Marcel A.L.M. van Assen

The Tilburg Frailty Indicator: Psychometric Properties

OBJECTIVES To assess the reliability, construct validity, and predictive (concurrent) validity of the Tilburg Frailty Indicator (TFI), a self-report questionnaire for measuring frailty in older persons. DESIGN Cross-sectional. SETTING Community-based. PARTICIPANTS Two representative samples of community-dwelling persons aged 75 years and older (n = 245; n = 234). MEASUREMENTS The TFI was validated using the LASA Physical Activity Questionnaire, BMI, Timed Up & Go test, Four test balance scale, Grip strength test, Shortened Fatigue Questionnaire, Mini-Mental State Examination, Center for Epidemiologic Studies Depression Scale, Anxiety subscale of the Hospital Anxiety and Depression Scale, Mastery Scale, Loneliness Scale, and the Social Support List. Adverse outcomes were measured using the Groningen Activity Restriction Scale and questions regarding health care use. Quality of life was measured using the WHOQOL-BREF. RESULTS The test-retest reliability of the TFI was good: 0.79 for frailty, and from 0.67 to 0.78 for its domains for a 1-year time interval. The 15 single components, and the frailty domains (physical, psychological, social) of the TFI correlated as expected with validated measures, demonstrating both convergent and divergent construct validity of the TFI. The predictive validity of the TFI and its physical domain was good for quality of life and the adverse outcomes disability and receiving personal care, nursing, and informal care. CONCLUSION This study demonstrates that the psychometric properties of the TFI are good, when performed in 2 samples of community-dwelling older people. The results regarding the TFIs validity provide strong evidence for an integral definition of frailty consisting of physical, psychological, and social domains.

Determinants of Frailty

OBJECTIVES To determine which determinants predict frailty and domains of frailty (physical, psychological, social) in a community-dwelling sample of elderly persons. DESIGN Cross-sectional. SETTING Community-based. PARTICIPANTS A representative sample of 484 community-dwelling persons aged 75 years and older. MEASUREMENTS The Tilburg Frailty Indicator (TFI), a self-report questionnaire, was used to collect information about determinants of frailty and to assess frailty and domains of frailty (physical, psychological, social). RESULTS Results were obtained by regression and mediation analyses. The 10 determinants explain about 35% of the variance of frailty. After controlling for other determinants, medium income, an unhealthy lifestyle, and multimorbidity predicted frailty. The effects of other determinants differed across domains of frailty; age predicted physical frailty, life events predicted psychological frailty, whereas being a woman predicted social frailty because older women have a higher probability of living alone. CONCLUSION Our finding that the effect of the determinants of frailty differs across frailty domains suggests that it is essential to divide the concept of frailty into domains.

The Predictive Validity of the Tilburg Frailty Indicator: Disability, Health Care Utilization, and Quality of Life in a Population at Risk

PURPOSE To assess the predictive validity of frailty and its domains (physical, psychological, and social), as measured by the Tilburg Frailty Indicator (TFI), for the adverse outcomes disability, health care utilization, and quality of life. DESIGN AND METHODS The predictive validity of the TFI was tested in a representative sample of 484 community-dwelling persons aged 75 years and older in 2008 (response rate 42%). A subset of all respondents participated 1 year later (N = 336, 69%) and again 2 years later (N = 266, 55%). We used the TFI, the Groningen Activity Restriction Scale assessing disability, seven indicators of health care utilization, and a brief version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF). The WHOQOL-BREF was assessed in 2008 and 2010; all others were assessed in 2008, 2009, and 2010. RESULTS The predictive validity of the TFI assessed in 2008 for disability, health care utilization, and quality of life was corroborated by (a) medium to very large associations of frailty with adverse outcomes 1 or 2 years later; (b) mostly good to excellent area under the curve of total frailty; and (c) an increase in predictive accuracy of most adverse outcomes, even after controlling for that same adverse outcome in 2008, and life-course determinants and multimorbidity. Physical frailty was mostly responsible for the predictive validity of the TFI. IMPLICATIONS This study showed that the TFI is a valid instrument to predict disability, many indicators of health care utilization, and quality of life of older people, 1 and 2 years later.

