Validation of Instruments to Classify the Frailty of the Elderly in Community

Insook Lee; Young Im Park; Eunok Park; Soon Hee Lee; Ihn Sook Jeong

doi:10.12799/jkachn.2011.22.3.302

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Original Article
Validation of Instruments to Classify the Frailty of the Elderly in Community: Insook Lee, Young Im Park, Eunok Park, Soon Hee Lee, Ihn Sook Jeong; Journal of Korean Academy of Community Health Nursing 2011;22(3):302-314.
DOI: https://doi.org/10.12799/jkachn.2011.22.3.302
Published online: April 4, 2014

¹Professor, College of Nursing, Seoul National University, Korea.

²Professor, Department of Nursing, Daejeon University, Korea.

³Professor, College of Nursing, Jeju National University, Korea.

⁴Professor, Department of Nursing, Chungju National University, Korea.

⁵Associate Professor, College of Nursing, Pusan National University, Korea.

• Received: August 11, 2011 • Revised: September 19, 2011 • Accepted: September 19, 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract

Abstract

Purpose
This study aimed to validate instruments to classify the frailty of Korean elderly people in community.
Methods
For this study, 632 elders were selected from community-based elderly houses and home visiting registries, and data on frailty were collected using three instruments during November, 2008. The Korean Frail Scale (KFS) was composed of 10 domains with the maximum score of 20. The Edmonton Frail Scale (EFS) had 10 domains with the maximum score of 17. The 25_Japan Frail Scale (25_JFS) was composed of 6 domains with the maximum score of 25. Internal consistency was measured with Cronbach's α. Sensitivity, specificity and area under the curve (AUC) of ROC were measured to see validity with long-term care insurance grade as a gold standard.
Results
The Cronbach's α was .72 for KFS, .55 for EFS, and .80 for 25_JFS. Sensitivity, specificity, and AUC were 70.0%, 83.2%, and .83, respectively, at cutting point 10.5 for the KFS, 50.0%, 80.9%, and .66, respectively, at 8.5 for EFS, and 80.0%, 85.9%, and .86, respectively, at 12.5 for 25_JFS.
Conclusion
KFS and three JFS showed favorable internal consistency and predictive validity. Further longitudinal studies are recommended to confirm predictive validity.
Key Words: Frail elderly; Sensitivity; Specificity; Area under curve

Figure 1

Receiver operating characteristics curves and area under the curves (AUC) for upper limit (a) and for lower limit of frailty (b).

Table 1

Components of Frail Scales Used in This Study

n=number of items.

^†'Depression 5 items' in 25point-Japan Frail Scale was replaced with Geriatric Depression Scale in 22 point-Japan Frail Scale.

^‡'Timed Up & Go', 'Sensation', 'Present disease were added in 31 point-Japan Frail Scale.

^§When KDSQ-C is needed, the total items are 68.

Table 2

Distribution of Each Instrument Scoring by General Characteristics of Participants

KFS=Korea frail scale; EFS=edmonton frail scale; 22-JFS=22 point-Japan frail scale; 25-JFS=25 point-Japan frail scale; 31-JFS=31 point-Japan frail scale; SCC=senior citizen's centers; HVP=home visiting projects.

^†M±SD=75.8±5.8

Table 3

Cronbach's alpha and Area Under the ROC Curve by General Characteristics

Table 4

Cronbach's alpha, Sensitivity and Specificity at Certain Cutting Points

^†Coverage between upper limit's and lower limit's cutting point.

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Validation of Instruments to Classify the Frailty of the Elderly in Community

Figure 1 Receiver operating characteristics curves and area under the curves (AUC) for upper limit (a) and for lower limit of frailty (b).

Figure 1

Validation of Instruments to Classify the Frailty of the Elderly in Community

Table 1 Components of Frail Scales Used in This Study

n=number of items.

^†'Depression 5 items' in 25point-Japan Frail Scale was replaced with Geriatric Depression Scale in 22 point-Japan Frail Scale.

^‡'Timed Up & Go', 'Sensation', 'Present disease were added in 31 point-Japan Frail Scale.

^§When KDSQ-C is needed, the total items are 68.

Table 2 Distribution of Each Instrument Scoring by General Characteristics of Participants

^†M±SD=75.8±5.8

Table 3 Cronbach's alpha and Area Under the ROC Curve by General Characteristics

Table 4 Cronbach's alpha, Sensitivity and Specificity at Certain Cutting Points