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Published on: July 24, 2013
Measurement properties of the Edmonton Frail Scale in older adults: A systematic review and meta-analysis
Zi Rong Lee1, Ling Jie Cheng2, Ying Yee Yeo3
1Residential Care Division, NTUC Health Co-operative Limited, Singapore, Singapore; Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Background:
Frailty is a clinical condition characterised by heightened vulnerabilities to stressors and negative health consequences. The Edmonton Frail Scale is a prominent multidimensional tool for assessing frailty across various settings.
Objectives:
This review aimed to synthesise and evaluate the certainty of evidence and the quality of Edmonton Frail Scale in older adults aged 60 and above with respect to its reliability (test-retest, inter-rater) and construct validity (convergent, known-group).
Design:
Systematic review and meta-analysis.
Setting And Participants:
Older adults across clinical and community settings.
Methods:
A comprehensive search was conducted across eight databases from inception to 29 January 2024. An updated search in MEDLINE (PubMed) on 10 April 2025 identified no additional eligible articles. COSMIN risk-of-bias checklist was used for quality appraisal, and evidence synthesis followed COSMIN guidelines. Random-effects meta-analysis and univariate logistic regression was used to quantitatively synthesise evidence for reliability and construct validity, respectively.
Results:
Twenty studies involving 3852 older adults were included. The original Edmonton Frail Scale demonstrated sufficient construct validity across most populations, supported by high certainty of evidence. However, construct validity was inconsistent in acute care populations and in studies using modified Edmonton Frail Scale versions, where content adaptations (e.g., omission of performance-based items) may have affected psychometric performance. Meta-regression revealed that modified versions were significantly less likely to yield positive validity ratings compared to the original Edmonton Frail Scale (OR = 0.29; 95 % CI: 0.09-0.95; p = 0.042). Test-retest and inter-rater reliability were sufficient, though heterogeneity was considerable, and certainty of evidence remained moderate.
Conclusion:
The Edmonton Frail Scale shows good overall reliability and validity in assessing frailty among older adults, particularly in stable clinical or community settings. However, caution is warranted when using modified versions or applying the tool in acutely ill populations. Future studies should validate Edmonton Frail Scale adaptations and enhance the precision of reliability estimates, especially in underrepresented regions and high-risk subgroups.
Registration:
The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42024504735).
