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Coelho T, Santos R, Paúl C, Gobbens RJJ, Fernandes L. Portuguese version of the Tilburg Frailty Indicator: Transcultural adaptation and psychometric validation. Geriatr Gerontol Int 2014; 15:951-60. [PMID: 25255891 DOI: 10.1111/ggi.12373] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2014] [Indexed: 01/14/2023]
Abstract
AIM To present the translation and validation process of the Portuguese version of the Tilburg Frailty Indicator (TFI). METHODS A cross-sectional study was designed using a non-probability sample of 252 community-dwelling older adults. Preliminary studies were carried out for face and content validity assessment. Internal consistency, test-retest reliability, construct (convergent/divergent) and criterion validity were subsequently analyzed. RESULTS The sample was mainly women (75.8%), with a mean age of 79.2 ± 7.3 years. TFI internal consistency was good (KR-20 = 0.78). Test-retest reliability for the total was also good (r = 0.91), with kappa coefficients showing substantial agreement for most items. TFI physical and social domains correlated as expected with concurrent measures, whereas the TFI psychological domain showed similar correlations with other psychological and physical measures. The TFI showed a good to excellent discrimination ability in regard to frailty criteria, and fair to good ability to predict adverse outcomes. CONCLUSIONS The psychometric properties of the TFI seem to be consistently good. These findings provide initial evidence that the Portuguese version is a valid and reliable measure for assessing frailty in the elderly.
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Affiliation(s)
- Tiago Coelho
- School of Allied Health Sciences, Porto Polytechnic Institute, Vila Nova de Gaia, Portugal.,UNIFAI/ICBAS, University of Porto, Porto, Portugal
| | - Rubim Santos
- Activity and Human Movement Study Center, School of Allied Health Sciences, Porto Polytechnic Institute, Vila Nova de Gaia, Portugal
| | | | - Robbert J J Gobbens
- Research & Development Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Lia Fernandes
- UNIFAI/CINTESIS - Faculty of Medicine, University of Porto, Porto, Portugal
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Uchmanowicz I, Jankowska-Polańska B, Łoboz-Rudnicka M, Manulik S, Łoboz-Grudzień K, Gobbens RJJ. Cross-cultural adaptation and reliability testing of the Tilburg Frailty Indicator for optimizing care of Polish patients with frailty syndrome. Clin Interv Aging 2014; 9:997-1001. [PMID: 25028543 PMCID: PMC4077386 DOI: 10.2147/cia.s64853] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Frail older people are at high risk of developing adverse outcomes, such as disability, mortality, hospitalization, and institutionalization. Previous research suggests that the Tilburg Frailty Indicator (TFI) is a valid and reliable instrument for measuring frailty. The aim of this study was to adapt and to test the reliability of the Polish version of the TFI. Method A standard guideline was used for translation and cultural adaptation of the English version of the TFI into Polish. The study included 100 Polish patients (mean age 68.2±6.5 years), among them 42 men and 58 women. Cronbach’s alpha was used for analysis of the internal consistency of the TFI. Results The mean total TFI score was 6.7±3.1. Forty patients scored ≥5, which corresponded to being frail. Cronbach’s alpha reliability coefficients of the instrument ranged from 0.68 to 0.72 and item-total correlation ranged from 0.12 to 0.52. Conclusion The TFI is valid and reproducible for assessment of frailty syndrome among a Polish population. The Polish adaptation of the TFI proved a useful and fast tool for assessing frailty.
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Affiliation(s)
| | | | | | | | - Krystyna Łoboz-Grudzień
- Department of Clinical Nursing, Wrocław Medical University, Wrocław, Poland ; Department of Cardiology, T Marciniak Memorial Hospital, Wrocław, Poland
| | - Robbert J J Gobbens
- Research and Development Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
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Andreasen J, Sørensen EE, Gobbens RJJ, Lund H, Aadahl M. Danish version of the Tilburg Frailty Indicator--translation, cross-cultural adaption and validity pretest by cognitive interviewing. Arch Gerontol Geriatr 2014; 59:32-8. [PMID: 24680192 DOI: 10.1016/j.archger.2014.02.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 11/21/2013] [Accepted: 02/20/2014] [Indexed: 11/24/2022]
Abstract
The Tilburg Frailty Indicator (TFI) is a self-administered questionnaire with a bio-psycho-social integrated approach that measures the degree of frailty in elderly persons. The TFI was developed in the Netherlands and tested in a population of elderly Dutch men and women. The aim of this study was to translate and culturally adapt the TFI to a Danish context, and to test face validity of the Danish version by cognitive interviewing. An internationally recognized procedure was applied as a basis for the translation process. The primary tasks were forward translation, reconciliation, back translation, harmonization and pretest. Pretest and review of the preliminary version by cognitive interviewing, were performed at a local community center and in an acute medical ward at the University Hospital in Aalborg, Denmark respectively. A large agreement regarding meaning of the items in the forward translation and reconciliation process was seen. Minor discrepancies were solved by consensus. Back translation revealed unclear wording in one matter. The harmonization committee agreed on a version for cognitive interviewing after revision of minor issues and thirty-four participants were interviewed. Two issues became evident and these were revised. The cognitive interviews and final lay-out resulted in minor adjustments as text type size, specific font, and lining for optimizing readability. In conclusion, we consider the TFI to be translated in such rigorous manner that the instrument can be further tested in clinical practice. The overall objective of the questionnaire being to identify frailty and improve the interventions relating to frail elderly persons in Denmark.
