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Iriarte E, Cianelli R, De Santis JP, Alamian A, Castro JG, Matsuda Y, Araya AX. Multidimensional Frailty, Quality of Life and Self-Management in Aging Hispanics Living With HIV. J Appl Gerontol 2024; 43:899-909. [PMID: 38173356 DOI: 10.1177/07334648231211743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
An observational cross-sectional study was conducted to examine multidimensional frailty and its potential impact on quality of life (QOL) in aging Hispanic people living with HIV (PLWH) and assess the extent to which HIV self-management moderates this association. The sample included 120 Hispanic PLWH aged 50 years and older (M = 59.11; SD = 7.04). The structural equation modeling analyses demonstrated that multidimensional frailty was significantly related to QOL in its two dimensions, physical and mental (p < .001). The relationship between multidimensional frailty and mental and physical QOL remained significant even after controlling for confounders (age and gender). The moderator analyses indicated no statistically significant moderator effect of HIV self-management on multidimensional frailty and mental or physical QOL. These study results have practical implications that highlight the need for early screening for frailty with a multidimensional focus. Age-appropriate and culturally tailored interventions to prevent or mitigate multidimensional frailty may improve QOL.
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Affiliation(s)
- Evelyn Iriarte
- Pontificia Universidad Católica de Chile, School of Nursing, Santiago, Chile
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora, CO, USA
- Millennium Institute for Care Research (MICARE) (ICS2019_024), Santiago, Chile
| | - Rosina Cianelli
- University of Miami, School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Joseph P De Santis
- University of Miami, School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Arsham Alamian
- University of Miami, School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Jose G Castro
- University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Yui Matsuda
- University of Miami, School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Alejandra-X Araya
- Millennium Institute for Care Research (MICARE) (ICS2019_024), Santiago, Chile
- Universidad Andres Bello, School of Nursing, Santiago, Chile
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Qiu Y, Li G, Wang X, Liu W, Li X, Yang Y, Wang L, Chen L. Prevalence of multidimensional frailty among community-dwelling older adults: A systematic review and meta-analysis. Int J Nurs Stud 2024; 154:104755. [PMID: 38522186 DOI: 10.1016/j.ijnurstu.2024.104755] [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: 10/18/2023] [Revised: 03/02/2024] [Accepted: 03/08/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE The aims of this systematic review were to explore the pooled prevalence of multidimensional frailty assessed by the Tilburg Frailty Indicator among community-dwelling older adults. DESIGN A systematic review and meta-analysis. METHODS A comprehensive literature search was conducted across multiple databases, including PubMed, Web of Science, Embase, the Cochrane Library, CINAHL and three Chinese databases. Two independent researchers selected the literatures, extracted the data and evaluated the quality. All statistical analyses were performed using STATA version 16.0. RESULTS There were 66 studies with a total of 40,597 individuals that were eligible for the meta-analysis. Data from the meta-analysis revealed the pooled prevalence of 42 % for multidimensional frailty (95 % CI: 38 %-45 %, I2 = 98.9 %, T2 = 0.024, p < 0.001). Among the six studies that provided data for different age groups, the results demonstrated an increasing trend in the prevalence of multidimensional frailty with advancing age. The results of gender-stratified analysis proved that the pooled prevalence of multidimensional frailty in women (45 %, 95 % CI: 39 %-51 %, p < 0.001) was higher than that in men (33 %, 95 % CI: 28 %-39 %, p < 0.001). Based on different education levels, the prevalence of multidimensional frailty is highest in the primary elementary or illiterate group (41 %, 95 % CI: 30 %-52 %, p < 0.001). According to different marital status types, the pooled prevalence of multidimensional frailty in the married group was significantly lower (36 %, 95 % CI: 28 %-43 %) than that in the unmarried, divorced or widowed group (51 %, 95 % CI: 37 %-65 %). CONCLUSIONS Through a comprehensive review, we identified that 42 % of elderly individuals living in communities exhibit multidimensional frailty, indicating that multidimensional frailty is relatively common in this population. Stratified analysis revealed that advanced age, female gender, lower education level and unmarried status were associated with higher rates of multidimensional frailty.
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Affiliation(s)
- Yiming Qiu
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin 130021, China.
| | - Guichen Li
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin 130021, China.
| | - Xinxin Wang
- The First Hospital of Jilin University, 1 Xinmin Street, Changchun 130021, China.
| | - Wei Liu
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin 130021, China.
| | - Xin Li
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin 130021, China.
| | - Yali Yang
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin 130021, China.
| | - Lisheng Wang
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin 130021, China.
| | - Li Chen
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin 130021, China; Department of Pharmacology, College of Basic Medical Sciences, Jilin University, Changchun, China.
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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.
