title: Screening for frailty in older adults using a postal questionnaire: rationale, methods, and instruments validation of the INTER-FRAIL study.
abstract: OBJECTIVE
  To develop and test a postal screening questionnaire to intercept frailty in older community-dwelling individuals.
  
  
  METHODS
  A questionnaire was developed on the basis of expert consensus and preliminarily tested against the occurrence of incident disability, in secondary analyses of previous epidemiological studies. The questionnaire was then mailed and its concurrent validity, defined from the association between its individual items and summary score and the presence of the Fried frailty phenotype (FFP), was subsequently evaluated cross-sectionally with in-person examination of initial participants.
  
  
  METHODS
  Community-based.
  
  
  METHODS
  Individuals aged 70 and older living in two communities near Florence, Italy.
  
  
  METHODS
  A home comprehensive geriatric assessment including the FFP was conducted in participants who screened positive for frailty and in a limited sample of negative responders.
  
  
  RESULTS
  A 10-item questionnaire, developed based on expert consensus, was preliminarily tested on preexisting epidemiological data and showed an area under the receiver operating characteristic curve (AUC) of 0.716 versus incident disability. The questionnaire was then mailed to 15,774 subjects, whose response rate was 53.6%. Of the first 1,037 participants included in the concurrent validation study, 833 (80.3%) screened positive, and 380 (36.6%) were frail on assessment. The ability of the questionnaire summary score to predict frailty was adequate, with an AUC of 0.695, a sensitivity of 71%, and a specificity of 58%.
  
  
  CONCLUSIONS
  A simple questionnaire delivered by mail was able to identify FFP in the community. This would facilitate large-scale screening for frailty in older persons.
authors.affiliation: Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Division of Geriatric Cardiology and Medicine, Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Di Bari
authors.forename: Francesco
authors.initials: F
authors.lastname: Profili
authors.forename: Stefania
authors.initials: S
authors.lastname: Bandinelli
authors.forename: Anna
authors.initials: A
authors.lastname: Salvioni
authors.forename: Enrico
authors.initials: E
authors.lastname: Mossello
authors.forename: Carla
authors.initials: C
authors.lastname: Corridori
authors.forename: Matilde
authors.initials: M
authors.lastname: Razzanelli
authors.forename: Teresa
authors.initials: T
authors.lastname: Di Fiandra
authors.forename: Paolo
authors.initials: P
authors.lastname: Francesconi
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D011177:Postal Service; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires
keywords: frailty; postal questionnaire; screening