Multidimensional Short Tools to assess frailty: a narrative review

Multidimensional Short Tools to assess frailty: a narrative review

Authors

  • V. Formosa
  • G. Lorusso
  • G. Lentini
  • E. Terracciano
  • S. Gentili
  • G. Liotta

Keywords:

Frailty, Elderly, Short tool, Health, Multidimensional evaluation, Primary care, Physical, Psychological, Care, Social

Abstract

Background. The population of the European Union is progressively ageing, therefore frailty is becoming a crucial public health issue. In recent years there is a growing interest in a multidimensional concept of frailty, that is not only physical but also psychological and social, in line with a person-centered care. Study design. To measure frailty represents a fundamental step to evaluate the needs for care at both population and individual levels. Of course, to assess frailty in a large population is essential to find short and quick tools able to give reliable results in terms of risk of occurrence of negative events, to stratify older adults according to their frailty level. In this way the most appropriate strategies can be chosen and applied, to delay the functional decline associated to frailty and its consequences, such as hospitalization, institutionalization, low quality of life, and death.

Methods. In this review we searched on PubMed for articles about scales assessing frailty with peculiar characteristics: published for the first time in 2010, available in English, with a short length and duration of administration, composed by multidimensional domains.

Results. Seven scales were found and analyzed: The Zulfiqar Frailty Scale (ZFS), The Pictorial Fit-Frail Scale

(PFFS), The Tilburg Frailty Indicator (TFI), The SUNFRAIL Tool, The (fr)AGILE, The Risk Instrument for Screening in the Community (RISC) and The Short Functional Geriatric Evaluation (SFGE). We compared their main features as the number of questions, the time for administration, the domains used and the psychometric properties as validity and reliability, with the aim of providing a set of useful information to health professionals in their everyday work.

Conclusions. The use of these tools provides important information to help plan community health and social care and meet individuals’ needs for care, but this approach is not common for community care in the EU yet.

References

1. Eurostat statistics explained. Available on: https://ec.europa.eu/eurostat/statistics-explained [Last accessed: 2022 February 15].

2. Liguori I, Russo G, Bulli G, et al. Validation of “(fr)AGILE”: a quick tool to identify multidimensional frailty in the elderly. BMC Geriatr. 2020 Sep 29; 20(1): 375. doi: 10.1186/s12877020-01788-1. PMID: 32993569; PMCID: PMC752609.

3. Gilardi F, Capanna A, Ferraro M, et al. Frailty screening and assessment tools: a review of characteristics and use in Public Health. Ann Ig. 2018 Mar-Apr; 30(2): 128-39. doi: 10.7416/ ai.2018.2204. PMID: 29465150.

4. O’Caoimh R, Gao Y, Svendrovski A, et al. Screening for markers of frailty and perceived risk of adverse outcomes using the Risk Instrument for Screening in the Community (RISC). BMC Geriatr. 2014 Sep 19; 14: 104. doi: 10.1186/1471-2318-14-104. PMID: 25238874; PMCID: PMC4177708.

5. van Oostrom SH, van der A DL, Rietman ML, et al. A four-domain approach of frailty explored in the Doetinchem Cohort Study. BMC Geriatr. 2017 Aug 30; 17(1): 196. doi: 10.1186/ s12877-017-0595-0. PMID: 28854882; PMCID: PMC5577839.

6. Scarcella P, Liotta G, Marazzi MC, Carbini R, Palombi L. Analysis of survival in a sample of elderly patients from Ragusa, Italy on the basis of a primary care level multidimensional evaluation. Arch Gerontol Geriatr. 2005 Mar-Apr; 40(2): 147-56. doi: 10.1016/j.archger.2004.07.004. PMID: 15680499.

7. World Health Organization (WHO) (2021).

Decade of healthy ageing: Baseline report. Avail-

able on: https://www.who.int/publications/m/ item/decade-of-healthy-ageing-baseline-report [Last accessed: 2022 February 15].

8. Araujo de Carvalho I, Epping-Jordan J, et al. Organizing integrated health-care services to meet older people’s needs. Bull World Health Organ. 2017 Nov 1; 95(11): 756-63. doi: 10.2471/ BLT.16.187617. Epub 2017 May 26. PMID: 29147056; PMCID: PMC56776.

9. Hendry A, Vanhecke E, Carriazo AM, et al. Integrated Care Models for Managing and Preventing Frailty: A Systematic Review for the European Joint Action on Frailty Prevention (ADVANTAGE JA). Transl Med UniSa. 2019 Jan 6; 19: 5-10. PMID: 31360661; PMCID: PMC6581495.