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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
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Zhao J, Liu YWJ, Tyrovolas S, Mutz J. Exploring the concept of psychological frailty in older adults: a systematic scoping review. J Clin Epidemiol 2023; 159:300-308. [PMID: 37156339 DOI: 10.1016/j.jclinepi.2023.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/18/2023] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES We reviewed the existing definitions of psychological frailty and provided a comprehensive overview of the concept and associated measurements. STUDY DESIGN AND SETTING We followed the PRISMA guidelines for scoping reviews and the Joanna Briggs Institute Manual for Evidence Synthesis. The eligibility criteria for including studies were developed based on the participants-concept-context framework. We searched the Cumulative Index to Nursing and Allied Health Literature, Scopus, PubMed, Web of Science and PsycINFO databases, and other sources for relevant studies published between January 2003 and March 2022. RESULTS The final scoping review included 58 studies. Of these, 40 defined psychological frailty, seven provided a novel definition, and 11 focused on the components defining psychological frailty. We proposed four groups of components to better characterize psychological frailty: mood, cognitive, other mental health, and fatigue-related problems. We identified 28 measuring tools across studies, and the Tilburg Frailty Indicator was the most frequently used (46.6%). CONCLUSION Psychological frailty is a complex concept whose definition seems to lack consensus. It could include both psychological and physical features. Depression and anxiety are commonly used to define it. This scoping review outlined future research directions for refining the concept of psychological frailty.
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Affiliation(s)
- Jinlong Zhao
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yat Wa Justina Liu
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Stefanos Tyrovolas
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Julian Mutz
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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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.
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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
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Fan JY, Xie W, Zhang WY, Liu YT, Wang Q, Zhao HM, Kong LL, Li J. To validate the integral conceptual model of frailty among community-dwelling older adults in China: a cross-sectional study. BMC Geriatr 2023; 23:242. [PMID: 37085758 PMCID: PMC10120217 DOI: 10.1186/s12877-023-03960-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 04/07/2023] [Indexed: 04/23/2023] Open
Abstract
PURPOSE The integral conceptual model of frailty (ICFM) integrates physical, psychological, social aspects of individuals and stresses that frailty is a dynamic state evolving over time. This study aimed to validate the ICMF among community-dwelling older adults in China. METHODS The study recruited 341 older community-dwelling adults by convenient sampling method between June 1 and August 30, 2019 in Hubei province, China. The data was collected by questionnaire-based survey. Frailty was assessed by the Chinese version of the Tilburg Frailty Index. Participants were assessed for life-course determinants, disease and adverse health outcomes. Hierarchical regression analyses, Bootstrap method and the structural equation model were conducted in data analysis. RESULTS Both linear and logistic hierarchical regression models were statistically significant. Life-course determinants, disease, and three domains of frailty together explained 35.6% to 50.6% of the variance of disability and all domains of quality of life. The mediation effect of frailty between disease and all adverse outcomes was significant, excluding hospitalization. The structural equation model guided by the ICMF fits the data well. CONCLUSIONS The ICMF is valid among community-dwelling older adults in China. Therefore, the multidimensional concept of frailty should be widely used in Chinese communities.
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Affiliation(s)
- Jun-Yao Fan
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen Xie
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Qiaokou District, Wuhan, China
| | - Wen-Ya Zhang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Qiaokou District, Wuhan, China
| | - Yue-Ting Liu
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Qiaokou District, Wuhan, China
| | - Quan Wang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Qiaokou District, Wuhan, China
| | - Hui-Min Zhao
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Qiaokou District, Wuhan, China
| | - Ling-Lin Kong
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Qiaokou District, Wuhan, China
| | - Jie Li
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Qiaokou District, Wuhan, China.
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Liu C, Gao W, Meng W, Ding M, Huang R, Xiao Y, Zhou L, Wang S, Wei X. Can the Tilburg Frailty Indicator predict post-operative quality of recovery in patients with gynecologic cancer? A prospective cohort study. Int J Gynecol Cancer 2023; 33:761-769. [PMID: 36754449 DOI: 10.1136/ijgc-2022-003822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVE Frailty is a marker of physiologic decline within multiple organ systems. The Tilburg Frailty Indicator (TFI) is an instrument for assessing frailty. We evaluated the ability of the TFI to predict the quality of post-operative recovery in patients with gynecologic cancer and explored the associations between frailty, post-operative complications, and length of stay. METHODS We conducted a prospective cohort study of patients scheduled for radical gynecologic cancer surgery between May 2021 and January 2022, and defined a TFI score ≥5 as 'frailty'. Our primary outcome was the post-operative quality of recovery based on the Quality of Recovery-15 (QoR-15), and the secondary outcomes were post-operative complications and length of stay. Multiple logistic regression was used to examine the relationship between frailty and outcomes. We developed receiver operating characteristics (ROCs) and assessed areas under the ROC curves (AUCs) to explore the ability of frailty to predict the quality of post-operative recovery. RESULTS A total of 169 patients were included. The prevalence of frailty using the TFI was 47.9% in this cohort. In the multivariate regression analysis, frailty emerged as a significant predictor of the 3-day QoR-15 score (aOR 11.69, 95% CI 4.26 to 32.08; p˂0.001) and complications (aOR 10.05, 95% CI 1.66 to 60.72; p=0.012). Frailty was not associated with length of stay (aOR 2.12, 95% CI 0.87 to 5.16; p=0.099). The combination of the TFI, American Society of Anesthesiologists (ASA) classification, and types of cancer resulted in an increase in the AUC compared with the TFI alone (AUC 0.796, 95% CI 0.727 to 0.865; p˂0.05). CONCLUSIONS The use of the TFI may assist surgeons in estimating the risk with respect to post-operative quality of recovery and complications in patients with gynecologic cancer. Combining the TFI with ASA classification and cancer type is expected to improve the predictive ability of poor quality of recovery.
