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• Frailty has become one of the hidden problems among Indonesian older adults. • 26.8 % of Indonesian older adult experience frailty, while 55.5 % of them are in the pre-frailty phase. • Tilburg Frailty Indicator-Indonesian version is a multidimensional frailty assessment which demonstrated good results in validity and reliability test to evaluate frailty status in Indonesian older adults. • The Tilburg Frailty Indicator-Indonesian version is a straightforward tool that can provide a multidomain perspective and help healthcare professionals to determine appropriate interventions for older adults. The aim of this study was to develop and examine the psychometric properties of the Tilburg Frailty Indicator-Indonesian version (TFI-I). 308 community-dwelling older adults aged ≥60 years participated. The TFI-I exhibited favorable internal consistency (Cronbach's alpha = 0.775) and test–retest reliability (intraclass correlation coefficient = 0.94). The physical, psychological, and social domains of the TFI-I correlated closely with the similar constructs of other scales, including the Short Physical Performance Battery (P <.001), Fried Frailty Phenotype (P < 0.001), Geriatric Depression Scale (P <.001), and the World Health Organization Quality of Life scale (P = 0.041), indicating its favorable construct validity. Significant differences were identified between the robust and frailty groups on the Barthel Index (P =.001) and Lawton Instrumental Activity of Daily Living Scale (P <.001). Overall, the TFI-I is valid and reliable when used to evaluate frailty status in clinical and research settings. [ABSTRACT FROM AUTHOR]

Limited knowledge exists about how the socialization of vocationally trained registered nurses both at school and during internships in the community of practice influences their perception of, and working relationship with certified nursing assistants. This paper studies, first, how registered nurse students internalize the perceptions and discourses about certified nursing assistants conveyed by teachers, mentors and other students during their socialization at school and in the community of practice. Second, it examines how this socialization forms student's perception of, and actual working relationship with certified nursing assistants. Qualitative descriptive and exploratory study using an interpretative framework. Individual in-depth interviews were conducted with 15 registered nurse students that were in their third or fourth year of training. The findings reveal that at school the division of tasks and working relationship between registered nurse students and certified nursing assistants was very rarely discussed explicitly. However, teachers and students implicitly and explicitly conveyed that certified nursing assistants have lower status, describing the latter's role as inferior and as assisting to the role of registered nurses. During internships in the community of practice, some students initially adjust this perception when directly working with certified nursing assistants, who generally are their mentor in the first years of training, consider certified nursing assistants as equal and highlight the interdependence of the two occupational groups. Yet, further in their training, registered nurse students start to relate more to graduated registered nurses and reproduce the dominant perception and discourse that certified nursing assistants are inferior and supposed to support registered nurses, thereby perpetuating pervasive status differences and inequality. Findings will assist nurse educators both in training centers and in the community of practice to understand how education can be used to end pervasive status differences and foster mutual respect and equity between different designations in nursing. [ABSTRACT FROM AUTHOR]

Objective To determine whether the effects of lifestyle factors on frailty can be adequately addressed by asking a single self-report question. Design Cross-sectional study. Setting A sample of Dutch citizens completed the web-based questionnaire “Seniorenbarometer”. Participants 610 persons aged 50 years and older. Measurements Seven lifestyle factors were assessed: smoking, use of alcohol, intake of vegetables, intake of fruit, having breakfast, exercise, and teeth brushing. The single self-report question of lifestyle was: “Overall, how healthy would you say your lifestyle is?” Frailty was measured by the Tilburg Frailty Indicator. Results Age was positively associated with a healthy lifestyle (less smoking, more intake of vegetables, fruit and eating breakfast). The lifestyle factors did not improve the prediction of total, physical, psychological, and social frailty, after controlling for the single self-report question. Conclusion Our study suggests that one general self-report lifestyle question, rather than a list of specific lifestyle factors, suffices for predicting frailty. [ABSTRACT FROM AUTHOR]

