Assessment of the validity and acceptability of the online FRAIL scale in identifying frailty among older people in community settings

Objectives: To assess the validity and acceptability of the online FRAIL scale in identifying frailty in community settings. Methods: Frailty was assessed using the online version of the FRAIL scale (a simple frailty questionnaire). Validity of the scale was examined in a sample of 1882 persons aged 60 years or older (inlcuding a pilot sample of 65 persons for assessing the face validity) recruited from 24 elderly centres in Hong Kong. Convergent validity was estimated using correlation coefficients between scores on the FRAIL, SARC-F (a simple questionnaire for assessing sarcopenia) and AMIC (Abbreviated Memory Inventory for the Chinese). Predictive validity was examined by logistic regression using IADL (Instrumental Activities of Daily Living) limitations and hospitalization as outcomes. Acceptability of the scale was assessed from the perspective of a sub-sample of 205 older persons and 33 centre staff. Results: Following minor revisions, all participants were able to understand and answer the online FRAIL scale. The FRAIL scale correlated with SARC-F (r = 0.627, p < 0.001) and AMIC (r = 0.302, p < 0.001). Being pre-frail and frail were associated with incident IADL limitations (OR = 1.58, 95 %CI = 1.11-2.25 and OR = 3.01, 95 %CI = 1.87-4.84, respectively) and incident hospitalization (OR = 1.38, 95 %CI = 1.03-1.85 and OR = 2.79, 95 % CI = 1.89-4.12, respectively) at year 2, after controlling for age, sex, marital status, and educational level. 77.8 % of participants agreed that the scale would enable them to understand their health status. However, only 35.0 % accepted a digital approach for conducting health assessment or accessing assessment results. 90.9 % of centre staff agreed that the scale could be used to identify their members who are potential candidates for frailty intervention. Conclusions: The online FRAIL scale is valid for use in community elderly centres in identifying frailty. Further effort is required to improve the acceptability of the online FRAIL scale among older persons.