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

Abstract

Screening the frailty level of older adults is essential to avoid morbidity, prevent falls and disability, and maintain quality of life. The Tilburg Frailty Indicator (TFI) is a self-report instrument developed to assess frailty for community-dwelling older adults. The aim of this study was to explore the psychometric properties of the Taiwanese version of TFI (TFI-T). The sample consisted of 210 elderly participants living in the community. The scale was implemented to conduct a confirmatory factor analysis (CFA) test for validity. The models were evaluated through sensitivity, specificity, area under the curve, and receiving operating characteristic (ROC) curve. CFA was performed to evaluate construct validity, and the TFI-T has a goodness of fit with the three-factor structure of the TFI. Totally, the 15 items of TFI-T have acceptable internal consistency (Cronbach’s alpha = 0.78), and test–retest reliability (r = 0.88, p < 0.001). The criterion-related validity was examined, the TFI-T correlation with the Kihon Checklist (KCL) score (r = 0.74; p < 0.001). The cutoff of 5.5 based on the Youden index was considered optimal. The area under the ROC curve analysis indicated that the TFI-T has good accuracy in frailty screening. The TFI-T exhibits good reliability and validity and can be used as a sensitive and accurate instrument, which is highly applicable to screen frailty in Taiwan among older adults.

Deepening the understanding of the structural validity of the Tilburg Frailty Indicator

“…The three-factor model showed better fit, but items 2, 5, and 6 showed loadings < 0.40 with the physical domain, as previously showed by other authors [13,18,21]. Moreover, previous studies also found low factor loadings for items 13, 15 (social domain) [13,18], and 14 (social domain) [18,21]. It must be considered that low factor loadings indicate that the item (indicator) does not relate to the rest of indicators in the factor or dimension, and therefore cannot be aggregated to them.…”

Frailty and Quality of Life among Older Adults in Communities: The Mediation Effects of Daily Physical Activity and Healthy Life Self-Efficacy

“…The mean TFI-T score was 5.69 (SD = 3.22). A cutoff score of ≥5.5 was used to diagnose frailty [ 27 ]. Accordingly, the conditions of the older adults in this study can be divided into two groups: frail (TFI-T ≥ 5.5, n = 109, 51.9%) and robust (TFI-T < 5.5, n = 101, 48.1%).…”

“…Frailty was measured by the Taiwanese version of the Tilburg Frailty Indicator (TFI-T) [ 27 ]. The scale is a widely used frailty screening scale with good reliability and validity [ 27 ] that consists of 15 questions, resulting in a total frailty score ranging from 0 to 15. A higher total score indicates a worse degree of frailty.…”

“…A higher total score indicates a worse degree of frailty. Lin’s (2021) study confirms that a TFI-T tool measurement score of 5.5 can be used as a cutoff value for the degree of frailty [ 27 ]. Frailty was defined based on three components: physical, psychological, and social frailty [ 28 ].…”

Frailty Viewed From a Nursing Perspective

“…Using the TFI for assessing frailty fits well with nursing because this questionnaire is used to assess the total functioning of an older person. Many studies that were conducted in different countries have shown that the TFI is a valid and reliable instrument to assess frailty in community-dwelling older people, such as in the Netherlands ( Gobbens et al, 2010b ), Poland ( Uchmanowicz et al, 2014 ), Brazil ( Santiago et al, 2013 ), China ( Dong et al, 2017 ), Iran ( Mazoochi et al, 2020 ), and Taiwan ( Lin et al, 2021 ).…”