Association of Resistance With Frailty Among Components of the FRAIL Scale in Geriatric Trauma Patients

Background  The FRAIL questionnaire is a validated screening tool for frailty in geriatric trauma patients that has been associated with functional outcomes and mortality. It includes five components: Fatigue, Resistance, Aerobic, Illness, and Loss of weight. This study aims to determine whether a single component was more strongly associated with the total frailty score than the other components in geriatric trauma patients.  Methods  A retrospective chart review was conducted on 613 geriatric trauma patients admitted between June 2023 and November 2024. Patient demographics, injury severity scores (ISS), and FRAIL questionnaire responses were obtained from electronic health records. Spearman's rank correlation coefficient (ρ) was used to assess the relationship between each FRAIL component and total FRAIL score. A bootstrap 95% confidence interval (CI) was calculated using 10,000 replicates to evaluate statistical significance.  Results All FRAIL components demonstrated positive associations with the total FRAIL score, with CIs that did not include zero. Corrected item-total correlation (CITC) analysis showed that resistance (ability to climb a flight of stairs) had the highest correlation with the remaining FRAIL components (ρ = 0.31, 95% CI: 0.24-0.39), followed by aerobic capacity (ρ = 0.27, 95% CI: 0.20-0.35), fatigue (ρ = 0.22, 95% CI: 0.15-0.30), and weight loss (ρ = 0.13, 95% CI: 0.06-0.20). Illness burden demonstrated no meaningful correlation with the other FRAIL components (ρ = 0.00, 95% CI: -0.08 to 0.08). Conclusions Resistance, specifically the ability to climb a flight of stairs, demonstrated the highest correlation with total FRAIL score among the five FRAIL components in this cohort of geriatric trauma patients. This finding suggests that resistance may reflect an important functional dimension of frailty, although further validation is needed to determine its clinical utility as a screening measure.