Development and Validation of the Chinese Frailty Screening Scale: A Study among Community-Dwelling Older Adults in Shanghai

Bo Ye; Yi Wang; Hao Chen; Yingwei Chen; Huihui Yan; Hua Fu; Zhijun Bao; Junling Gao

doi:10.3390/ijerph191811811

Development and Validation of the Chinese Frailty Screening Scale: A Study among Community-Dwelling Older Adults in Shanghai

Int J Environ Res Public Health. 2022 Sep 19;19(18):11811. doi: 10.3390/ijerph191811811.

Authors

Bo Ye¹, Yi Wang², Hao Chen², Yingwei Chen², Huihui Yan², Hua Fu^{2

3}, Zhijun Bao^{1

4}, Junling Gao^{2

5

6}

Affiliations

¹ Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China.
² School of Public Health, Fudan University, Shanghai 200032, China.
³ Health Communication Institute, Fudan University, Shanghai 200032, China.
⁴ Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital, Shanghai 200040, China.
⁵ Collaborative Innovation Cooperative Unit, National Clinical Research Center for Geriatric Diseases, Shanghai 200032, China.
⁶ Core Unit, Shanghai Clinical Research Center for Geriatric Diseases, Shanghai 200032, China.

Abstract

Background: Based on intrinsic capacity (IC) as defined by the World Health Organization, an accelerated decline may be an important precursor of frailty among older adults; however, there is a lack of validated instruments that both screen for frailty and monitor IC. This study aims to develop a comprehensive and acculturative frailty screening scale to determine healthy aging among older Chinese adults.

Setting and participants: A cross-sectional and a cohort study both based on community-dwelling older adults aged 65 and older.

Methods: This study mainly consisted of two parts. First, the selection and revision of 20 items related to frailty based on a literature review, expert consultation, and stakeholder analysis; second, a cross-sectional study was conducted to simplify the scale and test the reliability and validity of the new frailty screening tool. The fatigue, resistance, ambulation, illness, and loss of weight (FRAIL) scale, the Tilburg frailty indictor (TFI), and a 49-item Frailty Index (FI) were investigated as criteria. Additionally, a cohort study in Shanghai was conducted to verify the predictive validity of the new screening scale. The disability measured by the activity of daily living (ADL), instrumental activity of daily living (IADL) and all-cause mortality were documented as outcomes.

Results: A 10-item Chinese frailty screening scale (CFSS-10) was successfully developed and validated. It presented a Cronbach's α of 0.63 and an intraclass correlation coefficient of 0.73, which indicated good reliability. Taking the other frailty tools as criteria, Kappa values of 0.54-0.58 and an area under the curve of 0.87-0.91 showed good validity. The results of the log-binomial and Poisson models showed a high score, which predicted a higher risk of disability and all-cause mortality. An optimal cut-off point of 5 gave an excellent prediction of one-year disability.

Conclusions: The CFSS-10 has good validity and reliability as a quick and acculturative frailty screening scale for community-dwelling older adults in Shanghai. It may also supplement existing frailty screening tools.

Keywords: assessment tool; disability; frailty; healthy aging; older adults.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
China
Cohort Studies
Cross-Sectional Studies
Frail Elderly
Frailty* / diagnosis
Geriatric Assessment / methods
Humans
Independent Living
Middle Aged
Psychometrics / methods
Reproducibility of Results

Grants and funding

This research was funded by National Key Research and Development Program of China grant number 2018YFC2002001, 2018YFC2002000; National Natural Science Foundation of China grant number 82173634; Shanghai Medical Leadership Training Program grant number 2019LJ09; and Shanghai Clinical Research Center for Aging and Medicine grant number 19MC1910500.