Self-Reported Frailty Screening Tools: Comparing Construct Validity of the Frailty Phenotype Questionnaire and FRAIL



      We examined the construct validity of 2 self-reported frailty questionnaires, the Frailty Phenotype Questionnaire (FPQ) and FRAIL, against the Cardiovascular Health Study frailty phenotype (CHS-FP).


      Cross-sectional data analysis of longitudinal prospective cohort study.

      Settings and Participants

      We included data from 230 older adults (mean age: 67.2 ± 7.4 years) from the “Longitudinal Assessment of Biomarkers for characterization of early Sarcopenia and Osteosarcopenic Obesity in predicting frailty and functional decline in community-dwelling Asian older adults Study” (GeriLABS 2) recruited between December 2017 and March 2019.


      We compared area under receiver operating characteristic curves (AUC), agreement, correlation, and predictive validity against outcome measures [Short Physical Performance Battery, 5 times repeat chair stand (RCS-5), Frenchay activities index, International Physical Activity Questionnaire, life-space assessment, Social Functioning Scale 8 (SFS-8), EuroQol-5 dimensions (utility value)] using logistic regression adjusted for age, gender, and vascular risk factors. We examined concurrent validity across robust versus prefrail/frail for inflammatory blood biomarkers [tumor necrosis factor receptor 1 and C-reactive protein (CRP)] and dual-energy x-ray absorptiometry body composition [bone mineral density (BMD); appendicular lean mass index (ALMI), and fat mass index (FMI)].


      Prevalence of prefrail/frail was 25.7%, 14.8%, and 48.3% for FPQ, FRAIL, and CHS-FP, respectively. Compared with FRAIL, FPQ had better diagnostic performance (AUC = 0.617 vs 0.531, P = .002; sensitivity = 37.8% vs 18.0%; specificity = 85.6% vs 88.2%) and agreement (AC1-Stat = 0.303 vs 0.197). FPQ showed good predictive validity [RCS-5: odds ratio (OR) 2.38; 95% CI: 1.17–4.86; International Physical Activity Questionnaire: OR 3.62; 95% CI:1.78–7.34; SFS-8: OR 2.11; 95% CI: 1.64–5.89 vs FRAIL: all P > .05]. Only FRAIL showed concurrent validity for CRP, compared with both FPQ and FRAIL for TNF-R1. FRAIL showed better concurrent validity for BMD, FMI, and possibly ALMI, unlike FPQ (all P > .05).

      Conclusions and Implications

      Our results support complementary validity of FPQ and FRAIL in independent community-dwelling older adults. FPQ has increased case detection sensitivity with good predictive validity, whereas FRAIL demonstrates concurrent validity for inflammation and body composition. With better diagnostic performance and validity for blood biomarkers and clinical outcomes, FPQ has utility for early frailty detection in the community setting.


