Abstract: Disability is associated with lower quality of life and premature death in older people. Therefore, prevention and intervention targeting older people living with a disability is important. Frailty can be considered a major predictor of disability. In this study, we aimed to develop nomograms with items of the Tilburg Frailty Indicator (TFI) as predictors by using cross-sectional and longitudinal data (follow-up of five and nine years), focusing on the prediction of total disability, disability in activities of daily living (ADL), and disability in instrumental activities of daily living (IADL). At baseline, 479 Dutch community-dwelling people aged 75 years participated. They completed a questionnaire that included the TFI and the Groningen Activity Restriction Scale to assess the three disability variables. We showed that the TFI items scored different points, especially over time. Therefore, not every item was equally important in predicting disability. ‘Difficulty in walking’ and ‘unexplained weight loss’ appeared to be important predictors of disability. Healthcare professionals need to focus on these two items to prevent disability. We also conclude that the points given to frailty items differed between total, ADL, and IADL disability and also differed regarding years of follow-up. Creating one monogram that does justice to this seems impossible.
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Healthy gestational weight gain (GWG) is associated with better pregnancy outcomes and with improved health in the later lives of women and babies. In this thesis the author describes the process of developing an intervention to help pregnant women reach a healthy GWG. The need for this intervention was derived from discussions with midwives, working in primary care in the Netherlands. In this introduction, the author describes the background of the larger project “Promoting Health Pregnancy”, of which this study is a part (1.2), the problem of unhealthy GWG (1.3-1.6) and offers a brief introduction to the theoretical framework of the study and to the subsequent chapters (1.7-1.9).
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Objective: To predict mortality with the Tilburg Frailty Indicator (TFI) in a sample of community-dwelling older people, using a follow-up of 7 years. Setting and Participants: 479 Dutch community-dwelling people aged 75 years or older. Measurements: The TFI, a self-report questionnaire, was used to collect data about total, physical, psychological, and social frailty. The municipality of Roosendaal (a town in the Netherlands) provided the mortality dates. Conclusions and Implications: This study has shown the predictive validity of the TFI for mortality in community-dwelling older people. Our study demonstrated that physical and psychological frailty predicted mortality. Of the individual TFI components, difficulty in walking consistently predicted mortality. For identifying frailty, using the integral instrument is recommended because total, physical, psychological, and social frailty and its components have proven their value in predicting adverse outcomes of frailty, for example, increase in health care use and a lower quality of life.
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