Objective The aim of this cross-sectional study was to examine the validity of an integral model of the associations between life-course determinants, disease(s), frailty, and adverse outcomes in older persons who are resident in assisted living facilities. Methods Between June 2013 and May 2014 seven assisted living facilities were contacted. A total of 221 persons completed the questionnaire on life-course determinants, frailty (using the Tilburg Frailty Indicator), self-reported chronic diseases, and adverse outcomes disability, quality of life, health care utilization, and falls. Adverse outcomes were analyzed with sequential (logistic) regression analyses. Results The integral model is partially validated. Life-course determinants and disease(s) affected only physical frailty. All three frailty domains (physical, psychological, social) together affected disability, quality of life, visits to a general practitioner, and falls. Contrary to the model, disease(s) had no effect on adverse outcomes after controlling for frailty. Life-course determinants affected adverse outcomes, with unhealthy lifestyle having consistent negative effects, and women had more disability, scored lower on physical health, and received more personal and informal care after controlling for all other predictors. Conclusion The integral model of frailty is less useful for predicting adverse outcomes of residents of assisted living facilities than for community-dwelling older persons, because these residents are much frailer and already have access to healthcare facilities. Practical implications The present study showed that a multidimensional assessment of frailty, distinguishing three domains of frailty (physical, psychological, social), is beneficial with respect to predicting adverse outcomes in residents of assisted living facilities. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To establish whether the prediction of the adverse outcomes disability and six indicators of health care utilization one and two years later by the three frailty domains (physical, psychological, social) of the Tilburg Frailty Indicator (TFI) is improved by adding interview and physical measures of frailty. Materials and methods: A representative sample of 245 Dutch community-dwelling persons aged 75 years and older (response rate 53%) participated in 2008, one year later in 2009 (n =179, 73%) and again two years later in 2010 (n =141, 58%). Frailty was assessed with the TFI, an easy to administer self-report measure. Disability was measured using the Groningen Activity Restriction Scale (GARS). Indicators of health care utilization were: visit to a general practitioner (gp), contacts with health care professionals (hcps), hospital admission, receiving personal care, receiving nursing care, and receiving informal care. Results: After controlling for background characteristics, the TFI predicted disability and the indicators of health care utilization. Interviews and physical measures of frailty improved the prediction of disability. The Hospital Anxiety and Depression Scale (HADS-A) improved the prediction of contacts with hcps, but the interview and physical measures of frailty did not improve the predictions of the other indicators of health care utilization. Conclusions: Assessment by the self-report TFI is sufficient for predicting six indicators of health care utilization, but for predicting disability the use of both the TFI and the Timed Up & Go (TUG) test is recommended. It is advisable assessing all three frailty domains when examining frailty and its prediction of adverse outcomes. [Copyright &y& Elsevier]

Objectives: To assess the reliability, construct validity, and predictive (concurrent) validity of the Tilburg Frailty Indicator (TFI), a self-report questionnaire for measuring frailty in older persons. Design: Cross-sectional. Setting: Community-based. Participants: Two representative samples of community-dwelling persons aged 75 years and older (n = 245; n = 234). Measurements: The TFI was validated using the LASA Physical Activity Questionnaire, BMI, Timed Up & Go test, Four test balance scale, Grip strength test, Shortened Fatigue Questionnaire, Mini-Mental State Examination, Center for Epidemiologic Studies Depression Scale, Anxiety subscale of the Hospital Anxiety and Depression Scale, Mastery Scale, Loneliness Scale, and the Social Support List. Adverse outcomes were measured using the Groningen Activity Restriction Scale and questions regarding health care use. Quality of life was measured using the WHOQOL-BREF. Results: The test-retest reliability of the TFI was good: 0.79 for frailty, and from 0.67 to 0.78 for its domains for a 1-year time interval. The 15 single components, and the frailty domains (physical, psychological, social) of the TFI correlated as expected with validated measures, demonstrating both convergent and divergent construct validity of the TFI. The predictive validity of the TFI and its physical domain was good for quality of life and the adverse outcomes disability and receiving personal care, nursing, and informal care. Conclusion: This study demonstrates that the psychometric properties of the TFI are good, when performed in 2 samples of community-dwelling older people. The results regarding the TFI''s validity provide strong evidence for an integral definition of frailty consisting of physical, psychological, and social domains. [Copyright &y& Elsevier]

