Brief Report
Validity and Responsiveness of the FRAIL Scale in a Longitudinal Cohort Study of Older Australian Women

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Abstract

Background

To assess the validity and responsiveness of the FRAIL scale and investigate whether validity is related to the number of points used on the scale.

Methods

Participants were 12,432 women born in 1921–1926 from the Australian Longitudinal Study on Women's Health; surveyed up to 6 times from 1996 to 2011. The FRAIL scale is a 5-item measure and scored as a 6-, 3-, or 2-point measure. Face validity was determined by assessing relationships with age, construct validity was determined by assessing relationships with measures of disability (activities of daily living and independent activities of daily living), and responsiveness was determined by assessing relationships with changes in self-rated health.

Results

The proportion of women who reported their frailty as high (4 or 5 on a scale of 0 to 5) increased with age from 5.6% at age 73–78 years to 16.2% at age 85–90 years. The FRAIL scale was moderately correlated with disability, Spearman's rho ≥0.4 for activities of daily living and ≥0.5 for independent activities of daily living; slightly stronger associations were observed when it was scored as a 6-point measure. Mean change (95% confidence interval) in FRAIL 6-point scores decreased for women who reported improvements in self-rated health between successive surveys; by at least 0.08 (0.01, 0.15) and increased in those women who reported declines in self-rated health by at least 0.64 (0.57, 0.70).

Conclusions

The FRAIL scale is valid and responsive and is suitable for use in longitudinal studies of women in their 70s and older.

Section snippets

Study Population

The Australian Longitudinal Study on Women's Health (ALSWH) is a prospective nationwide study investigating factors related to the health and well-being initially of 3 cohorts of Australian women aged 18–23 years, aged 45–50 years, and aged 70–75 years at baseline in 1996. Women were randomly selected from the Medicare database, which covers all citizens and permanent residents of Australia, including refugees and immigrants. When first surveyed in 1996 (S1) 12,432 women born in 1921–1926

Results

The numbers of women who provided FRAIL score data at each survey and the proportion of women at each FRAIL6 score at each survey are presented in Figure 1. The figure shows that frailty increased with age (eg, the proportion of women who score a 4 or a 5 on the FRAIL6 scale increased from 5.6% for women aged 73–78 years to 16.2% for women aged 85–90 years).

Stronger correlations of frailty with IADLs were observed than of frailty with ADLs (Table 1). Slightly stronger correlations of frailty

Discussion

Frailty, as measured by the FRAIL scale was associated with increasing age and disability (ADLs and IADLs). The 6-item version of the FRAIL scale was responsive to changes in self-rated health in a population-based sample of older Australian women. Although previous studies have demonstrated the predictive validity of FRAIL scale in relation to new disability and mortality,3, 5, 11, 15, 16 this is the first study to assess responsiveness of the scale using longitudinal data and the impact of

Acknowledgments

The ALSWH was conceived and developed by groups of interdisciplinary researchers at the Universities of Newcastle and Queensland. The authors thank all participants for their valuable contribution to the study.

References (16)

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This work was supported by the Australian Government Department of Health; and the Australian National Health and Medical Research Council (Center of Research Excellence #APP1000986). The authors declare no conflicts of interest.

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