Critical reflections on the blind sides of frailty in later life

Since the 1970's, frailty emerged as a major theme and has become one of the most researched topics in aging studies. However, throughout the years, the concept 'frailty' became susceptible to different interpretations and has been approached by different synonyms, which resulted in a confusing picture. Based on a narrative literature review, this theoretical paper not only attempts to describe these different views on frailty, but by criticizing the dominance of some of these views, it also aspires to move the research and policy agenda on frailty forward. This paper is part of the D-SCOPE project in Belgium, and critically reflects on the blind sides of the biomedical domination of frailty and discusses three main themes: 1) frailty as a multidimensional and multilevel concept; 2) positive perspectives on frailty in later life; and 3) the suggestion of moving from a merely deficit-based frailty approach towards the concept of frailty-balance. At the theoretical level, conceptualizing frailty is not simply an exercise in semantics, but altering the theoretical definition of frailty can have wide-ranging implications, not only for the way frailty prevalence is measured and handled, but also for public or personal opinions on frailty in older people, for care and support practices, and for the scope of legislation. Therefore, the final section of the paper presents three building blocks for future research and policy-making: 1) adopting a multidimensional, multilevel, dynamic and positive view on frailty; 2) moving from dependency to interdependency; and 3) giving voice to (the resilience of) frail older people.</p

Focusing on positive outcomes in frailty research: development of a short well-being instrument for older adults (SWIO)

Objective: Studies of frailty have tended to focus on adverse outcomes. This study aims to develop a short instrument that identifies a positive outcome, namely, the level of well-being in older adults at risk of frailty. Method: 871 older adults (49.4% women; mean age 75.72 years; SD = 8.05) with a frailty risk profile participated in the first wave of the D-SCOPE study. The possible domains of well-being were identified using a bottom-up approach. Exploratory Structural Equation Modeling (ESEM) and multidimensional Item Response Theory (IRT) analysis of 17 items in 4 domains measuring well-being was performed on a calibration sample (n = 435) to develop the instrument. The instrument was subsequently corroborated by confirmatory factor analysis and convergent/divergent relations with relevant external measures in a validation sample (n = 436). Results: The ESEM three-factor solution, with the subdimensions of sense of mastery, meaning in life, and life satisfaction, displayed good fit to the data (RMSEA = 0.070). For each dimension, the three best discriminating items were retained for the instrument following IRT analysis. Internal consistency of these dimensions was good in the validation sample (sense of mastery alpha = 0.864, meaning in life alpha = 0.715, and life satisfaction alpha = 0.782). The confirmatory factor analysis (CFA) three-factor model also showed good fit to the data (RMSEA = 0.064). Small to large zero-order correlations with the external measures were as expected. Conclusions: Using a bottom-up approach, this study developed a short instrument to identify levels of well-being in vulnerable or frail older adults. The instrument can be applied in primary care and prevention programs

Focusing on positive outcomes in frailty research: development of a short well-being instrument for older adults (SWIO)

Objective: Studies of frailty have tended to focus on adverse outcomes. This study aims to develop a short instrument that identifies a positive outcome, namely, the level of well-being in older adults at risk of frailty. Method: 871 older adults (49.4% women; mean age 75.72 years; SD = 8.05) with a frailty risk profile participated in the first wave of the D-SCOPE study. The possible domains of well-being were identified using a bottom-up approach. Exploratory Structural Equation Modeling (ESEM) and multidimensional Item Response Theory (IRT) analysis of 17 items in 4 domains measuring well-being was performed on a calibration sample (n = 435) to develop the instrument. The instrument was subsequently corroborated by confirmatory factor analysis and convergent/divergent relations with relevant external measures in a validation sample (n = 436). Results: The ESEM three-factor solution, with the subdimensions of sense of mastery, meaning in life, and life satisfaction, displayed good fit to the data (RMSEA = 0.070). For each dimension, the three best discriminating items were retained for the instrument following IRT analysis. Internal consistency of these dimensions was good in the validation sample (sense of mastery alpha = 0.864, meaning in life alpha = 0.715, and life satisfaction alpha = 0.782). The confirmatory factor analysis (CFA) three-factor model also showed good fit to the data (RMSEA = 0.064). Small to large zero-order correlations with the external measures were as expected. Conclusions: Using a bottom-up approach, this study developed a short instrument to identify levels of well-being in vulnerable or frail older adults. The instrument can be applied in primary care and prevention programs

Concordances and differences between a unidimensional and multidimensional assessment of frailty: a cross-sectional study

Background: Many instruments to identify frail older people have been developed. One of the consequences is that the prevalence rates of frailty vary widely dependent on the instrument selected. The aims of this study were 1) to examine the concordances and differences between a unidimensional and multidimensional assessment of frailty, 2) to assess to what extent the characteristics of a 'frail sample' differ depending on the selected frailty measurement because 'being frail' is used in many studies as an inclusion criterion.Method: A cross-sectional study was conducted among 196 community-dwelling older adults (&gt;= 60 years), which were selected from the census records. Unidimensional frailty was operationalized according to the Fried Phenotype (FP) and multidimensional frailty was measured with the Comprehensive Frailty Assessment Instrument (CFAI). The concordances and differences were examined by prevalence, correlations, observed agreement and Kappa values. Differences between sample characteristics (e.g., age, physical activity, life satisfaction) were investigated with ANOVA and Kruskall-Wallis test.Results: The mean age was 72.74 (SD 8.04) and 48.98% was male. According to the FP 23.59% was not-frail, 56.92% pre-frail and 19.49% frail. According to the CFAI, 44.33% was no-to-low frail, 37.63% was mild frail and 18.04% was high frail. The correlation between FP and the CFAI was r = 0.46 and the observed agreement was 52.85%. The Kappa value was kappa = 0.35 (quadratic kappa = 0.45). In total, 11.92% of the participants were frail according to both measurements, 7.77% was solely frail according to the FP and 6.21% was solely frail according to the CFAI. The 'frail sample respondents' according to the FP had higher levels of life satisfaction and net income, but performed less physical activities in comparison to high frail people according to the CFAI.Conclusion: The present study shows that the FP and CFAI partly measure the same 'frailty-construct', although differences were found for instance in the prevalence of frailty and the composition of the 'frail participants'. Since 'being frail' is an inclusion criterion in many studies, researchers must be aware that the choice of the frailty measurement has an impact on both the estimates of frailty prevalence and the characteristics of the selected sample.</p