The comprehensive frailty assessment instrument: development, validity and reliability.

Population aging forces governments to change their policy on elderly care. Older people, even if they are frail and disabled, are motivated to stay in their own homes and environment for as long as possible. Consequently, the early detection of frail older persons is appropriate to avoid adverse outcomes. Several instruments to detect frailty exist, but none use environmental indicators. This study addresses the development and psychometric properties of the Comprehensive Frailty Assessment Instrument (CFAI). This new self-reporting instrument includes physical, psychological, social and environmental domains. The CFAI showed good fit indices and a high reliability. The underlying structure of the CFAI demonstrates the multidisciplinary nature of frailty. Using the CFAI can stimulate nurses and other community healthcare providers toward a more holistic approach of frailty and can guide them to take appropriate interventions to prevent adverse outcomes such as disabilities or hospitalization.

[1]  W. Browner,et al.  Association Between Depressive Symptoms and Mortality in Older Women , 2000 .

[2]  M. Nishi,et al.  Zung's depression scale as a predictor of death in elderly people: a cohort study in Hokkaido, Japan. , 1999, Journal of epidemiology.

[3]  S. Hoe,et al.  Quantitative Methods Inquires 76 ISSUES AND PROCEDURES IN ADOPTING STRUCTURAL EQUATION MODELING TECHNIQUE , 2008 .

[4]  S. Studenski,et al.  Research Agenda for Frailty in Older Adults: Toward a Better Understanding of Physiology and Etiology: Summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults , 2006, Journal of the American Geriatrics Society.

[5]  A. Grenier.  Constructions of frailty in the English language, care practice and the lived experience , 2007, Ageing and Society.

[6]  M. Browne,et al.  Alternative Ways of Assessing Model Fit , 1992 .

[7]  P. Bentler,et al.  Comparative fit indexes in structural models. , 1990, Psychological bulletin.

[8]  Alan Walker,et al.  A European perspective on quality of life in old age , 2005, European journal of ageing.

[9]  R. Gobbens,et al.  Towards an integral conceptual model of frailty , 2009 .

[10]  Robert J. Stimson,et al.  A Push – Pull Framework for Modelling the Relocation of Retirees to a Retirement Village: The Australian Experience , 2004 .

[11]  A. Bowling.  Research Methods in Health , 1998 .

[12]  Dominique Verté,et al.  Schaakmat of aan zet? Monitor voor lokaal ouderenbeleid in Vlaanderen , 2007 .

[13]  J. Unützer,et al.  Geriatric depression in primary care. , 2011, The Psychiatric clinics of North America.

[14]  A. Robertson.  Beyond Apocalyptic Demography: Towards a Moral Economy of Interdependence , 1997, Ageing and Society.

[15]  R. Hoyle.  Structural equation modeling: concepts, issues, and applications , 1997 .

[16]  W. Katon,et al.  Depressive symptoms and the cost of health services in HMO patients aged 65 years and older. A 4-year prospective study. , 1997, JAMA.

[17]  Andy P. Field,et al.  Discovering Statistics Using SPSS , 2000 .

[18]  Carole A Estabrooks,et al.  Factors contributing to frailty: literature review. , 2006, Journal of advanced nursing.

[19]  D. Crooks.  Development and testing of the Elderly Social Vulnerability Index (ESVI): A composite indicator to measure social vulnerability in the Jamaican elderly population , 2009 .

[20]  Ross T Tsuyuki,et al.  Validity and reliability of the Edmonton Frail Scale , 2006, Age and ageing.

[21]  J. Tanguma.  Effects of Sample Size on the Distribution of Selected Fit Indices: A Graphical Approach , 2001 .

[22]  W. Browner,et al.  Association Between Depressive Symptoms and Mortality in Older Women , 1998 .

[23]  Elisabeth Schröder-Butterfill,et al.  A framework for understanding old-age vulnerabilities , 2006, Ageing and Society.

[24]  Katrien G Luijkx,et al.  The Tilburg Frailty Indicator: psychometric properties. , 2010, Journal of the American Medical Directors Association.

[25]  J. Hair.  Multivariate data analysis , 1972 .

[26]  S. Iwarsson,et al.  The home environment and quality of life-related outcomes in advanced old age: findings of the ENABLE-AGE project , 2009, European journal of ageing.

[27]  Y. Conwell,et al.  Risks for depression onset in primary care elderly patients: potential targets for preventive interventions. , 2009, The American journal of psychiatry.

[28]  T. Tilburg,et al.  De ingekorte schaal voor algemene, emotionele en sociale eenzaamheid , 2008 .

[29]  N. Witte.  Schaakmat of aan zet , 2007 .

[30]  P. Bentler,et al.  Cutoff criteria for fit indexes in covariance structure analysis : Conventional criteria versus new alternatives , 1999 .

[31]  J. S. Long,et al.  Testing Structural Equation Models , 1993 .

[32]  P. Bentler,et al.  Evaluating model fit. , 1995 .

[33]  Phil Wood.  Confirmatory Factor Analysis for Applied Research , 2008 .

[34]  L. Ferrucci,et al.  Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. , 2004, The journals of gerontology. Series A, Biological sciences and medical sciences.

[35]  A. Grenier,et al.  Older Women and ‘Frailty’ , 2007 .

[36]  Joan Costa-Font,et al.  `Ageing in Place'? Exploring Elderly People's Housing Preferences in Spain , 2009 .

[37]  R B Wallace,et al.  Depressive symptoms and physical decline in community-dwelling older persons. , 1998, JAMA.

[38]  Emily Grundy,et al.  Ageing and vulnerable elderly people: European perspectives , 2006, Ageing and Society.

[39]  M. Weissman,et al.  Service utilization and social morbidity associated with depressive symptoms in the community. , 1992, JAMA.

[40]  Gina Browne,et al.  Conceptualizations of frailty in relation to older adults. , 2003, Journal of advanced nursing.

[41]  Katrien G Luijkx,et al.  Toward a conceptual definition of frail community dwelling older people. , 2010, Nursing outlook.

[42]  L. Borgquist,et al.  How to assess frailty and the need for care? Report from the Study of Health and Drugs in the Elderly (SHADES) in community dwellings in Sweden. , 2011, Archives of gerontology and geriatrics.

[43]  C. Phillipson,et al.  Ageing in urban environments: Developing ‘age-friendly’ cities , 2012 .

[44]  Howard Bergman,et al.  Models, definitions, and criteria of frailty. , 2003, Aging clinical and experimental research.

[45]  P. Lips,et al.  Static and dynamic measures of frailty predicted decline in performance-based and self-reported physical functioning. , 2005, Journal of clinical epidemiology.