Conclusions The TFI has the most robust evidence of reliability and validity and has been the most extensively examined in terms of psychometric properties .
However , there is insufficient evidence at present to determine the best tool for use in research and clinical practice .
Background Frailty is widely recognised as a distinct multifactorial clinical syndrome that implies vulnerability .
The links between frailty and adverse outcomes such as death and institutionalisation have been widely evidence d. There is currently no gold st and ard frailty assessment tool ; optimizing the assessment of frailty in older people therefore remains a research priority .
The objective of this systematic review is to identify existing multi-component frailty assessment tools that were specifically developed to assess frailty in adults aged ≥60 years old and to systematic ally and critically evaluate the reliability and validity of these tools .
Development of a frailty index for patients with coronary artery disease.
OBJECTIVES To construct a brief frailty index for older patients with coronary artery disease ( CAD ) undergoing coronary angiography  that includes physical , cognitive , and psychosocial criteria and accurately predicts future disability and decline in health-related quality of life ( HRQL ) . DESIGN Prospect i ve cohort . SETTING An urban tertiary care hospital in Alberta , Canada . PARTICIPANTS Three hundred seventy-four patients aged 60 and older ( 73 % male ) undergoing cardiac catheterization for CAD between October 2003 and May 2007 . MEASUREMENTS Potential frailty criteria examined at baseline ( before the procedure ) included measures of  balance , gait speed , cognition , self-reported health , body mass index ( BMI ) , depressive symptoms , and living alone . The outcomes assessed over 1 year were dependency in activities of daily living ( ADLs ) and HRQL . RESULTS The five best-fitting criteria from regression analyses for ADL decline were poor balance ( risk ratio (RR)=2.4 , 95 % confidence interval (CI)=1.4–4.0 ) , abnormal BMI ( RR=1.8 , 95 % CI=1.1–3.0 ) , impaired Trail-Making Test Part B performance ( RR=2.3 , 95 % CI=1.3–4.2 ) , depressive symptoms ( RR=1.8 , 95 % CI=1.1–3.1 ) , and living alone ( RR=2.2 , 95 % CI=1.3–3.8 ) . Using the five criteria as separate variables or as a summary frailty index yielded identical areas under the receiver operating characteristic curve ( 0.76 , 95 % CI=0.66–0.84 ) . Patients with three or more criteria ( vs none ) were at statistically significant greater risk for increased disability ( RR=10.4 , 95 % CI=4.4–24.2 ) and decreased HRQL ( RR=4.2 , 95 % CI=2.3–7.4 ) after 1 year . CONCLUSION This brief frailty index including physical , cognitive , and psychosocial criteria was predictive of increased disability and decreased HRQL at 1 year in older patients with CAD undergoing angiography . This index may have applications for clinicians and research ers but requires further validation
Conclusions The TFI has the most robust evidence of reliability and validity and has been the most extensively examined in terms of psychometric properties .
However , there is insufficient evidence at present to determine the best tool for use in research and clinical practice .
Background Frailty is widely recognised as a distinct multifactorial clinical syndrome that implies vulnerability .
The links between frailty and adverse outcomes such as death and institutionalisation have been widely evidence d. There is currently no gold st and ard frailty assessment tool ; optimizing the assessment of frailty in older people therefore remains a research priority .
The objective of this systematic review is to identify existing multi-component frailty assessment tools that were specifically developed to assess frailty in adults aged ≥60 years old and to systematic ally and critically evaluate the reliability and validity of these tools .