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Affiliation(s)
- Chunmei Liu
- Department of Anesthesiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Wei Gao
- Department of Anesthesiology and Pain Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Wenjun Meng
- Department of Anesthesiology and Pain Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Meng Ding
- Department of Anesthesiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Runsheng Huang
- Department of Anesthesiology and Pain Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Ya Xiao
- Department of Anesthesiology and Pain Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Ling Zhou
- Department of Anesthesiology and Pain Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Sheng Wang
- Department of Anesthesiology and Pain Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Xin Wei
- Department of Anesthesiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China .,Department of Anesthesiology and Pain Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
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Garcia-Gutierrez S, Villanueva A, Lafuente I, Rodriguez I, Lozano-Bahamonde A, Murga N, Orus J, Camacho ER, Quintana JM, Quiros R, Fernández-Ruiz J, Cacicedo A, Escobar V, Redondo M, Cabello G, Baré M. Factors related to early readmissions after acute heart failure: a nested case-control study. BMC Cardiovasc Disord 2023; 23:17. [PMID: 36635633 PMCID: PMC9837935 DOI: 10.1186/s12872-022-03029-2] [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: 06/24/2022] [Accepted: 12/23/2022] [Indexed: 01/13/2023] Open
Abstract
AIMS To describe the main characteristics of patients who were readmitted to hospital within 1 month after an index episode for acute decompensated heart failure (ADHF). METHODS AND RESULTS This is a nested case-control study in the ReIC cohort, cases being consecutive patients readmitted after hospitalization for an episode of ADHF and matched controls selected from those who were not readmitted. We collected clinical data and also patient-reported outcome measures, including dyspnea, Minnesota Living with Heart Failure Questionnaire (MLHFQ), Tilburg Frailty Indicator (TFI) and Hospital Anxiety and Depression Scale scores, as well as symptoms during a transition period of 1 month after discharge. We created a multivariable conditional logistic regression model. Despite cases consulted more than controls, there were no statistically significant differences in changes in treatment during this first month. Patients with chronic decompensated heart failure were 2.25 [1.25, 4.05] more likely to be readmitted than de novo patients. Previous diagnosis of arrhythmia and time since diagnosis ≥ 3 years, worsening in dyspnea, and changes in MLWHF and TFI scores were significant in the final model. CONCLUSION We present a model with explanatory variables for readmission in the short term for ADHF. Our study shows that in addition to variables classically related to readmission, there are others related to the presence of residual congestion, quality of life and frailty that are determining factors for readmission for heart failure in the first month after discharge. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03300791. First registration: 03/10/2017.
