Assessing Frailty with the Tilburg Frailty Indicator (TFI): A Review of Reliability and Validity

Abstract

Objective: The Tilburg Frailty Instrument (TFI) is an instrument for assessing frailty in community-dwelling older people. Since its development, many studies have been carried out examining the psychometric properties. The aim of this study was to provide a review of the main findings with regard to the reliability and validity of the TFI. Methods: We conducted a literature search in the PubMed and CINAHL databases on May 30, 2020. An inclusion criterion was the use of the entire TFI, part B, referring to the 15 components. No restrictions were placed on language or year of publication. Results: In total, 27 studies reported about the psychometric properties of the TFI. By far, most of the studies (n = 25) were focused on community-dwelling older people. Many studies showed that the internal consistency and test-retest reliability are good, which also applies for the criterion and construct validity. In many studies, adverse outcomes of interest were disability, increased health-care utilization, lower quality of life, and mortality. Regarding disability, studies predominantly show results that are excellent, with an area under the curve (AUC) >0.80. In addition, the TFI showed good associations with lower quality of life and the findings concerning mortality were at least acceptable. However, the association of the TFI with some indicators of health-care utilization can be indicated as poor (eg, visits to a general practitioner, hospitalization). Conclusion:Since population aging is occurring all over the world, it is important that the TFI is available and well known that it is a user-friendly instrument for assessing frailty and its psychometric properties being qualified as good. The findings of this assessment can support health-care professionals in selecting interventions to reduce frailty and delay its adverse outcomes, such as disability and lower quality of life.

Psychometric Properties of the Taiwanese Version of the Tilburg Frailty Indicator for Community-Dwelling Older Adults

“…The value was close to that reported in previous studies (0.71-0.78) [14]. In this present study, the test-retest reliability coefficient of 0.88 was good, with similar results as previous studies (0.79-0.80) [14,17].…”

“…Studies demonstrated that higher scores on the TFI were correlated with lower quality of life [15]. Moreover, regarding disability in performing ADL and/or IADL, the AUCs were acceptable in previous studies [14,19]. One study also reported the relationship between the total domain and psychological domain of TFI and depression (GDS-15), which are 0.67 and 0.49 (p < 0.001) [16].…”

“…The Cronbach’s α for the physical domain was 0.70, the psychological domain was 0.63, the social domain was 0.34, and 0.73 for the total TFI [ 16 ]. Significant correlations between the frailty domains were 0.42 between the physical and psychological, 0.19 between the physical and social, and 0.18 between the psychological and social domains (all p < 0.001) [ 14 , 15 ].…”

“…The Tilburg Frailty Indicator (TFI) was developed from an integral understanding of frailty that includes physical, psychological, and social domains [ 14 ]. The TFI questionnaire contains 15 questions; it is a user-friendly self-report questionnaire that takes less than 15 min to complete the response.…”

“…The TFI questionnaire contains 15 questions; it is a user-friendly self-report questionnaire that takes less than 15 min to complete the response. It is also easy to understand and widely administered to community-dwelling older adults [ 14 , 15 ]. Researchers had done a systematic review about TFI as one of the frailty assessment tools which had evidence of reliability and validity within statistically significant parameters and of fair-excellent methodological quality [ 16 ].…”