Predicting Disability Using a Nomogram of the Tilburg Frailty Indicator (TFI)

Disability is associated with lower quality of life and premature death in older people. Therefore, prevention and intervention targeting older people living with a disability is important. Frailty can be considered a major predictor of disability. In this study, we aimed to develop nomograms with items of the Tilburg Frailty Indicator (TFI) as predictors by using cross-sectional and longitudinal data (follow-up of five and nine years), focusing on the prediction of total disability, disability in activities of daily living (ADL), and disability in instrumental activities of daily living (IADL). At baseline, 479 Dutch community-dwelling people aged ≥75 years participated. They completed a questionnaire that included the TFI and the Groningen Activity Restriction Scale to assess the three disability variables. We showed that the TFI items scored different points, especially over time. Therefore, not every item was equally important in predicting disability. 'Difficulty in walking' and 'unexplained weight loss' appeared to be important predictors of disability. Healthcare professionals need to focus on these two items to prevent disability. We also conclude that the points given to frailty items differed between total, ADL, and IADL disability and also differed regarding years of follow-up. Creating one monogram that does justice to this seems impossible.

Cross-sectional and Longitudinal Associations of Environmental Factors with Frailty and Disability in Older People

PURPOSE

To determine cross-sectional and longitudinal associations of environmental factors with frailty and disability.

METHODS

This study was conducted in a sample of Dutch citizens. At baseline the sample consisted of 429 subjects (aged ≥ 65 years); a subset of this sample participated again two and half years later (N = 355). The participants completed a web-based questionnaire, "the Senioren Barometer", comprising seven scales for assessing environmental factors, and the Tilburg Frailty Indicator (TFI) and the Groningen Activity Restriction Scale (GARS), for assessing frailty and disability, respectively. Environmental factors of interest were: nuisance; housing; facilities; residents; neighborhood; stench/noise; and traffic.

RESULTS

Sequential regression analyses demonstrated that all environmental factors together explained a significant part of the variance of physical and social frailty and disability in performing activities of daily living (ADL) and instrumental activities of daily living (IADL), measured at Time 1 (T1) and Time 2 (T2). These analyses also showed that four of the environmental factors were associated with at least one of the outcome measures: housing, nuisance, residents, and neighborhood. Housing was the only environmental factor associated with three different outcome measures (social frailty, ADL disability, IADL disability), assessed at T1 and T2.

CONCLUSION

The findings offer health-care and welfare professionals and also policymakers starting points for interventions. These interventions should focus, in particular, on housing, nuisance, residents, and neighborhood, because their impact on frailty and/or disability was the largest.