Original Study
The Tilburg Frailty Indicator: Psychometric Properties

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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.

Section snippets

Study Populations and Data Collection

Two samples of community-dwelling individuals aged 75 years and older were randomly drawn from a register of the municipality in Roosendaal (The Netherlands), a town of 78,000 inhabitants. In Sample 1 (N = 245; 54% response rate) we investigated the construct validity of the TFI using additional measures of frailty, and in Sample 2 (N = 234; 34% response rate) we examined the predictive validity of the TFI using questions on adverse outcomes and quality of life. The proportion of men (0.46) and

Participant Characteristics

See Table 1 for an overview of descriptive statistics of Sample 1 and Sample 2. The t-tests show no statistically significant differences between the 2 samples on determinants of frailty, components of frailty, and quality of life. The mean age was 80.3 and 80.2 years, 55% and 59% were female, 35% and 41% were widowed, respectively, for both samples.

Development of the TFI: Face Validity and Content Validity

The first draft of the TFI was developed on the basis of previous research on frailty.19 This draft was presented to participants at 2 geriatrics

Discussion

We developed a measurement instrument, the Tilburg Frailty Indicator (TFI), for identifying frail community-dwelling older people. The TFI is based on an integral view of human functioning, based on a definition of frailty that excludes disability but includes physical, psychological, and social components of frailty. In the present study the psychometric properties of the TFI were examined in representative samples of Dutch community-dwelling elderly persons.

This study shows that the TFI is a

References (50)

  • G. Abellan van Kan et al.

    Frailty: Toward a clinical definition

    J Am Med Dir Assoc

    (2008)
  • A. Abellan van Kan et al.

    The I.A.N.A Task Force on frailty assessment of older people in clinical practice

    J Nutr Health Aging

    (2008)
  • M. Markle-Reid et al.

    Conceptualizations of frailty in relation to older adults

    J Adv Nurs

    (2003)
  • D.B. Rolfson et al.

    Validity and reliability of the Edmonton Frail Scale

    Age Ageing

    (2006)
  • M.T. Puts et al.

    Sex differences in the risk of frailty for mortality independent of disability and chronic diseases

    J Am Geriatr Soc

    (2005)
  • H. Bergman et al.

    Frailty: an emerging research and clinical paradigm—issues and controversies

    J Gerontol A Biol Sci Med Sci

    (2007)
  • Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New...
  • F. Aminzadeh et al.

    Targeting frail older adults for outpatient comprehensive geriatric assessment and management services: An overview of concepts and criteria

    Rev Clin Gerontol

    (2002)
  • D.M. Jones et al.

    Operationalizing a frailty index from a standardized comprehensive geriatric assessment

    J Am Geriatr Soc

    (2004)
  • H. Schuurmans et al.

    Old or frail: What tells us more?

    J Gerontol A Biol Sci Med Sci

    (2004)
  • L.P. Fried et al.

    Frailty in older adults: Evidence for a phenotype

    J Gerontol A Biol Sci Med Sci

    (2001)
  • S. Studenski et al.

    Clinical global impression of change in physical frailty: Development of a measure based on clinical judgment

    J Am Geriatr Soc

    (2004)
  • K. Rockwood et al.

    Frailty in elderly people: An evolving concept

    CMAJ

    (1994)
  • M. Brown et al.

    Physical and performance measures for the identification of mild to moderate frailty

    J Gerontol A Biol Sci Med Sci

    (2000)
  • A.J. Campbell et al.

    Unstable disability and the fluctuations of frailty

    Age Ageing

    (1997)
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    The authors have no conflicts of interest.

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