Search

Robbert J Gobbens,1– 3 Izabella Uchmanowicz4 1Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; 2Zonnehuisgroep Amstelland, Amstelveen, the Netherlands; 3Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; 4Division of Nursing in Internal Medicine Procedures, Department of Clinical Nursing, The Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, PolandCorrespondence: Robbert J GobbensFaculty of Health, Sports and Social Work, Inholland University of Applied Sciences, De Boelelaan 1109, Amsterdam, 1081 HV, The NetherlandsTel +31 6 21115578Email robbert.gobbens@inholland.nlObjective: The Tilburg Frailty Instrument (TFI) is an instrument for assessing frailty in community-dwelling older people. Since its development, many studies have been carried out examining the psychometric properties. The aim of this study was to provide a review of the main findings with regard to the reliability and validity of the TFI.Methods: We conducted a literature search in the PubMed and CINAHL databases on May 30, 2020. An inclusion criterion was the use of the entire TFI, part B, referring to the 15 components. No restrictions were placed on language or year of publication.Results: In total, 27 studies reported about the psychometric properties of the TFI. By far, most of the studies (n = 25) were focused on community-dwelling older people. Many studies showed that the internal consistency and test–retest reliability are good, which also applies for the criterion and construct validity. In many studies, adverse outcomes of interest were disability, increased health-care utilization, lower quality of life, and mortality. Regarding disability, studies predominantly show results that are excellent, with an area under the curve (AUC) > 0.80. In addition, the TFI showed good associations with lower quality of life and the findings concerning mortality were at least acceptable. However, the association of the TFI with some indicators of health-care utilization can be indicated as poor (eg, visits to a general practitioner, hospitalization).Conclusion: Since population aging is occurring all over the world, it is important that the TFI is available and well known that it is a user-friendly instrument for assessing frailty and its psychometric properties being qualified as good. The findings of this assessment can support health-care professionals in selecting interventions to reduce frailty and delay its adverse outcomes, such as disability and lower quality of life.Keywords: older people, frailty, Tilburg Frailty Indicator, reliability, validity

Kathleen Van Royen,1,2 Paul Van Royen,1 Liesbeth De Donder,3 Robbert J Gobbens1,4,5 1Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium; 2Department of Communication Studies, University of Antwerp, Antwerp, Belgium; 3Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium; 4Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; 5Zonnehuisgroep Amstelland, Amstelveen, the NetherlandsCorrespondence: Kathleen Van RoyenDepartment of Primary and Interdisciplinary Care, University of Antwerp, Gouverneur Kinsbergencentrum, Doornstraat 331-2610, Doornstraat, Wilrijk, BelgiumTel +32 32655099Email kathleen.vanroyen@uantwerpen.beBackground and Aim: Caregivers in the home environment have an important role in timely detecting and responding to abuse. The aim of this review was to provide insight into both the existing tools for the assessment of and interventions for elder abuse by formal and informal caregivers in the home environment, and to categorize them according to a public health perspective, into primary, secondary, tertiary or quaternary prevention.Methods: We selected the assessment tools and interventions that can be used by caregivers in the home environment included in previous reviews by Gallione et al (2017) and Fearing et al (2017). To identify published studies after these reviews, a search was performed using PubMed, Cochrane Database, CINAHL and Web of Science.Results: In total, fifteen assessment tools and twelve interventions were included. The number of assessment tools for elder abuse for use in the home environment is increasing; however, tools must be validated over different cultures and risk groups. In addition, the tools lack attention for the needs of vulnerable older persons such as persons with dementia. Existing interventions for caregivers in the home environment lack evidence for addressing elder abuse and do not address potential adverse effects (quaternary prevention).Conclusion: Assessment tools for elder abuse need further testing for validity and reliability for use by caregivers in the home environment. For interventions, meaningful outcome measures are needed. Important to note is that quaternary prevention requires more attention. This argues for taking into account perspectives of (abused) older persons and caregivers in the development of assessment tools and interventions protocols.Keywords: caregivers, elder abuse management, prevention, assessment tools, interventions, review

Mattia Roppolo,1,2 Anna Mulasso,1 Robbert J Gobbens,3,4 Cristina O Mosso,1 Emanuela Rabaglietti1 1Department of Psychology, University of Torino, Torino, Italy; 2Department of Developmental Psychology, Rijksuniversiteit Groningen, Groningen, the Netherlands; 3Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; 4Zonnehuisgroep Amstelland, Amstelveen, the Netherlands Background: Over the years, a plethora of frailty assessment tools has been developed. These instruments can be basically grouped into two types of conceptualizations – unidimensional, based on the physical–biological dimension – and multidimensional, based on the connections among the physical, psychological, and social domains. At present, studies on the comparison between uni- and multidimensional frailty measures are limited.Objective: The aims of this paper were: 1) to compare the prevalence of frailty obtained using a uni- and a multidimensional measure; 2) to analyze differences in the functional status among individuals captured as frail or robust by the two measures; and 3) to investigate relations between the two frailty measures and disability.Methods: Two hundred and sixty-seven community-dwelling older adults (73.4±6 years old, 59.9% of women) participated in this cross-sectional study. The Cardiovascular Health Study (CHS) index and the Tilburg Frailty Indicator (TFI) were used to measure frailty in a uni- and multidimensional way, respectively. The International Physical Activity Questionnaire, the Center of Epidemiologic Studies Depression scale, and the Loneliness Scale were administered to evaluate the functional status. Disability was assessed using the Groningen Activity Restriction Scale. Data were treated with descriptive statistics, one-way analysis of variance, correlations, and receiver operating characteristic analyses through the evaluation of the areas under the curve.Results: Results showed that frailty prevalence rate is strictly dependent on the index used (CHS =12.7%; TFI =44.6%). Furthermore, frail individuals presented differences in terms of functional status in all the domains. Frailty measures were significantly correlated with each other (r=0.483), and with disability (CHS: r=0.423; TFI: r=0.475). Finally, the area under the curve of the TFI (0.833) for disability was higher with respect to the one of CHS (0.770).Conclusion: Data reported here confirm that different instruments capture different frail individuals. Clinicians and researchers have to consider the different abilities of the two measures to detect frail individuals. Keywords: functional decline, older adults, health outcomes, active aging, indexes selection

Tjeerd van der Ploeg,1 René Schalk,2– 4 Robbert J J Gobbens1,2,5,6 1Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; 2Tranzo, Tilburg University, Tilburg, the Netherlands; 3Human Resource Studies, Tilburg University, Tilburg, the Netherlands; 4Economic and Management Science, North West University, Potchefstroom, South Africa; 5Zonnehuisgroep Amstelland, Amstelveen, the Netherlands; 6Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, BelgiumCorrespondence: Tjeerd van der Ploeg, Inholland University of Applied Sciences, Faculty of Health, Sports and Social Work, De Boelelaan 1109, Amsterdam, 1081 HV, the Netherlands, Tel +31 6 53519264, Email tvdploeg@quicknet.nlBackground: Advanced statistical modeling techniques may help predict health outcomes. However, it is not the case that these modeling techniques always outperform traditional techniques such as regression techniques. In this study, external validation was carried out for five modeling strategies for the prediction of the disability of community-dwelling older people in the Netherlands.Methods: We analyzed data from five studies consisting of community-dwelling older people in the Netherlands. For the prediction of the total disability score as measured with the Groningen Activity Restriction Scale (GARS), we used fourteen predictors as measured with the Tilburg Frailty Indicator (TFI). Both the TFI and the GARS are self-report questionnaires. For the modeling, five statistical modeling techniques were evaluated: general linear model (GLM), support vector machine (SVM), neural net (NN), recursive partitioning (RP), and random forest (RF). Each model was developed on one of the five data sets and then applied to each of the four remaining data sets. We assessed the performance of the models with calibration characteristics, the correlation coefficient, and the root of the mean squared error.Results: The models GLM, SVM, RP, and RF showed satisfactory performance characteristics when validated on the validation data sets. All models showed poor performance characteristics for the deviating data set both for development and validation due to the deviating baseline characteristics compared to those of the other data sets.Conclusion: The performance of four models (GLM, SVM, RP, RF) on the development data sets was satisfactory. This was also the case for the validation data sets, except when these models were developed on the deviating data set. The NN models showed a much worse performance on the validation data sets than on the development data sets.Keywords: prediction models, modeling techniques, external validation, performance, calibration, correlation coefficient, root of the mean squared error

