Psychometric properties of the Brazilian version of the Tilburg frailty indicator (TFI)
Introduction
In the last few decades, studies about frailty are becoming increasingly frequent in the scientific literature about aging (De Vries et al., 2011, Sternberg et al., 2011). Frailty results from the diminished physiological reserve and ability to maintain homeostasis in elderly individuals. Frailty makes elderly individuals more vulnerable to environmental stressful situations and is associated with high risk of adverse health outcomes such as functional dependence, falls, recurrent hospitalization and death (Ávila-Funes et al., 2008, Berges et al., 2009, Ensrud et al., 2008, Fried et al., 2001, Van Kan et al., 2008).
Ever since the term frailty appeared in the literature, two conceptual approaches have been adopted. One of the approaches to frailty focuses on factors regarding an elderly individual's physical functioning (Folson et al., 2007, Fried et al., 2001), whereas the other also includes some psychological and social factors (Frieswijk et al., 2004, Gobbens et al., 2010a, Rockwood et al., 1999). The latter multidimensional concept of frailty has currently been the most prevailing (Rothman et al., 2008, Van Kan et al., 2008).
A systematic review of Brazilian literature on instruments identifying frailty in elderly individuals revealed that no multidimensional instrument yet exists in Portuguese. Therefore, we aimed to identify an instrument in the international literature, which addressed the multidimensional concept of frailty and that had been validated in its original culture, showing satisfactory psychometric properties. The TFI was the single instrument which met such requirements (Gobbens et al., 2012, Gobbens et al., 2010b). A recent systematic review concluded that the TFI is potentially relevant for screening for frailty in a primary care setting (Pialoux, Goyard, & Lesourd, 2012). Hence we selected the TFI and submitted it to the process of transcultural adaptation for use in the Brazilian elderly population. The TFI, developed in the Netherlands, consists of two different parts. One part addresses potential determinants of frailty and the other specifically addresses components of frailty. We examined the second part on components of frailty, which consists of fifteen questions, covering the physical, psychological and social domains of frailty. The first stages of the transcultural adaptation of the TFI for use in the elderly population of Brazil have already been completed. We observed good comprehension and reasonable acceptance of the items of the Brazilian version in the pre-test (Santiago, Luz, Mattos, & Gobbens, 2012). This suggests that the instrument may be a useful tool to assess frailty in Brazil.
The aim of this study was to assess the psychometric properties (reliability and construct validity) of the Brazilian version of the TFI.
Section snippets
Study population
From March to June 2012, we recruited a convenience sample of 219 individuals, aged 60 or older. These individuals lived in the community and were assessed at a senior healthcare facility, located in the municipality of Juiz de Fora, in the southeast of Brazil. All recruited individuals agreed to participate and were interviewed by a trained nurse. The first 118 were also submitted to interview and physical measurements of frailty in order to evaluate the validity of the Brazilian version of
Participants characteristics
Mean age of all participants was 70.5 (7.9) with a median of 69.0 years, 52.5% was female, and the majority had a low level of education (67.7% with 0–4 years of education). See Table 1 for participant characteristics as assessed with part B of the TFI, by samples 1 and 2. Prevalence of frailty based on the Brazilian version of the TFI was 35.6% and 31.7%, for sample 1 and 2, respectively, T-tests and chi-square tests showed no statistically significant differences between the two samples.
Discussion
This study was conducted to continue the process of transcultural adaptation of the original TFI to the Brazilian population, according to the universalist approach proposed by Herdman, Fox-Rushby, and Badia (1998). We report on the psychometric properties (test–retest reliability, internal consistency and convergent and divergent validity) of the Brazilian version.
The reliability of the Portuguese TFI is good, evidenced by (i) strong test–retest reliability, (ii) fair to high simple and
Conflict of interest statement
Authors declare no conflict of interest.
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