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Cited by 1,643Frailty in Older AdultsPharmaceutical Practices and Patient OutcomesChronic Disease Management Strategies

The DOI matches its Crossref record; 25 of the 27 references it cites were found in a registry or an index; none of the 13 sources its claims cite is checked for support yet.

Validity and reliability of the Edmonton Frail Scale

Open access
Rolfson, Darryl B, Majumdar, Sumit R, Tsuyuki, Ross T, Tahir, Adeel, Rockwood, Kenneth·2006·Age and Ageing
DOI 10.1093/ageing/afl041PMC PMC5955195
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Abstract

SIR—Age is broadly recognised to confer a risk for adverse health outcomes, but it is an insensitive and non-specific measure for use in individual decision-making. Frailty has been emerging to take its rightful place as a better measure for over a decade [1]. Despite general consensus that the concept of frailty is clinically useful, the lack of agreement on its definition and the challenge of its measurement by front-line health providers mean that frailty remains only ‘heir apparent’ to chronological age as a criterion to select older persons at risk [2]. Frailty is multidimensional, heterogeneous and unstable, thus distinguishing it from disability or ageing alone [3]. Rather, it is widely conceived of as a state of vulnerability. Frailty is measured in many ways, including ‘rules based’ instruments, summative impairment lists and algorithms derived from clinical judgement [4-6]. However much these tools might have advanced research in frailty, most are impractical for bedside screening by front-line providers because they require the multidimensional clinical data that constitute a comprehensive geriatric assessment (CGA) and/or require special training. Often, neither is available to the primary care providers who care for these patients. Furthermore, previously validated frailty assessments are time-consuming, making them impractical in more volume-driven settings, such as a primary care physician’s office. We therefore developed and tested a brief and user-friendly screening interview for frailty in seniors commonly encountered by geriatricians in both the inpatient and outpatient settings. Our objective was to assess the validity and reliability of the Edmonton Frail Scale (EFS) in a sample referred for CGA (Table 1). All patients aged 65+ years were approached for informed consent; exclusions were only for communication barriers (deafness, blindness or the need for translation), problems with manual dexterity or previous enrolment in our study. Patients were a referral population for CGA seen during July 2000 in acute care wards, rehabilitation units, day hospitals and outpatient clinics in Edmonton, Alberta, a major Canadian metropolitan centre (population one million). The Edmonton Frail Scale A lay research assistant who had no formal medical training collected demographic and medical data and then administered the EFS [7]. The EFS samples 10 domains; the maximum score is 17 and represents the highest level of frailty. Two domains are tested using performance-based items: the Clock test [8] for cognitive impairment and the ‘Timed Get Up and Go’ [9] for balance and mobility. The other domains are mood, functional independence, medication use, social support, nutrition, health attitudes, continence, burden of medical illness and quality of life (all standard historical items in geriatric assessment). All patients had a minimum of 1 h specialist CGA, which included a personal and informant history, a physical examination, a functional performance assessment, a mental status examination and a formulation. The CGA was completed independent of and blinded to the EFS scoring. Following each CGA, the specialist completed a questionnaire (developed by the study investigators, with its content validity tested by a panel of geriatricians) summarised as a Geriatrician’s Clinical Impression of Frailty (GCIF) [10]. The GCIF (Appendix: available online at http://ageing.oxfordjournals.org) included nine items for pre-morbid geriatric syndromes that threaten future independence and six items about acute atypical disease presentations. Finally, using each of the four different definitions of frailty, subjects were rated on a scale from 0 (not frail) to 5 (maximal frailty). These included definitions based on physical frailty (e.g. muscle wasting and weakness), physiological frailty (organ system-based vulnerability), frailty as disability (impairment in functional independence) and dynamic frailty (functional instability inclusive of social reserve). The GCIF thus has a score ranging from 0 (none) to 35 (maximal) frailty, which was correlated with the EFS score. In a randomly selected subset, the EFS was re-administered within 24 h by a geriatric assessment nurse blinded to the first score and to the CGA. For additional convergent construct validity, other subsets of participants were similarly requested to complete the Mini-Mental State Examination (MMSE) [11] and the Barthel Index [12]. To estimate the sample size for construct validity using a Pearson correlation, we reckoned a modest correlation of 0.30 and an expected correlation of 0.70, with α = 0.05 and β = 0.90 showing a need for 60 subjects [13]. This was doubled to allow for multiple testing. To test inter-rater reliability of the EFS using the kappa coefficient (κ) and assuming that excellent agreement was indicated by a value of ≥0.80, we calculated a requirement of 23 subjects [12]. The EFS score was also correlated with age, gender, number of medi

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

The Edmonton Frail Scale (EFS) was tested in 158 older adults referred for comprehensive geriatric assessment and showed validity against geriatricians’ clinical impression, good inter-rater reliability, and acceptable internal consistency. It was brief, usable by non-specialists, and correlated with age, medication count, and functional dependence, though the authors call for cross-validation in other settings.