Robbert JJ Gobbens,1– 3 Tjeerd van der Ploeg4 1Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; 2Zonnehuisgroep Amstelland, Amstelveen, the Netherlands; 3Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; 4Faculty of Engineering, Design and Computer Technology, Inholland University of Applied Sciences, Alkmaar, the NetherlandsCorrespondence: Robbert JJ GobbensFaculty of Health, Sports and Social Work, Inholland University of Applied Sciences, De Boelelaan 1109, Amsterdam 1081 HV, the NetherlandsTel +31 6 21115578Email robbert.gobbens@inholland.nlObjective: To predict mortality by disability in a sample of 479 Dutch community-dwelling people aged 75 years or older.Methods: A longitudinal study was carried out using a follow-up of seven years. The Groningen Activity Restriction Scale (GARS), a self-reported questionnaire with good psychometric properties, was used for data collection about total disability, disability in activities in daily living (ADL) and disability in instrumental activities in daily living (IADL). The mortality dates were provided by the municipality of Roosendaal (a city in the Netherlands). For analyses of survival, we used Kaplan–Meier analyses and Cox regression analyses to calculate hazard ratios (HR) with 95% confidence intervals (CI).Results: All three disability variables (total, ADL and IADL) predicted mortality, unadjusted and adjusted for age and gender. The unadjusted HRs for total, ADL and IADL disability were 1.054 (95%-CI: [1.039;1.069]), 1.091 (95%-CI: [1.062;1.121]) and 1.106 (95%-CI: [1.077;1.135]) with p-values < 0.001, respectively. The AUCs were < 0.7, ranging from 0.630 (ADL) to 0.668 (IADL). Multivariate analyses including all 18 disability items revealed that only “Do the shopping” predicted mortality. In addition, multivariate analyses focusing on 11 ADL items and 7 IADL items separately showed that only the ADL item “Get around in the house” and the IADL item “Do the shopping” significantly predicted mortality.Conclusion: Disability predicted mortality in a seven years follow-up among Dutch community-dwelling older people. It is important that healthcare professionals are aware of disability at early stages, so they can intervene swiftly, efficiently and effectively, to maintain or enhance the quality of life of older people.Keywords: disability, mortality, community-dwelling older people, activities of daily living

Xiaoyue Song,1,2 Weihong Zhang,2 Cynthia Hallensleben,1 Anke Versluis,1 Rianne van der Kleij,1 Zongliang Jiang,2 Niels H Chavannes,1 Robbert JJ Gobbens3– 5 1Department of Public Health and Primary Care, Leiden University Medical Center, Leiden 2333 ZD, The Netherlands; 2School of Nursing, Zhengzhou University, Zhengzhou, People’s Republic of China; 3Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands; 4Zonnehuisgroep Amstelland, Amstelveen, The Netherlands; 5Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, BelgiumCorrespondence: Xiaoyue SongDepartment of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden 2333 ZD, The NetherlandsTel +31682817080Email x.song@lumc.nlPurpose: To investigate the prevalence of multidimensional frailty in older people with hypertension and to examine a possible relationship of general obesity and abdominal obesity to frailty in older people with hypertension.Patients and Methods: A sample of 995 community-dwelling older people with hypertension, aged 65 years and older and living in Zhengzhou (China), completed the Tilburg Frailty Indicator (TFI), a validated self-report questionnaire for assessing multidimensional frailty. In addition, socio-demographic and lifestyle characteristics were assessed by self-report, and obesity was determined by measuring waist circumference and calculating the body mass index.Results: The prevalence of multidimensional frailty in this older population with hypertension was 46.5%. Using multiple linear regression analysis, body mass index was significantly associated with physical frailty (p = 0.001), and waist circumference was significantly positively associated with multidimensional frailty and all three frailty domains. Older age was positively associated with multidimensional frailty, physical frailty, and psychological frailty, while gender (woman) was positively associated with multidimensional, psychological, and social frailty. Furthermore, comorbid diseases and being without a partner were positively associated with multidimensional, physical, psychological, and social frailty. Of the lifestyle characteristics, drinking alcohol was positively associated with frailty domains.Conclusion: Multidimensional frailty was highly prevalent among Chinese community-dwelling older people with hypertension. Abdominal obesity could be a concern in physical frailty, psychological frailty, and social frailty, while general obesity was concerning in relation to physical frailty.Keywords: older people, multidimensional frailty, obesity, hypertension

Robbert JJ Gobbens, 1–3 Petra Boersma, 1 Izabella Uchmanowicz, 4 Livia Maria Santiago 5 1Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; 2Zonnehuisgroep Amstelland, Amstelveen, the Netherlands; 3Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; 4Division of Nursing in Internal Medicine Procedures, Department of Clinical Nursing, The Faculty of Health Sciences, Wroclaw Medical University, Wrocław, Poland; 5Faculty of Medicine, Department of Speech and Language Pathology, Federal University of Rio de Janeiro, Rio de Janeiro, BrazilCorrespondence: Robbert JJ GobbensFaculty of Health, Sports and Social Work, Inholland University of Applied Sciences, De Boelelaan 1109, 1081 HV, Amsterdam, the NetherlandsTel +31 6 21115578Email robbert.gobbens@inholland.nlObjective: The Tilburg Frailty Indicator (TFI) is a self-report user-friendly questionnaire for assessing multidimensional frailty among community-dwelling older people. The main aim of this study is to re-evaluate the validity of the TFI, both cross-sectionally and longitudinally, focusing on the predictive value of the total TFI and its physical, psychological, and social domains for adverse outcomes disability, indicators of healthcare utilization, and falls.Methods: The validity of the TFI was determined in a sample of 180 Dutch community-dwelling older people aged 70 years and older. The participants completed questionnaires including the TFI, the Groningen Activity Restriction Scale (GARS) for assessing disability, and questions with regard to health care utilization and falls in 2016 and again one year later.Results: The physical and psychological domains of the TFI were significantly correlated as expected with adverse outcomes disability, many indicators of healthcare utilization, and falls. Regression analyses showed that physical frailty was mostly responsible for the effect of frailty on the adverse outcomes. The cross-sectional and longitudinal predictive validity of total frailty with respect to disability and receiving personal care was excellent, evidenced by Areas Under the Curves (AUCs) > 0.8. In most cases, using the cut-off point 5 for total frailty ensured the best values for sensitivity and specificity.Conclusion: The present study provided new, additional evidence for the validity of the TFI for assessing frailty in Dutch community-dwelling older people aiming to prevent or delay adverse outcomes, including disability.Keywords: older people, frailty, disability, validity, Tilburg Frailty Indicator

Marta Muszalik,1 Mateusz Gurtowski,1 Halina Doroszkiewicz,2 Robbert JJ Gobbens,3–5 Kornelia Kędziora-Kornatowska11Department of Geriatrics, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Toruń, Poland; 2Department of Geriatrics, Medical University of Bialystok, Białystok, Poland; 3Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; 4Zonnehuisgroep Amstelland, Amstelveen, the Netherlands; 5Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, BelgiumObjective: The aim of this study was to assess the relationship between frailty syndrome and the nutritional status of older patients.Material and methods: This cross-sectional study was conducted in a sample of 120 patients hospitalized at the Geriatric Clinic between January 2017 and May 2017. The research tools were the Frailty Instrument of the Survey of Health, Ageing and Retirement in Europe (SHARE-FI), including relevant anthropometric measurements and muscle strength measurement, and the Mini Nutritional Assessment (MNA). All the calculations were performed using the Statistica 10.0 program. The p-values lower than 0.05 were considered as statistically significant.Results: The mean age of the participants was 71 years (SD=9.03). Most participants were from urban areas. More than half of the participants (53.3%) were women. Based on the SHARE-FI, the frailty syndrome was found in 33.3% of the participants. The mean value in the MNA scale was 24.4 points (SD=3.4). The frailty syndrome was significantly correlated to gender (p

