Turkish Adaptation, Validity and Reliability of the Pictorial Fit-Frail Scale

This study aimed to translate, culturally adapt, and evaluate the psychometric properties, including feasibility, reliability, and validity, of the Pictorial Fit-Frail Scale (PFFS) in Turkish older adults (PFFS-TR).

A multicenter methodological study was conducted with 202 older adults recruited from geriatrics outpatient clinics. The PFFS was translated and adapted using a six-step protocol. Psychometric analyses included Confirmatory Factor Analysis (CFA) for construct validity, Kendall's tau-b correlation with the Clinical Frailty Scale (CFS) for convergent validity, and Intraclass Correlation Coefficients (ICC) for test-retest and inter-rater reliability.

Mean age was 72.99 ± 6.36 years; 67.8% were female. The PFFS-TR demonstrated good internal consistency (α = 0.881) and excellent reliability, with ICCs of 0.97 for test-retest and 0.98 for inter-rater agreement. Convergent validity with the CFS was strong, showing a significant positive correlation (Kendall's tau-b = 0.629, p < 0.001). The scale also showed strong discriminative ability for CFS-defined frailty (AUC = 0.877). The CFA results indicated that the unidimensional model provided partial support for the scale's structure. While the CFI and TLI values were within acceptable ranges (Comparative Fit Index = 0.91, Tucker-Lewis Index = 0.90), the RMSEA was 0.12, reflecting a significant indicator of discordance that suggests the model shows limited fit. Higher PFFS-TR scores were significantly associated with older age, multimorbidity, hospitalization in past 6 months, using assistive devices, and falls.

The PFFS-TR is highly suitable for routine use in various clinical and community settings where screening is required, due to its low literacy requirements, strong visual support, and quick administration. It is a psychometrically practical, reliable, and valid screening-first tool for identifying frailty in older adults in Türkiye, particularly prior to more advanced clinical assessment.