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

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.

Attitudes to aging mediated the reciprocal associations between frailty and depressive symptoms: ageism as a moderator

“…Frailty was measured by the Chinese Frailty Screening scale (CFSS), which includes 10 items that are scored on 0 (no) and 1 (yes). The total score ranged from 0 to 10, with a higher score indicating greater severity of frailty [25]. The internal consistency of the CFSS-10 in the present study showed good (Cronbach's α = 0.689).…”

Global frailty screening tools: Review and application of frailty screening tools from 2001 to 2023

“…However, there is no standard assessment instrument. The most widely used measures are the FP (16) and the frailty index (FI), but these cannot be easily implemented in large-scale population studies or busy clinics (17). To assess frailty in large populations, it is important to find short-term rapid instruments that give reliable results for the risk of a negative event and to stratify older adults according to their level of frailty.…”

“…Japan (80,81) China (17,20,82,83) Singapore (84,85) Denmark (86) Greek (38) African (87) Thai (15,88) Korean (39,89)…”