The prediction of readmission and mortality by the domains and components of the Tilburg Frailty Indicator (TFI): A prospective cohort study among acutely admitted older patients

Frailty in community-dwelling older people and nursing home residents: An adaptation and validation study

AIM

The aim of this was to psychometrically adapt and evaluate the Tilburg Frailty Indicator to assess frailty among older people living in Slovenia's community and nursing home settings.

DESIGN

A cross-cultural adaptation and validation of instruments throughout the cross-sectional study.

METHODS

Older people living in the community and nursing homes throughout Slovenia were recruited between March and August 2021. Among 831 participants were 330 people living in nursing homes and 501 people living in the community, and all were older than 65 years.

RESULTS

All items were translated into the Slovene language, and a slight cultural adjustment was made to improve the clarity of the meaning of all items. The average scale validity index of the scale was rated as good, which indicates satisfactory content validity. Cronbach's α was acceptable for the total items and subitems.

CONCLUSIONS

The Slovenian questionnaire version demonstrated adequate internal consistency, reliability, and construct and criterion validity. The questionnaire is suitable for investigating frailty in nursing homes, community dwelling and other settings where older people live.

IMPACT

The Slovenian questionnaire version can be used to measure and evaluate frailty among older adults. We have found that careful translation and adaptation processes have maintained the instrument's strong reliability and validity for use in a new cultural context. The instrument can foster international collaboration to identify and manage frailty among older people in nursing homes and community-dwelling homes.

REPORTING METHOD

The Strengthening the Reporting of Observational Studies in Epidemiology checklist for reporting cross-sectional studies was used.

NO PATIENT OR PUBLIC CONTRIBUTION

No patient or public involvement in the design or conduct of the study. Head nurses from nursing homes and community nurses helped recruit older adults. Older adults only contributed to the data collection and were collected from nursing homes and community dwelling.

The effect of regional transmural agreements on the information transfer of frail older patients

INTRODUCTION

Frail older patients are at risk for many complications when admitted to the hospital. Multidisciplinary regional transmural agreements (RTA) in which guidelines were set concerning the information transfer of frail older patients might improve outcomes. We aim to investigate the effect of implementation of the RTA on the completeness of the information transfer of frail older patients when admitted to and discharged from the hospital.

METHODS

This is a retrospective cohort study in which we collected data from 400 randomly selected hospitalized frail older patients (70+) before the implementation of the RTA, January through March 2021, and after, October through December 2021. The cohort was split up into four groups, which determined what correspondence would be checked (referral letter by General Practitioner (GP) and three groups of 'hospital letters': ED letter upon admittance, clinical discharge letter to the elderly care physician and clinical discharge letter to the GP. We assessed for mention of frailty, a medication list and mention of resuscitation orders.

RESULTS

In the period before implementation the mean age of patients was 82.6 years (SD 7.4) and 101 were female (50.5%), after implementation mean age was 82.3 (SD 6.9) and 112 were female (56.0%). Frailty was mentioned in hospital letters in 12.7% before and 15.3% after implementation (p = 0.09). More GP referral letters were present after implementation (32.0% vs. 54.0%, p = 0.03), however frailty was mentioned only in 12.5% before and 7.4% after (p = 0.58). There was a good handover of medication lists from the hospital (89.3% before, 94% after, p = 0.20) and even better from the GP (93.8% before, 100% after, p = 0.19). Resuscitation orders were mentioned in 59.3% of letters from the hospital before implementation and 57.3% after (p = 0.77), which is higher than in the referral letters (18.8% before and 22.2% after (p = 0.91).

DISCUSSION

The implementation of RTA improved the number of GP referral letters present; however, it did not lead to other significant improvements in communication between the hospital and the GP's. Frailty and resuscitation orders are still frequently not mentioned in the reports. After a successful reimplementation, the improvements of outcomes could be investigated.

Exploring the concept of psychological frailty in older adults: a systematic scoping review

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.

Can the Tilburg Frailty Indicator predict post-operative quality of recovery in patients with gynecologic cancer? A prospective cohort study

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.

Nurses' Opinions on Frailty

Nurses come into frequent contact with frail older people in all healthcare settings. However, few studies have specifically asked nurses about their views on frailty. The main aim of this study was to explore the opinions of nurses working with older people on the concept of frailty, regardless of the care setting. In addition, the associations between the background characteristics of nurses and their opinions about frailty were examined. In 2021, members of professional association of nurses and nursing assistants in the Netherlands (V&VN) received a digital questionnaire asking their opinions on frailty, and 251 individuals completed the questionnaire (response rate of 32.1%). The questionnaire contained seven topics: keywords of frailty, frailty domains, causes of frailty, consequences of frailty, reversing frailty, the prevention of frailty, and addressing frailty. Regarding frailty, nurses especially thought of physical deterioration and dementia. However, other domains of human functioning, such as the social and psychological domains, were often mentioned, pointing to a holistic approach to frailty. It also appears that nurses can identify many causes and consequences of frailty. They see opportunities to reverse frailty and an important role for themselves in this process.

The Tilburg Frailty Indicator: A psychometric systematic review

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.

Assessing Frailty with the Tilburg Frailty Indicator (TFI): A Review of Reliability and Validity

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.