Key findings

  • EFS scores were normally distributed (mean 7.6, SD 3.0, range 0–16) and correlated significantly with the Geriatrician’s Clinical Impression of Frailty (r = 0.64, P < 0.001), age (r = 0.27, P = 0.015), and medication count (r = 0.34, P < 0.001), but not sex (r = 0.05, P = 0.647).
  • Inpatients scored higher than outpatients (9.9 ± 2.5 vs 6.2 ± 2.5; t = −8.9, P < 0.001), and those living with assistance scored higher than those living independently (8.1 SD 2.8 vs 7.0 SD 2.8; t = −2.29, P = 0.02).
  • Construct validity: EFS correlated significantly with the Barthel Index (r = −0.58, P = 0.006, n = 21) but not with the MMSE (r = −0.05, P = 0.801, n = 30).
  • Reliability: inter-rater reliability was k = 0.77 (P = 0.0001, n = 18); internal consistency was Cronbach’s alpha = 0.62; administration took <5 min and was acceptable to operators and participants.

Methods

  • Referral sample for comprehensive geriatric assessment (CGA): patients aged 65+ seen in July 2000 in acute care wards, rehabilitation units, day hospitals, and outpatient clinics in Edmonton, Alberta; exclusions were communication barriers, manual dexterity problems, or previous enrolment. Of 364 eligible, 163 were excluded, 34 declined, leaving 158 participants (43% of eligible); mean age 80.4 years (SD 6.8), 53% women, 59% unmarried, mean medications 5.4 (SD 3.3).
  • A lay research assistant administered the EFS, which samples 10 domains with a maximum score of 17. All patients had ≥1 h specialist CGA blinded to EFS scoring; the specialist completed a Geriatrician’s Clinical Impression of Frailty (GCIF) scored 0–35, correlated with EFS. Random subsets had EFS re-administered within 24 h by a blinded geriatric assessment nurse, or completed MMSE and Barthel Index.
  • Analyses included Pearson correlations, t-tests by residence and consultation site, kappa for inter-rater reliability, and Cronbach’s alpha for internal reliability; sample size calculations targeted 60 subjects for construct validity and 23 for inter-rater reliability.

Limitations

  • The authors state the GCIF is no “gold standard,” although it reflects blinded specialist judgement after CGA; they also caution that the sample was a select referral population, so findings may not generalise to an unscreened community population or to a narrower research population.
  • The authors state that further studies are needed to test responsiveness of the EFS and to cross-validate it in other settings.
  • Evident from the text: no systematic information was available on non-responders, and only 43% of eligible individuals participated; the inter-rater reliability sample was n = 18, below the 23 subjects calculated as required.

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Integrity signals

Registry

Crossref · 10.1093/ageing/afl041

Cites

25 of 25 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 13 cited sources checked · 0 supported · 0 flagged

Show all 13 claims

  • Probably not a substantial claim. 16
  • The quote only partly states this claim. 4
  • It may state two separate claims as one. 10
27 of 27

  • The paper relies on this without support.

    The need for a brief tool that can be used by nonspecialist geriatrician remains.

    “What is known: Frailty is broadly used and measurable, but the need for a brief tool that can be used by nonspecialist geriatrician remains.”

  • The paper relies on this without support.

    The GCIF has good face validity.

    “Although the GCIF has a good face validity”

  • The paper relies on this without support.

    The GCIF includes most current concepts of frailty.

    “includes most current concepts of frailty (physical, physiological, functional and dynamic)”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • July recruitment window conflicts with eight-week enrolment

    Minor

    The methods describe patients seen during July 2000, whereas the results describe an eight-week enrolment period. Eight weeks cannot fit within July alone.

  • Domain count conflicts with the domains listed

    Minor

    The text says the EFS samples 10 domains, but then describes two performance-based domains and lists nine other domains, for a total of 11.

2 of 2

Citations

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2 of the 27 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Kaethler Y , Molnar F, Mitchell S, Soucie P, Man-Son-Hing M. Defining the concept of frailty: a survey of multi-disciplinary health professionals. Geriatrics Today2003; 6: 26–31.

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Metadata

Authors
Rolfson, D. B., Majumdar, S. R., Tsuyuki, R. T., Tahir, A., & Rockwood, K.
Affiliations
  • University of Alberta (CA)
  • 48 Patterson Drive SW, Calgary, Alberta, Canada T3H 2B7
  • Dalhousie University (CA)
Corresponding author
Rolfson, Darryl B
ORCID
Venue
Age and Ageing
Publisher
Oxford University Press (OUP)
Published
2006-06-06
Volume
35
Issue
5
Pages
526-529
ISSN
  • 0002-0729 (ISSN-L)
  • 1468-2834
DOI
10.1093/ageing/afl041
PMC
PMC5955195
OpenAlex
W2103940618
Cited by
1,643
References
27
Citations by year
2026: 141 · 2025: 171 · 2024: 167 · 2023: 154 · 2022: 138 · 2021: 155 · 2020: 157 · 2019: 111 · 2018: 90 · 2017: 76 · 2016: 62 · 2015: 48 · 2014: 33 · 2013: 31 · 2012: 34
FWCI
3.86
Type
journal article
Language
en
Open access
Licence
Locations
  • Age and Ageing (publishedVersion, cc-by-nc-nd)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
  • University of Alberta
  • Fondation pour la Recherche Médicale
  • Dalhousie University
  • Alberta Heritage Foundation for Medical Research
  • Canadian Institutes of Health Research
Topics
  • Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
Keywords
Edmonton Frail Scale, frailty assessment, frailty screening, comprehensive geriatric assessment, scale validity, test-retest reliability, inter-rater reliability, older adults, primary care
MeSH terms
Activities of Daily Living, Affect, Aged, Aged, 80 and over, Cognition, Postural Balance, Female, Humans, Male, Quality of Life, Geriatric Assessment, Nutrition Assessment, Frail Elderly

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