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Affiliation(s)
- Jane Andreasen
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.
| | - Erik E Sørensen
- Clinical Nursing Research Unit, Aalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, Denmark
| | - Robbert J J Gobbens
- Rotterdam University of Applied Sciences, P.O. Box 25035, 3001 HA Rotterdam, The Netherlands; Department of Tranzo, Scientific Center for Care and Welfare, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
| | - Hans Lund
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute for Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark; Centre for Knowledge Based Practice, Bergen University College, Møllendalsveien 6, N-5009 Bergen, Norway
| | - Mette Aadahl
- Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup Hospital, Ndr. Ringvej 57, Afsnit 84/85, 2600 Glostrup, Denmark
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Santiago LM, Luz LL, Mattos IE, Gobbens RJJ, van Assen MALM. Psychometric properties of the Brazilian version of the Tilburg frailty indicator (TFI). Arch Gerontol Geriatr 2013; 57:39-45. [PMID: 23538005 DOI: 10.1016/j.archger.2013.03.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 02/19/2013] [Accepted: 03/04/2013] [Indexed: 12/14/2022]
Abstract
This study aims to assess the psychometric properties of the Brazilian version of the TFI, an instrument that identifies frailty in elderly individuals. We interviewed 219 individuals aged 60 or older, living in the community. Individuals were predominantly female (52.5%) and mean age was 70.5 (±7.9) years. In order to assess test-retest reliability, 101 individuals were re-interviewed by the same observer within seven to ten days after the first interview. The internal consistency of the instrument was assessed using Cronbach's alpha. To assess construct validity, we used established alternative measures for the items that constitute the TFI, such as: body mass index (BMI), timed up and go (TUG) test, whisper test, Snellen test, upper extremity strength clinical test and mini-mental state examination (MMSE). The test-retest reliability showed high percent agreement for all the items of the instrument, with values ranging from 63% to 100%. Test-retest reliabilities were good (total TFI score r=0.88; physical domain r=0.88; psychological domain r=0.88; and social domain r=0.67). Internal consistency reliability of the Brazilian version was satisfactory (Cronbach's alpha=0.78). The correlations between TFI items and their corresponding measures were consistent except for one item (related to "ability to deal with problems"), demonstrating both convergent and divergent construct validity of the TFI and its items. After the completion of all stages of transcultural adaptation, the Brazilian version of the TFI proved to be well suited for assessing frailty in the elderly population of Brazil.
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Affiliation(s)
- Lívia Maria Santiago
- Federal University of Rio de Janeiro, School of Medicine, Rua Rodolpho Paulo Rocco, 255/ sala 9E11, Cidade Universitária, Ilha do Fundão, Zip Code 21941-913, Rio de Janeiro, RJ, Brazil.
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Gobbens RJJ, van Assen MALM, Luijkx KG, Wijnen-Sponselee MT, Schols JMGA. [Young frail elderly: assessed using the Tilburg Frailty Indicator]. Tijdschr Gerontol Geriatr 2012; 43:296-307. [PMID: 23371872 DOI: 10.1007/s12439-012-0043-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Frail elderly have a higher risk of adverse outcomes, e.g., hospitalization,institutionalization, or premature death. The Tilburg Frailty Indicator (TFI) is a validated questionnaire for measuring frailty in independently living older people aged 70 years and over. AIMS Determining the prevalence of frailty among independently living young elderly, and examining which factors predict frailty among this target group. METHODS 308 young elderly (58 to 64 years) completed the TFI before they visited the ambulatory health screening centre in Roosendaal. The TFI includes questions concerning physical, psychological and social frailty, and questions on possible determinants of frailty. RESULTS 18-4% of the sample of young elderly was frail. Women scored significantly higher on psychological and social frailty. The determinants explained 37% of the frailty score. As expected,low income, an unhealthy lifestyle, multimorbidity, experiencing life events, and dissatisfaction with the living environment predicted frailty. The three frailty domains(physical, psychological, social) were affected by different determinants. CONCLUSION A substantial part of the young elderly in the sample turned out to be frail. The finding that the three domains of frailty are predicted by different determinants underlines the importance the importance of a broad perspective regarding the functioning of the individual older person.
