the alternative measures in the total population and in each country. The concurrent validity of the full TFI and the physical, psychological, and social domains was supported with most area under the receiver operating characteristic curve ≥0.70 in the total population and in each country. CONCLUSIONS AND IMPLICATIONS The TFI is a reliable and valid instrument to assess frailty in community-dwelling older people in Spain, Greece, Croatia, the Netherlands, and the United Kingdom.
Collapse
Affiliation(s)
- Xuxi Zhang
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Siok Swan Tan
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lovorka Bilajac
- University of Rijeka, Faculty of Medicine, Department of Social Medicine and Epidemiology, Rijeka, Croatia
| | | | - Jorge Garcés-Ferrer
- Polibienestar Research Institute - Universitat de València C/Serpis, Valencia, Spain
| | - Arpana Verma
- Manchester Urban Collaboration on Health, Center for Epidemiology, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Elin Koppelaar
- Rotterdam University of Applied Sciences, Research Centre Innovations in Care, Rotterdam, The Netherlands
| | | | - Francesco Mattace-Raso
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Carmen Betsy Franse
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
| |
Collapse
|
24
|
Instruments to measure quality of life in institutionalised older adults: Systematic review. Geriatr Nurs 2020; 41:445-462. [PMID: 32178880 DOI: 10.1016/j.gerinurse.2020.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 01/18/2020] [Accepted: 01/20/2020] [Indexed: 11/24/2022]
Abstract
This study analysed the available instruments intended to measure the quality of life of institutionalised older adults, the psychometric properties of said instruments, and their use. This review was conducted using six international databases. The quality of the psychometric properties was assessed using the COSMIN checklist. Risk of bias was assessed using the QUADAS-2 tool. Twenty-four instruments which measure quality of life were analysed. The instruments assessed are related to two areas, thus establishing two stages of the concept of quality of life in the ageing process. The Dementia Quality of Life (DQoL) scale and the FACIT-Sp Spiritual Well-Being Scale were found to be the instruments with the best combination of length, high methodological quality, and bias control for use in older people with and without cognitive impairment, respectively. Knowing which instruments have higher quality will facilitate the evaluation of the aspects that influence quality of life in geriatric institutions.
Collapse
|
25
|
Gobbens RJ, Boersma P, Uchmanowicz I, Santiago LM. The Tilburg Frailty Indicator (TFI): New Evidence for Its Validity. Clin Interv Aging 2020; 15:265-274. [PMID: 32110005 PMCID: PMC7041595 DOI: 10.2147/cia.s243233] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 01/31/2020] [Indexed: 01/30/2023] Open
Abstract
Objective The Tilburg Frailty Indicator (TFI) is a self-report user-friendly questionnaire for assessing multidimensional frailty among community-dwelling older people. The main aim of this study is to re-evaluate the validity of the TFI, both cross-sectionally and longitudinally, focusing on the predictive value of the total TFI and its physical, psychological, and social domains for adverse outcomes disability, indicators of healthcare utilization, and falls. Methods The validity of the TFI was determined in a sample of 180 Dutch community-dwelling older people aged 70 years and older. The participants completed questionnaires including the TFI, the Groningen Activity Restriction Scale (GARS) for assessing disability, and questions with regard to health care utilization and falls in 2016 and again one year later. Results The physical and psychological domains of the TFI were significantly correlated as expected with adverse outcomes disability, many indicators of healthcare utilization, and falls. Regression analyses showed that physical frailty was mostly responsible for the effect of frailty on the adverse outcomes. The cross-sectional and longitudinal predictive validity of total frailty with respect to disability and receiving personal care was excellent, evidenced by Areas Under the Curves (AUCs) >0.8. In most cases, using the cut-off point 5 for total frailty ensured the best values for sensitivity and specificity. Conclusion The present study provided new, additional evidence for the validity of the TFI for assessing frailty in Dutch community-dwelling older people aiming to prevent or delay adverse outcomes, including disability.
Collapse
Affiliation(s)
- Robbert Jj Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, the Netherlands.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Petra Boersma
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands
| | - Izabella Uchmanowicz
- Division of Nursing in Internal Medicine Procedures, Department of Clinical Nursing, The Faculty of Health Sciences, Wroclaw Medical University, Wrocław, Poland
| | - Livia Maria Santiago
- Faculty of Medicine, Department of Speech and Language Pathology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
26
|
Franse CB, Zhang X, van Grieken A, Rietjens J, Alhambra-Borrás T, Durá E, Garcés-Ferrer J, van Staveren R, Rentoumis T, Markaki A, Bilajac L, Vasiljev Marchesi V, Rukavina T, Verma A, Williams G, Clough G, Koppelaar E, Martijn R, Mattace Raso F, Voorham AJJ, Raat H. A coordinated preventive care approach for healthy ageing in five European cities: A mixed methods study of process evaluation components. J Adv Nurs 2019; 75:3689-3701. [PMID: 31441529 DOI: 10.1111/jan.14181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 07/19/2019] [Accepted: 08/13/2019] [Indexed: 12/14/2022]
Abstract
AIMS To evaluate specific process components of the Urban Health Centres Europe (UHCE) approach; a coordinated preventive care approach aimed at healthy ageing by decreasing falls, polypharmacy, loneliness and frailty among older persons in community settings of five cities in the United Kingdom, Greece, Croatia, the Netherlands and Spain. DESIGN Mixed methods evaluation of specific process components of the UHCE approach: reach of the target population, dose of the intervention actually delivered and received by participants and satisfaction and experience of main stakeholders involved in the approach. METHODS The UHCE approach intervention consisted of a preventive assessment, shared decision-making on a care plan and enrolment in one or more of four coordinated care-pathways that targeted falls, polypharmacy, loneliness and frailty. Quantitative data from a questionnaire and quantitative/qualitative data from logbooks were collected among older persons involved in the approach. Qualitative data from focus groups were collected among older persons, informal caregivers and professionals involved in the approach. Quantitative data were analysed by means of descriptive statistics and multilevel logistic regression models. Qualitative data were analysed through thematic analysis. RESULTS Having limited function was associated with non-enrolment in falls and loneliness care-pathways (both p < .01). The mean rating of the approach was 8.3/10 (SD 1.9). Feeling supported by a care professional and meeting people were main benefits for older persons. Mistrust towards unfamiliar care providers, lack of confidence to engage in care activities and health constraints were main barriers towards engagement in care. CONCLUSIONS Although the UHCE approach was received generally positively, health constraints and psychosocial barriers prevented older person's engagement in care. IMPACT Coordinated preventive care approaches for older community-dwelling persons should address health constraints and psychosocial barriers that hinder older person's engagement in care. TRIAL REGISTRATION ISRCTN registry number is ISRCTN52788952. Date of registration is 13/03/2017.
