<p>The Tilburg Frailty Indicator (TFI): New Evidence for Its Validity</p>

Abstract

Objective: The Tilburg Frailty Indicator (TFI) is a self-report user-friendly questionnaire for assessing multidimensional frailty among community-dwelling older people. The main aim of this study is to re-evaluate the validity of the TFI, both cross-sectionally and longitudinally, focusing on the predictive value of the total TFI and its physical, psychological, and social domains for adverse outcomes disability, indicators of healthcare utilization, and falls. Methods: The validity of the TFI was determined in a sample of 180 Dutch communitydwelling older people aged 70 years and older. The participants completed questionnaires including the TFI, the Groningen Activity Restriction Scale (GARS) for assessing disability, and questions with regard to health care utilization and falls in 2016 and again one year later. Results: The physical and psychological domains of the TFI were significantly correlated as expected with adverse outcomes disability, many indicators of healthcare utilization, and falls. Regression analyses showed that physical frailty was mostly responsible for the effect of frailty on the adverse outcomes. The cross-sectional and longitudinal predictive validity of total frailty with respect to disability and receiving personal care was excellent, evidenced by Areas Under the Curves (AUCs) >0.8. In most cases, using the cutoff point 5 for total frailty ensured the best values for sensitivity and specificity. Conclusion: The present study provided new, additional evidence for the validity of the TFI for assessing frailty in Dutch community-dwelling older people aiming to prevent or delay adverse outcomes, including disability.

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

“…The TFI, however, clearly has a poor association with visits to a general practitioner 1,9,42 and hospitalization. 1,13,[37][38][39]42,43 In all six studies using quality of life as the outcome, the TFI showed good associations with lower quality of life, independent of the quality of life instrument that has been used. 1,10,[40][41][42]45 Moreover, the TFI predicted mortality, with only Op Het Veld et al 43 qualifying the predicted value for this outcome as low.…”

“…In many studies focusing on criterion validity (concurrent and predictive), 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, 1 , 9 , 38 , 42 , 47 with AUCs >0.80. 29 The findings pertaining to an increase in health-care utilization present a less unambiguous picture and seem to depend strongly on the indicator used (eg, personal care, informal care, visits to a general practitioner or hospitalization).…”

“…The first studies were performed in 2010. 1,36 Thirteen studies were carried out in the Netherlands, 1,[36][37][38][39][40][41][42][43][44][45][46][47] of which two were part of a large study that also collected data in other European countries. 46,47 Three studies were exclusively conducted in Denmark, 8,48,49 and two in Poland 11,50 and Brazil.…”

“…37,38,[42][43][44]51 In particular, adverse outcomes of interest were disability, 37,38,[42][43][44]51 mortality, 37,43,46,49,51 increased health-care utilization 37,38,42,43,51 and lower quality of life. 41,42 Disability was predicted by the TFI; however, Gobbens et al 38,42 indicated that the predictive value was excellent, while Op Het Veld et al concluded that it was poor, 43 presenting a positive predictive value of 42.6% and a negative predictive value of 75.2%. 44 In four studies, the findings concerning mortality were at least acceptable; only Op Het Veld et al qualified the predictive value of the TFI as poor.…”

“…Op Het Veld et al 43 Predictive, 2 years later, using AUC: poor for mortality, hospitalization, and disability in IADL Gobbens et al 38 Predictive, 1 year later, using linear and logistic regression analyses: the three frailty domains together predicted disability, visits general practitioner, contacts with health care professionals, receiving nursing; no effects were found on hospitalization, receiving personal care, falls (after controlling for sociodemographic characteristics and multimorbidity)…”