Original Study
Measurement Properties of the Groningen Frailty Indicator in Home-Dwelling and Institutionalized Elderly People

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Abstract

Objectives

To enable prevention of poor outcome in elderly people, a valid instrument is required to detect individuals at high risk. The concept of frailty is a better predictor than age alone. The Groningen Frailty Indicator (GFI) has been developed to identify frailty. We assessed feasibility, reliability, and construct validity of the self-assessment version of the GFI.

Design

Cross-sectional.

Setting

Community-based.

Participants

Home-dwelling and institutionalized elderly persons were included in the study (n = 353) who met the following inclusion criteria: persons 65 years and older who were able to fill out questionnaires.

Measurements

The feasibility of the GFI was assessed by determining the proportion of missing values per item. The internal consistency reliability of the GFI was established by calculating the KR-20. Mann-Whitney and Kruskal-Wallis tests were applied to assess discrimination between specific subgroups (known group validity). Convergent and discriminant validity was assessed using Spearman Rank correlations between GFI and diseases and disorders, case complexity, and health care needs (INTERMED), life satisfaction (Cantril Ladder of Life), activities of daily living (Katz), quality of life (EQ-5D), and mental health (SF-36). Finally, we used multivariate regression analyses to evaluate the cutoff score of the GFI (<4 versus ≥4).

Results

A total of 296 (84%) of the participants completed all items of the GFI; the internal consistency was 0.68. The GFI yielded statistically significant GFI scores for subgroups (known group validity). The correlations for the convergent (range 0.45 to 0.61) and discriminant validity (range 0.08 to 0.50) were also as hypothesized. In contrast with nonfrail participants, frail older persons had higher levels of case complexity, disability, and lower quality of life and life satisfaction.

Conclusions

This study supports the feasibility, reliability, and validity of the self-assessment version of the GFI in home-dwelling and institutionalized elderly people.

Section snippets

Methods

From June 2008 until February 2010, a cross-sectional study was conducted among individuals residing in the northern provinces of the Netherlands. We recruited 359 elderly people who met the following inclusion criteria: persons 65 years and older who were able to fill out questionnaires. We excluded elderly people who had severe cognitive dysfunction or were very ill. The exclusion of severe cognitive dysfunction during the home interview was based on the professional judgment of

Results

A total of 359 elderly persons consented to participate in the study and filled out a postal questionnaire. All included elderly persons participated in the home interviews for the assessment of case complexity (INTERMED) and life satisfaction (Cantril Ladder of Life). During the study period, the assessment of ADLs (Katz), quality of life (EQ-5D), and mental health (SF-36) were added to the interview. For most of the included elderly people (n = 260), all instruments mentioned previously were

Discussion

This study collaborates the feasibility, reliability, and validity of the self-report version of the GFI in home-dwelling and institutionalized elderly people.

The feasibility of the self-report version of the GFI in the present study was good, which supports the results of a previous study.22 Most of the elderly persons (84%, n = 296) had no difficulty completing the GFI, a minority (16%, n = 57) skipped at least one item on the GFI. Persons who had at least one missing value were older in age,

Conclusion

We conclude that the results of this cross-sectional study showed evidence that confirms the feasibility, reliability, and validity of the self-report version of the GFI in a heterogeneous elderly population.

Acknowledgments

We thank all elderly people who participated in the study and we show our gratitude to the research nurses, Marijke Kastermans and Karin Knuvers, for collecting the study data.

References (46)

  • F.C. Stiefel et al.

    Operationalizing integrated care on a clinical level: The INTERMED project

    Med Clin North Am

    (2006)
  • K. Schultz-Larsen et al.

    Tiredness in daily activities: A subjective measure for the identification of frailty among non-disabled community-living older adults

    Arch Gerontol Geriatr

    (2007)
  • R.A. Pol et al.

    Standardised frailty indicator as predictor for postoperative delirium after vascular surgery: A prospective cohort study

    Eur J Vasc Endovasc Surg

    (2011)
  • B. Biesma et al.

    Quality of life, geriatric assessment and survival in elderly patients with non-small-cell lung cancer treated with carboplatin-gemcitabine or carboplatin-paclitaxel: NVALT-3 a phase III study

    Ann Oncol

    (2011)
  • L. Ferrucci

    An exciting thought

    J Gerontol A Biol Sci Med Sci

    (2005)
  • T. Fulop et al.

    Aging, frailty and age-related diseases

    Biogerontology

    (2010)
  • H. Bergman et al.

    Frailty: An emerging research and clinical paradigm—Issues and controversies

    J Gerontol A Biol Sci Med Sci

    (2007)
  • J. Walston 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

    J Am Geriatr Soc

    (2006)
  • W.J. Strawbridge et al.

    Antecedents of frailty over three decades in an older cohort

    J Gerontol B Psychol Sci Soc Sci

    (1998)
  • K. Rockwood et al.

    Frailty in elderly people: An evolving concept

    CMAJ

    (1994)
  • L.P. Fried et al.

    Frailty in older adults: Evidence for a phenotype

    J Gerontol A Biol Sci Med Sci

    (2001)
  • L.P. Fried et al.

    Untangling the concepts of disability, frailty, and comorbidity: Implications for improved targeting and care

    J Gerontol A Biol Sci Med Sci

    (2004)
  • D.M. Jones et al.

    Operationalizing a frailty index from a standardized comprehensive geriatric assessment

    J Am Geriatr Soc

    (2004)
  • Cited by (0)

    This study was supported by a grant from ZonMw—the Netherlands Organization for Health Research and Development (60-61900-98-218). ZonMw had no role in study design, data collection, data analysis, data interpretation, writing of the manuscript, or the decision to submit the paper for publication. Finally, the authors have no financial or other relationships that might lead to a conflict of interest.

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