Collapse
Affiliation(s)
- Carmen B Franse
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Xuxi Zhang
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Amy van Grieken
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Judith Rietjens
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Estrella Durá
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | | | | | | | | | - Lovorka Bilajac
- Faculty of Medicine, Department of Social Medicine and Epidemiology, University of Rijeka, Rijeka, Croatia.,Teaching Institute of Public Health Primorsko-Goranska County, Rijeka, Croatia
| | - Vanja Vasiljev Marchesi
- Faculty of Medicine, Department of Social Medicine and Epidemiology, University of Rijeka, Rijeka, Croatia.,Faculty of Health Studies, Department of Public Health, University of Rijeka, Rijeka, Croatia
| | - Tomislav Rukavina
- Faculty of Medicine, Department of Social Medicine and Epidemiology, University of Rijeka, Rijeka, Croatia.,Teaching Institute of Public Health Primorsko-Goranska County, Rijeka, Croatia
| | - Arpana Verma
- Manchester Urban Collaboration on Health, Centre for Epidemiology, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Greg Williams
- Manchester Urban Collaboration on Health, Centre for Epidemiology, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Gary Clough
- Manchester Urban Collaboration on Health, Centre for Epidemiology, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Elin Koppelaar
- Research Centre Innovation in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Rens Martijn
- Research Centre Innovation in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Francesco Mattace Raso
- Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Antonius J J Voorham
- Research Centre Innovation in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
27
|
Crocker TF, Brown L, Clegg A, Farley K, Franklin M, Simpkins S, Young J. Quality of life is substantially worse for community-dwelling older people living with frailty: systematic review and meta-analysis. Qual Life Res 2019; 28:2041-2056. [PMID: 30875008 PMCID: PMC6620381 DOI: 10.1007/s11136-019-02149-1] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2019] [Indexed: 01/21/2023]
Abstract
PURPOSE Frailty is an important predictor of adverse health events in older people, and improving quality of life (QOL) is increasingly recognised as a focus for services in this population. This systematic review synthesised evidence of the relationship between frailty and QOL in community-dwelling older people, with an emphasis on how this relationship varied across QOL domains. METHODS We conducted a systematic review with meta-analysis. We searched five databases for reports of QOL in older people with frailty and included studies based on pre-defined criteria. We conducted meta-analyses comparing "frail" and "not frail" groups for each QOL scale where data were available. We compared pooled results to distribution-based and known-group differences to enhance interpretation. We summarised reported cross-sectional and longitudinal analyses. RESULTS Twenty-two studies (24,419 participants) were included. There were medium or larger standardised mean differences for 24 of 31 QOL scales between frail and not frail groups, with worse QOL for frail groups. These scales encompassed constructs of health-related quality of life as well as psychological and subjective well-being. There were similar findings from mean difference meta-analyses and within-study analyses. CONCLUSIONS The association between frailty and lower QOL across a range of constructs is clear and often substantial. Future research should establish whether causal mechanisms link the constructs, which aspects of QOL are most important to older people with frailty, and investigate their tractability. Services focused on measuring and improving QOL for older people with frailty should be introduced.
Collapse
Affiliation(s)
- Thomas F Crocker
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Temple Bank House, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK.
| | - Lesley Brown
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Temple Bank House, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Andrew Clegg
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford, BD9 6RJ, UK
| | - Katherine Farley
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9NL, UK
| | - Matthew Franklin
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, S1 4DT, UK
| | - Samantha Simpkins
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
| | - John Young
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford, BD9 6RJ, UK
| |
Collapse
|
28
|
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: 159] [Impact Index Per Article: 31.8] [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.
Collapse
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
| |
Collapse
|
29
|
Abstract
Background Recently frailty has drawn significant interest as an important predictor of several clinically relevant outcomes. There is no widely accepted instrument for the assessment of frailty and most of the current ones evaluate only physical features. The Tilburg Frailty Indicator (TFI) is a valid and reliable instrument which enables multidimensional assessment of frailty. We aimed to adapt and evaluate the Turkish version of the TFI. Methods We translated and culturally adapted the English version of the TFI into Turkish using standard guidelines. We enrolled consecutive patients who were 70 years old or older and were admitted to our outpatient geriatrics clinic. We used Cronbach’s alpha values to evaluate the internal consistency and also assessed inter-observer and test–retest variability using intraclass correlation coefficient (ICC). Results The Cronbach’s alpha reliability coefficients of the instrument ranged from 0.65 to 0.72 and item-total correlation ranged between −0.05 and 0.57. There was a good agreement between two assessments (ICC=0.99) and between two observers (ICC=0.99). Conclusion We have shown the reliability of the Turkish version of the TFI as a tool to evaluate frailty in a multidimensional manner among the Turkish outpatient population.
