A comparison between physical and biopsychosocial measures of frailty: Prevalence and associated factors in Brazilian older adults.

PURPOSE: To estimate the prevalence of frailty, according to Tilburg Frailty Indicator (TFI) and CHS index, to investigate the correlation between both instruments and to identify the factors associated with this condition in older users of primary health care. METHODS: This is a sectional study with 302 individuals aged 60 years or more of Rio de Janeiro/Brazil. Sociodemographic, health, functional dependence and lifestyle variables were collected. Frailty was evaluated by the TFI (biopsychosocial frailty) and the CHS index (physical frailty). RESULTS: The prevalence of frailty estimated by the TFI was 35.8% and by the CHS index was 23.5%, while 19.2% were considered frail by both instruments. Significant correlations were observed between the two measures (r = 0.675, p < 0.001) and between the CHS index and the physical (r = 0.744, p < 0.001) and psychological domains (r = 0.322, p < 0.001) of the TFI. Considering the TFI, sex, age, healthy lifestyle, osteoarticular diseases, stroke/ischemia and functional dependence in IADL were associated with frailty. By the CHS index, marital status, satisfaction with housing environment, osteoarticular diseases, medication, functional dependence in ADL and IADL were associated with frailty. CONCLUSION: Our study demonstrates that the CHS index and the TFI identify different groups of frail older adults, and the factors associated with physical frailty and biopsychosocial frailty, also differ. Both instruments seem suitable to be used by primary health care professionals in Brazil. Nevertheless, we believe that a fully self-rated assessment is more practical to be applied routinely in this level of attention in the country.

Predictive validity of the Brazilian version of the Tilburg Frailty Indicator for adverse health outcomes in older adults.

PURPOSE: This study aimed to determine the predictive value of the Brazilian Tilburg Frailty Indicator (TFI) for adverse health outcomes (falls, hospitalization, disability and death), in a follow-up period of twelve months. METHODS: This longitudinal study was carried out with a sample of people using primary health care services in Rio de Janeiro, Brazil. At baseline the sample consisted of 963 people aged 60 years and older. A subset of all respondents participated again one year later (n = 640, 66.6% response rate). We used the TFI, the Katz's scale for assessing ADL disability and the Lawton Scale for assessing IADL disability. Falls, hospitalization and death were also assessed using a questionnaire. RESULTS: The prevalence of frailty was 44.2% and the mean score of the TFI was 4.4 (SD = 3.0). There was a higher risk of loss in functional capacity in ADL (OR = 3.03, CI95% 1.45-6.29) and in IADL (OR = 1.51, CI95% 1.05-2.17), falls (OR = 2.08, CI95% 1.21-3.58), hospitalization (OR = 1.83, CI95% 1.10-3.06), and death (HR = 2.73, CI95% 1.04-7.19) for frail when compared to non-frail elderly, in the bivariate analyses. Controlling for the sociodemographic variables, the frailty domains together improved the prediction of hospitalization, falls and loss in functional capacity in ADL, but not loss in functional capacity in IADL. CONCLUSION: The TFI is a good predictor of adverse health outcomes among elderly users of primary care services in Brazil and appears an adequate and easy to administer tool for monitoring their health conditions.

Psychometric properties of the Brazilian version of the Tilburg frailty indicator (TFI).

This study aims to assess the psychometric properties of the Brazilian version of the TFI, an instrument that identifies frailty in elderly individuals. We interviewed 219 individuals aged 60 or older, living in the community. Individuals were predominantly female (52.5%) and mean age was 70.5 (±7.9) years. In order to assess test-retest reliability, 101 individuals were re-interviewed by the same observer within seven to ten days after the first interview. The internal consistency of the instrument was assessed using Cronbach's alpha. To assess construct validity, we used established alternative measures for the items that constitute the TFI, such as: body mass index (BMI), timed up and go (TUG) test, whisper test, Snellen test, upper extremity strength clinical test and mini-mental state examination (MMSE). The test-retest reliability showed high percent agreement for all the items of the instrument, with values ranging from 63% to 100%. Test-retest reliabilities were good (total TFI score r=0.88; physical domain r=0.88; psychological domain r=0.88; and social domain r=0.67). Internal consistency reliability of the Brazilian version was satisfactory (Cronbach's alpha=0.78). The correlations between TFI items and their corresponding measures were consistent except for one item (related to "ability to deal with problems"), demonstrating both convergent and divergent construct validity of the TFI and its items. After the completion of all stages of transcultural adaptation, the Brazilian version of the TFI proved to be well suited for assessing frailty in the elderly population of Brazil.

[Cross-cultural adaptation of the Tilburg Frailty Indicator (TFI) for use in the Brazilian population]. / Adaptação transcultural do instrumento Tilburg Frailty Indicator (TFI) para a população Brasileira.

The current study aimed to adapt the Tilburg Frailty Indicator (TFI), used to assess frailty in the elderly, to the Brazilian population. Conceptual, item, and semantic equivalences were analyzed and the summary version was pre-tested. In the evaluation of conceptual equivalence, the construct for frailty adopted in Brazil demonstrated the same conceptualization as in other cultures where this condition has been investigated. All items included in the original version also showed similarity in the two cultures. High semantic equivalence was observed in the analysis of the items' referential and general meanings. The pre-test showed a high percentage of understanding of items and good acceptance of items by elderly individuals. The results suggest that the TFI version adapted to the Brazilian culture can be a useful tool for assessing health conditions in older Brazilians.