Objectives: To determine which determinants predict frailty and domains of frailty (physical, psychological, social) in a community-dwelling sample of elderly persons. Design: Cross-sectional. Setting: Community-based. Participants: A representative sample of 484 community-dwelling persons aged 75 years and older. Measurements: The Tilburg Frailty Indicator (TFI), a self-report questionnaire, was used to collect information about determinants of frailty and to assess frailty and domains of frailty (physical, psychological, social). Results: Results were obtained by regression and mediation analyses. The 10 determinants explain about 35% of the variance of frailty. After controlling for other determinants, medium income, an unhealthy lifestyle, and multimorbidity predicted frailty. The effects of other determinants differed across domains of frailty; age predicted physical frailty, life events predicted psychological frailty, whereas being a woman predicted social frailty because older women have a higher probability of living alone. Conclusion: Our finding that the effect of the determinants of frailty differs across frailty domains suggests that it is essential to divide the concept of frailty into domains. [Copyright &y& Elsevier]

Introduction: There are many different conceptual definitions of frailty in circulation. Most of these definitions focus mainly on physical problems affecting older people. Only a few also draw attention to other domains of human functioning such as the psychological domain. The authors of this article fear that this could lead to fragmentation of care for frail older people. The aim is to develop an integral conceptual definition of frailty that starts from the premise of a holistic view of the person. Methods: To achieve this, a literature search was carried out. Thereafter a group of experts (N=20) were consulted, both verbally during 2 expert meetings and via a written questionnaire. These experts were asked which existing conceptual definition of frailty places most stress on the integral functioning of older people. Results: The experts expressed a clear preference for one of the conceptual definitions. The result of the literature search and the consultation with the experts led to a new integral conceptual definition of frailty. Conclusion: The conceptual definition is intended to offer a framework for an operational definition of frailty for identifying frail older people. [Copyright &y& Elsevier]

To predict mortality with the Tilburg Frailty Indicator (TFI) in a sample of community-dwelling older people, using a follow-up of 7 years. Longitudinal. 479 Dutch community-dwelling people aged 75 years or older. The TFI, a self-report questionnaire, was used to collect data about total, physical, psychological, and social frailty. The municipality of Roosendaal (a town in the Netherlands) provided the mortality dates. Total, physical, and psychological frailty predicted mortality, with unadjusted hazard ratios of 1.295, 1.168, and 1.194, and areas under the receiver operating characteristic curves of 0.664, 0.671, and 0.567, respectively. After adjustment for age and gender, the areas under the curves for total, physical, and psychological frailty were 0.704, 0.702, and 0.652, respectively. Analyses using individual components of the TFI show that difficulty in walking and unexplained weight loss predict mortality. This study has shown the predictive validity of the TFI for mortality in community-dwelling older people. Our study demonstrated that physical and psychological frailty predicted mortality. Of the individual TFI components, difficulty in walking consistently predicted mortality. For identifying frailty, using the integral instrument is recommended because total, physical, psychological, and social frailty and its components have proven their value in predicting adverse outcomes of frailty, for example, increase in health care use and a lower quality of life. [ABSTRACT FROM AUTHOR]

The Tilburg Frailty Indicator is a questionnaire with a bio-psycho-social approach, which measures frailty by 15 questions. A questionnaire about frailty should be in alignment with experiences of frail elderly themselves as a target population is an important source of knowledge in content validation. Aim To validate the Tilburg Frailty Indicator on content in relation to the physical, psychological and social domain by exploring the experience of daily life of community dwelling frail elderly. Methods The design was a qualitative content validation study. The participants were acutely admitted frail elderly discharged to home and interviewed one week after discharge. A deductive content analysis, with categories structured in advance, was performed. Results A total of 422 meaning units were extracted from the transcriptions; 131 units related to the physical domain, 106 units to the psychological domain and 185 units to the social domain. 56 units were not linked into the existing structure of the questionnaire. 14 of 15 questions were confirmed from a target population perspective. The four issues pain, sleep quality, spirituality and meaningful activities that seem to be important elements for frail elderly were not directly covered by the questionnaire. Discussion It seems likely that the majority of important items related to frailty are covered in the questionnaire. The findings add to the scientific body of knowledge in relation to the validity of the questionnaire. Future research should investigate the importance of the four issues pain, sleep quality, spirituality and meaningful activities in relation to the screening of frailty. [ABSTRACT FROM AUTHOR]