Collapse
Affiliation(s)
- Yildiray Topcu
- Department of Geriatrics, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey,
| | - Fatih Tufan
- Department of Geriatrics, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey,
| | - Cihan Kilic
- Department of Geriatrics, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey,
| |
Collapse
|
30
|
|
31
|
Op Het Veld LPM, Beurskens AJHM, de Vet HCW, van Kuijk SMJ, Hajema K, Kempen GIJM, van Rossum E. The ability of four frailty screening instruments to predict mortality, hospitalization and dependency in (instrumental) activities of daily living. Eur J Ageing 2019; 16:387-394. [PMID: 31543731 PMCID: PMC6728401 DOI: 10.1007/s10433-019-00502-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to assess the predictive ability of the frailty phenotype (FP), Groningen Frailty Indicator (GFI), Tilburg Frailty Indicator (TFI) and frailty index (FI) for the outcomes mortality, hospitalization and increase in dependency in (instrumental) activities of daily living ((I)ADL) among older persons. This prospective cohort study with 2-year follow-up included 2420 Dutch community-dwelling older people (65+, mean age 76.3 ± 6.6 years, 39.5% male) who were pre-frail or frail according to the FP. Mortality data were obtained from Statistics Netherlands. All other data were self-reported. Area under the receiver operating characteristic curves (AUC) was calculated for each frailty instrument and outcome measure. The prevalence of frailty, sensitivity and specificity were calculated using cutoff values proposed by the developers and cutoff values one above and one below the proposed ones (0.05 for FI). All frailty instruments poorly predicted mortality, hospitalization and (I)ADL dependency (AUCs between 0.62–0.65, 0.59–0.63 and 0.60–0.64, respectively). Prevalence estimates of frailty in this population varied between 22.2% (FP) and 64.8% (TFI). The FP and FI showed higher levels of specificity, whereas sensitivity was higher for the GFI and TFI. Using a different cutoff point considerably changed the prevalence, sensitivity and specificity. In conclusion, the predictive ability of the FP, GFI, TFI and FI was poor for all outcomes in a population of pre-frail and frail community-dwelling older people. The FP and the FI showed higher values of specificity, whereas sensitivity was higher for the GFI and TFI.
Collapse
Affiliation(s)
- Linda P M Op Het Veld
- 1Centre of Research Autonomy and Participation for Persons with a Chronic Illness, Faculty of Health, Zuyd University of Applied Sciences, P.O. Box 550, 6400 AN Heerlen, The Netherlands.,2CAPHRI, Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Anna J H M Beurskens
- 1Centre of Research Autonomy and Participation for Persons with a Chronic Illness, Faculty of Health, Zuyd University of Applied Sciences, P.O. Box 550, 6400 AN Heerlen, The Netherlands.,3CAPHRI, Care and Public Health Research Institute, Department of Family Practice, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Henrica C W de Vet
- 4Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, location VU University, De Boelelaan 1089A, 1081 HV Amsterdam, The Netherlands
| | - Sander M J van Kuijk
- 5Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - KlaasJan Hajema
- Community Health Service South Limburg, Academic Collaborative Centres Public Health (ACC), P.O. Box 33, 6400 AA Heerlen, The Netherlands
| | - Gertrudis I J M Kempen
- 2CAPHRI, Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Erik van Rossum
- 1Centre of Research Autonomy and Participation for Persons with a Chronic Illness, Faculty of Health, Zuyd University of Applied Sciences, P.O. Box 550, 6400 AN Heerlen, The Netherlands.,2CAPHRI, Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| |
Collapse
|
32
|
Lourenço RA, Moreira VG, Banhato EFC, Guedes DV, Silva KCAD, Delgado FEDF, Marmora CHC. Prevalência e fatores associados à fragilidade em uma amostra de idosos que vivem na comunidade da cidade de Juiz de Fora, Minas Gerais, Brasil: estudo FIBRA-JF. CIENCIA & SAUDE COLETIVA 2019; 24:35-44. [DOI: 10.1590/1413-81232018241.29542016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 01/28/2017] [Indexed: 12/31/2022] Open
Abstract
Resumo Fragilidade é um estado de vulnerabilidade fisiológica multissistêmica relacionada à idade e a um risco aumentado de desfechos adversos. O objetivo do presente estudo foi avaliar a prevalência e os fatores associados à fragilidade no estudo FIBRA em Minas Gerais, Brasil. Selecionou-se uma amostra aleatória, estratificada por unidade territorial, sexo e idade, de 461 indivíduos, com 65 anos ou mais. A fragilidade foi estabelecida pela presença de três ou mais de cinco itens: sensação de exaustão, baixa força de preensão manual, velocidade da marcha lenta, perda de peso e baixo gasto calórico. A média de idade foi de 74,4 anos (DP± 6,8), 69,6% eram mulheres e 71,9% brancos. A prevalência de fragilidade foi de 5,2%; 49,9% foram de indivíduos pré-frágeis. Idade avançada (OR: 6,4; IC 1,76-23,8), comprometimento das atividades básicas de vida diária (OR: 5,2; IC 1,1-23,1) e auto percepção de saúde ruim (OR: 0,13; IC 0,03-0,4), foram associados à fragilidade. No presente estudo, um número substancial de indivíduos apresentou-se frágil, enquanto que metade da amostra estava sob risco de progressão para esta condição, sugerindo que é urgente a adoção de medidas de saúde pública com objetivo de prevenção e redução de complicações.
Collapse
|
33
|
Sutton JL, Gould RL, Coulson MC, Ward EV, Butler AM, Smith M, Lavelle G, Rosa A, Langridge M, Howard RJ. Multicomponent Frailty Assessment Tools for Older People with Psychiatric Disorders: A Systematic Review. J Am Geriatr Soc 2018; 67:1085-1095. [PMID: 30589075 DOI: 10.1111/jgs.15710] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To review evidence evaluating the use of multicomponent frailty assessment tools in assessing frailty in older adults with psychiatric disorders. METHODS A systematic literature review was conducted to identify all multicomponent frailty assessment tools (ie, a tool that assesses two or more indicators of frailty). The items of each frailty assessment tool were compared with Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) diagnostic criteria for psychiatric disorders to assess construct overlap. Studies conducted in community, inpatient, and outpatient clinical settings were considered for inclusion. PARTICIPANTS Adults aged 60 years or older. RESULTS A total of 5639 records were identified following the removal of duplicates, from which 95 studies were included for review. Of the 48 multicomponent frailty assessment tools identified, no tool had been developed for, or validated in, older adult populations with a psychiatric disorder. Overall, 20 of 48 frailty assessment tools contained a psychological assessment domain, with 17 of 48 tools citing the presence of depressed mood and/or anxiety as a frailty indicator. Common areas of construct overlap in frailty assessment tools and DSM-5 diagnostic criteria included weight loss (29 of 48) and fatigue (21 of 48). CONCLUSIONS Significant construct overlap exists between the indicators of frailty as conceptualized in existing frailty assessment tools and DSM-5 diagnostic criteria for common psychiatric disorders including major depressive episode and generalized anxiety disorder that has the potential to confound frailty assessment results. Further research is necessary to establish a reliable and valid tool to assess frailty in this population. J Am Geriatr Soc 67:1085-1095, 2019.
