A newly developed 29-item Multidimensional Frailty Scale (MFS) demonstrated robust psychometric properties across five frailty domains — physical, cognitive, affective, social, and environmental — in a cross-sectional study of 283 older adults. Confirmatory factor analysis supported a five-factor second-order hierarchical model with excellent fit. Internal consistency was high across all dimensions, and convergent validity was confirmed through moderate-to-strong correlations with the Tilburg Frailty Indicator (TFI). Expected associations with age, loneliness, life satisfaction, and daily living independence further supported construct validity.
Most clinical frailty tools — including the widely used Fried Phenotype and Rockwood Cumulative Deficit Model — heavily emphasize physical decline while underweighting psychological and social vulnerabilities. The MFS addresses a genuine gap: loneliness, cognitive vulnerability, and environmental barriers are increasingly recognized as independent predictors of adverse aging outcomes, yet few validated instruments integrate all five dimensions simultaneously. The hierarchical structure enabling both global scoring and domain-specific profiling is particularly valuable for tailoring interventions — a frail person whose primary deficit is social isolation needs a fundamentally different intervention than one facing physical or cognitive decline.
Limitations are substantial, however. The sample of 283 is modest for scale validation, the cross-sectional design precludes causal inference, and test-retest reliability and longitudinal predictive validity remain undemonstrated. Crucially, this is a preprint posted on medRxiv and has not yet undergone peer review — findings and psychometric claims should be considered preliminary. If externally validated in diverse populations, the MFS could meaningfully advance precision frailty assessment in clinical and research settings.
