COSMIN database

Psychometric properties of multicomponent tools designed to assess frailty in older adults: A systematic review

Sutton, J. L., Gould, R. L., Daley, S., Coulson, M. C., Ward, E. V., Butler, A. M., Nunn, S. P., and Howard, R. J.
BACKGROUND: Frailty is widely recognised as a distinct multifactorial clinical syndrome that implies vulnerability. The links between frailty and adverse outcomes such as death and institutionalisation have been widely evidenced. There is currently no gold standard frailty assessment tool; optimizing the assessment of frailty in older people therefore remains a research priority. The objective of this systematic review is to identify existing multi-component frailty assessment tools that were specifically developed to assess frailty in adults aged >/=60 years old and to systematically and critically evaluate the reliability and validity of these tools.

METHODS: A systematic literature review was conducted using the standardised COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist to assess the methodological quality of included studies.

RESULTS: Five thousand sixty-three studies were identified in total: 73 of which were included for review. 38 multi-component frailty assessment tools were identified: Reliability and validity data were available for 21 % (8/38) of tools. Only 5 % (2/38) of the frailty assessment tools had evidence of reliability and validity that was within statistically significant parameters and of fair-excellent methodological quality (the Frailty Index-Comprehensive Geriatric Assessment [FI-CGA] and the Tilburg Frailty Indicator [TFI]).

CONCLUSIONS: The TFI has the most robust evidence of reliability and validity and has been the most extensively examined in terms of psychometric properties. However, there is insufficient evidence at present to determine the best tool for use in research and clinical practice. Further in-depth evaluation of the psychometric properties of these tools is required before they can fulfil the criteria for a gold standard assessment tool.
BMC Geriatr
1471-2318 (Electronic); 1471-2318 (Linking)
Publication year:
Symptom status:
Cognitive/mental state
Emotional state
Physical state
Functional status:
Cognitive/mental functioning
Physical functioning
Role functioning
Social functioning
Seniors (65+)
Codes for special purposes
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
2 - Interviews
4 - Performance-based tests
6 - Clinical rating scales
7 - Observations
1994 Frailty Measure Strawbridge
9-item Frailty Measure
Brief Clinical Instrument to Classify Frailty
Brief Frailty Index
British Frailty Index
CAF - Comprehensive Assessment of Frailty
CGIC-PF - Clinical Global Impression of Change in Physical Frailty
Comprehensive Frailty Assessment Instrument
Continuous Composite Measure of Frailty
CP-FI-CGA - Care Partners-Frailty Index-Comprehensive Geriatric Assessment
CSHA Clinical Frailty Scale - Canadian study of health and aging Clinical Frailty Scale
Easy-Care TOS - Easy-Care Two-step Older persons Screening
EFIP - Evaluative Frailty Index for Physical activity
EFS - Edmonton Frail Scale
FI-CGA - Frailty Index-Comprehensive Geriatric Assessment
FIFE - Frailty Index for Elders
FIND - Frail Non-Disabled Instrument
FORECAST - Frailty predicts death One yeaR after Elective Cardiac Surgery Test
FRAIL Scale - Fatigue Resistance Ambulation Illness Loss of Weight Scale
Frailty Index (accumulation of deficits)
Frailty Index based on Primary Care Data
Frailty Phenotype [alias: Phenotype of Frailty]
Frailty Screening Tool
Frailty Trait Scale
GFI - Groninger Frailty Indicator
Guilley Frailty Instrument
Inactivity and Weight loss
INTER-FRAIL Study Questionnaire
KLoSHA Frailty Index
Marigliano-Cacciafesta Polypathological Scale
Predictive Physical Frailty Score
Prognostic Risk Score
Self-Report Screening Tool for Frailty
SHARE-FI75+ - Survey of Health, Ageing and Retirement in Europe Frailty Instrument 75+
SHARE Frailty Instrument - Survey of Health, Ageing and Retirement in Europe Frailty Instrument
SOF Frailty Criteria - Study of Osteoporotic Fractures Frailty Criteria
Tilburg Frailty Indicator
WHIOS Multicomponent Measure - Women's Health Initiative Observational Study Multicomponent Measure