Collapse
Affiliation(s)
- Jennifer L Sutton
- King's College London, Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Rebecca L Gould
- King's College London, Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,Division of Psychiatry, University College London, London, UK
| | - Mark C Coulson
- Department of Psychology, Faculty of Science and Technology, Middlesex University, London, UK
| | - Emma V Ward
- Department of Psychology, Faculty of Science and Technology, Middlesex University, London, UK
| | | | - Megan Smith
- Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Grace Lavelle
- King's College London, Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Amy Rosa
- Division of Psychiatry, University College London, London, UK
| | - Margaret Langridge
- Mental Health of Older Adults and Dementia Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert J Howard
- King's College London, Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,Division of Psychiatry, University College London, London, UK
| |
Collapse
|
34
|
Santiago LM, Gobbens RJJ, Mattos IE, Ferreira DB. A comparison between physical and biopsychosocial measures of frailty: Prevalence and associated factors in Brazilian older adults. Arch Gerontol Geriatr 2018; 81:111-118. [PMID: 30553181 DOI: 10.1016/j.archger.2018.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/05/2018] [Accepted: 12/05/2018] [Indexed: 01/10/2023]
Abstract
PURPOSE To estimate the prevalence of frailty, according to Tilburg Frailty Indicator (TFI) and CHS index, to investigate the correlation between both instruments and to identify the factors associated with this condition in older users of primary health care. METHODS This is a sectional study with 302 individuals aged 60 years or more of Rio de Janeiro/Brazil. Sociodemographic, health, functional dependence and lifestyle variables were collected. Frailty was evaluated by the TFI (biopsychosocial frailty) and the CHS index (physical frailty). RESULTS The prevalence of frailty estimated by the TFI was 35.8% and by the CHS index was 23.5%, while 19.2% were considered frail by both instruments. Significant correlations were observed between the two measures (r = 0.675, p < 0.001) and between the CHS index and the physical (r = 0.744, p < 0.001) and psychological domains (r = 0.322, p < 0.001) of the TFI. Considering the TFI, sex, age, healthy lifestyle, osteoarticular diseases, stroke/ischemia and functional dependence in IADL were associated with frailty. By the CHS index, marital status, satisfaction with housing environment, osteoarticular diseases, medication, functional dependence in ADL and IADL were associated with frailty. CONCLUSION Our study demonstrates that the CHS index and the TFI identify different groups of frail older adults, and the factors associated with physical frailty and biopsychosocial frailty, also differ. Both instruments seem suitable to be used by primary health care professionals in Brazil. Nevertheless, we believe that a fully self-rated assessment is more practical to be applied routinely in this level of attention in the country.
Collapse
Affiliation(s)
- Lívia Maria Santiago
- Federal University of Rio de Janeiro, Faculty of Medicine, Rua Rodolpho Paulo Rocco, 255/ room 9E11, Cidade Universitária, 21941- 913, Rio de Janeiro, RJ, Brazil; National School of Public Health/Oswaldo Cruz Foundation, Department of Epidemiology and Quantitative Methods, Rua Leopoldo Bulhões, 1480/room 817b, Manguinhos, 21041-210 Rio de Janeiro, RJ, Brazil.
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, De Boelelaan1109, 1081 HV, Amsterdam, the Netherlands; Zonnehuisgroep Amstelland, Groenelaan 7, 1186 AA, Amstelveen, the Netherlands; Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Inês Echenique Mattos
- National School of Public Health/Oswaldo Cruz Foundation, Department of Epidemiology and Quantitative Methods, Rua Leopoldo Bulhões, 1480/room 817b, Manguinhos, 21041-210 Rio de Janeiro, RJ, Brazil.
| | - Daniele Bittencourt Ferreira
- National School of Public Health/Oswaldo Cruz Foundation, Department of Epidemiology and Quantitative Methods, Rua Leopoldo Bulhões, 1480/room 817b, Manguinhos, 21041-210 Rio de Janeiro, RJ, Brazil.
| |
Collapse
|
35
|
Vrotsou K, Machón M, Rivas-Ruíz F, Carrasco E, Contreras-Fernández E, Mateo-Abad M, Güell C, Vergara I. Psychometric properties of the Tilburg Frailty Indicator in older Spanish people. Arch Gerontol Geriatr 2018; 78:203-212. [PMID: 30007234 DOI: 10.1016/j.archger.2018.05.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/29/2018] [Accepted: 05/31/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND The Tilburg Frailty Indicator (TFI) is a 15-item scale. It diagnoses frailty in the elderly based on three domains: physical, psychological and social. A Spanish cross-cultural adaptation and its psychometric properties are presented here. MATERIALS AND METHODS Independent, non-institutionalized ≥70 year-olds were recruited. The TFI structure was assessed with Kuder-Richardson (KR-20) and confirmatory factor analyses. Sperman´s correlations (rs) with Timed Up-and-Go, Self-assessed-health, Fried criteria, Short Physical Performance Battery, Gerontopole Frailty tool, assessed convergent validity. Known groups' validity and test-retest reliability were tested. RESULTS Based on n = 856 participants, domain and total scale KR-20 were <0.70. The social domain and certain physical items did not fit adequately. Most physical and total scalers were 0.31-0.48. Social domain rs were <0.30. The TFI differentiated frail and no-frail subjects, but test-retest variation was considerable. DISCUSSION TFI applicability at different social contexts and frailty stages are worth of additional study. Certain scale aspects should be reconsidered.