10. British Geriatrics Society. Fit for frailty. Consensus best practice guidance for the care of older people living in community and outpatient settings—a report from the British Geriatrics Society. 2014. ISBN: No. 978-0-9929663-1-7.

11. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29; 372: n71. doi: 10.1136/bmj.n71. PMID: 33782057; PMCID: PMC8005924.

12. Mokkink LB, de Vet HCW, Prinsen CAC, et al. COSMIN Risk of Bias checklist for systematic reviews of Patient-Reported Outcome Measures. Qual Life Res 2018; 27(5):1171-79. doi:

10.1007/s11136-017-1765-4. Epub 2017 Dec

19. PMID: 29260445; PMCID: PMC5891552.

13. Liotta G, Ussai S, Illario M, et al. Frailty as the Future Core Business of Public Health: Report of the Activities of the A3 Action Group of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). Int J Environ Res Public Health. 2018 Dec 13; 15(12): 2843. doi: 10.3390/ijerph15122843. PMID: 30551599; PMCID: PMC6313423.

14. Gobbens RJ, Uchmanowicz I. Assessing Frailty with the Tilburg Frailty Indicator (TFI): A Review of Reliability and Validity. Clin Interv

Aging. 2021 May 18; 16: 863-75. doi: 10.2147/ CIA.S298191. PMID: 34040363; PMCID: PMC8140902.

15. Op Het Veld LPM, Beurskens AJHM, de Vet

HCW, et al. The ability of four frailty screening instruments to predict mortality, hospitalization and dependency in (instrumental) activities of daily living. Eur J Ageing. 2019 Feb 19; 16(3): 387-94. doi: 10.1007/s10433-019-00502-4.

PMID: 31543731; PMCID: PMC6728401.

16. Zulfiqar AA. Creation of a New Frailty Scale in Primary Care: The Zulfiqar Frailty Scale (ZFS). Medicines (Basel). 2021 Apr 13; 8(4): 19. doi: 10.3390/medicines8040019. PMID: 33924562; PMCID: PMC8069187.

17. Theou O, Andrew M, Ahip SS, et al. The Pictorial Fit-Frail Scale: Developing a Visual Scale to Assess Frailty. Can Geriatr J. 2019 Jun 30; 22(2): 64-74. doi: 10.5770/cgj.22.357. PMID: 31258829; PMCID: PMC6542581.

18. McGarrigle L, Squires E, Wallace LMK, et al. Investigating the feasibility and reliability of the Pictorial Fit-Frail Scale. Age Ageing. 2019 Nov

1; 48(6): 832-7. doi: 10.1093/ageing/afz111. PMID: 31579907; PMCID: PMC6814089.

19. Wallace LMK, McGarrigle L, Rockwood K, Andrew MK, Theou O. Validation of the Pictorial Fit-Frail Scale in a memory clinic setting.

Int Psychogeriatr. 2020 Sep; 32(9): 1063-72. doi:

10.1017/S1041610219000905. Epub 2019 Sep

16. PMID: 31524122.

20. Gobbens RJ, van Assen MA, Luijkx KG, Wijnen-Sponselee MT, Schols JM. The Tilburg Frailty Indicator: psychometric properties. J Am Med Dir Assoc. 2010 Jun; 11(5): 344-55. doi:

10.1016/j.jamda.2009.11.003. Epub 2010 May

8. PMID: 20511102.

21. Mulasso A, Roppolo M, Gobbens RJ, Rabaglietti E. The Italian Version of the Tilburg Frailty Indicator: Analysis of Psychometric Properties. Res Aging. 2016 Nov; 38(8): 842-63. doi:

10.1177/0164027515606192. Epub 2015 Sep

16. PMID: 26377805.

22. Si H, Jin Y, Qiao X, Tian X, Liu X, Wang C. Predictive performance of 7 frailty instruments for short-term disability, falls and hospitalization among Chinese community-dwelling older adults: A prospective cohort study. Int J Nurs Stud. 2021 May; 117: 103875. doi: 10.1016/j. ijnurstu.2021.103875. Epub 2021 Feb 1. PMID: 33621721.