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Affiliation(s)
- R J J Gobbens
- Instituut voor Gezondheidszorg, Hogeschool Rotterdam, Rotterdam, The Netherlands.
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Santiago LM, Luz LL, Mattos IE, Gobbens RJJ. Adaptação transcultural do instrumento Tilburg Frailty Indicator (TFI) para a população brasileira. CAD SAUDE PUBLICA 2012; 28:1795-801. [DOI: 10.1590/s0102-311x2012000900018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 06/25/2012] [Indexed: 11/21/2022] Open
Abstract
Este estudo tem como objetivo realizar a adaptação para a população brasileira do Tilburg Frailty Indicator (TFI), instrumento utilizado para a avaliação da fragilidade em idosos. Foram realizadas análises das equivalências conceitual, de itens e semântica, além do pré-teste da versão-síntese do instrumento. Na avaliação da equivalência conceitual, pôde-se constatar que o constructo fragilidade adotado no Brasil tem a mesma concepção das demais culturas onde essa condição tem sido investigada. Verificou-se que todos os itens incluídos no instrumento original apresentavam similaridade de conteúdo nas duas culturas. Identificou-se, também, alta equivalência semântica tanto na análise do significado referencial quanto do significado geral dos itens. No pré-teste, foram observados elevado percentual de entendimento e boa aceitação dos itens do instrumento por parte dos idosos. Os resultados sugerem que a versão do TFI para a cultura brasileira pode representar uma ferramenta útil na avaliação da saúde dos idosos do país.
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Gobbens RJJ, van Assen MALM. Frailty and its prediction of disability and health care utilization: the added value of interviews and physical measures following a self-report questionnaire. Arch Gerontol Geriatr 2012; 55:369-79. [PMID: 22595766 DOI: 10.1016/j.archger.2012.04.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 04/13/2012] [Accepted: 04/17/2012] [Indexed: 11/25/2022]
Abstract
AIMS To establish whether the prediction of the adverse outcomes disability and six indicators of health care utilization one and two years later by the three frailty domains (physical, psychological, social) of the Tilburg Frailty Indicator (TFI) is improved by adding interview and physical measures of frailty. MATERIALS AND METHODS A representative sample of 245 Dutch community-dwelling persons aged 75 years and older (response rate 53%) participated in 2008, one year later in 2009 (n=179, 73%) and again two years later in 2010 (n=141, 58%). Frailty was assessed with the TFI, an easy to administer self-report measure. Disability was measured using the Groningen Activity Restriction Scale (GARS). Indicators of health care utilization were: visit to a general practitioner (gp), contacts with health care professionals (hcps), hospital admission, receiving personal care, receiving nursing care, and receiving informal care. RESULTS After controlling for background characteristics, the TFI predicted disability and the indicators of health care utilization. Interviews and physical measures of frailty improved the prediction of disability. The Hospital Anxiety and Depression Scale (HADS-A) improved the prediction of contacts with hcps, but the interview and physical measures of frailty did not improve the predictions of the other indicators of health care utilization. CONCLUSIONS Assessment by the self-report TFI is sufficient for predicting six indicators of health care utilization, but for predicting disability the use of both the TFI and the Timed Up & Go (TUG) test is recommended. It is advisable assessing all three frailty domains when examining frailty and its prediction of adverse outcomes.
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Affiliation(s)
- Robbert J J Gobbens
- Rotterdam University of Applied Sciences, Museumpark 40, 3015 CX Rotterdam, The Netherlands.
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Gobbens RJJ, van Assen MALM, Luijkx KG, Wijnen-Sponselee MT, Schols JMGA. The Tilburg Frailty Indicator: psychometric properties. J Am Med Dir Assoc 2010; 11:344-55. [PMID: 20511102 DOI: 10.1016/j.jamda.2009.11.003] [Citation(s) in RCA: 597] [Impact Index Per Article: 42.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 11/09/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the reliability, construct validity, and predictive (concurrent) validity of the Tilburg Frailty Indicator (TFI), a self-report questionnaire for measuring frailty in older persons. DESIGN Cross-sectional. SETTING Community-based. PARTICIPANTS Two representative samples of community-dwelling persons aged 75 years and older (n = 245; n = 234). MEASUREMENTS The TFI was validated using the LASA Physical Activity Questionnaire, BMI, Timed Up & Go test, Four test balance scale, Grip strength test, Shortened Fatigue Questionnaire, Mini-Mental State Examination, Center for Epidemiologic Studies Depression Scale, Anxiety subscale of the Hospital Anxiety and Depression Scale, Mastery Scale, Loneliness Scale, and the Social Support List. Adverse outcomes were measured using the Groningen Activity Restriction Scale and questions regarding health care use. Quality of life was measured using the WHOQOL-BREF. RESULTS The test-retest reliability of the TFI was good: 0.79 for frailty, and from 0.67 to 0.78 for its domains for a 1-year time interval. The 15 single components, and the frailty domains (physical, psychological, social) of the TFI correlated as expected with validated measures, demonstrating both convergent and divergent construct validity of the TFI. The predictive validity of the TFI and its physical domain was good for quality of life and the adverse outcomes disability and receiving personal care, nursing, and informal care. CONCLUSION This study demonstrates that the psychometric properties of the TFI are good, when performed in 2 samples of community-dwelling older people. The results regarding the TFI's validity provide strong evidence for an integral definition of frailty consisting of physical, psychological, and social domains.