Jantine van Rijckevorsel-Scheele,1 Renate CWJ Willems,1 Pepijn DDM Roelofs,1 Elin Koppelaar,1 Robbert JJ Gobbens,2–4 Marleen JBM Goumans1 1Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands; 2Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; 3Zonnehuisgroep Amstelland, Amstelveen, the Netherlands; 4Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium Introduction: Many health care interventions have been developed that aim to improve or maintain the quality of life for frail elderly. A clear overview of these health care interventions for frail elderly and their effects on quality of life is missing. Purpose: To provide a systematic overview of the effect of health care interventions on quality of life of frail elderly. Methods: A systematic search was conducted in Embase, Medline (OvidSP), Cochrane Central, Cinahl, PsycInfo and Web of Science, up to and including November 2017. Studies describing health care interventions for frail elderly were included if the effect of the intervention on quality of life was described. The effects of the interventions on quality of life were described in an overview of the included studies. Results: In total 4,853 potentially relevant articles were screened for relevance, of which 19 intervention studies met the inclusion criteria. The studies were very heterogeneous in the design: measurement of frailty, health care intervention and outcome measurement differ. Health care interventions described were: multidisciplinary treatment, exercise programs, testosterone gel, nurse home visits and acupuncture. Seven of the nineteen intervention studies, describing different health care interventions, reported a statistically significant effect on subdomains of quality of life, two studies reported a statistically significant effect of the intervention on the overall quality of life score. Ten studies reported no statistically significant difference between the intervention and control groups. Conclusion: Reported effects of health care interventions on frail elderly persons’ quality of life are inconsistent, with most of the studies reporting no differences between the intervention and control groups. As the number of frail elderly persons in the population will continue to grow, it will be important to continue the search for effective health care interventions. Alignment of studies in design and outcome measurements is needed. Keywords: frailty, quality of life, interventions, systematic review, multidisciplinary treatment, exercise programs

Robbert JJ Gobbens,1–3 Roy Remmen3 1Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; 2Zonnehuisgroep Amstelland, Amstelveen, the Netherlands; 3Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium Objective: The effects of sociodemographic factors on quality of life in older people differ strongly, possibly due to the fact that different measurement instruments have been used. The main aim of this cross-sectional study is to compare the associations of sex, age, marital status, education, and income with quality of life assessed with the Short-Form Health Survey (SF-12), the World Health Organization Quality of Life Questionnaire-BREF (WHOQOL-BREF), and the World Health Organization Quality of Life Questionnaire-Older Adults Module (WHOQOL-OLD). Methods: The associations between sociodemographic factors and eleven quality of life domains were examined using a sample of 1,492 Dutch people aged ≥50 years. Participants completed the “Senioren Barometer”, a web-based questionnaire including sociodemographic factors, the SF-12, the WHOQOL-BREF, and the WHOQOL-OLD. Results: All the sociodemographic factors together explained a significant part of the variance of all the quality of life domains’ scores, ranging from 5% to 17% for the WHOQOL-BREF, 5.8% to 6.7% for the SF-12, and 1.4% to 26% for the WHOQOL-OLD. Being a woman and being older were negatively associated with two and four quality of life domains, respectively. Being a woman, being married or cohabiting, and having higher education and a higher income were positively associated with six, six, one, and eleven quality of life domains, respectively. Conclusion: Our study showed that the associations of sociodemographic factors and quality of life in middle-aged and older people depend on the instruments used to assess quality of life. We recommend that health care and welfare professionals focus particularly on people with a low income and carry out interventions aimed at improving their quality of life. Keywords: quality of life, older people, sociodemographic factors, SF-12, WHOQOL-BREF, WHOQOL-OLD

Inge Renne,1 Robbert JJ Gobbens2–4 1General Practice Beeker, Hofland Medisch Centrum, Mijdrecht, the Netherlands; 2Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; 3Zonnehuisgroep Amstelland, Amstelveen, the Netherlands; 4Department of General Practice, University of Antwerp, Antwerp, Belgium Objective: The aim of this cross-sectional study was to determine the associations between frailty and multimorbidity on the one hand and quality of life on the other in community-dwelling older people.Methods: A questionnaire was sent to all people aged 70 years and older belonging to a general practice in the Netherlands; 241 persons completed the questionnaire (response rate 47.5%). For determining multimorbidity, nine chronic diseases were examined by self-report. Frailty was assessed by the Tilburg Frailty Indicator, and quality of life was assessed by the World Health Organization Quality of Life Instrument—Older Adults Module.Results: Multimorbidity, physical, psychological, as well as social frailty components were negatively associated with quality of life. Multimorbidity and all 15 frailty components together explained 11.6% and 36.5% of the variance of the score on quality of life, respectively.Conclusion: Health care professionals should focus their interventions on the physical, psychological, and social domains of human functioning. Interprofessional cooperation between health care professionals and welfare professionals seems necessary to be able to meet the needs of frail older people. Keywords: older people, frailty, quality of life, multimorbidity

Robbert JJ Gobbens,1–3 Jos MGA Schols,4 Marcel ALM van Assen5,6 1Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; 2Zonnehuisgroep Amstelland, Amstelveen, the Netherlands; 3Department of General Practice, University of Antwerp, Antwerp, Belgium; 4Department of Health Services Research and Department of Family Medicine, CAPHRI-Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands; 5Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands; 6Department of Sociology, Utrecht University, Utrecht, the Netherlands Abstract: Due to rapidly aging human populations, frailty has become an essential concept, as it identifies older people who have higher risk of adverse outcomes, such as disability, institutionalization, lower quality of life, and premature death. The Tilburg Frailty Indicator (TFI) is a user-friendly questionnaire based on a multidimensional approach to frailty, assessing physical, psychologic, and social aspects of human functioning. This review aims to explore the efficiency of the TFI in assessing frailty as a means to carry out research into the antecedents and consequences of frailty, and its use both in daily practice and for future intervention studies. Using a multidimensional approach to frailty, in contexts where health care professionals or researchers may have no time to interview or examine the client, we recommend employing the TFI because there is robust evidence of its reliability and validity and it is easy and quick to administer. More studies are needed to establish whether the TFI is suitable for intervention studies not only in the community, but also for specific groups such as patients in the hospital or admitted to an emergency department. We conclude that it is important to not only determine the deficits that frail older people may have, but also to assess their balancing strengths and resources. In order to be able to meet the individual needs of frail older persons, traditional and often fragmented elderly care should be developed toward a more proactive elderly care, in which frail older persons and their informal network are in charge. Keywords: frailty, Tilburg Frailty Indicator, measurement instruments, psychometric properties, elderly care

Izabella Uchmanowicz,1 Robbert JJ Gobbens2,3 1Department of Clinical Nursing, Wroclaw Medical University, Wroclaw, Poland; 2Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; 3Zonnehuisgroep Amstelland, Amstelveen, the Netherlands Objective: Elderly people constitute over 80% of the population of patients with heart failure (HF). Frailty is a distinct biological syndrome that reflects decreased physiologic reserve and resistance to stressors. Moreover, frailty can serve as an independent predictor of visits to the emergency department, hospitalizations, and mortality. The purpose of this paper was to assess the relationship between frailty, anxiety and depression, and the health-related quality of life (HRQoL) of elderly patients with HF.Patients and methods: The study included 100 patients (53 men and 47 women) with a diagnosis of HF. Frailty was measured using the Tilburg Frailty Indicator (TFI) scale. HRQoL was measured using the 36-Item Short Form Medical Outcomes Study Survey. To determine the prevalence of anxiety and depression, the Hospital Anxiety and Depression Scale was used.Results: Frailty was found in 89% of the studied population. The study showed significant inverse correlations between the values of the physical component scale (PCS) domain results and TFI score, and a significant inverse correlation between the values of the mental component scale (MCS) domain and TFI score. When participants showed increased levels of frailty as measured by the TFI scale, there was also an increase in the levels of anxiety and depression. With increased anxiety and depression, there was deterioration in the quality of life of patients with HF.Conclusion: Frailty has a negative impact on the HRQoL results of elderly patients with HF. The assessment of frailty syndrome, and anxiety and depression should be taken into account when estimating risk and making therapeutic decisions for cardiovascular disease treatment and care. Keywords: frailty, health-related quality of life, heart failure, elderly, anxiety, depression

Izabella Uchmanowicz,1 Marta Wleklik,1 Robbert JJ Gobbens2,3 1Department of Clinical Nursing, Wroclaw Medical University, Wroclaw, Poland; 2Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, 3Zonnehuisgroep Amstelland, Amstelveen, the Netherlands Background: Chronic heart failure is a serious medical condition. Recently, there has been an increasing interest in frailty syndrome and self-care levels among patients with cardiovascular conditions. Demonstrating the influence of frailty syndrome on self-care could improve the quality of self-care and prevent the adverse effects of frailty syndrome. The purpose of this study was to assess the influence of frailty syndrome on the self-care capabilities of patients with chronic heart failure, and to identify factors associated with frailty.Methods: The data were collected between January and July 2014. The study included 110 patients with chronic heart failure who were hospitalized in the cardiology clinic. Frailty syndrome was assessed using the Tilburg Frailty Indicator, a self-report questionnaire, and self-care behavior was assessed using the European Heart Failure Self-Care Behavior Scale.Results: Fifty-four percent of the study patients were male and 46% were female. The mean age was 66±11 years, the mean Tilburg Frailty Indicator score was 7.45±3.02 points, and the mean self-care level was 27.6±7.13 points. Correlation analyses showed that patients with higher scores in the social components of the frailty scale had better self-care capabilities. Frailty was associated with age, education, duration of heart failure, number of hospitalizations, and New York Heart Association class. The effects of these patient characteristics differed across components of frailty (physical, psychological, social).Conclusion: The social components of frailty syndrome adversely affect the ability to self-care in elderly patients with heart failure. It is relevant to use a multidimensional measurement of frailty. Keywords: frailty syndrome, self-care, heart failureA Letter to the Editor has been received and published for this article.

