Development and psychometric validation of a new scale for assessment and screening of frailty among older indians

Abstract

Background: Frailty is a major challenge for healthcare systems in ageing societies. This dynamic state of health is a reflection of reduced reserve in various organ systems and enhanced vulnerability to stressors. Research in this area of geriatrics and gerontology is limited in low-and middle-income countries (LMICs) like India. This study is directed at development of a culturally appropriate and validated assessment scale for frailty among older Indians. Methods: After extensive review of the literature on existing scales, a preliminary draft scale was formed. This draft was pre-and pilot-tested to check feasibility and modified accordingly. The final scale was validated on 107 older adults by confirmatory factor analysis and was named the Frailty Assessment and Screening Tool (FAST). The Fried’s frailty phenotype was also administered on the same 107 older adults and scores of both were co-related. Suitable cut-off scores were found for frail and pre-frail older adults. Results: The final version of the FAST consisted of 14 questions pertaining to 10 domains. It has good reliability. Cronbach’s alpha co-efficient was 0.99; test–retest reliability was 0.97 and validity by confirmatory factor analysis was adequate. The Kaiser–CMeyer–Olkin (KMO) of sampling adequacy was 0.699, and Bartlett’s test of sphericity was significant (χ2 = 353.471, p < 0.001). FAST scores had a cut-off of ≥ 7/14 for frail and ≥ 5/14 for pre-frail elderly. Conclusion: The FAST is a validated tool with good psychometric properties. It is expected that it will be helpful in screening pre-frail and frail older adults in India and other LMICs and guide in clinical decision making for intervention.