The prevalence of statistical reporting errors in psychology (1985-2013).

This study documents reporting errors in a sample of over 250,000 p-values reported in eight major psychology journals from 1985 until 2013, using the new R package “statcheck.” statcheck retrieved null-hypothesis significance testing (NHST) results from over half of the articles from this period. In line with earlier research, we found that half of all published psychology papers that use NHST contained at least one p-value that was inconsistent with its test statistic and degrees of freedom. One in eight papers contained a grossly inconsistent p-value that may have affected the statistical conclusion. In contrast to earlier findings, we found that the average prevalence of inconsistent p-values has been stable over the years or has declined. The prevalence of gross inconsistencies was higher in p-values reported as significant than in p-values reported as nonsignificant. This could indicate a systematic bias in favor of significant results. Possible solutions for the high prevalence of reporting inconsistencies could be to encourage sharing data, to let co-authors check results in a so-called “co-pilot model,” and to use statcheck to flag possible inconsistencies in one’s own manuscript or during the review process.

Psychological Characteristics of BDSM Practitioners

INTRODUCTION It has been generally thought that the practice of bondage-discipline, dominance-submission, sadism-masochism (BDSM) is in some form associated with psychopathology. However, several more recent studies suggest a relative good psychological health of BDSM practitioners. AIM The aim of this study was to compare scores of BDSM practitioners and a control group on various fundamental psychological characteristics. METHODS For this aim, 902 BDSM and 434 control participants completely filled out online questionnaires. Associations were examined using χ(2) tests of independence with φ and Cramers V as effect size measures and eta or Pearsons correlation. Group differences were tested using analysis of covariance, with partial η(2) as effect size measure. A priori contrasts were tested using α = 0.01 to correct for multiple testing; for all other tests we used α = 0.05, two tailed. MAIN OUTCOME MEASURES The study used Big Five personality dimensions (NEO Five-Factor Inventory), attachment styles (Attachment Styles Questionnaire), rejection sensitivity (Rejection Sensitivity Questionnaire), and subjective well-being (World Health Organization-Five Well-being Index). RESULTS The results mostly suggest favorable psychological characteristics of BDSM practitioners compared with the control group; BDSM practitioners were less neurotic, more extraverted, more open to new experiences, more conscientious, less rejection sensitive, had higher subjective well-being, yet were less agreeable. Comparing the four groups, if differences were observed, BDSM scores were generally more favorably for those with a dominant than a submissive role, with least favorable scores for controls. CONCLUSION We conclude that BDSM may be thought of as a recreational leisure, rather than the expression of psychopathological processes.

Response to Comment on "Estimating the reproducibility of psychological science"

Gilbert et al. conclude that evidence from the Open Science Collaboration’s Reproducibility Project: Psychology indicates high reproducibility, given the study methodology. Their very optimistic assessment is limited by statistical misconceptions and by causal inferences from selectively interpreted, correlational data. Using the Reproducibility Project: Psychology data, both optimistic and pessimistic conclusions about reproducibility are possible, and neither are yet warranted.

Micro-macro links and microfoundations in sociology

Using Colemans well-known scheme as an anchor, we review key features of explanations of social phenomena that employ micro-macro models. Some antecedents of micro-macro models and of Colemans scheme as well as some paradigmatic examples of micro-macro links are sketched. We then discuss micro-level assumptions in micro-macro explanations and the robustness of macro-level implications to variations in micro-level assumptions. We conclude with an overview of some recent developments in micro-macro modeling and of the contributions to the special issue.

A short form of the Autonomy Scale: properties of the Autonomy-Connectedness Scale (ACS-30).

