Early detection of frail older people is important. Timely intervention may allow health care professionals to prevent or delay the occurrence of adverse outcomes such as disability, increases in health care utilization, and premature death.
We assessed the construct and criterion validity of the SUNFRAIL tool, a questionnaire for measuring frailty among older people.
Design, Setting and Participants
This cross-sectional study was carried out in a sample of Dutch citizens. A total of 195 community-dwelling persons aged 71 years and older completed the questionnaire.
Construct validity was examined by determining the correlation between the SUNFRAIL tool and the Tilburg Frailty Indicator (TFI). Criterion validity for the SUNFRAIL tool was determined by establishing the correlations with chronic diseases and adverse outcomes of frailty (disability, falls, indicators of health care utilization). Disability was measured using the Groningen Activity Restriction Scale. Participants also answered questions regarding falls and health care utilization.
The construct validity of this tool was good and showed significant correlations with the TFI. The correlation between SUNFRAIL total and TFI total was 0.624. The criterion validity of the SUNFRAIL tool was good for chronic diseases and good-to-excellent for adverse outcomes disability, receiving nursing care, and falls. The area under the curve for these outcomes was 0.840 (95% CI 0.781–0.899), 0.782 (95% CI 0.696–0.868), and 0.769 (95% CI 0.686–0.859), respectively.
The results of our study suggest that the SUNFRAIL tool is a valid instrument for assessing frailty in community-dwelling older people. It is an attractive instrument for use in practice because it takes little time for health care professionals and older people to complete the questionnaire, and it expresses the integral functioning of human beings.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Gobbens RJ, Luijkx KG, Wijnen-Sponselee MT, Schols JM. Toward a conceptual definition of frail community dwelling older people. Nurs Outlook. 2010;58(2):76–86.
Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.
Gobbens RJ, van Assen MA, Luijkx KG, Schols JM. The predictive validity of the Tilburg Frailty Indicator: disability, health care utilization, and quality of life in a population at risk. Gerontologist. 2012;52(5):619–31.
Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95.
Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. The journal of nutrition, health & aging. 2012;16(7):601–8.
Gobbens RJ, van Assen MA, Luijkx KG, Wijnen-Sponselee MT, Schols JM. The Tilburg Frailty Indicator: psychometric properties. J Am Med Dir Assoc. 2010;11(5):344–55.
Sutorius FL, Hoogendijk EO, Prins BA, van Hout HP. Comparison of 10 single and stepped methods to identify frail older persons in primary care: diagnostic and prognostic accuracy. BMC family practice. 2016;17:102.
Maggio M, Longobucco Y, Barbieri L, et al. A novel tool for the early identification of frailty in elderly people: the application in primary care settings J Frailty Aging, 2019 in press
Renne I, Gobbens RJJ. Effects of frailty and chronic diseases on quality of life in Dutch community-dwelling older adults: A cross-sectional study. Clin Interv Aging. 2018; accepted for publication.
Sutton JL, Gould RL, Daley S, et al. Psychometric properties of multicomponent tools designed to assess frailty in older adults: A systematic review. BMC Geriatr. 2016;16(1):55.
Kempen GI, Miedema I, Ormel J, Molenaar W. The assessment of disability with the Groningen Activity Restriction Scale. Conceptual framework and psychometric properties. Soc Sci Med. 1996;43(11):1601–10.
Ormel J, Rijsdijk FV, Sullivan M, van Sonderen E, Kempen GI. Temporal and reciprocal relationship between IADL/ADL disability and depressive symptoms in late life. J Gerontol B Psychol Sci Soc Sci. 2002;57(4):P338–47.
Cohen J. Statistical Power Analysis for the Behavioral Sciences (2nd edition ed). 1988. Lawrence Erlbaum Assoc Inc, Hillsdale.
Central Committee on Research Involving Human Subjects. http://www.ccmo.nl/en/your-research-does-it-fall-under-the-wmo. Accessed June 20, 2016.
Mitnitski AB, Mogilner AJ, Rockwood K. Accumulation of deficits as a proxy measure of aging. TheScientificWorldJournal. 2001;1:323–36.
Rolfson DB, Majumdar SR, Tsuyuki RT, Tahir A, Rockwood K. Validity and reliability of the Edmonton Frail Scale. Age Ageing. 2006;35(5):526–9.
van Kempen JA, Schers HJ, Melis RJ, Olde Rikkert MG. Construct validity and reliability of a two-step tool for the identification of frail older people in primary care. J Clin Epidemiol. 2014;67(2):176–83.
Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142–8.
Radloff LS. The CES-D Scale: a Self-Report Depression Scale for Research in the General Population. Appl Psychol Measure. 1977;1(3):385–401.
Morley JE, Haren MT, Rolland Y, Kim MJ. Frailty. Med Clin North Am. 2006;90(5):837–47.
Boeckxstaens P, Vaes B, Legrand D, Dalleur O, De Sutter A, Degryse JM. The relationship of multimorbidity with disability and frailty in the oldest patients: a cross-sectional analysis of three measures of multimorbidity in the BELFRAIL cohort. Eur J Gen Pract. 2015;21(1):39–44.
den Ouden ME, Schuurmans MJ, Mueller-Schotte S, Brand JS, van der Schouw YT. Domains contributing to disability in activities of daily living. J Am Med Dir Assoc. 2013;14(1):18–24.
Walter LC, Brand RJ, Counsell SR, et al. Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. JAMA. 2001;285(23):2987–94.
Rochat S, Cumming RG, Blyth F, et al. Frailty and use of health and community services by community-dwelling older men: the Concord Health and Ageing in Men Project. Age Ageing. 2010;39(2):228–33.
Kojima G, Iliffe S, Jivraj S, Walters K. Association between frailty and quality of life among community-dwelling older people: a systematic review and meta-analysis. J Epidemiol Community Health. 2016;70(7):716–21.
Schuurmans H, Steverink N, Lindenberg S, Frieswijk N, Slaets JP. Old or frail: What tells us more? J Gerontol A Biol Sci Med Sci. 2004;59(9):M962–5.
Metzelthin SF, Daniels R, van Rossum E, de Witte L, van den Heuvel WJ, Kempen GI. The psychometric properties of three self-report screening instruments for identifying frail older people in the community. BMC Public Health. 2010;10:176.
Authors would like to thank Inge Renne for her support of the data collection.
Conflict of interest: None declared
Electronic supplementary material
About this article
Cite this article
Gobbens, R.J.J., Maggio, M., Longobucco, Y. et al. The Validity of the Sunfrail Tool: A Cross-Sectional Study Among Dutch Community-Dwelling Older People. J Frailty Aging 9, 219–225 (2020). https://doi.org/10.14283/jfa.2020.4
- SUNFRAIL tool
- health care utilization