Izabella Uchmanowicz,1 Beata Jankowska-Polańska,1 Maria Łoboz-Rudnicka,2 Stanislaw Manulik,3 Krystyna Łoboz-Grudzień,1,2 Robbert JJ Gobbens4 1Department of Clinical Nursing, Wroclaw Medical University, 2Department of Cardiology, T Marciniak Memorial Hospital, 3Primary Care Practice, Wroclaw, Poland; 4Research and Development Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands Background: Frail older people are at high risk of developing adverse outcomes, such as disability, mortality, hospitalization, and institutionalization. Previous research suggests that the Tilburg Frailty Indicator (TFI) is a valid and reliable instrument for measuring frailty. The aim of this study was to adapt and to test the reliability of the Polish version of the TFI. Method: A standard guideline was used for translation and cultural adaptation of the English version of the TFI into Polish. The study included 100 Polish patients (mean age 68.2±6.5 years), among them 42 men and 58 women. Cronbach’s alpha was used for analysis of the internal consistency of the TFI. Results: The mean total TFI score was 6.7±3.1. Forty patients scored ≥5, which corresponded to being frail. Cronbach’s alpha reliability coefficients of the instrument ranged from 0.68 to 0.72 and item-total correlation ranged from 0.12 to 0.52. Conclusion: The TFI is valid and reproducible for assessment of frailty syndrome among a Polish population. The Polish adaptation of the TFI proved a useful and fast tool for assessing frailty. Keywords: internal consistency, validity, older individuals, aging

The hip fracture causes significant disabilities in many elderly people. Many studies around the world have identified various risk factors for the hip fracture. The aim of this study was to systematically investigate the risk factors of hip fractures. This study is a systematic review of risk factors for hip fractures. All published papers in English and Persian languages on patients in Iran and other countries between 2002 - 2022 were examined. The search strategy used keywords matching the mesh, including : predictors, hip fracture, and disability. Articles were selected from international databases (PubMed, Proquest ,Web of Sience, Scopus, Google scholar and Persian(Sid,Magiran), and the Newcastle Ottawa Scale was used to assess the risk of bias. The study has identified several factors that were significantly correlated with the risk of hip fracture, including age, cigarette and alcohol consumption, visual and hearing problems, low BMI levels, history of falling, weakness, and diseases such as stroke, cardiovascular disease, high blood pressure, arthritis, diabetes, dementia, Alzheimer's, Parkinson's, liver and kidney diseases, bone density, osteoporosis, vertebral fracture, and hyperthyroidism. However, the study did not find any significant correlations between the consumption of calcium and vitamin D, history of fractures, cognitive disorders, schizophrenia, and household income, and the risk of hip fracture. The results of this study reveal the determining role of some risk factors in hip fracture in older persons. Therefore, it is recommended that health policy makers provide the possibility of early intervention for some changeable factors., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 International Journal of Preventive Medicine.)

To investigate the impact of Appreciative Inquiry (AI) on learning and developing together for improving the quality of care in a nursing home, and to explore experiences following the four phases of the AI cycle, an AI was performed as part of participative action research. Interviews, group discussions, creative methods of storytelling, and reflections were used in the AI sessions. Staff members were interviewed to evaluate the AI process. All of the interviews were recorded and transcribed. Data were analyzed thematically using Maxqda and were discussed by the interviewers until consensus was reached. The sessions resulted in ten action proposals to improve healthcare. One proposal was worked out in agreements on cooperation. The evaluation revealed that the sessions have given a boost to the team spirit, and involvement at the location leading to more cooperation and communication during the shifts. The evaluation indicated that it is important to convert the action plans of the sessions into actions, which are then evaluated. AI was advised as a way of learning where everyone is involved, and mutual agreements are made. This study has shown that AI can be a valuable way to support learning and development to promote the quality of care in a nursing home.

Disability is associated with lower quality of life and premature death in older people. Therefore, prevention and intervention targeting older people living with a disability is important. Frailty can be considered a major predictor of disability. In this study, we aimed to develop nomograms with items of the Tilburg Frailty Indicator (TFI) as predictors by using cross-sectional and longitudinal data (follow-up of five and nine years), focusing on the prediction of total disability, disability in activities of daily living (ADL), and disability in instrumental activities of daily living (IADL). At baseline, 479 Dutch community-dwelling people aged ≥75 years participated. They completed a questionnaire that included the TFI and the Groningen Activity Restriction Scale to assess the three disability variables. We showed that the TFI items scored different points, especially over time. Therefore, not every item was equally important in predicting disability. 'Difficulty in walking' and 'unexplained weight loss' appeared to be important predictors of disability. Healthcare professionals need to focus on these two items to prevent disability. We also conclude that the points given to frailty items differed between total, ADL, and IADL disability and also differed regarding years of follow-up. Creating one monogram that does justice to this seems impossible.

Nurses come into frequent contact with frail older people in all healthcare settings. However, few studies have specifically asked nurses about their views on frailty. The main aim of this study was to explore the opinions of nurses working with older people on the concept of frailty, regardless of the care setting. In addition, the associations between the background characteristics of nurses and their opinions about frailty were examined. In 2021, members of professional association of nurses and nursing assistants in the Netherlands (V&VN) received a digital questionnaire asking their opinions on frailty, and 251 individuals completed the questionnaire (response rate of 32.1%). The questionnaire contained seven topics: keywords of frailty, frailty domains, causes of frailty, consequences of frailty, reversing frailty, the prevention of frailty, and addressing frailty. Regarding frailty, nurses especially thought of physical deterioration and dementia. However, other domains of human functioning, such as the social and psychological domains, were often mentioned, pointing to a holistic approach to frailty. It also appears that nurses can identify many causes and consequences of frailty. They see opportunities to reverse frailty and an important role for themselves in this process.

Background: The increase in life expectancy has brought about a higher prevalence of chronic illnesses among older people., Objectives: To identify common chronic illnesses among older adults, to examine the influence of such conditions on their Health-Related Quality of Life (HRQoL), and to determine factors predicting their HRQoL., Method: A population-based cross-sectional study was conducted involving 377 individuals aged 60 years and above who were selected using multi-stage sampling techniques in Olorunda Local Government, Osun State, Nigeria. Data were collected using an interviewer-administered questionnaire comprising socio-demographic characteristics, chronic illnesses, and the World Health Organization quality of life instrument (WHOQOL-BREF) containing physical health, psychological, social relationships, and environmental domains., Results: About half (51.5%) of the respondents reported at least one chronic illness which has lasted for 1-5 years (43.3%). The prevalence of hypertension was 36.1%, diabetes 13.9% and arthritis 13.4%. Respondents with chronic illness had significantly lower HRQoL overall and in the physical health, social relationships and the environmental domains (all p<0.05) compared to those without a chronic illness. Factors that predicted HRQoL include age, marital status, level of education, the presence of chronic illness and prognosis of the condition., Conclusion: This study concluded that chronic illness is prevalent in Nigerian older people and significantly influence their HRQoL. Age, marital status, and level of education were associated with HRQoL in this group., Funding: Postdoctoral fellowship from Consortium for Advanced Research Training in Afric., Competing Interests: Conflict of interest: None declared, (Copyright © The Author(s).)