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        • Fried L.P.
        • Tangen C.M.
        • Walston J.
        • et al.
        Frailty in older adults: Evidence for a phenotype.
        J Gerontol Med Sci. 2001; 56: M146-M156
        • Morley J.E.
        • Malmstrom T.K.
        • Miller D.K.
        A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans.
        J Nutr Health Aging. 2012; 16: 601-608
        • Kim S.
        • Kim M.
        • Jung H.W.
        • et al.
        Development of a frailty phenotype questionnaire for use in screening community-dwelling older adults.
        J Am Med Dir Assoc. 2020; 21: 660-664
        • Van Kan G.A.
        • Rolland Y.M.
        • Morley J.E.
        • et al.
        Frailty: Toward a clinical definition.
        J Am Med Dir Assoc. 2008; 9: 71-72
        • Chen S.
        • Chen T.
        • Kishimoto H.
        • et al.
        Development of a Fried Frailty Phenotype Questionnaire for use in screening community-dwelling older adults.
        J Am Med Dir Assoc. 2020; 21: 272-276
        • Woo J.
        • Yu R.
        • Wong M.
        • et al.
        Frailty screening in the community using the FRAIL scale.
        J Am Med Dir Assoc. 2015; 16: 412-419
        • Dong L.
        • Qiao X.
        • Tian X.
        • et al.
        Cross-cultural adaptation and validation of the FRAIL scale in Chinese community-dwelling older adults.
        J Am Med Dir Assoc. 2018; 19: 12-17
        • Aprahamian I.
        • Cezar N.O.C.
        • Izbicki R.
        • et al.
        Screening for frailty with the FRAIL scale: A comparison with the phenotype criteria.
        J Am Med Dir Assoc. 2017; 18: 592-596
        • Jung H.W.
        • Yoo H.J.
        • Park S.Y.
        • et al.
        The Korean version of the FRAIL scale: Clinical feasibility and validity of assessing the frailty status of Korean elderly.
        Korean J Intern Med. 2016; 3: 594-600
        • Leng S.X.
        • Cappola A.R.
        • Andersen R.E.
        • et al.
        Serum levels of insulin-like growth factor-I (IGF-I) and dehydroepiandrosterone sulfate (DHEA-S), and their relationships with serum interleukin-6, in the geriatric syndrome of frailty.
        Aging Clin Exp Res. 2004; 16: 153-157
        • Lim W.S.
        • Lim J.P.
        • Chew J.
        • et al.
        Calf circumference as a case-finding tool for sarcopenia: Influence of obesity on diagnostic performance.
        J Am Med Dir Assoc. 2020; 21: 1359-1361
        • Chew J.
        • Tay L.
        • Lim J.P.
        • et al.
        Serum myostatin and IGF-1 as gender-specific biomarkers of frailty and low muscle mass in community-dwelling older adults.
        J Nutr Health Aging. 2019; 23: 979-986
        • Chen L.K.
        • Woo J.
        • Assantachai P.
        • et al.
        Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment.
        J Am Med Dir Assoc. 2020; 21: 300-307
        • Wade D.T.
        • Legh-Smith J.
        • Hewer R.L.
        Social activities after stroke: Measurement and natural history using the Frenchay Activities Index.
        Int Rehabil Med. 1985; 7: 176-181
        • Guralnik J.M.
        • Ferrucci L.
        • Simonsick E.M.
        • et al.
        Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability.
        N Engl J Med. 1995; 332: 556-561
        • Hurtig-Wennlöf A.
        • Hagströmer M.
        • Olsson L.A.
        The International Physical Activity Questionnaire modified for the elderly: Aspects of validity and feasibility.
        Public Health Nutr. 2010; 13: 1847-1854
        • Peel C.
        • Baker P.S.
        • Roth D.L.
        • et al.
        Assessing mobility in older adults: The UAB Study of Aging Life-Space Assessment.
        Phys Ther. 2005; 85: 1008-1019
        • Pek K.
        • Chew J.
        • Lim J.P.
        • et al.
        Social frailty is independently associated with mood, nutrition, physical performance, and physical activity: Insights from a theory-guided approach.
        Int J Environ Res Public Health. 2020; 17: 4239
        • Van Hout B.
        • Janssen M.F.
        • Feng Y.S.
        • et al.
        Interim scoring for the EQ-5D-5L: Mapping the EQ-5D-5L to EQ-5D-3L value sets.
        Value Health. 2012; 15: 708-715
        • Ong M.
        • Pek K.
        • Tan C.N.
        • et al.
        Social frailty and executive function: Association with geriatric syndromes, life space and quality of life in healthy community-dwelling older adults.
        J Frailty Aging. 2021; 11: 206-213
        • Gwet K.
        Handbook of Inter-Rater Reliability.
        STATAXIS Publishing Company, 1991
        • Cesari M.
        • Marzetti E.
        • Calvani R.
        Sarcopenia and SARC-F: “Perfect is the enemy of good”.
        J Am Med Dir Assoc. 2021; 22: 1862-1863
        • Dent E.
        • Lien C.
        • Lim W.S.
        • et al.
        The Asia-Pacific clinical practice guidelines for the management of frailty.
        J Am Med Dir Assoc. 2017; 18: 564-575
        • Pistilli E.E.
        • Jackson J.R.
        • Alway S.E.
        Death receptor-associated pro-apoptotic signalling in aged skeletal muscle.
        Apoptosis. 2006; 11: 2115-2126
        • Wajant H.
        • Siegmund D.
        TNFR1 and TNFR2 in the control of the life and death balance of macrophages.
        Front Cell Dev Biol. 2019; 7: 91
        • Badimon L.
        • Peña E.
        • Arderiu G.
        • et al.
        C-reactive protein in atherothrombosis and angiogenesis.
        Front Immunol. 2018; 9: 430
        • Su L.
        • Hao Q.K.
        • Liu S.
        • et al.
        Monocytes related inflammatory biomarkers are associated with frailty syndrome.
        Int J Gerontol. 2017; 11: 225-229
        • Cawthon P.M.
        • Peters K.W.
        • Shardell M.D.
        • et al.
        Cutpoints for low appendicular lean mass that identify older adults with clinically significant weakness.
        J Gerontol A Biol Sci Med Sci. 2014; 69: 567-575
        • Ambagtsheer R.C.
        • Beilby J.J.
        • Visvanathan R.
        Should we screen for frailty in primary care settings? A fresh perspective on the frailty evidence base: a narrative review.
        Prev Med. 2019; 119: 63-69
        • Yu R.
        • Tong C.
        • Ho F.
        • et al.
        Effects of a multicomponent frailty prevention program in prefrail community-dwelling older persons: a randomized controlled trial.
        J Am Med Dir Assoc. 2020; 21: 294.e1
        • Buckinx F.
        • Landi F.
        • Cesari M.
        • et al.
        Pitfalls in the measurement of muscle mass: A need for a reference standard.
        J Cachexia Sarcopenia Muscle. 2018; 9: 269-278
        • Cawthon P.M.
        • Orwoll E.S.
        • Peters K.E.
        • et al.
        Strong relation between muscle mass determined by D3-creatine dilution, physical performance, and incidence of falls and mobility limitations in a prospective cohort of older men.
        J Gerontol A Biol Sci Med Sci. 2019; 74: 844-885