Collapse
Affiliation(s)
- Kalliopi Vrotsou
- Unidad de Investigación de Atención Primaria-OSIS Gipuzkoa, Osakidetza, Instituto de Investigación Sanitaria Biodonostia, San Sebastián, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain; Centro de Investigación en Cronicidad Kronikgune, Barakaldo, Spain.
| | - Mónica Machón
- Unidad de Investigación de Atención Primaria-OSIS Gipuzkoa, Osakidetza, Instituto de Investigación Sanitaria Biodonostia, San Sebastián, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain; Centro de Investigación en Cronicidad Kronikgune, Barakaldo, Spain.
| | - Francisco Rivas-Ruíz
- Unidad de Investigación, Hospital Costa del Sol, Marbella, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain.
| | - Estefanía Carrasco
- Grupo de Oncología Celular, Instituto de Investigación Sanitaria Biodonostia, San Sebastián, Spain; CIBER de Fragilidad y Envejecimiento Saludable (CIBERfes), Spain.
| | - Eugenio Contreras-Fernández
- Unidad Gestión Clínica de Prevención, Promoción y Vigilancia de la Salud, Distrito Sanitario Costa del Sol, Servicio Andaluz de Salud, Mijas, Málaga, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain.
| | - Maider Mateo-Abad
- Unidad de Investigación de Atención Primaria-OSIS Gipuzkoa, Osakidetza, Instituto de Investigación Sanitaria Biodonostia, San Sebastián, Spain; Centro de Investigación en Cronicidad Kronikgune, Barakaldo, Spain.
| | - Carolina Güell
- Unidad de Investigación de Atención Primaria-OSIS Gipuzkoa, Osakidetza, Instituto de Investigación Sanitaria Biodonostia, San Sebastián, Spain; Centro de Salud de Alza, OSI Donostialdea, Osakidetza, San Sebastián, Spain.
| | - Itziar Vergara
- Unidad de Investigación de Atención Primaria-OSIS Gipuzkoa, Osakidetza, Instituto de Investigación Sanitaria Biodonostia, San Sebastián, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain; Centro de Investigación en Cronicidad Kronikgune, Barakaldo, Spain.
| |
Collapse
|
36
|
Frailty syndrome and rehospitalizations in elderly heart failure patients. Aging Clin Exp Res 2018; 30:617-623. [PMID: 28849550 PMCID: PMC5968054 DOI: 10.1007/s40520-017-0824-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/11/2017] [Indexed: 11/04/2022]
Abstract
Background Heart failure (HF) patients with frailty syndrome (FS) are at higher risk of falling, decreased mobility, ability to perform the basic activities of daily living, frequent hospitalizations, and death. Aims The purpose of this study was to evaluate the correlations between FS and hospital readmissions, and to assess which factors are associated with rehospitalizations. Methods The study included 330 patients with a mean age of 72.1 ± 7.9 years, diagnosed with HF. Frailty was measured using the Polish version of the Tilburg Frailty Indicator (TFI). Demographic, sociodemographic, and clinical data, such as the New York Heart Association (NYHA) functional class, ejection fraction (EF), number of rehospitalizations, and the medications taken, were obtained. Results Positive correlation was observed between the number of hospitalizations and FS. In the single-factor correlation analysis, treatment with diuretics, a higher NYHA class, and a lower left ventricular EF were predictors of a higher number of hospitalizations. Additionally, the physical and psychological components of the TFI, as well as the total TFI score, predisposed HF patients to more frequent hospitalizations. Discussion It seems that a deterioration of functional capabilities and an increase in symptom severity naturally lead to increased hospitalization frequency in HF. In the own study, regression analysis indicates that high NYHA classes and TFI social component scores are significant predictors of the number of hospitalizations in the studied group. Conclusions FS is highly prevalent among elderly HF patients. Higher frailty levels in elderly patients are a determinant of more frequent rehospitalizations in HF.
Collapse
|
37
|
Coelho T, Paúl C, Gobbens RJJ, Fernandes L. Multidimensional Frailty and Pain in Community Dwelling Elderly. PAIN MEDICINE 2018; 18:693-701. [PMID: 25800906 DOI: 10.1111/pme.12746] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective To examine the relationship between frailty and pain, particularly to analyze whether pain predicts physical, psychological and social frailty, after controlling for the effects of life-course determinants and comorbidity. Design Cross-sectional. Methods A nonprobabilistic sample of 252 community dwelling elderly was recruited. Frailty and determinants of frailty were assessed with the Tilburg Frailty Indicator and pain was measured with the Pain Impact Questionnaire. Hierarchical and logistic regression analyses were conducted. Results In this study, 52.4% of the participants were aged 80 years and over, and 75.8% were women. Pain and frailty were higher in women, and physical frailty was higher in those aged ≥80 years. After controlling for the effects of the determinants and comorbidity, pain predicted 5.8% of the variance of frailty, 5.9% of the variance of physical frailty, and 4.0% of the variance of psychological frailty, while the prediction of social frailty was nonsignificant. Overall, a greater pain impact score was associated with the presence of frailty (odds ratio 1.06; 95% CI 1.03–1.10; P < 0.001). Conclusion Frailty was independently predicted by pain, emphasizing the importance of its treatment, potentially contributing to the prevention of vulnerability, dependency, and mortality. Nonetheless, longitudinal studies are required to better understand the possible association between pain and frailty.
Collapse
Affiliation(s)
- Tiago Coelho
- Department of Occupational Therapy, School of Allied Health Technologies, Polytechnic Institute of Porto, Vila Nova de Gaia, Portugal.,Department of Behaviour Sciences, UNIFAI/ICBAS, University of Porto, Porto, Portugal
| | - Constança Paúl
- Department of Behaviour Sciences, UNIFAI/ICBAS, University of Porto, Porto, Portugal
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, The Netherlands
| | - Lia Fernandes
- Department of Clinical Neurosciences and Mental HealthCenter for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
38
|
Park MS, Kang KJ, Jang SJ, Lee JY, Chang SJ. Evaluating test-retest reliability in patient-reported outcome measures for older people: A systematic review. Int J Nurs Stud 2018; 79:58-69. [DOI: 10.1016/j.ijnurstu.2017.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/07/2017] [Accepted: 11/07/2017] [Indexed: 12/24/2022]
|
39
|
Gobbens RJ, Schols JM, van Assen MA. Exploring the efficiency of the Tilburg Frailty Indicator: a review. Clin Interv Aging 2017; 12:1739-1752. [PMID: 29089748 PMCID: PMC5656351 DOI: 10.2147/cia.s130686] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Due to rapidly aging human populations, frailty has become an essential concept, as it identifies older people who have higher risk of adverse outcomes, such as disability, institutionalization, lower quality of life, and premature death. The Tilburg Frailty Indicator (TFI) is a user-friendly questionnaire based on a multidimensional approach to frailty, assessing physical, psychologic, and social aspects of human functioning. This review aims to explore the efficiency of the TFI in assessing frailty as a means to carry out research into the antecedents and consequences of frailty, and its use both in daily practice and for future intervention studies. Using a multidimensional approach to frailty, in contexts where health care professionals or researchers may have no time to interview or examine the client, we recommend employing the TFI because there is robust evidence of its reliability and validity and it is easy and quick to administer. More studies are needed to establish whether the TFI is suitable for intervention studies not only in the community, but also for specific groups such as patients in the hospital or admitted to an emergency department. We conclude that it is important to not only determine the deficits that frail older people may have, but also to assess their balancing strengths and resources. In order to be able to meet the individual needs of frail older persons, traditional and often fragmented elderly care should be developed toward a more proactive elderly care, in which frail older persons and their informal network are in charge.