Background: Quality of life is an important health outcome for older persons. It predicts the adverse outcomes of institutionalization and premature death. The aim of this cross-sectional study was to determine the influence of both disability in activities of daily living (ADL) and instrumental activities of daily living (IADL) on physical and mental dimensions of quality of life., Methods: A total of 377 Dutch people aged 75 years and older completed a web-based questionnaire. This questionnaire contained the Groningen Activity Restriction Scale (GARS) for measuring ADL and IADL and the Short-Form Health Survey (SF-12) for measuring quality of life. The SF-12 distinguishes two dimensions of quality of life, a physical and mental dimension., Results: All ADL disability items combined and all IADL disability items combined explained a significant part of the variance of the physical and the mental dimension of quality of life. Only ADL item "stand up from sitting in a chair", and IADL items "do "heavy" household activities" and "do the shopping" were negatively associated with both quality of life dimensions after controlling for all the variables in the model., Discussion: This study showed that disability in ADL and IADL is negatively associated with quality of life in older people. Therefore, it is important for health care professionals to carry out interventions aimed to prevent and diminish disability or the adverse outcomes of disability such as a lower quality of life. In order to be effective these interventions should be inexpensive, feasible, and easy to implement., Competing Interests: The author declares there are no competing interests.

Aim: The present study aimed, first, to compare the ability to predict falls over 12 months for three measures - mobility, balance and frailty. Second, among the three domains of frailty - physical, psychological and social - we investigated what is the strongest predictor of falls., Methods: A total of 192 community-dwelling older adults (age 73.0 ± 6.2 years; 62% women) were involved in this longitudinal study. The Timed Up and Go (TUG) test, One Leg Standing (OLS) test and the Tilburg Frailty Indicator (TFI) were respectively used to measure mobility, balance and frailty. The TFI is a questionnaire based on a multidimensional conceptualization of frailty consisting of 15 items in three domains (physical, psychological and social). Falls were self-reported during the 12-month follow up. Logistic regression models, adjusted for interesting variables, were carried out to predict the risk of falls., Results: History of falls and chronic conditions were the indicators more strongly related with falls over 12 months. The TFI resulted as a stronger predictor of falls when compared with the TUG and OLS tests. The explained variance of the three models was 31.2%, 22.4% and 22.2%, respectively. The TFI was significantly associated with falls (P < 0.001), whereas the TUG and the OLS were not (P > 0.05). Among the three frailty domains, physical (P < 0.001) and psychological (P = 0.041) domains were significant predictors of falls., Conclusions: The findings showed that the TFI might be an effective tool for predicting falls at 12 months in aged populations, probably because it is able to capture the multifactorial facets that can lead to falls. Geriatr Gerontol Int 2017; 17: 1463-1469., (© 2016 Japan Geriatrics Society.)

Background: Postprocedural complications after elective cardiac interventions include hematomas and infections. Telemedical wound assessment using mobile phones with integrated cameras may improve quality of care and help reduce costs., Aims: We aimed to study the feasibility of telemedical wound assessment using a mobile phone. The primary aim was the number of patients who were able to upload their pictures. Secondary aims were image interpretability, agreement between nurse practitioners, and patient evaluation of the intervention., Methods: This is a prospective study of all consecutive patients who underwent an elective cardiac intervention. Patients were instructed to photograph their wound or puncture site after hospital discharge and upload the pictures to a secure email address 6 days after hospital discharge. Received photos were assessed by 2 nurse practitioners. The intervention was evaluated using a peer-reviewed questionnaire and photo assessment scheme., Results: In total, 46 eligible patients were included in the study, with 5 screen failures (eg, clinical stay ≥ 6 days) and 1 patient lost to follow-up. Thirty-three of 40 patients (83%) were able to upload their pictures. Smartphone users were more successful in uploading their pictures compared with feature phone users (93% vs 55%, P < .01). Eighty-eight percent of the clinical pictures were interpretable. The interobserver variability had an agreement between 93% and 97%., Conclusions: Patients are able to take and upload the mobile clinical photos to the secure email address, and the vast majority was interpretable. Smartphone users were more successful than feature phone users in uploading their pictures. The interobserver variability was good.

This study aims to assess the reliability, construct validity (convergent/divergent), and criterion validity of the Italian version of the Tilburg Frailty Indicator (TFI). The TFI is a self-report questionnaire for screening frailty in older adults. Two hundred and sixty-seven community-dwelling older adults were involved. Psychometric properties were analyzed using validated instruments. Adverse outcomes such as disability, falls, and visits to a general practitioner were detected. Participants were mainly women (59.9%), with a mean age of 73.4 years (SD = 6.0). Internal consistency reliability was acceptable. Construct validity was good, since each item of the TFI correlated as expected with corresponding frailty measures. Convergent and divergent validity were adequate for all the domains of the TFI. Criterion validity was excellent for disability and mediocre for the other two outcomes. This study supports the validity of the Italian TFI and offers to clinicians and scientists a multidimensional instrument for identifying frail individuals in the Italian context., (© The Author(s) 2015.)

Objectives: The objectives of this study were to provide reference values of the Tilburg Frailty Indicator (TFI) for community-dwelling older people by age, sex, marital status, ethnicity, education, income, and residence, and examine the effects of these seven socio-demographic variables on frailty., Methods: 47,768 individuals aged 65 years and older living in the Netherlands completed a health questionnaire (58.5% response rate), including the TFI. The TFI is a self-report questionnaire for measuring frailty, developed from an integral approach of frailty, including physical, psychological, and social domains., Results: Reference values were provided for men and women separately, as a function of age. We found associations of all socio-demographic variables with frailty, also after controlling for the effects of age. These associations held for both sexes and for big cities as wells as more rural areas. For instance, the effect of age was large for total and physical frailty, women were more frail than men, and some very large average frailty differences between the ethnic groups were found, with autochthon people having the lowest frailty score., Conclusions: In conclusion, this study offers reference values of the TFI by socio-demographic characteristics and explains frailty using these characteristics. This information will support researchers, policymakers and health care professionals in interpreting scores of the TFI, which may guide their efforts to reduce frailty and its adverse outcomes., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Objective: To determine whether the effects of lifestyle factors on frailty can be adequately addressed by asking a single self-report question., Design: Cross-sectional study., Setting: A sample of Dutch citizens completed the web-based questionnaire "Seniorenbarometer"., Participants: 610 persons aged 50 years and older., Measurements: Seven lifestyle factors were assessed: smoking, use of alcohol, intake of vegetables, intake of fruit, having breakfast, exercise, and teeth brushing. The single self-report question of lifestyle was: "Overall, how healthy would you say your lifestyle is?" Frailty was measured by the Tilburg Frailty Indicator., Results: Age was positively associated with a healthy lifestyle (less smoking, more intake of vegetables, fruit and eating breakfast). The lifestyle factors did not improve the prediction of total, physical, psychological, and social frailty, after controlling for the single self-report question., Conclusion: Our study suggests that one general self-report lifestyle question, rather than a list of specific lifestyle factors, suffices for predicting frailty., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: To assess the internal consistency reliability and construct validity of the Dutch version of the World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD)., Methods: The psychometric properties of the Dutch WHOQOL-OLD were examined in a cross-sectional study using a sample of 1,340 people aged 60 years or older. Participants completed a Web-based questionnaire, the 'Senioren Barometer'. Reliability was evaluated using Cronbach's alpha and corrected item-total correlations. Construct validity of the Dutch WHOQOL-OLD was evaluated with confirmatory factor analyses, and correlations within and between scales, using scales WHOQOL-BREF, Short Form Health Survey (SF-12), Tilburg Frailty Indicator (TFI), and the Emotional and Social Loneliness Scale (ESLS)., Results: The reliabilities of the six WHOQOL-OLD facets or subscales were sufficient to good (.66-.91). The convergent validity of the WHOQOL-OLD was good, whereas our findings on the divergent validity of the WHOQOL-OLD were somewhat mixed. Findings corroborating the divergent validity were that the 6-factor model fitted better than the second-order factor model, and WHOQOL-OLD facets sensory abilities, past, present and future activities, death and dying, intimacy correlated more strongly with similar than dissimilar scales. Not fully supporting divergent validity were the extremely high correlations between the factors corresponding to autonomy, past, present and future activities, and social participation., Conclusion: We offer Dutch healthcare and social workers an instrument with good psychometric properties for measuring quality of life in older people. Further research on interrelations between WHOQOL-OLD facets is recommended.

