Development and content validity of the evaluation of multidimensional functioning and risks in aging scale

Rising life expectancy has led to an increased prevalence of age-related conditions such as pain, dementia, and falls. To address these challenges, healthcare systems require efficient tools to identify which health domains are preserved or impaired in older adults. Existing frailty instruments present both conceptual and operational limitations. Therefore, there is a need to shift toward domain-specific evaluations of functioning and potential risks, aligned with established protocols such as the Comprehensive Geriatric Assessment and framed within the International Classification of Functioning, Disability and Health (ICF). This study aimed to develop the Evaluation of Multidimensional Functioning and Risks in Aging (EMFRA) scale, encompassing four assessment domains: physical function, cognitive function, emotional status, and social situation.

The EMFRA scale was developed by identifying potential items through a comprehensive literature review and expert input. The first preliminary version was validated by a panel of 15 experts, who assessed the scale's clarity, coherence, and relevance using a 5-point Likert scale. Cognitive interviews were then conducted with 10 clinicians and 10 older adults to evaluate the comprehensibility and practical applicability of the second preliminary version.

Following the literature review, 24 items were grouped into four domains (six items per domain), each supported by evidence linking them to health-related adverse outcomes. Expert evaluation showed substantial agreement on comprehension, coherence, and relevance (Aiken's V >0.7) for all but two items-language and fear-which were excluded. Cognitive interviews led to the exclusion of one additional item (sedentarism) and further refinement of the remaining items. These changes were incorporated into the final version of EMFRA, enhancing its usability and comprehensiveness.

EMFRA provides a multidimensional framework for assessing functioning and risks in older adults, capturing physical, cognitive, emotional, and social factors. The inclusion of end-user feedback ensured the scale's practical relevance. However, the current version of EMFRA should not yet be used in clinical practice, as further psychometric validation is required to confirm its utility.