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Affiliation(s)
- Susana Garcia-Gutierrez
- Research Unit, Galdakao-Usansolo University Hospital, Barrio Labeaga s/n, 48960 Galdakao, Vizcaya Spain ,grid.424267.1Kronikgune Institute for Health Services Research, Barakaldo, Spain ,Red de Investigación en Servicios Sanitarios Y Enfermedades Crónicas (REDISSEC), Galdakao, Spain ,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Girona, Spain ,grid.14724.340000 0001 0941 7046Faculty of Health Sciences, Medicine Department, University of Deusto, Bilbo, Spain
| | - Ane Villanueva
- Research Unit, Galdakao-Usansolo University Hospital, Barrio Labeaga s/n, 48960 Galdakao, Vizcaya Spain ,grid.424267.1Kronikgune Institute for Health Services Research, Barakaldo, Spain ,Red de Investigación en Servicios Sanitarios Y Enfermedades Crónicas (REDISSEC), Galdakao, Spain ,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Girona, Spain
| | - Iratxe Lafuente
- Research Unit, Galdakao-Usansolo University Hospital, Barrio Labeaga s/n, 48960 Galdakao, Vizcaya Spain ,grid.424868.40000 0004 1762 3896Fundación Vasca de Innovación e Investigación Sanitarias, BIOEF, Barakaldo, Spain
| | - Ibon Rodriguez
- grid.414476.40000 0001 0403 1371Cardiology Department, Hospital Galdakao-Usansolo, Galdakao, Spain
| | | | - Nekane Murga
- grid.414269.c0000 0001 0667 6181Cardiology Department, Hospital Basurto, Bilbo, Spain
| | - Josefina Orus
- grid.414560.20000 0004 0506 7757Cardiology Department, Hospital Parc Taulí, Sabadell, Spain
| | - Emilia Rosa Camacho
- grid.414423.40000 0000 9718 6200Internal Medicine Department, Hospital Costa del Sol, Marbella, Spain
| | - Jose María Quintana
- Research Unit, Galdakao-Usansolo University Hospital, Barrio Labeaga s/n, 48960 Galdakao, Vizcaya Spain ,grid.424267.1Kronikgune Institute for Health Services Research, Barakaldo, Spain ,Red de Investigación en Servicios Sanitarios Y Enfermedades Crónicas (REDISSEC), Galdakao, Spain ,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Girona, Spain
| | - Raul Quiros
- grid.414423.40000 0000 9718 6200Internal Medicine Department, Hospital Costa del Sol, Marbella, Spain
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Pizarro-Mena R, Duran-Aguero S, Parra-Soto S, Vargas-Silva F, Bello-Lepe S, Fuentes-Alburquenque M. Effects of a Structured Multicomponent Physical Exercise Intervention on Quality of Life and Biopsychosocial Health among Chilean Older Adults from the Community with Controlled Multimorbidity: A Pre-Post Design. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15842. [PMID: 36497916 PMCID: PMC9735590 DOI: 10.3390/ijerph192315842] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
Structured multicomponent physical exercise (PE) for older adults, with a combination of strength, aerobic, flexibility, and balance exercises, has been shown to have benefits for physical, cognitive, social, and metabolic functioning, as well as counteracting chronic pathologies and geriatric syndromes. However, little is known about the effect of these interventions in Chilean older adults. Our objective was to determine the effect of a structured multicomponent PE intervention on the quality of life (QoL) and biopsychosocial factors of community-living older adults. We conducted a pre-post intervention without control group, with a face-to-face structured multicomponent PE intervention (cardiovascular, strength/power, flexibility, static and dynamic balance, other psychomotor components, and education), based on FITT-VP principles (frequency, intensity, type, time, volume, and progression of exercise), at moderate intensity, 60 min per session, three times per week, and 12 weeks in duration, among 45 persons with an average age of 70.74 years. Participants were evaluated at the beginning and end of the intervention with different instruments of comprehensive gerontological assessment (CGA). Post intervention, participants (83.70% average attendance) significantly improved scores in QoL, biological and biopsychosocial frailty, sarcopenia, functionality in basic, instrumental, and advanced activities of daily living, dynamic balance, cognitive status and mood, systolic and diastolic blood pressure, weight, body mass index, strength and flexibility clinical tests of lower and upper extremity, aerobic capacity, agility, and tandem balance. The indication and prescription of structured multicomponent PE based on FITT-VP principles, as evaluated with the CGA, improved the QoL and biopsychosocial health of older adults. This intervention could serve as a pilot for RCTs or to improve PE programs or services for older adults under the auspices of existing public policy.
