A comparison between uni- and multidimensional frailty measures: prevalence, functional status, and relationships with disability

Abstract

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

Acknowledgments

Funding has been received from the project for publication of this paper “Sistema di allerta integrato delle fragilità emer-genti” within the Regional call “Bando Regionale a sostegno di progetti di ricerca industrial e/o sviluppo sperimentale di applicazioni integrate e innovative in ambito Internet of Data” funded by Regione Piemonte and the “Fondo Europeo di Sviluppo Regionale (POR-FESR). The funding bodies were not involved in the study design, data collection, and analysis or in writing the report.

Disclosure

Anna Mulasso and Mattia Roppolo received a research fellowship from the Department of Psychology, University of Torino (reference number 17/2015, protocol n 320), funded by “Regione Piemonte” and the “Fondo Europeo di Sviluppo Regionale (POR-FESR)”, for the project “Sistema di allerta integrato delle fragilità emergenti”.

The authors report no other conflicts of interest in this work.