Assessment of frailty in older adults: Psychometric properties of the Multidimensional Frailty Scale (MFS)

BackgroundThere is growing consensus regarding the multidimensional nature of frailty and the need for comprehensive approaches to its assessment. However, existing assessment instruments have shown limited validity evidence or failed to adequately cover all the proposed theoretical dimensions of frailty. To address this gap, we recently developed the preliminary items of the Multidimensional Frailty Scale (MFS), a new instrument aimed to assess physical, cognitive, affective, social, and environmental frailty in older adults. This study sought to determine the final item set and to evaluate the psychometric properties of the final version. MethodsWe conducted a cross-sectional observational study with 283 individuals aged 65- 98 years. Participants completed the preliminary 51-item version of the MFS, the Tilburg Frailty Indicator (TFI), and a sociodemographic questionnaire. Item selection was guided by corrected item-dimension correlations, standardized factor loadings and content validity considerations. We examined dimensionality using confirmatory factor analysis comparing a unidimensional model and a five-factor second-order model, assessed internal consistency with Cronbachs alpha, and evaluated convergent validity through Spearman correlations between analogous dimensions of the MFS and the TFI. ResultsItem analysis yielded a final 29-item version of the MFS. The five-factor second-order model demonstrated excellent fit to the data, whereas the unidimensional model showed poor fit. Internal consistency was high for all dimensions and for the total scale. Convergent validity was supported by moderate-to-large correlations between corresponding MFS and TFI dimensions. ConclusionsThe MFS demonstrates robust psychometric properties and provides a brief yet comprehensive instrument to assess multidimensional frailty in older adults. Its hierarchical structure allows both global and domain-specific assessment, supporting more precise identification of frailty profiles. The ease of administration facilitates its use in research and clinical practice. Further validation in diverse linguistic and cultural contexts may enhance its applicability and support cross-national comparative research on multidimensional frailty.