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Affiliation(s)
- Rafael Pizarro-Mena
- Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Sede Los Leones, Santiago 7500000, Chile
| | - Samuel Duran-Aguero
- Facultad de Ciencias para el Cuidado de la Salud, Universidad San Sebastián, Sede Los Leones, Santiago 7500000, Chile
| | - Solange Parra-Soto
- Departamento de Nutrición y Salud Pública, Universidad del Bío-Bío, Chillan 3780000, Chile
| | - Francisco Vargas-Silva
- Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Sede Los Leones, Santiago 7500000, Chile
| | - Sebastian Bello-Lepe
- Escuela de Fonoaudiología, Universidad de Valparaíso, Viña del Mar 2520000, Chile
- Centro de Investigación del Desarrollo en Cognición y Lenguaje (CIDCL), Universidad de Valparaíso, Viña del Mar 2520000, Chile
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Huang EYZ, Cheung J, Liu JYW, Kwan RYC, Lam SC. Groningen Frailty Indicator-Chinese (GFI-C) for pre-frailty and frailty assessment among older people living in communities: psychometric properties and diagnostic accuracy. BMC Geriatr 2022; 22:788. [PMID: 36207703 PMCID: PMC9540721 DOI: 10.1186/s12877-022-03437-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 09/05/2022] [Indexed: 11/19/2022] Open
Abstract
Background The early identification of pre-frailty and frailty among older people is a global priority because of the increasing incidence of frailty and associated adverse health outcomes. This study aimed to validate the Groningen Frailty Indicator-Chinese (GFI-C), a widely used screening instrument, and determine the optimal cut-off value in Chinese communities to facilitate pre-frailty and frailty screening. Methods This methodological study employed a cross-sectional and correlational design to examine the psychometric properties of GFI-C, namely, internal consistency, stability, and concurrent and construct validities. The appropriate cut-off values for pre-frailty and frailty screening in the receiver-operating characteristic (ROC) curve were determined through sensitivity and specificity analysis. Results A total of 350 community older people had been assessed and interviewed by a nurse. The GFI-C showed satisfactory internal consistency (Cronbach’s α = 0.87) and two-week test-retest reliability (intra-class correlation coefficient = 0.87). Concurrent validity (r = 0.76, p < 0.001) showed a moderate correlation with Fried’s frailty phenotype. The known-groups method, hypothesis testing and confirmatory factory analysis (three-factor model; χ2/df = 2.87, TLI = 0.92, CFI = 0.93, GFI = 0.92, RMR = 0.014; RMSEA = 0.073) were suitable for the establishment of construct validity. Based on the ROC and Youden’s index, the optimal cut-off GFI-C values were 2 (sensitivity, 71.5%; specificity, 84.7%) for pre-frailty and 3 for frailty (sensitivity, 88.2%; specificity, 79.6%). Conclusions The result indicated that GFI-C is a reliable and valid instrument for pre-frailty and frailty screening among older Chinese people in communities. For optimal diagnostic accuracy, the cut-off values of 3 for frailty and 2 for pre-frailty are recommended. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03437-1.
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Affiliation(s)
- Emma Yun Zhi Huang
- Division of Social Worker, Zhongshan Polytechnic, No.25 Bo'ai 7th Road, East District, Zhongshan City, Guangdong Province, People's Republic of China
| | - Jasmine Cheung
- School of Nursing, Tung Wah College, Ma Kam Chan Memorial Building, 31 Wylie Road, Hong Kong SAR, China
| | - Justina Yat Wa Liu
- School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong SAR, China
| | - Rick Yiu Cho Kwan
- School of Nursing, Tung Wah College, Ma Kam Chan Memorial Building, 31 Wylie Road, Hong Kong SAR, China
| | - Simon Ching Lam
- School of Nursing, Tung Wah College, Ma Kam Chan Memorial Building, 31 Wylie Road, Hong Kong SAR, China. .,Integrative Health Centre, Tung Wah College, Cheung Chin Lan Hong Building, 98 Shantung Street, Hong Kong SAR, China.
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Yuan K, Luo Y, Sun J, Chang H, Hu H, Zhao B. Depression and Cognition Mediate the Effect of Self-Perceptions of Aging Over Frailty Among Older Adults Living in the Community in China. Front Psychol 2022; 13:830667. [PMID: 35783795 PMCID: PMC9243527 DOI: 10.3389/fpsyg.2022.830667] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesThe aims of the study were first to investigate the association between self-perceptions of aging and frailty and second to determine whether self-perceptions of aging affects frailty via depressive symptoms and cognitive status among older adults living in the community in China.MethodsAmong 850 older adults who participated in this cross-sectional study, 822 older adults made valid responses to Tilburg Frailty Indicator, Brief Aging Perceptions Questionnaire, UCLA loneliness scale-8, Mini-Mental State Examination, and Patient Health Questionnaire-9 between March to December 2019. The possible pathways of self-perceptions of aging affecting frailty were analyzed based on the structural equation modeling analysis.ResultsA total of 21.53% of older adults reported frailty. Correlation analyses showed that higher degrees of frailty were related to greater loneliness, more depressive symptoms, more negative self-perceptions of aging, worse locomotive function, and cognitive status (r = 0.267, r = 0.440, r = 0.481, r = 0.451, r = −0.337; p < 0.001). Multiple regression analysis showed that loneliness, depressive symptoms, self-perceptions of aging, locomotive function, and cognitive status were the five factors to be entered the regression equation, and the variance of joint explanation was 46.60%. SPA had a direct effect on frailty (β = 0.306 and p < 0.001), and SPA indirectly affects frailty by independently affecting depressive symptoms (β = 0.391, 95% CI [0.027, 0.061], and p < 0.001) or cognitive status (β = 0.148, 95% CI [0.009, 0.024], and p < 0.001) of older adults.ConclusionThese findings help explain the potential psychological mechanisms through which SPA impacts frailty and may aid community healthcare providers in China in identifying individuals at high risk of frailty. The results suggest that health staff should help older adults improve their perspectives on aging, alleviate or prevent depressive symptoms, and improve cognitive status to delay the progress of frailty and promote healthy aging.