Background: The Tilburg frailty indicator (TFI) is a self-report measurement instrument which integrates the physical, psychological and social domains to assess frailty in older adults. The aim of this study was the adaptation of the TFI to a German version and testing of the psychometric properties., Material and Methods: This study surveyed 210 individuals aged 64-91 years living at home. The mean age of participants was M = 75.3±5.7 years with 62 % females. The internal consistency was tested with Cronbach's alpha. The test-retest reliability was calculated after 20 weeks. The German TFI was validated using alternative measures for assessment of the quality of life, e.g. Eurohis-QoL-8 and short form health survey (SF-12), the patient health questionnaire (PHQ), the geriatric anxiety inventory short form (GAI-SF), the social support scale (F-Soz-U-K-14) and the resilience scale (RS-11)., Results: The internal consistency was acceptable with a value for Cronbach's alpha of 0.67. The test-retest reliability was good after 5 months α = 0.87 (physical domain r = 0.85, psychological domain r = 0.75 and social domain r = 0.84). The inter-item correlations ranged between - 0.06 and 0.57. Correlations with alternative frailty measures showed good convergent and divergent validity., Conclusion: This study showed acceptable psychometric properties of the German adaptation of the TFI which was found to be age and frailty sensitive. The results of the validity of the TFI support the three domains integrated in the frailty score. Further application and testing of the German TFI in primary care and clinical settings are suggested to consolidate the findings.

We assessed self-management in patients with adrenal insufficiency and patient-related factors that affect self-management. A self-report questionnaire was developed to assess self-management. The questionnaire contained three main topics, including: (i) medication adherence; (ii) anticipated measures; and (iii) dose adaptation during medical emergencies. Sixty per cent of the patients (n = 116) completed the questionnaire. The score for the medication adherence was 3.5 out of 4. The score for anticipated measures was 3.4 out of 5, and dose adaptation during medical emergencies was 1.9 out of 3. Older age was a positive predictor for all three self-management topics. The female sex was a positive predictor for anticipated measures and dose adaptation during medical emergencies. High education level was associated with higher scores on dose adaptation during medical emergencies in women, not in men. Education level did not affect other self-management aspects. There seems to be a need to improve self-management in these patients. Self-management might be improved by continuous education, and involvement of endocrine nurses and nurse practitioners is likely to be a key factor in the effectiveness of patient education., (© 2014 Wiley Publishing Asia Pty Ltd.)

Background: In the last decade, studies on frailty have become increasingly frequent in the literature on aging, and also the number of available questionnaires regarding frailty has increased over the years. Therefore, the choice of which questionnaire to use is becoming more difficult., Objective: The aim of this study was to assess the psychometric properties of the Polish version of the Tilburg Frailty Indicator (TFI), an instrument that identifies frailty in the elderly population., Design: Setting, and Participants. The study was carried out in a community-based setting in Wrocław, Poland. Nurses and doctors (general practitioners) administered the TFI in primary care facilities. Participants included a sample of 212 community dwelling elderly aged 60 or older (mean age:70.6 SD≥7.16)., Measurements: The validation (assessment of face validity, content validity) was carried out in accordance with the literature. The Tilburg Frailty Indicator (TFI) consists of two different parts. One part addresses the potential determinants of frailty and the other specifically addresses the components of frailty, covering its physical, psychological and social domains. Scale reliability was estimated using two methods: Cronbach's alpha, measuring the scale's internal consistency, and the test-retest method, determining the scale's absolute stability. To assess test-retest reliability, the same group was re-interviewed by the same observer within 10-14 days of the first interview., Results: The test-retest reliability showed a high level of agreement for all items of the instrument, with values ranging from 96 to 100%. The Cronbach's Alpha internal consistency was 0.74., Conclusion: The Polish version of the TFI proved to be a valid and reproducible tool for assessment of Frailty Syndrome for the Polish population. We would recommend to be used as the screening tool to assess frailty.

Unlabelled: The Tilburg Frailty Indicator is a questionnaire with a bio-psycho-social approach, which measures frailty by 15 questions. A questionnaire about frailty should be in alignment with experiences of frail elderly themselves as a target population is an important source of knowledge in content validation., Aim: To validate the Tilburg Frailty Indicator on content in relation to the physical, psychological and social domain by exploring the experience of daily life of community dwelling frail elderly., Methods: The design was a qualitative content validation study. The participants were acutely admitted frail elderly discharged to home and interviewed one week after discharge. A deductive content analysis, with categories structured in advance, was performed., Results: A total of 422 meaning units were extracted from the transcriptions; 131 units related to the physical domain, 106 units to the psychological domain and 185 units to the social domain. 56 units were not linked into the existing structure of the questionnaire. 14 of 15 questions were confirmed from a target population perspective. The four issues pain, sleep quality, spirituality and meaningful activities that seem to be important elements for frail elderly were not directly covered by the questionnaire., Discussion: It seems likely that the majority of important items related to frailty are covered in the questionnaire. The findings add to the scientific body of knowledge in relation to the validity of the questionnaire. Future research should investigate the importance of the four issues pain, sleep quality, spirituality and meaningful activities in relation to the screening of frailty., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objective: The aim of this cross-sectional study was to examine the validity of an integral model of the associations between life-course determinants, disease(s), frailty, and adverse outcomes in older persons who are resident in assisted living facilities., Methods: Between June 2013 and May 2014 seven assisted living facilities were contacted. A total of 221 persons completed the questionnaire on life-course determinants, frailty (using the Tilburg Frailty Indicator), self-reported chronic diseases, and adverse outcomes disability, quality of life, health care utilization, and falls. Adverse outcomes were analyzed with sequential (logistic) regression analyses., Results: The integral model is partially validated. Life-course determinants and disease(s) affected only physical frailty. All three frailty domains (physical, psychological, social) together affected disability, quality of life, visits to a general practitioner, and falls. Contrary to the model, disease(s) had no effect on adverse outcomes after controlling for frailty. Life-course determinants affected adverse outcomes, with unhealthy lifestyle having consistent negative effects, and women had more disability, scored lower on physical health, and received more personal and informal care after controlling for all other predictors., Conclusion: The integral model of frailty is less useful for predicting adverse outcomes of residents of assisted living facilities than for community-dwelling older persons, because these residents are much frailer and already have access to healthcare facilities., Practical Implications: The present study showed that a multidimensional assessment of frailty, distinguishing three domains of frailty (physical, psychological, social), is beneficial with respect to predicting adverse outcomes in residents of assisted living facilities., (Copyright © 2015. Published by Elsevier Ireland Ltd.)

Aim: To present the translation and validation process of the Portuguese version of the Tilburg Frailty Indicator (TFI)., Methods: A cross-sectional study was designed using a non-probability sample of 252 community-dwelling older adults. Preliminary studies were carried out for face and content validity assessment. Internal consistency, test-retest reliability, construct (convergent/divergent) and criterion validity were subsequently analyzed., Results: The sample was mainly women (75.8%), with a mean age of 79.2 ± 7.3 years. TFI internal consistency was good (KR-20 = 0.78). Test-retest reliability for the total was also good (r = 0.91), with kappa coefficients showing substantial agreement for most items. TFI physical and social domains correlated as expected with concurrent measures, whereas the TFI psychological domain showed similar correlations with other psychological and physical measures. The TFI showed a good to excellent discrimination ability in regard to frailty criteria, and fair to good ability to predict adverse outcomes., Conclusions: The psychometric properties of the TFI seem to be consistently good. These findings provide initial evidence that the Portuguese version is a valid and reliable measure for assessing frailty in the elderly., (© 2014 Japan Geriatrics Society.)

The objectives of this study were to compare how different frailty measures (Frailty Phenotype/FP, Groningen Frailty Indicator/GFI and Tilburg Frailty Indicator/TFI) predict short-term adverse outcomes. Secondarily, adopting a multidimensional approach to frailty (integral conceptual model-TFI), this study aims to compare how physical, psychological and social frailty predict the outcomes. A longitudinal study was carried out with 95 community-dwelling elderly. Participants were assessed at baseline for frailty, determinants of frailty, and adverse outcomes (healthcare utilization, quality of life, disability in basic and instrumental activities of daily living/ADL and IADL). Ten months later the outcomes were assessed again. Frailty was associated with specific healthcare utilization indicators: the FP with a greater utilization of informal care; GFI with an increased contact with healthcare professionals; and TFI with a higher amount of contacts with a general practitioner. After controlling for the effect of life-course determinants, comorbidity and adverse outcome at baseline, GFI predicted IADL disability and TFI predicted quality of life. The effect of the FP on the outcomes was not significant, when compared with the other measures. However, when comparing TFI's domains, the physical domain was the most significant predictor of the outcomes, even explaining part of the variance of ADL disability. Frailty at baseline was associated with adverse outcomes at follow-up. However, the relationship of each frailty measure (FP, GFI and TFI) with the outcomes was different. In spite of the role of psychological frailty, TFI's physical domain was the determinant factor for predicting disability and most of the quality of life.

