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.
Two representative samples of community-dwelling persons aged 75 years and older (n = 245; n = 234).
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.
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.
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of the American Medical Directors Association
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Developing a working framework for understanding frailty.Gérontologie et société. 2004; 109: 15-29
- A brief clinical instrument to classify frailty in elderly people.Lancet. 1999; 353: 205-206
- Just what defines frailty?.J Am Geriatr Soc. 2005; 53: 2229-2230
- Untangling the concepts of disability, frailty, and comorbidity: Implications for improved targeting and care.J Gerontol A Biol Sci Med Sci. 2004; 59: 255-263
- Frailty: Toward a clinical definition.J Am Med Dir Assoc. 2008; 9: 71-72
- The I.A.N.A Task Force on frailty assessment of older people in clinical practice.J Nutr Health Aging. 2008; 12: 29-37
- Frailty. Med Clin North Am. 2006; 90: 837-847
- Conceptualizations of frailty in relation to older adults.J Adv Nurs. 2003; 44: 58-68
- Validity and reliability of the Edmonton Frail Scale.Age Ageing. 2006; 35: 526-529
- Sex differences in the risk of frailty for mortality independent of disability and chronic diseases.J Am Geriatr Soc. 2005; 53: 40-47
- Frailty: an emerging research and clinical paradigm—issues and controversies.J Gerontol A Biol Sci Med Sci. 2007; 62: 731-737
Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
- In search of an integral conceptual definition of frailty: Opinions of experts.J Am Med Dir Assoc. 2010; 11: 338-343
- Targeting frail older adults for outpatient comprehensive geriatric assessment and management services: An overview of concepts and criteria.Rev Clin Gerontol. 2002; 12: 82-92
- Operationalizing a frailty index from a standardized comprehensive geriatric assessment.J Am Geriatr Soc. 2004; 52: 1929-1933
- Old or frail: What tells us more?.J Gerontol A Biol Sci Med Sci. 2004; 59: M962-M965
- Frailty in older adults: Evidence for a phenotype.J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
- Clinical global impression of change in physical frailty: Development of a measure based on clinical judgment.J Am Geriatr Soc. 2004; 52: 1560-1566
- Towards an integral conceptual model of frailty.J Nutr Health Aging. 2010; 14: 175-181
- Frailty in elderly people: An evolving concept.CMAJ. 1994; 150: 489-495
- Physical and performance measures for the identification of mild to moderate frailty.J Gerontol A Biol Sci Med Sci. 2000; 55: M350-M355
- Unstable disability and the fluctuations of frailty.Age Ageing. 1997; 26: 315-318
- Frailty and injuries in later life: the FICSIT trials.J Am Geriatr Soc. 1993; 41: 283-296
- Antecedents of frailty over three decades in an older cohort.J Gerontol B Psychol Sci Soc Sci. 1998; 53: S9-16
- Screening for frailty: Criteria and predictors of outcomes.J Am Geriatr Soc. 1991; 39: 778-784
- Falls and injuries in frail and vigorous community elderly persons.J Am Geriatr Soc. 1991; 39: 46-52
- Frailty: A public health perspective.Can J Public Health. 1995; 86: 224-227
- Comparison of the LASA Physical Activity Questionnaire with a 7-day diary and pedometer.J Clin Epidemiol. 2004; 57: 252-258
- The timed “Up & Go”: a test of basic functional mobility for frail elderly persons.J Am Geriatr Soc. 1991; 39: 142-148
- Practical implementation of an exercise-based falls prevention programme.Age Ageing. 2001; 30: 77-83
- ['Abbreviated fatigue questionnaire': a practical tool in the classification of fatigue].Ned Tijdschr Geneeskd. 1997; 141 (Dutch): 1526-1530
- Mini-mental state. A practical method for grading the cognitive state of patients for the clinician.J Psychiatr Res. 1975; 12: 189-198
- The CES-D Scale: A self-report depression scale for research in the general population.Appl Psychol Measure. 1977; 1: 385-401
- The hospital anxiety and depression scale.Acta Psychiatr Scand. 1983; 67: 361-370
- The structure of coping.J Health Soc Behav. 1978; 19: 2-21
- The development of a Rasch-type loneliness scale.Appl Psychol Measure. 1985; 9: 289-299
- Manual of the loneliness scale.Department of Social Research Methodology Free University Amsterdam, Amsterdam1999
- Het meten van sociale steun met de Sociale Steun Lijst Handleiding [Assessing social support with the Social Support List Manual].Noordelijk Centrum voor gezondheidsvraagstukken, Groningen, The Netherlands1993 (Dutch)
- Development of the World Health Organization WHOQOL-BREF quality of life assessment.Psychol Med. 1998; 28: 551-558
- The World Health Organization's WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial. A report from the WHOQOL group.Qual Life Res. 2004; 13: 299-310
- The development of a hierarchical polychotomous ADL-IADL scale for noninstitutionalized elders.Gerontologist. 1990; 30: 497-502
- The Groningen Activity Restriction Scale for measuring disability: Its utility in international comparisons.Am J Public Health. 1994; 84: 1270-1273
- Temporal and reciprocal relationship between IADL/ADL disability and depressive symptoms in late life.J Gerontol B Psychol Sci Soc Sci. 2002; 57: P338-P347
- Impairments in physical performance and cognitive status as predisposing factors for functional dependence among nondisabled older persons.J Gerontol A Biol Sci Med Sci. 1996; 51: M283-M288
- White paper on elderly health. Report of the Council on Scientific Affairs.Arch Intern Med. 1990; 150: 2459-2472
- The yield, reliability, and validity of a postal survey for screening community-dwelling older people.J Am Geriatr Soc. 2003; 51: 194-202
- Predictive validity of a postal questionnaire for screening community-dwelling elderly individuals at risk of functional decline.Age Ageing. 1996; 25: 159-167
- Evaluation of a self-report screening instrument to predict frailty outcomes in aging populations.Gerontologist. 1997; 37: 182-191
- Conjugating the “tenses” of function: discordance among hypothetical, experimental, and enacted function in older adults.Gerontologist. 1998; 38: 101-112
- Determinants of frailty.J Am Med Dir Assoc. 2010; 11: 356-364
Published online: May 10, 2010
The authors have no conflicts of interest.
© 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.