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Affiliation(s)
- Kun Yuan
- School of Nursing, Xinxiang Medical University, Xinxiang, China
| | - Yanyan Luo
- School of Nursing, Xinxiang Medical University, Xinxiang, China
- *Correspondence: Yanyan Luo,
| | - Junjun Sun
- School of Nursing, Xinxiang Medical University, Xinxiang, China
| | - Hongjuan Chang
- School of Nursing, Xinxiang Medical University, Xinxiang, China
| | - Huijie Hu
- Faculty of Nursing, Sanquan College of Xinxiang Medical University, Xinxiang, China
| | - Bingwei Zhao
- School of Nursing, Huzhou University, Huzhou, China
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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.
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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.
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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.
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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
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Zupo R, Castellana F, Bortone I, Griseta C, Sardone R, Lampignano L, Lozupone M, Solfrizzi V, Castellana M, Giannelli G, De Pergola G, Boeing H, Panza F. Nutritional domains in frailty tools: Working towards an operational definition of nutritional frailty. Ageing Res Rev 2020; 64:101148. [PMID: 32827687 DOI: 10.1016/j.arr.2020.101148] [Citation(s) in RCA: 39] [Impact Index Per Article: 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.
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Zhang X, Tan SS, Franse CB, Alhambra-Borrás T, Durá-Ferrandis E, Bilajac L, Markaki A, Verma A, Mattace-Raso F, Voorham AJJ, Raat H. Association between physical, psychological and social frailty and health-related quality of life among older people. Eur J Public Health 2020; 29:936-942. [PMID: 31168603 PMCID: PMC9186303 DOI: 10.1093/eurpub/ckz099] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Studies on the association between frailty and health-related quality of life (HRQoL) are scarce and show contradictory results. This study aimed to evaluate the association between physical, psychological and social frailty and HRQoL among community-dwelling older people. METHODS A cross-sectional study was performed with baseline data collected in 2015 from the Urban Health Centers Europe (UHCE) project in five European countries, the United Kingdom, Greece, Croatia, The Netherlands and Spain. A total of 2325 participants were included in the baseline measurements of the Urban Health Centers Europe project; 2167 participants (mean age = 79.7; SD=5.6) were included in the analyses after excluding participants with missing data. The Tilburg Frailty Indicator measured overall frailty as well as physical, psychological and social frailty. The 12-Item Short-Form Health Survey was used to measured physical and mental HRQoL. RESULTS Regarding physical HRQoL, a large difference (d=1.29) between physically and not physically frail participants was observed. Regarding mental HRQoL, a large difference (d=1.20) between psychologically and not psychologically frail participants was observed. In the full model with all three domains of frailty and the covariates to explain physical HRQoL, physical (P <0.001) and social frailty (P <0.001) remained significant. In the full model to explain mental HRQoL, all three domains of frailty remained significant (P <0.001). CONCLUSION Physical frailty had the strongest association with physical HRQoL, and psychological frailty had the strongest association with mental HRQoL. The associations between social frailty and both physical and mental HRQoL remain significant when controlling for physical and psychological frailty.
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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
| | - Carmen Betsy Franse
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | - Lovorka Bilajac
- Department of Social Medicine and Epidemiology, Faculty of Medicine, University of Rijeka, 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
| | - Francesco Mattace-Raso
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Antonius J J Voorham
- Rotterdam University of Applied Sciences, Research Centre Innovation in Care, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Alqahtani BA, Abdelbasset WK, Alenazi AM. Psychometric analysis of the Arabic (Saudi) Tilburg Frailty Indicator among Saudi community-dwelling older adults. Arch Gerontol Geriatr 2020; 90:104128. [PMID: 32521419 DOI: 10.1016/j.archger.2020.104128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Frailty is a common geriatric syndrome that can be screened using validated questionnaires. A commonly used assessment is the Tilburg Frailty Indicator (TFI), containing fifteen self-reported questions about components of frailty, with scores ranging from zero to fifteen (higher scores representing increased frailty and a cutoff score of greater than five used to diagnose frailty). Despite its widespread use, the TFI is not commonly used in Arabic-speaking countries, and there is an overall lack of Arabic-translated questionnaires to adequately detect and measure frailty for older adults in Saudi Arabia. OBJECTIVES To translate and cross-culturally adapt the Tilburg Frailty Indicator (TFI) specifically for use with the Saudi population, and to examine reliability and construct validity among adults in senior-living facilities in Saudi Arabia. METHODS A total of 84 community-dwelling older adults were enrolled (mean age = 72 ± 4.7 years). The translation and cross-cultural adaptation of the TFI from English to Arabic was performed using standardized guidelines. Test-retest reliability and internal consistency were examined in two visits, spaced one-week apart. Construct validity of the TFI against other measurements related to frailty was examined. The physical domain for TFI was validated against the Short Physical Performance Battery (SPPB), the timed Up and Go Test (TUG), and gait speed (as part of the SPPB). The psychological domains were validated against the Patient Health Questionnaire, and the social domains were validated against the social domain scores from the WHOQOL-BREF. RESULTS The internal consistency of the TFI with the overall KR-20 was 0.70. For the domain scores KR-20 was 0.68 for the physical, 0.57 for the psychological, and 0.42 for the social. The KR-20 after deletion of each item correlations ranged from 0.66 to 0.72. For the test-retest reliability with one-week interval, the ICC was 0.86 (95 % CI = 0.67-0.94). The Arabic TFI showed statistically significant association with other measurements related to frailty. CONCLUSION This study found that the translated Arabic (Saudi) TFI is a valid and reliable instrument in assessing the frailty among Saudi community-dwelling older adults. Our results suggest that the use of this Arabic-translated TFI for clinical screening of frailty in any primary health setting may aid continued understanding for the validity of this instrument and help provide a quantitative diagnostic tool for the prevention and treatment of frailty.