This study aims to analyze which determinants predict frailty in general and each frailty domain (physical, psychological, and social), considering the integral conceptual model of frailty, and particularly to examine the contribution of medication in this prediction. A cross-sectional study was designed using a non-probabilistic sample of 252 community-dwelling elderly from three Portuguese cities. Frailty and determinants of frailty were assessed with the Tilburg Frailty Indicator. The amount and type of different daily-consumed medication were also examined. Hierarchical regression analysis were conducted. The mean age of the participants was 79.2 years (±7.3), and most of them were women (75.8%), widowed (55.6%) and with a low educational level (0-4 years: 63.9%). In this study, determinants explained 46% of the variance of total frailty, and 39.8, 25.3, and 27.7% of physical, psychological, and social frailty respectively. Age, gender, income, death of a loved one in the past year, lifestyle, satisfaction with living environment and self-reported comorbidity predicted total frailty, while each frailty domain was associated with a different set of determinants. The number of daily-consumed drugs was independently associated with physical frailty, and the consumption of medication for the cardiovascular system and for the blood and blood-forming organs explained part of the variance of total and physical frailty. The adverse effects of polymedication and its direct link with the level of comorbidities could explain the independent contribution of the amount of prescribed drugs to frailty prediction. On the other hand, findings in regard to medication type provide further evidence of the association of frailty with cardiovascular risk. In the present study, a significant part of frailty was predicted, and the different contributions of each determinant to frailty domains highlight the relevance of the integral model of frailty. The added value of a simple assessment of medication was considerable, and it should be taken into account for effective identification of frailty.

Purpose: To assess the predictive validity of the 15 components of the Tilburg Frailty Indicator (TFI), a self-report questionnaire, for quality of life domains physical health, psychological, social relations and environmental in community-dwelling older persons in a longitudinal study., Methods: The predictive validity of the components of the TFI was tested in a sample of 484 community-dwelling persons aged 75 years and older in the Netherlands in 2008 (response rate 42%). A subset of all respondents participated two years later, in 2010 (n = 261, 54%), and a subset of these respondents participated again in 2012 (n = 196, 75%). The WHOQOL-BREF was used for measuring four quality of life domains., Results: Four physical frailty components (physical unhealthy, difficulty in maintaining balance, difficulty in walking and physical tiredness), one psychological frailty component (feeling down) and one social frailty component (lack of social support) predicted future scores on quality of life domains, even after controlling for background characteristics and diseases., Conclusion: This longitudinal study showed that quality of life is predicted by physical as well as psychological and social frailty components. This finding emphasizes the relevance of a multidimensional assessment of frailty. To improve quality of life of older persons, special attention should go to the screening and subsequent interventions focusing on the frailty components difficulty in walking, feeling down and lack of social support.

Disability is an important health outcome for older persons; it is associated with impaired quality of life, future hospitalization, and mortality. Disability also places a high burden on health care professionals and health care systems. Disability is regarded as an adverse outcome of physical frailty. The main objective of this study was to assess the predictive validity of the eight individual self-reported components of the physical frailty subscale of the TFI for activities of daily living (ADL) and instrumental activities of daily living (IADL) disability. This longitudinal study was carried out with a sample of Dutch citizens. At baseline the sample consisted at 429 people aged 65 years and older and a subset of all respondents participated again two and a half years later (N=355, 83% response rate). The respondents completed a web-based questionnaire comprising the TFI and the Groningen Activity Restriction Scale (GARS) for measuring disability. Five components together (unintentional weakness, weakness, poor endurance, slowness, low physical activity), referring to the phenotype of Fried et al., predicted disability, even after controlling for previous disability and other background characteristics. The other three components of the physical frailty subscale of the TFI (poor balance, poor hearing, poor vision) together did not predict disability. Low physical activity predicted both total and ADL disability, and slowness both total and IADL disability. In conclusion, self-report assessment using the physical subscale of the TFI aids the prediction of future ADL and IADL disability in older persons two and a half years later., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

The Tilburg Frailty Indicator (TFI) is a self-administered questionnaire with a bio-psycho-social integrated approach that measures the degree of frailty in elderly persons. The TFI was developed in the Netherlands and tested in a population of elderly Dutch men and women. The aim of this study was to translate and culturally adapt the TFI to a Danish context, and to test face validity of the Danish version by cognitive interviewing. An internationally recognized procedure was applied as a basis for the translation process. The primary tasks were forward translation, reconciliation, back translation, harmonization and pretest. Pretest and review of the preliminary version by cognitive interviewing, were performed at a local community center and in an acute medical ward at the University Hospital in Aalborg, Denmark respectively. A large agreement regarding meaning of the items in the forward translation and reconciliation process was seen. Minor discrepancies were solved by consensus. Back translation revealed unclear wording in one matter. The harmonization committee agreed on a version for cognitive interviewing after revision of minor issues and thirty-four participants were interviewed. Two issues became evident and these were revised. The cognitive interviews and final lay-out resulted in minor adjustments as text type size, specific font, and lining for optimizing readability. In conclusion, we consider the TFI to be translated in such rigorous manner that the instrument can be further tested in clinical practice. The overall objective of the questionnaire being to identify frailty and improve the interventions relating to frail elderly persons in Denmark., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Frailty is a predictor of disability. A proper understanding of the contribution of individual indicators of frailty in the prediction of disability is a requisite for preventive interventions. The aim of this study was to determine the predictive power of the individual physical frailty indicators: gait speed, physical activity, hand grip strength, Body Mass Index (BMI), fatigue, and balance, for ADL and IADL disability. The sample consisted of 505 community-dwelling persons (≥75 years, response rate 35.1%). Respondents first participated between November 2007 and June 2008, and a subset of all respondents participated again one year later (N = 264, 52.3% response rate). ADL and IADL disability were assessed by the Groningen Activity Restriction Scale. BMI was assessed by self-report, and the other physical frailty indicators were assessed with the TUG test (gait speed), the LAPAQ (physical activity), a hand grip strength test, the SFQ (fatigue), and the Four-test balance scale. All six physical frailty indicators were associated with ADL and IADL disability. After controlling for previous disability, sociodemographic characteristics, self-perceived lifestyle, and chronic diseases, only gait speed was predictive of both ADL and IADL disability, whereas there was a small effect of fatigue on IADL disability. Hence, these physical frailty indicators should be included in frailty assessment when predicting future disability.

Purpose: Although frailty was originally a medical concept, nowadays more and more researchers are convinced of its multidimensional nature, including a psychological and social domain of frailty as well as a physical domain. The objective of this study was to test the hypothesis that the prediction of quality of life by physical frailty components is improved by adding psychological and social frailty components., Methods: This cross-sectional study was carried out with a sample of Dutch citizens. A total of 1,031 people aged 65 years and older completed a Web-based questionnaire containing the Tilburg Frailty Indicator for measuring physical, psychological, and social frailty, and the WHOQOL-BREF for measuring four quality of life domains (physical health, psychological, social relations, environmental)., Results: The findings show that the prediction of all quality of life domains by eight physical components of frailty was improved after adding four psychological and three social frailty components. The psychological frailty component 'feeling down' significantly improved the prediction of all four quality of life domains, after controlling for the effects of background characteristics and all other frailty components., Conclusion: This study emphasizes the importance of a multidimensional assessment of frailty in the prediction of quality of life in older people.