Collapse
Affiliation(s)
- Robbert Jj Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, the Netherlands.,Department of General Practice, University of Antwerp, Antwerp, Belgium
| | - Jos Mga Schols
- Department of Health Services Research and Department of Family Medicine, CAPHRI-Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Marcel Alm van Assen
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands.,Department of Sociology, Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
40
|
Dong L, Liu N, Tian X, Qiao X, Gobbens RJJ, Kane RL, Wang C. Reliability and validity of the Tilburg Frailty Indicator (TFI) among Chinese community-dwelling older people. Arch Gerontol Geriatr 2017; 73:21-28. [PMID: 28734173 DOI: 10.1016/j.archger.2017.07.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 06/17/2017] [Accepted: 07/01/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To translate the Tilburg Frailty Indicator (TFI) into Chinese and assess its reliability and validity. METHODS A sample of 917 community-dwelling older people, aged ≥60 years, in a Chinese city was included between August 2015 and March 2016. Construct validity was assessed using alternative measures corresponding to the TFI items, including self-rated health status (SRH), unintentional weight loss, walking speed, timed-up-and-go tests (TUGT), making telephone calls, grip strength, exhaustion, Short Portable Mental Status Questionnaire (SPMSQ), Geriatric Depression scale (GDS-15), emotional role, Adaptability Partnership Growth Affection and Resolve scale (APGAR) and Social Support Rating Scale (SSRS). Fried's phenotype and frailty index were measured to evaluate criterion validity. Adverse health outcomes (ADL and IADL disability, healthcare utilization, GDS-15, SSRS) were used to assess predictive (concurrent) validity. RESULTS The internal consistency reliability was good (Cronbach's α=0.71). The test-retest reliability was strong (r=0.88). Kappa coefficients showed agreements between the TFI items and corresponding alternative measures. Alternative measures correlated as expected with the three domains of TFI, with an exclusion that alternative psychological measures had similar correlations with psychological and physical domains of the TFI. The Chinese TFI had excellent criterion validity with the AUCs regarding physical phenotype and frailty index of 0.87 and 0.86, respectively. The predictive (concurrent) validities of the adverse health outcomes and healthcare utilization were acceptable (AUCs: 0.65-0.83). CONCLUSIONS The Chinese TFI has good validity and reliability as an integral instrument to measure frailty of older people living in the community in China.
Collapse
Affiliation(s)
- Lijuan Dong
- School of Nursing, Shandong University, 250012 Jinan, China
| | - Na Liu
- School of Nursing, Shandong University, 250012 Jinan, China
| | - Xiaoyu Tian
- School of Nursing, Shandong University, 250012 Jinan, China
| | - Xiaoxia Qiao
- School of Nursing, Shandong University, 250012 Jinan, China
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, De Boelelaan 1109, 1081 HV Amsterdam, The Netherlands; Zonnehuisgroep Amstelland, Amstelveen, The Netherlands
| | - Robert L Kane
- School of Public Health, University of Minnesota, 55455, USA
| | - Cuili Wang
- School of Nursing, Shandong University, 250012 Jinan, China.
| |
Collapse
|
41
|
Rosas-Carrasco O, Cruz-Arenas E, Parra-Rodríguez L, García-González AI, Contreras-González LH, Szlejf C. Cross-Cultural Adaptation and Validation of the FRAIL Scale to Assess Frailty in Mexican Adults. J Am Med Dir Assoc 2016; 17:1094-1098. [PMID: 27567463 DOI: 10.1016/j.jamda.2016.07.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/07/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The objectives of this study were to cross-culturally adapt and validate the FRAIL scale in Mexican community-dwelling adults. DESIGN Cross-sectional analysis of a prospective cohort. SETTING The FraDysMex study, a 2-round evaluation of community-dwelling adults from 2 municipalities in Mexico City. PARTICIPANTS Participants were 606 men and women living in the designated area in Mexico City. MEASUREMENTS Interviewers obtained data regarding demographics, comorbidities, mental status, nutritional status, dependency in activities of daily living, quality of life, mobility, balance, and strength. The FRAIL scale translated to Spanish and the Fried criteria were applied to screen frailty. RESULTS The Mexican Spanish version of the FRAIL scale showed internal consistency (4 of 5 items in the scale correlated to the scale's total score, rho = 0.41-0.74), external consistency (interrater correlation CCI = 0.82), known-group validity based on age (9.6% of frailty in persons ≥50 years × 3.2% in persons <50 years, P = .001), convergent validity with the Fried criteria (CCI = 0.63), and the scale was also correlated with other measures related to frailty (such as age, quality of life, self-rated health status, cognition, dependency, nutritional status, depression, and physical performance). CONCLUSION The FRAIL scale was successfully adapted to Mexican Spanish and validated in community-dwelling Mexican adults.
