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Table 2 The issues that a patient-oriented frailty scale might address and those that might emerge

From: A proposal for a self-rated frailty index and status for patient-oriented research

Classifications of the shortcomings

Issues that can be avoided by a patient-oriented frailty scale

Issues merging if patient-oriented frailty scales in use

Index related

1. Unclear rationales for equal weighting of domain variables that leads to unequal weighting of input variables and inclusion of duplicate information


2. Biases introduced by data processing that is not based on evidence


3. Reproducibility limited by measurement devices and data processing

1. Subjective measurement


4. Disconnection between frailty theories and produced indices because of excessive numbers of input variables and biases introduced due to data processing


5. Complex indices that can be simplified


6. Constraints on the regression coefficients of input or domain variables


7. Relatively poorer predictive power regarding mortality than input variables

2. Predictive power to be tested

Frailty theory-related

8. Arbitrary thresholds of frailty indices for the diagnosis of frailty statuses


9. Arbitrary assumptions about frailty distribution, age correlation, and input variable eligibility of input variables


10. Potential disconnection between biology of frailty and the measurement


11. Patients’ and the public’ perspectives ignored

3. Deviation from researchers’ definitions


12. Disconnection to socio-economic determinants

4. Questions on socioeconomic status may deter some to respond

Information generation

13. Old information shuffled, if frailty estimated based on available research or administrative data

5. Reliability and validity to be tested