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

Figures & data

Table 1 Socio-Demographic and Other Age-Related Characteristics of the Study Participants (n = 107)

Variable	Frequency	Percentage (%)
Age (Mean ± SD)	68.55 ± 6.29
Gender
Male	65	61
Female	42	39
BMI (Mean ± SD)	26.42 ± 5.53
Underweight	8	7.5
Normal	35	32.7
Overweight	44	41
Obese	20	18.8
Literacy
Illiterate/no formal education	15	14
Less than high school	52	48.5
More than high school	40	37.5
Nutritional status (MNA) (Mean ± SD)	12.28 ± 2.39
Malnourished	5	4.7
At risk	24	22.4
Normal	78	72.9
Occupation
Unemployed	39	36.5
Skilled/Semi-skilled	22	20.5
Office/Business	34	31.8
Professional	12	11.2
Living condition
With spouse	8	7.8
With spouse and children	94	87.4
Alone	4	4.1
Assisted living	1	0.7

Note: This table shows the demographic characteristics and some age particulars of the sample population.

Abbreviations: MNA, Mini Nutritional Assessment scale; BMI, body mass index.

Table 2 Phases of Development of FAST

Phases	Nature of Activity	Method	Number of Domains	Domain Name	Number of Items	Response Range	Deletion of Item	Time Taken (Minutes)
Phase-I	Face and content validation	7 SMEs selected the domain and/or items	No domain formed	Pooling of items	21	No response range	0	Open
Phase-II	Pre-test	Tested on 20 patients and modified	10	Nutrition	21	0–1	7	45–49 min
				Memory
				Mobility
				Physical performance
				Functionality
				Mood
				Medication
				Multi-morbidity
				Continence
				Pain
Phase-III	Pilot test	Tested on 30 patients and updated the domain/items for finalizing the tool	10	Modification of continence and mood domain questions	14	0–1	nil	22–30 min
Phase-IV	Validation	Modified tool applied on 107 participants	10	-	14	0–1	nil	15 min

Notes: This table shows the different stages in development of the tool. Many relevant changes in terms of response range, number of items selected and deleted, dimension selection, time taken to complete the tool, etc. took place in different phases of the tool development. The tool was modified and updated at every stage and finally a total of 14 items spread over 10 domains were retained, with a response range of 0–1 rating and the time for completion of this tool reduced to an average 15 min (10–20 min).

Abbreviation: SME, subject matter expert.

Figure 1 The different stages in the scale development; content validation, pre-study, pilot study and psychometric validation.

Table 3 Domains, Questions, Factor Loading Items and Confirmatory Factor Analysis of FAST

Domains and Questions	Number of Items	Response	Factor Loading	Total Score
Nutrition				2
Q1 Over the past 6 months has your appetite reduced?	1	Yes/No	0.739
Q2 Over the past 6 months have you lost 5 kg or more?	1	Yes/No	0.215
Memory				1
Q Do your family or your friends point out your memory loss frequently? Eg “you ask the same question over and over again.”	1	Yes/No	0.971
Mobility				2
Q1 Do you have difficulty in standing up from sitting position?	1	Yes/No	0.920
Q2 Over the past 6 months do you feel that you are more confined to your bedroom?	1	Yes/No	0.140
Functional Status				2
Q1 Over the past 6 months have you felt tired for most of the day?	1	Yes/no	0.758
Q2 Over the past 6 months has your physical health declined?	1	Yes/No	0.547
Mood				1
Q1 Over the past 2 weeks, have you been bothered by the following?	1	If yes to both, then 1	0.696
a. Little interest or pleasure in doing things?
b. Feeling down, depressed, or hopeless?
Physical Performance				1
Q1 I would like you to sit in this chair with your arms and back resting. When I say go, please stand up and walk to the mark on the floor (for about 3 meters), then return to the chair and sit down. 0–20 sec: No, Yes >20 sec: Patient unwilling, requires assistance.	1	>20sec: yes	0.942
		<20sec: no
General Health Status				1
Q1 Does your current state of health affect your day-to-day activities?	1	Yes/no	0.853
Medication and Multi-morbidity				2
Q1 Do you use five or more medication prescriptions on a regular basis?	1	Yes/no	0.915
Q2 Do you have two or more diseases and/or chronic disorders?	1	Yes/no	0.860
Continence				1
Q1 Do you have a problem with losing control of urine or stool when you do not want to?	1	Yes/no	0.931
Pain				1
Q1 Over the past 6 months has bodily pain limited your normal day-to-day work?	1	Yes/no	0.359
Total Domains =10		Yes/no		14

Note: Depicts the different domains, number of items in each domain, response type, factor loading of items, and total scores of each domain.

Figure 2 (A–D) depicts the receiver operator characteristic curve (ROC) and area under curve to predict cut-off scores of pre-frail from robust (A), frail from pre-frail (B), robust from pre-frail or frail (C), and frail from pre-frail and robust (D) older participants.