Turkish Adaptation, Validity and Reliability of the Pictorial Fit-Frail Scale
Pınar Sırmatel Bücük1, Asli Kilavuz2, Fatma Ozge Kayhan Kocak3
1Division of Geriatrics, Department of Internal Medicine, Buca Seyfi Demirsoy Education and Research Hospital, the University of Health Sciences, Izmir, Türkiye.
Geriatrics & Gerontology International
|March 11, 2026
Summary
The Pictorial Fit-Frail Scale-Turkish version (PFFS-TR) is a reliable and valid tool for screening frailty in older adults in Türkiye. Its visual nature and ease of use make it suitable for various settings.
Area of Science:
- Gerontology
- Psychometrics
- Public Health
Background:
- Frailty is a significant geriatric syndrome associated with adverse health outcomes.
- Screening tools are essential for early identification and intervention in older adults.
- The Pictorial Fit-Frail Scale (PFFS) offers a visually supported approach to frailty assessment.
Purpose of the Study:
- To translate and culturally adapt the Pictorial Fit-Frail Scale (PFFS) for the Turkish population.
- To evaluate the psychometric properties, including feasibility, reliability, and validity, of the PFFS-TR in Turkish older adults.
- To establish PFFS-TR as a practical screening tool for frailty in Türkiye.
Main Methods:
- A multicenter methodological study involving 202 older adults.
- Translation and cultural adaptation of the PFFS using a six-step protocol.
- Psychometric evaluation including Confirmatory Factor Analysis (CFA), correlation with the Clinical Frailty Scale (CFS), and Intraclass Correlation Coefficients (ICC).
Main Results:
- The PFFS-TR demonstrated excellent internal consistency (α=0.881) and reliability (ICC=0.97 test-retest, 0.98 inter-rater).
- Strong convergent validity with CFS (Kendall's tau-b=0.629, p<0.001) and good discriminative ability (AUC=0.877).
- Higher scores associated with older age, multimorbidity, hospitalization, assistive device use, and falls; CFA indicated partial support for unidimensionality.
Conclusions:
- The PFFS-TR is a psychometrically sound, reliable, and valid screening tool for frailty in Turkish older adults.
- Its low literacy requirements, visual support, and quick administration make it suitable for clinical and community settings.
- PFFS-TR facilitates early identification of frailty, enabling timely clinical assessment and intervention.
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