Abstract
Objectives
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).
Design
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.
Methods
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)].
Results
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.
Keywords
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Article info
Publication history
Published online: June 02, 2022
Footnotes
This work was supported by the Lee Foundation, Singapore Grant 2019.
Identification
Copyright
© 2022 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
