Psychometric analysis of the Arabic (Saudi) Tilburg Frailty Indicator among Saudi community-dwelling older adults

Background: Frailty is a common geriatric syndrome that can be screened using validated questionnaires. A commonly used assessment is the Tilburg Frailty Indicator (TFI), containing fifteen self-reported questions about components of frailty, with scores ranging from zero to fifteen (higher scores representing increased frailty and a cutoff score of greater than five used to diagnose frailty). Despite its widespread use, the TFI is not commonly used in Arabic-speaking countries, and there is an overall lack of Arabic-translated questionnaires to adequately detect and measure frailty for older adults in Saudi Arabia. Objectives: To translate and cross-culturally adapt the Tilburg Frailty Indicator (TFI) specifically for use with the Saudi population, and to examine reliability and construct validity among adults in senior-living facilities in Saudi Arabia. Methods: A total of 84 community-dwelling older adults were enrolled (mean age = 72 +/- 4.7 years). The translation and cross-cultural adaptation of the TFI from English to Arabic was performed using standardized guidelines. Test-retest reliability and internal consistency were examined in two visits, spaced one-week apart. Construct validity of the TFI against other measurements related to frailty was examined. The physical domain for TFI was validated against the Short Physical Performance Battery (SPPB), the timed Up and Go Test (TUG), and gait speed (as part of the SPPB). The psychological domains were validated against the Patient Health Questionnaire, and the social domains were validated against the social domain scores from the WHOQOL-BREF. Results: The internal consistency of the TFI with the overall KR-20 was 0.70. For the domain scores KR-20 was 0.68 for the physical, 0.57 for the psychological, and 0.42 for the social. The KR-20 after deletion of each item correlations ranged from 0.66 to 0.72. For the test-retest reliability with one-week interval, the ICC was 0.86 (95 % CI = 0.67-0.94). The Arabic TFI showed statistically significant association with other measurements related to frailty. Conclusion: This study found that the translated Arabic (Saudi) TFI is a valid and reliable instrument in assessing the frailty among Saudi community-dwelling older adults. Our results suggest that the use of this Arabic-translated TFI for clinical screening of frailty in any primary health setting may aid continued understanding for the validity of this instrument and help provide a quantitative diagnostic tool for the prevention and treatment of frailty.