This study aims to assess the psychometric properties of the Brazilian version of the TFI, an instrument that identifies frailty in elderly individuals. We interviewed 219 individuals aged 60 or older, living in the community. Individuals were predominantly female (52.5%) and mean age was 70.5 (±7.9) years. In order to assess test-retest reliability, 101 individuals were re-interviewed by the same observer within seven to ten days after the first interview. The internal consistency of the instrument was assessed using Cronbach's alpha. To assess construct validity, we used established alternative measures for the items that constitute the TFI, such as: body mass index (BMI), timed up and go (TUG) test, whisper test, Snellen test, upper extremity strength clinical test and mini-mental state examination (MMSE). The test-retest reliability showed high percent agreement for all the items of the instrument, with values ranging from 63% to 100%. Test-retest reliabilities were good (total TFI score r=0.88; physical domain r=0.88; psychological domain r=0.88; and social domain r=0.67). Internal consistency reliability of the Brazilian version was satisfactory (Cronbach's alpha=0.78). The correlations between TFI items and their corresponding measures were consistent except for one item (related to "ability to deal with problems"), demonstrating both convergent and divergent construct validity of the TFI and its items. After the completion of all stages of transcultural adaptation, the Brazilian version of the TFI proved to be well suited for assessing frailty in the elderly population of Brazil., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background: Frail elderly have a higher risk of adverse outcomes, e.g., hospitalization,institutionalization, or premature death. The Tilburg Frailty Indicator (TFI) is a validated questionnaire for measuring frailty in independently living older people aged 70 years and over., Aims: Determining the prevalence of frailty among independently living young elderly, and examining which factors predict frailty among this target group., Methods: 308 young elderly (58 to 64 years) completed the TFI before they visited the ambulatory health screening centre in Roosendaal. The TFI includes questions concerning physical, psychological and social frailty, and questions on possible determinants of frailty., Results: 18-4% of the sample of young elderly was frail. Women scored significantly higher on psychological and social frailty. The determinants explained 37% of the frailty score. As expected,low income, an unhealthy lifestyle, multimorbidity, experiencing life events, and dissatisfaction with the living environment predicted frailty. The three frailty domains(physical, psychological, social) were affected by different determinants., Conclusion: A substantial part of the young elderly in the sample turned out to be frail. The finding that the three domains of frailty are predicted by different determinants underlines the importance the importance of a broad perspective regarding the functioning of the individual older person.

Purpose: To assess the predictive validity of frailty and its domains (physical, psychological, and social), as measured by the Tilburg Frailty Indicator (TFI), for the adverse outcomes disability, health care utilization, and quality of life., Design and Methods: The predictive validity of the TFI was tested in a representative sample of 484 community-dwelling persons aged 75 years and older in 2008 (response rate 42%). A subset of all respondents participated 1 year later (N = 336, 69%) and again 2 years later (N = 266, 55%). We used the TFI, the Groningen Activity Restriction Scale assessing disability, seven indicators of health care utilization, and a brief version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF). The WHOQOL-BREF was assessed in 2008 and 2010; all others were assessed in 2008, 2009, and 2010., Results: The predictive validity of the TFI assessed in 2008 for disability, health care utilization, and quality of life was corroborated by (a) medium to very large associations of frailty with adverse outcomes 1 or 2 years later; (b) mostly good to excellent area under the curve of total frailty; and (c) an increase in predictive accuracy of most adverse outcomes, even after controlling for that same adverse outcome in 2008, and life-course determinants and multimorbidity. Physical frailty was mostly responsible for the predictive validity of the TFI., Implications: This study showed that the TFI is a valid instrument to predict disability, many indicators of health care utilization, and quality of life of older people, 1 and 2 years later.

Aims: To establish whether the prediction of the adverse outcomes disability and six indicators of health care utilization one and two years later by the three frailty domains (physical, psychological, social) of the Tilburg Frailty Indicator (TFI) is improved by adding interview and physical measures of frailty., Materials and Methods: A representative sample of 245 Dutch community-dwelling persons aged 75 years and older (response rate 53%) participated in 2008, one year later in 2009 (n=179, 73%) and again two years later in 2010 (n=141, 58%). Frailty was assessed with the TFI, an easy to administer self-report measure. Disability was measured using the Groningen Activity Restriction Scale (GARS). Indicators of health care utilization were: visit to a general practitioner (gp), contacts with health care professionals (hcps), hospital admission, receiving personal care, receiving nursing care, and receiving informal care., Results: After controlling for background characteristics, the TFI predicted disability and the indicators of health care utilization. Interviews and physical measures of frailty improved the prediction of disability. The Hospital Anxiety and Depression Scale (HADS-A) improved the prediction of contacts with hcps, but the interview and physical measures of frailty did not improve the predictions of the other indicators of health care utilization., Conclusions: Assessment by the self-report TFI is sufficient for predicting six indicators of health care utilization, but for predicting disability the use of both the TFI and the Timed Up & Go (TUG) test is recommended. It is advisable assessing all three frailty domains when examining frailty and its prediction of adverse outcomes., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

The current study aimed to adapt the Tilburg Frailty Indicator (TFI), used to assess frailty in the elderly, to the Brazilian population. Conceptual, item, and semantic equivalences were analyzed and the summary version was pre-tested. In the evaluation of conceptual equivalence, the construct for frailty adopted in Brazil demonstrated the same conceptualization as in other cultures where this condition has been investigated. All items included in the original version also showed similarity in the two cultures. High semantic equivalence was observed in the analysis of the items' referential and general meanings. The pre-test showed a high percentage of understanding of items and good acceptance of items by elderly individuals. The results suggest that the TFI version adapted to the Brazilian culture can be a useful tool for assessing health conditions in older Brazilians.

Aim: This paper is a report of a study conducted to test three hypotheses derived from an integral conceptual model of frailty., Background:   The integral model of frailty describes the pathway from life-course determinants to frailty to adverse outcomes. The model assumes that life-course determinants and the three domains of frailty (physical, psychological, social) affect adverse outcomes, the effect of disease(s) on adverse outcomes is mediated by frailty, and the effect of frailty on adverse outcomes depends on the life-course determinants., Methods: In June 2008 a questionnaire was sent to a sample of community-dwelling people, aged 75 years and older (n = 213). Life-course determinants and frailty were assessed using the Tilburg frailty indicator. Adverse outcomes were measured using the Groningen activity restriction scale, the WHOQOL-BREF and questions regarding healthcare utilization. The effect of seven self-reported chronic diseases was examined., Results: Life-course determinants, chronic disease(s), and frailty together explain a moderate to large part of the variance of the seven continuous adverse outcomes (26-57%). All these predictors together explained a significant part of each of the five dichotomous adverse outcomes. The effect of chronic disease(s) on all 12 adverse outcomes was mediated at least partly by frailty. The effect of frailty domains on adverse outcomes did not depend on life-course determinants., Conclusion: Our finding that the adverse outcomes are differently and uniquely affected by the three domains of frailty (physical, psychological, social), and life-course determinants and disease(s), emphasizes the importance of an integral conceptual model of frailty., (© 2011 Blackwell Publishing Ltd.)

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., (Copyright 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.)

Objectives: To determine which determinants predict frailty and domains of frailty (physical, psychological, social) in a community-dwelling sample of elderly persons., Design: Cross-sectional., Setting: Community-based., Participants: A representative sample of 484 community-dwelling persons aged 75 years and older., Measurements: The Tilburg Frailty Indicator (TFI), a self-report questionnaire, was used to collect information about determinants of frailty and to assess frailty and domains of frailty (physical, psychological, social)., Results: Results were obtained by regression and mediation analyses. The 10 determinants explain about 35% of the variance of frailty. After controlling for other determinants, medium income, an unhealthy lifestyle, and multimorbidity predicted frailty. The effects of other determinants differed across domains of frailty; age predicted physical frailty, life events predicted psychological frailty, whereas being a woman predicted social frailty because older women have a higher probability of living alone., Conclusion: Our finding that the effect of the determinants of frailty differs across frailty domains suggests that it is essential to divide the concept of frailty into domains., (Copyright 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.)

Introduction: There are many different conceptual definitions of frailty in circulation. Most of these definitions focus mainly on physical problems affecting older people. Only a few also draw attention to other domains of human functioning such as the psychological domain. The authors of this article fear that this could lead to fragmentation of care for frail older people. The aim is to develop an integral conceptual definition of frailty that starts from the premise of a holistic view of the person., Methods: To achieve this, a literature search was carried out. Thereafter a group of experts (N=20) were consulted, both verbally during 2 expert meetings and via a written questionnaire. These experts were asked which existing conceptual definition of frailty places most stress on the integral functioning of older people., Results: The experts expressed a clear preference for one of the conceptual definitions. The result of the literature search and the consultation with the experts led to a new integral conceptual definition of frailty., Conclusion: The conceptual definition is intended to offer a framework for an operational definition of frailty for identifying frail older people., (Copyright 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.)