Assessment of frailty in Saudi community-dwelling older adults: Validation of measurements

Abstract

BACKGROUND: Frailty status among Saudi adults is unknown due to the lack of a reliable and validated Arabic instrument that can be applied directly to the Saudi population. OBJECTIVES: Cross-culturally adapt and validate the Arabic version of the FRAIL scale in community-dwelling older adults. DESIGN: Cross-sectional. SETTINGS: The outpatient clinic of a tertiary care hospital. SUBJECTS AND METHODS: People aged ≥65 years who attended the outpatient clinic were recruited to participate. The original FRAIL scale was translated into Arabic and psychometric properties were examined for each item on the FRAIL scale and the total score, test-retest reliability over two visits with a one-week interval. We assessed criterion-related validity with the Fried Frailty Index as a reference measure and construct validity with other related measurements. MAIN OUTCOME MEASURES: Arabic version of the FRAIL Scale, grip strength, the Mini-Mental State Examination, a short physical performance battery, the Timed Up and Go test, the Fried Frailty Index, and the Duke Comorbidity Index. SAMPLE SIZE AND CHARACTERISTICS: 47 community-dwelling older adults (66% male, mean [SD] age 70 [4] years). RESULTS: The Arabic version of the FRAIL scale showed acceptable internal consistency (Cronbach’s alpha=0.786) and good test-retest reliability within a one-week interval (intraclass correlation coefficient=0.77). Statistically significant correlations were found between the Arabic FRAIL scale, the Fried Frailty Index, and other frailty related measurements such as the Mini-Mental State Examination, the Duke comorbidity index, the Short Physical Performance Battery, and the Timed Up And Go Test. Using the Fried Frailty Index as the criterion measure, the Arabic FRAIL scale demonstrated good diagnostic accuracy for frailty (AUC=0.71). The optimal cutoff point for frailty on the Arabic FRAIL scale was 3, which yielded a sensitivity of 72% and specificity of 67%. The prevalence of frailty varied according to the FRAIL-AR (37%) and the Fried Frailty Index (28%). CONCLUSIONS: The FRAIL scale was successfully translated and culturally-adapted to Saudi older adults. The adapted Arabic version demonstrated acceptable internal consistency, test-retest reliability, and validity. Further study is needed to establish the validity of FRAIL-AR scale in a larger cohort in Saudi Arabia LIMITATIONS: The small sample size and single geographic area may affect the generalizability of the results across the country. CONFLICT OF INTEREST: None.