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Affiliation(s)
- Bader A Alqahtani
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Saudi Arabia.
| | - Walid Kamal Abdelbasset
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Saudi Arabia
| | - Aqeel M Alenazi
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Saudi Arabia
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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.
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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.
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Vergara I, Mateo-Abad M, Saucedo-Figueredo MC, Machón M, Montiel-Luque A, Vrotsou K, Nava Del Val MA, Díez-Ruiz A, Güell C, Matheu A, Bueno A, Núñez J, Rivas-Ruiz F. Description of frail older people profiles according to four screening tools applied in primary care settings: a cross sectional analysis. BMC Geriatr 2019; 19:342. [PMID: 31795949 PMCID: PMC6892171 DOI: 10.1186/s12877-019-1354-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 11/11/2019] [Indexed: 11/30/2022] Open
Abstract
Background Regarding the health care of older populations, WHO recommends shifting from disease-driven attention models towards a personalized, integrated and continuous care aimed to the maintenance and enhancement of functional capacities. Impairments in the construct of functional intrinsic capacity have been understood as the condition of frailty or vulnerability. No consensus has been yet reached regarding which tools are the most suitable for screening this kind of patients in primary care settings. Tools based on the measurement of functional performance such as Timed up and go test (TUG), Short Physical Performance battery (SPPB), self-completed questionnaires like Tilburg Frailty Indicator (TFI) and clinical judgement, as the Gerontopole Frailty Scale (GFS) may be adequate. The objective of this work is to describe and compare characteristics of community-dwelling individuals identified as vulnerable or frail by four tools applied in primary care settings. Methods Cross sectional analysis developed in primary care services in two regions of Spain. Community-dwelling independent individuals aged 70 or more willing to participate were recruited and data was collected via face-to-face interviews. Frailty was assessed by TUG, SPPB, TFI and GFST. Also socio-demographic characteristics, lifestyle habits and health status data (comorbidities, polypharmacy, self-perceived health), were collected. Multiple correspondence analysis (MCA) and cluster analysis were used to identify groups of individuals with similar characteristics. Results Eight hundred sixty-five individuals were recruited, 53% women, with a mean age of 78 years. Four clusters of participants emerge. Cluster 1 (N = 263) contained patients categorized as robust by most of the studied tools, whereas clusters 2 (N = 199), 3 (N = 183) and 4 (N = 220) grouped patients classified as frail or vulnerable by at least one of the tools. Significant differences were found between clusters. Conclusions The assessed tools identify different profiles of patients according to their theoretical construct of frailty. There is a group of patients that are identified by TUG and SPPB but not by GFS or TFI. These tools may be useful in primary care settings for the implementation of a function- driven clinical care of older patients.
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Affiliation(s)
- Itziar Vergara
- Unidad de Investigación APOSIs Gipuzkoa, Osakidetza, Instituto de Investigación Sanitaria Biodonostia, 20014, Donostia-San Sebastian, Spain. .,Instituto Biodonostia, Donostia-San Sebastian, Spain. .,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain. .,Kronikgune, Barakaldo, Spain.