23. Vrotsou K, Machón M, Rivas-Ruíz F, et al. Psychometric properties of the Tilburg Frailty Indicator in older Spanish people. Arch Gerontol Geriatr. 2018 Sep-Oct; 78: 203-12. doi:

10.1016/j.archger.2018.05.024. Epub 2018 Jun

1. PMID: 30007234.

24. Gobbens RJJ, Maggio M, Longobucco Y, Barbolini M. The Validity of the SUNFRAIL Tool: A Cross-Sectional Study among Dutch

Community-Dwelling Older People. J Frailty Aging. 2020; 9(4): 219-25. doi: 10.14283/ jfa.2020.4. PMID: 32996558.

25. Maggio M, Barbolini M, Longobucco Y, et al. A Novel Tool for The Early Identification Of Frailty In Elderly People: The Application In

Primary Care Settings. J Frailty Aging. 2020; 9(2): 101-6. doi: 10.14283/jfa.2019.41. PMID: 32259184.

26. Cardoso AF, Bobrowicz-Campos E, TeixeiraSantos L, Cardoso D, Couto F, Apóstolo J. Validation and Screening Capacity of the European Portuguese Version of the SUNFRAIL Tool for Community-Dwelling Older Adults. Int J Environ Res Public Health. 2021 Feb 3; 18(4): 1394. doi: 10.3390/ijerph18041394. PMID: 33546251.

27. Capanna A, Scarcella, Gilardi F, et al. Sensitivity and Specificity of a Short Questionnaire to Screen Frailty in the Community-Dwelling Older Population. Adv Aging Res. 2018; 7: 5263. https://doi.org/10.4236/aar.2018.73005.

28. Kim B, McKay SM, Lee J. Consumer-Grade Wearable Device for Predicting Frailty in Canadian Home Care Service Clients: Prospective Observational Proof-of-Concept Study. J Med Internet Res. 2020 Sep 3; 22(9): e19732. doi: 10.2196/19732. PMID: 32880582.

29. Adja KYC, Lenzi J, Sezgin D, et al. The Importance of Taking a Patient-Centered, Community-Based Approach to Preventing and Managing Frailty: A Public Health Perspective. Front Public Health. 2020 Nov 12; 8: 599170. doi: 10.3389/fpubh.2020.599170. PMID: 33282818.

30. Vergara I, Rivas-Ruiz F, Vrotsou K, et al. Validation and comparison of instruments to identify frail patientes in primary care settings: Study protocol. BMC Health Serv Res. 2016 Aug 5; 16(a):354. doi: 10.1186/s12913-016-1540-1.

PMID: 27492438.

31. Terwee CB, Bot SD, de Boer MR, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007 Jan; 60(1): 34-42. doi: 10.1016/j. jclinepi.2006.03.012. Epub 2006 Aug 24. PMID: 17161752.

32. Cook DA, Beckman TJ. Current concepts in validity and reliability for psychometric instruments: theory and application. Am J Med.

2006 Feb; 119(2): 166.e7-16. doi: 10.1016/j.

amjmed.2005.10.036. PMID: 16443422.

33. Ginty AT. Psychometric properties. In: Gellman MD, Turner JR, eds. Encyclopedia of Behavioral Medicine. New York, NY: Springer, 2013: 1563-4.

34. Souza AC, Alexandre NMC, Guirardello EB. Psychometric properties in instruments evaluation of reliability and validity. Epidemiol Serv Saude. 2017 Jul-Sep; 26(3): 649-59. English, Portuguese. doi: 10.5123/S167949742017000300022. PMID: 28977189.

35. Farmer C, Fenu E, O’Flynn N, Guthrie B. Clinical assessment and management of multimorbidity: summary of NICE guidance. BMJ. 2016 Sep 21; 354: i4843. doi: 10.1136/bmj.i4843. PMID: 27655884.

36. Røsvik J, Michelet M, Engedal K, et al. Development of best practice recommendations to enhance access to and use of formal community care services for people with dementia in Europe: a Delphi process conducted by the Actifcare project. Aging Ment Health. 2020 Oct 8: 1-12. doi: 10.1080/13607863.2020.1822286. Epub ahead of print. PMID: 33030026.

327. Chehade MJ, Yadav L, Kopansky-Giles D, et al. Innovations to improve access to musculoskeletal care. Best Pract Res Clin Rheumatol. 2020 Oct; 34(5): 101559. doi: 10.1016/j. berh.2020.101559. Epub 2020 Jul 24. PMID:

32718885.

Downloads

Published

2025-08-04

Issue

Section

Original research

How to Cite

1.
Formosa V, Lorusso G, Lentini G, Terracciano E, Gentili S, Liotta G. Multidimensional Short Tools to assess frailty: a narrative review. Ann Ig. 2025;35(1):21-33. doi:10.7416/ai.2022.2516