Development and Psychometric Validation of a New Scale for Assessment and Screening of Frailty Among Older Indians

Abstract

Background

Frailty is a major challenge for healthcare systems in ageing societies. This dynamic state of health is a reflection of reduced reserve in various organ systems and enhanced vulnerability to stressors. Research in this area of geriatrics and gerontology is limited in low- and middle-income countries (LMICs) like India. This study is directed at development of a culturally appropriate and validated assessment scale for frailty among older Indians.

Methods

After extensive review of the literature on existing scales, a preliminary draft scale was formed. This draft was pre- and pilot-tested to check feasibility and modified accordingly. The final scale was validated on 107 older adults by confirmatory factor analysis and was named the Frailty Assessment and Screening Tool (FAST). The Fried’s frailty phenotype was also administered on the same 107 older adults and scores of both were co-related. Suitable cut-off scores were found for frail and pre-frail older adults.

Results

The final version of the FAST consisted of 14 questions pertaining to 10 domains. It has good reliability. Cronbach’s alpha co-efficient was 0.99; test–retest reliability was 0.97 and validity by confirmatory factor analysis was adequate. The Kaiser–CMeyer–Olkin (KMO) of sampling adequacy was 0.699, and Bartlett’s test of sphericity was significant (χ² = 353.471, p < 0.001). FAST scores had a cut-off of ≥ 7/14 for frail and ≥ 5/14 for pre-frail elderly.

Conclusion

The FAST is a validated tool with good psychometric properties. It is expected that it will be helpful in screening pre-frail and frail older adults in India and other LMICs and guide in clinical decision making for intervention.

Keywords:

• frailty
• pre-frail
• robust
• screening tool
• psychometry

Acknowledgments

The authors would like to thank all study participants. They also acknowledge the help and support provided by all faculty and staff in the Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India.

Abbreviations

LMIC, Low- and middle-income country; HIC, Hig- income country; ICFSR, International Conference on Frailty and Sarcopenia Research; CCHA, Clinical Consortium on Healthy Ageing; ICD, International Classification of Diseases; MNA, Mini Nutritional Assessment; CFA, Confirmatory factor analysis; CVR, Content validity ratio; SME, Subject matter expert; ROC, Receiver operator characteristic; ICC, Intra class co-efficient; AUC, Area under curve; SD, Standard deviation; CGA, Comprehensive Geriatric Assessment; BMI, Body mass index; TUG, Timed up and go test; FAST, Frailty Assessment and Screening Tool; AIIMS, All India Institute of Medical Sciences.

Data Sharing Statement

The datasets generated and/or analyzed during the current study are not publicly available as they are still being used for analyses but are available from the corresponding author on reasonable request.

Ethics Approval and Consent to Participate

The present study was approved by the Institutional Ethics Committee of the All India Institute of Medical Sciences, New Delhi, India. All participants gave informed, written consent. This study was conducted in accordance with the Declaration of Helsinki.

Author Contributions

All authors made substantial contributions to the conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors disclosed no conflicts of interest or competing interests for this work.