| | - Maider Mateo-Abad
- Unidad de Investigación APOSIs Gipuzkoa, Osakidetza, Instituto de Investigación Sanitaria Biodonostia, 20014, Donostia-San Sebastian, Spain.,Instituto Biodonostia, Donostia-San Sebastian, Spain.,Kronikgune, Barakaldo, Spain
| | | | - Mónica Machón
- Unidad de Investigación APOSIs Gipuzkoa, Osakidetza, Instituto de Investigación Sanitaria Biodonostia, 20014, Donostia-San Sebastian, Spain.,Instituto Biodonostia, Donostia-San Sebastian, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.,Kronikgune, Barakaldo, Spain
| | - Alonso Montiel-Luque
- Unidad Gestión Clínica San Miguel, Torremolinos. Distrito de Atención Primaria Costa del Sol, Málaga, Spain
| | - Kalliopi Vrotsou
- Unidad de Investigación APOSIs Gipuzkoa, Osakidetza, Instituto de Investigación Sanitaria Biodonostia, 20014, Donostia-San Sebastian, Spain.,Instituto Biodonostia, Donostia-San Sebastian, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.,Kronikgune, Barakaldo, Spain
| | - María Antonia Nava Del Val
- Unidad Gestión Clínica Las Albarizas, Marbella, Distrito de Atención Primaria Costa del Sol, Málaga, Spain
| | - Ana Díez-Ruiz
- Instituto Biodonostia, Donostia-San Sebastian, Spain.,Centro de Salud Beraun, OSI Donostialdea, Osakidetza, Errenteria, Spain
| | - Carolina Güell
- Unidad de Investigación APOSIs Gipuzkoa, Osakidetza, Instituto de Investigación Sanitaria Biodonostia, 20014, Donostia-San Sebastian, Spain.,Instituto Biodonostia, Donostia-San Sebastian, Spain
| | - Ander Matheu
- Grupo de Oncología Celular, Instituto Biodonostia, San Sebastián, Spain; IKERBASQUE, Fundación Vasca para la Ciencia, Bilbao, Spain; CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Bilbao, Spain
| | - Antonio Bueno
- Centro de Salud Beraun, OSI Donostialdea, Osakidetza, Errenteria, Spain
| | - Jazmina Núñez
- Centro de Salud Beraun, OSI Donostialdea, Osakidetza, Errenteria, Spain
| | - Francisco Rivas-Ruiz
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.,Unidad de Investigación Agencia Sanitaria Costa del Sol, Marbella, Málaga, Spain
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Faller JW, Pereira DDN, de Souza S, Nampo FK, Orlandi FDS, Matumoto S. Instruments for the detection of frailty syndrome in older adults: A systematic review. PLoS One 2019; 14:e0216166. [PMID: 31034516 PMCID: PMC6488093 DOI: 10.1371/journal.pone.0216166] [Citation(s) in RCA: 171] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/15/2019] [Indexed: 12/15/2022] Open
Abstract
Frailty is a dynamic process in which there is a reduction in the physical, psychological and/or social function associated with aging. The aim of this study was to identify instruments for the detection of frailty in older adults, characterizing their components, application scenarios, ability to identify pre-frailty and clinimetric properties evaluated. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), under registration number CRD42017039318. A total of 14 electronic sources were searched to identify studies that investigated instruments for the detection of frailty or that presented the construction and/or clinimetric evaluation of the instrument, according to criteria established by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). 96 studies were included in the qualitative synthesis: 51 instruments for the detection of frailty were identified, with predominantly physical domains; 40 were constructed and/or validated for use in the older adult community population, 28 only highlighted the distinction between frail and non-frail individuals and 23 presented three or more levels of frailty. The FRAGIRE, FRAIL Scale, Edmonton Frail Scale and IVCF-20 instruments were the most frequently analyzed in relation to clinimetric properties. It was concluded that: (I) there is a large number of instruments for measuring the same construct, which makes it difficult for researchers and clinicians to choose the most appropriate; (II) the FRAGIRE and CFAI stand out due to their multidimensional aspects, including an environmental assessment; however, (III) the need for standardization of the scales was identified, since the use of different instruments in clinical trials may prevent the comparability of the results in systematic reviews and; (IV) considering the different instruments identified in this review, the choice of researchers/clinicians should be guided by the issues related to the translation and validation for their location and the suitability for their context.
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Affiliation(s)
- Jossiana Wilke Faller
- Department of Maternal and Child Health and Public Health, University of São Paulo, PAHO/WHO Collaborating Center for Nursing Research Development, Ribeirão Preto School of Nursing, Ribeirão Preto, Brazil
- * E-mail:
| | - David do Nascimento Pereira
- Program in Health Promotion and Care in Hospital Care of the Medical School of the University of São Paulo, São Paulo, Brazil
| | - Suzana de Souza
- Latin-American Institute of Life and Natural Sciences, Federal University of Latin-American Integration, Foz do Iguassu, Paraná, Brazil
| | - Fernando Kenji Nampo
- Latin-American Institute of Life and Natural Sciences, Federal University of Latin-American Integration, Foz do Iguassu, Paraná, Brazil
| | - Fabiana de Souza Orlandi
- Department of Gerontology of the Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Silvia Matumoto
- Department of Maternal and Child Health and Public Health, University of São Paulo, PAHO/WHO Collaborating Center for Nursing Research Development, Ribeirão Preto School of Nursing, Ribeirão Preto, Brazil
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