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Open Access Research article

The predictive validity of three self-report screening instruments for identifying frail older people in the community

Ramon Daniels1234*, Erik van Rossum234, Anna Beurskens24, Wim van den Heuvel45 and Luc de Witte34

Author Affiliations

1 Faculty of Health and Care, Zuyd University of Applied Sciences, PO Box 550, 6400 AN Heerlen, The Netherlands

2 Centre of Research on Autonomy and Participation, Zuyd University of Applied Sciences, PO Box 550, 6400 AN Heerlen, The Netherlands

3 Centre of Research on Technology in Care, Zuyd University of Applied Sciences, PO Box 550, 6400 AN Heerlen, The Netherlands

4 School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands

5 University Medical Centre Groningen, University of Groningen, PO Box 30, 0019700 RB Groningen, The Netherlands

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BMC Public Health 2012, 12:69  doi:10.1186/1471-2458-12-69

Published: 23 January 2012



If brief and easy to use self report screening tools are available to identify frail elderly, this may avoid costs and unnecessary assessment of healthy people. This study investigates the predictive validity of three self-report instruments for identifying community-dwelling frail elderly.


This is a prospective study with 1-year follow-up among community-dwelling elderly aged 70 or older (n = 430) to test sensitivity, specificity, and positive and negative predicted values of the Groningen Frailty Indicator, Tilburg Frailty Indicator and Sherbrooke Postal Questionnaire on development of disabilities, hospital admission and mortality. Odds ratios were calculated to compare frail versus non-frail groups for their risk for the adverse outcomes.


Adjusted odds ratios show that those identified as frail have more than twice the risk (GFI, 2.62; TFI, 2.00; SPQ, 2,49) for developing disabilities compared to the non-frail group; those identified as frail by the TFI and SPQ have more than twice the risk of being admitted to a hospital. Sensitivity and specificity for development of disabilities are 71% and 63% (GFI), 62% and 71% (TFI) and 83% and 48% (SPQ). Regarding mortality, sensitivity for all tools are about 70% and specificity between 41% and 61%. For hospital admission, SPQ scores the highest for sensitivity (76%).


All three instruments do have potential to identify older persons at risk, but their predictive power is not sufficient yet. Further research on these and other instruments is needed to improve targeting frail elderly.