Instruments to assess frailty in community dwelling older adults: A systematic review

Frailty has been investigated for decades with a proliferation of frailty instruments attributed to many existing conceptual models and operational criteria. The purpose of this systematic review was to understand how instruments were developed to assess frailty in community dwelling older adults. This review followed standard conduct, reporting, and quality assessment guidelines. Articles published in English that described instruments used to measure frailty in community dwelling older adults 65 years of age or older; and instruments developed for research purposes or in clinical practice were included. MEDLINE, CINAHL, and EMBASE (March 2022) and Abstracts in Social Gerontology (March 2020) were searched. A total of 32 frailty instruments were identified with self-reported, performance-based, or researcher/clinician observed items. Common characteristics across instruments were categorized as follows: frailty conceptualized as a state or a syndrome; frailty operationalized as continuous, categorical, or dichotomous; and instruments developed for clinical, research or both purposes. All items in the instruments were developed based on theories of frailty; some were informed by panels of experts; and others used statistical methods to compare variables across instruments. Results from this review will assist clinicians/researchers select appropriate instruments to assess frailty in older adults living in the community. It is time to pause on the development of more instruments. Instead, efforts must be directed toward advancing research and clinical practice using existing validated instruments to inform clinical decision-making and health care coordination to avoid, delay, or manage frailty in the community. More research and clinical practice using existing validated frailty instruments to assess frailty in older adults living in the community is a must!