title: Multidimensional structure of the Groningen Frailty Indicator in community-dwelling older people.
abstract: BACKGROUND
  Due to the rapidly increasing number of older people worldwide, the prevalence of frailty among older adults is expected to escalate in coming decades. It is crucial to recognize early onset symptoms to initiate specific preventive care. Therefore, early detection of frailty with appropriate screening instruments is needed. The aim of this study was to evaluate the underlying dimensionality of the Groningen Frailty Indicator (GFI), a widely used self-report screening instrument for identifying frail older adults. In addition, criterion validity of GFI subscales was examined and composition of GFI scores was evaluated.
  
  
  METHODS
  A cross-sectional study design was used to evaluate the structural validity, internal consistency and criterion validity of the GFI questionnaire in older adults aged 65 years and older. All subjects completed the GFI questionnaire (n = 1508). To assess criterion validity, a smaller sample of 119 older adults completed additional questionnaires: De Jong Gierveld Loneliness Scale, Hospital Anxiety Depression Scale, RAND-36 physical functioning, and perceived general health item of the EuroQol-5D. Exploratory factor analysis and Mokken scale analysis were used to evaluate the structural validity of the GFI. A Venn diagram was constructed to show the composition of GFI subscale scores for frail subjects.
  
  
  RESULTS
  The factor structure of the GFI supported a three-dimensional structure of the scale. The subscales Daily Activities and Psychosocial Functioning showed good internal consistency, scalability, and criterion validity (Daily Activities: Cronbach's α = 0.81, H(s) = .84, r = -.62; Psychosocial Functioning: Cronbach's α = 0.80, H(s) = .35, r = -.48). The subscale Health Problems showed less strong internal consistency but acceptable scalability and criterion validity (Cronbach's α = .57, H(s) = .35, r = -.48). The present data suggest that 90% of the frail older adults experience problems in the Psychosocial Functioning domain.
  
  
  CONCLUSIONS
  The present findings support a three-dimensional factor structure of the GFI, suggesting that a multidimensional assessment of frailty with the GFI is possible. These GFI subscale scores produce a richer assessment of frailty than with a single overall sum GFI score, and likely their use will contribute to more directed and customized care for older adults.
authors: Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences, PO Box 3109, 9701 DC, Groningen, The Netherlands. j.h.bielderman@pl.hanze.nl.
authors: Annemiek
authors: A
authors: Bielderman
authors: Cees P
authors: CP
authors: van der Schans
authors: Marie-Rose J
authors: MR
authors: van Lieshout
authors: Mathieu Hg
authors: MH
authors: de Greef
authors: Froukje
authors: F
authors: Boersma
authors: Wim P
authors: WP
authors: Krijnen
authors: Nardi
authors: N
authors: Steverink
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D016330:Frail Elderly / Q000523:psychology*; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D012111:Residence Characteristics; D011795:Surveys and Questionnaires / Q000592:standards*
references: Sports Med. 2008;38(9):781-93
references: 18712944
references: J Am Geriatr Soc. 2008 Dec;56(12):2211-16
references: 19093920
references: Qual Life Res. 2001;10(7):637-45
references: 11822796
references: J Am Geriatr Soc. 2006 Jun;54(6):991-1001
references: 16776798
references: J Clin Epidemiol. 2010 Jul;63(7):737-45
references: 20494804
references: Psychol Med. 1997 Mar;27(2):363-70
references: 9089829
references: J Clin Epidemiol. 2005 Nov;58(11):1180-7
references: 16223662
references: J Gerontol A Biol Sci Med Sci. 2004 Mar;59(3):255-63
references: 15031310
references: BMC Public Health. 2010 Mar 31;10:176
references: 20353611
references: J Am Geriatr Soc. 2001 Dec;49(12):1691-9
references: 11844005
references: Am J Med. 2007 Sep;120(9):748-53
references: 17765039
references: Health Soc Care Community. 2009 Sep;17(5):447-58
references: 19245421
references: Geriatr Gerontol Int. 2012 Apr;12(2):189-97
references: 22233158
references: J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-56
references: 11253156
references: J Am Med Dir Assoc. 2012 Jul;13(6):546-51
references: 22579590
references: Age Ageing. 1996 Nov;25(6):458-64
references: 9003883
references: J Epidemiol Community Health. 2012 Dec;66(12):1116-21
references: 22544921
references: ScientificWorldJournal. 2001 Aug 08;1:323-36
references: 12806071
references: Ann Intern Med. 2004 Sep 21;141(6):489-92
references: 15381535
references: J Gerontol B Psychol Sci Soc Sci. 2004 Sep;59(5):P250-7
references: 15358798
references: Tijdschr Gerontol Geriatr. 2008 Feb;39(1):4-15
references: 18365511
references: J Am Geriatr Soc. 2009 May;57(5):830-9
references: 19453306
references: Age Ageing. 2008 Mar;37(2):161-6
references: 18238805
references: J Am Geriatr Soc. 2009 Sep;57(9):1532-9
references: 19682112
references: Ageing Res Rev. 2011 Jan;10(1):104-14
references: 20850567
references: J Gerontol A Biol Sci Med Sci. 2004 Sep;59(9):M962-5
references: 15472162
references: J Am Geriatr Soc. 2004 Nov;52(11):1929-33
references: 15507074
references: Arch Gerontol Geriatr. 2005 Mar-Apr;40(2):147-56
references: 15680499
references: Age Ageing. 1996 Mar;25(2):159-67
references: 8670547
references: Health Policy. 1990 Dec;16(3):199-208
references: 10109801
references: J Am Med Dir Assoc. 2010 Jun;11(5):344-55
references: 20511102
references: J Am Geriatr Soc. 2004 Sep;52(9):1560-6
references: 15341562
references: J Adv Nurs. 2003 Oct;44(1):58-68
references: 12956670
references: J Aging Res. 2011 Apr 04;2011:569194
references: 21584244
references: J Gerontol A Biol Sci Med Sci. 2009 Jan;64(1):61-8
references: 19164276
references: J Am Geriatr Soc. 2005 Jan;53(1):40-7
references: 15667374
references: Age Ageing. 2006 Sep;35(5):526-9
references: 16757522