Collapse
|
42
|
van Assen MALM, Pallast E, Fakiri FE, Gobbens RJJ. Measuring frailty in Dutch community-dwelling older people: Reference values of the Tilburg Frailty Indicator (TFI). Arch Gerontol Geriatr 2016; 67:120-9. [PMID: 27498172 DOI: 10.1016/j.archger.2016.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 07/19/2016] [Accepted: 07/20/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The objectives of this study were to provide reference values of the Tilburg Frailty Indicator (TFI) for community-dwelling older people by age, sex, marital status, ethnicity, education, income, and residence, and examine the effects of these seven socio-demographic variables on frailty. METHODS 47,768 individuals aged 65 years and older living in the Netherlands completed a health questionnaire (58.5% response rate), including the TFI. The TFI is a self-report questionnaire for measuring frailty, developed from an integral approach of frailty, including physical, psychological, and social domains. RESULTS Reference values were provided for men and women separately, as a function of age. We found associations of all socio-demographic variables with frailty, also after controlling for the effects of age. These associations held for both sexes and for big cities as wells as more rural areas. For instance, the effect of age was large for total and physical frailty, women were more frail than men, and some very large average frailty differences between the ethnic groups were found, with autochthon people having the lowest frailty score. CONCLUSIONS In conclusion, this study offers reference values of the TFI by socio-demographic characteristics and explains frailty using these characteristics. This information will support researchers, policymakers and health care professionals in interpreting scores of the TFI, which may guide their efforts to reduce frailty and its adverse outcomes.
Collapse
Affiliation(s)
- Marcel A L M van Assen
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands; Department of Sociology, Utrecht University, Utrecht, The Netherlands
| | - Esther Pallast
- Department of Health Promotion, Regional Public Health Service, Hart voor Brabant, 's-Hertogenbosch, The Netherlands
| | - Fatima El Fakiri
- Department of Epidemiology and Health Promotion, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands; Zonnehuisgroep Amstelland, Amstelveen, The Netherlands.
| |
Collapse
|
43
|
Roppolo M, Mulasso A, Gobbens RJ, Mosso CO, Rabaglietti E. A comparison between uni- and multidimensional frailty measures: prevalence, functional status, and relationships with disability. Clin Interv Aging 2015; 10:1669-78. [PMID: 26543356 PMCID: PMC4622490 DOI: 10.2147/cia.s92328] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Over the years, a plethora of frailty assessment tools has been developed. These instruments can be basically grouped into two types of conceptualizations – unidimensional, based on the physical–biological dimension – and multidimensional, based on the connections among the physical, psychological, and social domains. At present, studies on the comparison between uni- and multidimensional frailty measures are limited. Objective The aims of this paper were: 1) to compare the prevalence of frailty obtained using a uni- and a multidimensional measure; 2) to analyze differences in the functional status among individuals captured as frail or robust by the two measures; and 3) to investigate relations between the two frailty measures and disability. Methods Two hundred and sixty-seven community-dwelling older adults (73.4±6 years old, 59.9% of women) participated in this cross-sectional study. The Cardiovascular Health Study (CHS) index and the Tilburg Frailty Indicator (TFI) were used to measure frailty in a uni- and multidimensional way, respectively. The International Physical Activity Questionnaire, the Center of Epidemiologic Studies Depression scale, and the Loneliness Scale were administered to evaluate the functional status. Disability was assessed using the Groningen Activity Restriction Scale. Data were treated with descriptive statistics, one-way analysis of variance, correlations, and receiver operating characteristic analyses through the evaluation of the areas under the curve. Results Results showed that frailty prevalence rate is strictly dependent on the index used (CHS =12.7%; TFI =44.6%). Furthermore, frail individuals presented differences in terms of functional status in all the domains. Frailty measures were significantly correlated with each other (r=0.483), and with disability (CHS: r=0.423; TFI: r=0.475). Finally, the area under the curve of the TFI (0.833) for disability was higher with respect to the one of CHS (0.770). Conclusion Data reported here confirm that different instruments capture different frail individuals. Clinicians and researchers have to consider the different abilities of the two measures to detect frail individuals.
Collapse
Affiliation(s)
- Mattia Roppolo
- Department of Psychology, University of Torino, Torino, Italy ; Department of Developmental Psychology, Rijksuniversiteit Groningen, Groningen, the Netherlands
| | - Anna Mulasso
- Department of Psychology, University of Torino, Torino, Italy
| | - Robbert J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands ; Zonnehuisgroep Amstelland, Amstelveen, the Netherlands
| | | | | |
Collapse
|
44
|
Mulasso A, Roppolo M, Gobbens RJJ, Rabaglietti E. The Italian Version of the Tilburg Frailty Indicator: Analysis of Psychometric Properties. Res Aging 2015; 38:842-63. [PMID: 26377805 DOI: 10.1177/0164027515606192] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aims to assess the reliability, construct validity (convergent/divergent), and criterion validity of the Italian version of the Tilburg Frailty Indicator (TFI). The TFI is a self-report questionnaire for screening frailty in older adults. Two hundred and sixty-seven community-dwelling older adults were involved. Psychometric properties were analyzed using validated instruments. Adverse outcomes such as disability, falls, and visits to a general practitioner were detected. Participants were mainly women (59.9%), with a mean age of 73.4 years (SD = 6.0). Internal consistency reliability was acceptable. Construct validity was good, since each item of the TFI correlated as expected with corresponding frailty measures. Convergent and divergent validity were adequate for all the domains of the TFI. Criterion validity was excellent for disability and mediocre for the other two outcomes. This study supports the validity of the Italian TFI and offers to clinicians and scientists a multidimensional instrument for identifying frail individuals in the Italian context.