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Affiliation(s)
- Robbert J J Gobbens
- Department of Tranzo Academic Centre for Transformation in Care and Welfare, Faculty of Behavioural and Social Sciences, Tilburg University, Tilburg, The Netherlands.
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Gobbens RJJ, Luijkx KG, Wijnen-Sponselee MT, Schols JMGA. In search of an integral conceptual definition of frailty: opinions of experts. J Am Med Dir Assoc 2010; 11:338-43. [PMID: 20511101 DOI: 10.1016/j.jamda.2009.09.015] [Citation(s) in RCA: 233] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 09/28/2009] [Accepted: 09/29/2009] [Indexed: 12/01/2022]
Abstract
INTRODUCTION There are many different conceptual definitions of frailty in circulation. Most of these definitions focus mainly on physical problems affecting older people. Only a few also draw attention to other domains of human functioning such as the psychological domain. The authors of this article fear that this could lead to fragmentation of care for frail older people. The aim is to develop an integral conceptual definition of frailty that starts from the premise of a holistic view of the person. METHODS To achieve this, a literature search was carried out. Thereafter a group of experts (N=20) were consulted, both verbally during 2 expert meetings and via a written questionnaire. These experts were asked which existing conceptual definition of frailty places most stress on the integral functioning of older people. RESULTS The experts expressed a clear preference for one of the conceptual definitions. The result of the literature search and the consultation with the experts led to a new integral conceptual definition of frailty. CONCLUSION The conceptual definition is intended to offer a framework for an operational definition of frailty for identifying frail older people.
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Affiliation(s)
- Robbert J J Gobbens
- Tranzo Academic Centre for Transformation in Care and Welfare, Tilburg University, Tilburg, The Netherlands.
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Abstract
OBJECTIVES Most conceptual and operational definitions of frailty place heavy emphasis on the physical problems encountered by older people. The accompanying models are based largely on a medical model. An integral approach is almost never adopted. This study aims to develop both an integral operational definition of frailty and an integral conceptual model of frailty. DESIGN In order to achieve these aims, a thorough literature search was performed on components of operational definitions and models of frailty. In addition, experts (N=17) were consulted during two expert meetings. RESULTS There was consensus among the experts on the inclusion of the following components in the operational definition of frailty: strength, balance, nutrition, endurance, mobility, physical activity and cognition. Some respondents indicated that they would wish to add components from the psychological or social domain. Supported by results from the literature search, a new integral operational definition of frailty was developed. This operational definition lies at the heart of an integral conceptual working model of frailty. This model expresses the relationships between three domains of frailty, adverse outcomes such as disability and the determinants. CONCLUSION The model should be able to serve as a basis for further scientific research on frailty. The model also provides a framework for the development of a measurement instrument which can be used for the identification of frail elderly persons.
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Affiliation(s)
- R J J Gobbens
- Tilburg University, Tranzo, PO Box 90153, 5000 LE Tilburg, The Netherlands.
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Gobbens RJJ, Luijkx KG, Wijnen-Sponselee MT, Schols JMGA. [Frail elderly. Identification of a population at risk]. Tijdschr Gerontol Geriatr 2007; 38:65-76. [PMID: 17605284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
In the future the number of frail independently living older people will continue to increase. It is unclear however, which people are meant exactly by those frail elderly. The aim of this article is to discuss the concept of frailty and its adequacy in identifying the frail elderly population. To this end, a literature search has been performed regarding the conceptual and operational definitions of frailty. The results show that frailty often is put on a continuum opposite to vitality. It is emphasised that the process of frailty can be modified or (partly) reversed. Focusing on this reversibility is important because frail elderly have a higher risk for adverse outcomes such as dependence, hospitalization, falls and mortality. After studying the conceptual and operational definitions it is concluded that no actual definition meets the criteria for a successful definition of frailty. Frailty is predominantly defined in terms of physical loss. This may lead to fragmentation of care with lack of an integral approach. In a follow-up study it will be tried to develop consensus on a conceptual and operational definition of frailty.
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Affiliation(s)
- R J J Gobbens
- Hogeschooldocent, lid kenniskring lectoraat Gerontologie, Avans Hogeschool Breda.
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