The Relatioship Between Frailty And Health-related Quality Of Life Among Community-dwelling Older People

ObjectiveTo translate the Tilburg Frailty Indicator(TFI)into Chinese,then assess its reliability and validity among community-dwelling older people.In addition,to explore the feasible cut-off point for frailty.Then,to analyze the exhaustive relationship between frailty and quality of life.MethodsAfter obtaining authorization of translation and use of the TFI from the original author,the Brislin's steps for translating were adopted in translation process.Then,an expert team was convened for the harmonization process to discuss discrepancies in the Chinese version until a consensus was reached and the final Chinese Tilburg Frailty Indicator version was achieved.Three districts(Lixia,Shizhong and Tianqiao districts)were selected stratified by economic status of Jinan city.A sample of 917 older adults aged 60 and older living in the community was enrolled.Instruments applied to assess the reliability and validity were as follows:general information questionnaire,Short Portable Mental Status Questionnaire(SPMSQ),ADL,IADL,Geriatric Depression scale(GDS-15),Timed Up and Go test,social support rating scale(SSRS),APGAR,Fried's phenotype.We used the SF-12 to investigate the status of quality of life(QOL)and its relationship with frailty.The reliability was tested by Cronbach's a internal consistency and Pearson correlation analysis.The Cohen's Kappa coefficients between each item of the TFI and its corresponding alternative measure were used to determine the construct validity of the TFI.The receiver operating characteristic(ROC)curve analysis was applied to assess the criterion validity with other specific frailty measures.Relationships between frailty and quality of life were examined using t-test,analysis of variance,correlation analysis and multiple linear regression analysis.Statistical analyses were carried out using SPSS version 21.0 and STATA 12.0.Results1.The Cronbach's alpha coefficient of internal consistency reliability of the Chinese version TFI was 0.71.The test-retest reliability of 103 participants was 0.88.2.All of the Kappa values between each item of the TFI and corresponding alternative measures were statistically significant(P<0.01).The AUCs of using the Fried's phenotype as criteria was 0.87.The optimal cut-off point of the TFI total scale was 4.3.The TFI total score and the frailty status were predictive of quality of life,and explained higher percentage of variances for MCS(35.8%,22.3%)than for PCS(15.0%,10.5%),respectively.4.The explained variances of physical frailty items for PCS and MCS were 25.2%,20.4%,respectively.After inclusion of items of psychological and social,it explained an outstanding increase for PCS and MCS of 1.4%and 20.8%,respectively.5.The items of physical domain of the TFI difficulty in walking,self-rated health,physical tiredness were statistically significant for quality of life physical component summary;and items of physical tiredness,weight loss,and difficulty in maintaining balance were statistically significant for quality of life mental component summary.None of items of psychological domain were statistically significant for quality of life physical component summary;for quality of life mental component summary,it turned out just the opposite results.The item of social support of social domain was statistically significant for both of physical and mental component summary,as well as the social relations for mental component summary.6.The item of mobility showed the largest prediction for quality of life physical component summary(?=-0.254,P<0.001),and the item of feeling down for quality of life mental component summary(?=-0.272,P<0.001).Conclusions1.The Chinese TFI has good validity and reliability to measure frailty of older people living in the community in China.The new cut-off point of frailty is more applicable to Chinese.2.The total score of the TFI and frailty status are powerful predictors of quality of life.3.The influential components of the TFI for predicting quality of life include difficulty in walking,poor self-rated health,physical tiredness,unexplained weight loss,difficulty in maintaining balance,and feeling down,anxious,and problems with memory,unable to cope with problems,weak social relations,and lacking of social support.