Collapse
Affiliation(s)
- Anna Mulasso
- Department of Psychology, University of Torino, Torino, Italy
| | - Mattia Roppolo
- Department of Psychology, University of Torino, Torino, Italy Department of Developmental Psychology, Rijksuniversiteit Groningen, Groningen, The Netherlands
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands Zonnehuisgroep Amstelland, Laan van de Helende Meesters 114, Amstelveen, The Netherlands
| | | |
Collapse
|
45
|
Coelho T, Paúl C, Gobbens RJJ, Fernandes L. Frailty as a predictor of short-term adverse outcomes. PeerJ 2015; 3:e1121. [PMID: 26246968 PMCID: PMC4525687 DOI: 10.7717/peerj.1121] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 07/03/2015] [Indexed: 01/10/2023] Open
Abstract
The objectives of this study were to compare how different frailty measures (Frailty Phenotype/FP, Groningen Frailty Indicator/GFI and Tilburg Frailty Indicator/TFI) predict short-term adverse outcomes. Secondarily, adopting a multidimensional approach to frailty (integral conceptual model–TFI), this study aims to compare how physical, psychological and social frailty predict the outcomes. A longitudinal study was carried out with 95 community-dwelling elderly. Participants were assessed at baseline for frailty, determinants of frailty, and adverse outcomes (healthcare utilization, quality of life, disability in basic and instrumental activities of daily living/ADL and IADL). Ten months later the outcomes were assessed again. Frailty was associated with specific healthcare utilization indicators: the FP with a greater utilization of informal care; GFI with an increased contact with healthcare professionals; and TFI with a higher amount of contacts with a general practitioner. After controlling for the effect of life-course determinants, comorbidity and adverse outcome at baseline, GFI predicted IADL disability and TFI predicted quality of life. The effect of the FP on the outcomes was not significant, when compared with the other measures. However, when comparing TFI’s domains, the physical domain was the most significant predictor of the outcomes, even explaining part of the variance of ADL disability. Frailty at baseline was associated with adverse outcomes at follow-up. However, the relationship of each frailty measure (FP, GFI and TFI) with the outcomes was different. In spite of the role of psychological frailty, TFI’s physical domain was the determinant factor for predicting disability and most of the quality of life.
Collapse
Affiliation(s)
- Tiago Coelho
- School of Allied Health Technologies, Polytechnic Institute of Porto , Porto , Portugal ; UNIFAI, ICBAS, University of Porto , Porto , Portugal
| | | | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences , Amsterdam , The Netherlands ; Zonnehuisgroep Amstelland , Amstelveen , The Netherlands
| | - Lia Fernandes
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto , Porto , Portugal ; UNIFAI/CINTESIS Research Unit, Faculty of Medicine, University of Porto , Porto , Portugal
| |
Collapse
|
46
|
Uchmanowicz I, Wleklik M, Gobbens RJJ. Frailty syndrome and self-care ability in elderly patients with heart failure. Clin Interv Aging 2015; 10:871-7. [PMID: 26028966 PMCID: PMC4441356 DOI: 10.2147/cia.s83414] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Chronic heart failure is a serious medical condition. Recently, there has been an increasing interest in frailty syndrome and self-care levels among patients with cardiovascular conditions. Demonstrating the influence of frailty syndrome on self-care could improve the quality of self-care and prevent the adverse effects of frailty syndrome. The purpose of this study was to assess the influence of frailty syndrome on the self-care capabilities of patients with chronic heart failure, and to identify factors associated with frailty. Methods The data were collected between January and July 2014. The study included 110 patients with chronic heart failure who were hospitalized in the cardiology clinic. Frailty syndrome was assessed using the Tilburg Frailty Indicator, a self-report questionnaire, and self-care behavior was assessed using the European Heart Failure Self-Care Behavior Scale. Results Fifty-four percent of the study patients were male and 46% were female. The mean age was 66±11 years, the mean Tilburg Frailty Indicator score was 7.45±3.02 points, and the mean self-care level was 27.6±7.13 points. Correlation analyses showed that patients with higher scores in the social components of the frailty scale had better self-care capabilities. Frailty was associated with age, education, duration of heart failure, number of hospitalizations, and New York Heart Association class. The effects of these patient characteristics differed across components of frailty (physical, psychological, social). Conclusion The social components of frailty syndrome adversely affect the ability to self-care in elderly patients with heart failure. It is relevant to use a multidimensional measurement of frailty.
Collapse
Affiliation(s)
| | - Marta Wleklik
- Department of Clinical Nursing, Wrocław Medical University, Wrocław, Poland
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands ; Zonnehuisgroep Amstelland, Amstelveen, the Netherlands
| |
Collapse
|
47
|
Coelho T, Paúl C, Gobbens RJJ, Fernandes L. Determinants of frailty: the added value of assessing medication. Front Aging Neurosci 2015; 7:56. [PMID: 25954195 PMCID: PMC4404866 DOI: 10.3389/fnagi.2015.00056] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 04/02/2015] [Indexed: 01/09/2023] Open
Abstract
This study aims to analyze which determinants predict frailty in general and each frailty domain (physical, psychological, and social), considering the integral conceptual model of frailty, and particularly to examine the contribution of medication in this prediction. A cross-sectional study was designed using a non-probabilistic sample of 252 community-dwelling elderly from three Portuguese cities. Frailty and determinants of frailty were assessed with the Tilburg Frailty Indicator. The amount and type of different daily-consumed medication were also examined. Hierarchical regression analysis were conducted. The mean age of the participants was 79.2 years (±7.3), and most of them were women (75.8%), widowed (55.6%) and with a low educational level (0-4 years: 63.9%). In this study, determinants explained 46% of the variance of total frailty, and 39.8, 25.3, and 27.7% of physical, psychological, and social frailty respectively. Age, gender, income, death of a loved one in the past year, lifestyle, satisfaction with living environment and self-reported comorbidity predicted total frailty, while each frailty domain was associated with a different set of determinants. The number of daily-consumed drugs was independently associated with physical frailty, and the consumption of medication for the cardiovascular system and for the blood and blood-forming organs explained part of the variance of total and physical frailty. The adverse effects of polymedication and its direct link with the level of comorbidities could explain the independent contribution of the amount of prescribed drugs to frailty prediction. On the other hand, findings in regard to medication type provide further evidence of the association of frailty with cardiovascular risk. In the present study, a significant part of frailty was predicted, and the different contributions of each determinant to frailty domains highlight the relevance of the integral model of frailty. The added value of a simple assessment of medication was considerable, and it should be taken into account for effective identification of frailty.
Collapse
Affiliation(s)
- Tiago Coelho
- Department of Occupational Therapy, School of Allied Health Technologies, Polytechnic Institute of Porto, Vila Nova de Gaia Portugal ; The Research and Education Unit on Ageing, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto Portugal
| | - Constança Paúl
- The Research and Education Unit on Ageing, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto Portugal
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam Netherlands ; Zonnehuisgroep Amstelland, Amstelveen Netherlands
| | - Lia Fernandes
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto Portugal
| |
Collapse
|