The Autonomy Scale (Bekker, 1993) measures individual differences in gender-linked autonomy, a psychological condition resulting from the process of individuation and separation. The theoretical background of the concept is found in a combination of feminist, neoanalytical object relations theory and attachment theory. The 3 subscales are Self-Awareness, Sensitivity to Others, and Capacity for Managing New Situations. We report the development and properties of the Autonomy–Connectedness Scale (ACS–30), a shortened 30-item version of the Autonomy Scale. We present 2 studies. In the first study, we examined the structure of the scale as well as its validity and reliability. The second study was aimed at further validation by relating the ACS–30 to various indexes of psychopathology. Exploratory as well as confirmatory factor analyses provided support for a 3-factor structure that was identical to that of the original scale. The ACS–30 showed good internal consistency reliability and an expected pattern of convergent validity with personality and mental health variables. The psychometric properties of the ACS–30 suggest it can be used to assess gender-linked autonomy. It also has the advantage of being more economical and simple as compared with the original 50-item version.

Testing an integral conceptual model of frailty.

AIM This paper is a report of a study conducted to test three hypotheses derived from an integral conceptual model of frailty. BACKGROUND   The integral model of frailty describes the pathway from life-course determinants to frailty to adverse outcomes. The model assumes that life-course determinants and the three domains of frailty (physical, psychological, social) affect adverse outcomes, the effect of disease(s) on adverse outcomes is mediated by frailty, and the effect of frailty on adverse outcomes depends on the life-course determinants. METHODS In June 2008 a questionnaire was sent to a sample of community-dwelling people, aged 75 years and older (n = 213). Life-course determinants and frailty were assessed using the Tilburg frailty indicator. Adverse outcomes were measured using the Groningen activity restriction scale, the WHOQOL-BREF and questions regarding healthcare utilization. The effect of seven self-reported chronic diseases was examined. RESULTS Life-course determinants, chronic disease(s), and frailty together explain a moderate to large part of the variance of the seven continuous adverse outcomes (26-57%). All these predictors together explained a significant part of each of the five dichotomous adverse outcomes. The effect of chronic disease(s) on all 12 adverse outcomes was mediated at least partly by frailty. The effect of frailty domains on adverse outcomes did not depend on life-course determinants. CONCLUSION Our finding that the adverse outcomes are differently and uniquely affected by the three domains of frailty (physical, psychological, social), and life-course determinants and disease(s), emphasizes the importance of an integral conceptual model of frailty.

Frailty and its prediction of disability and health care utilization: The added value of interviews and physical measures following a self-report questionnaire

AIMS To establish whether the prediction of the adverse outcomes disability and six indicators of health care utilization one and two years later by the three frailty domains (physical, psychological, social) of the Tilburg Frailty Indicator (TFI) is improved by adding interview and physical measures of frailty. MATERIALS AND METHODS A representative sample of 245 Dutch community-dwelling persons aged 75 years and older (response rate 53%) participated in 2008, one year later in 2009 (n=179, 73%) and again two years later in 2010 (n=141, 58%). Frailty was assessed with the TFI, an easy to administer self-report measure. Disability was measured using the Groningen Activity Restriction Scale (GARS). Indicators of health care utilization were: visit to a general practitioner (gp), contacts with health care professionals (hcps), hospital admission, receiving personal care, receiving nursing care, and receiving informal care. RESULTS After controlling for background characteristics, the TFI predicted disability and the indicators of health care utilization. Interviews and physical measures of frailty improved the prediction of disability. The Hospital Anxiety and Depression Scale (HADS-A) improved the prediction of contacts with hcps, but the interview and physical measures of frailty did not improve the predictions of the other indicators of health care utilization. CONCLUSIONS Assessment by the self-report TFI is sufficient for predicting six indicators of health care utilization, but for predicting disability the use of both the TFI and the Timed Up & Go (TUG) test is recommended. It is advisable assessing all three frailty domains when examining frailty and its prediction of adverse outcomes.