Identification of the Central Symptoms of Multidimensional Frailty Among Older Adults Using the Tilburg Frailty Indicator: A Network Analysis

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Abstract
Background: Symptom networks offer a new approach to explore the relationships among various symptoms and provide information for optimising precise symptom management strategies. However, no previous studies have identified the central symptoms of multidimensional frailty. Design: A cross‐sectional study was conducted from December 2023 to March 2024 in China. Settings and Participants: A total of 933 community‐dwelling older adults (aged 60 years or older) in China were recruited via convenience sampling. Methods: Sociodemographic variables, clinical variables and scores on the Tilburg Frailty Indicator were assessed in all participants. The qgraph package and IsingFit package of R software were applied to construct the symptom network. Three node centrality indices (strength, betweenness and closeness) and the expected influence were calculated to identify the central symptoms of the multidimensional frailty network. All statistical analyses were performed in R. Results: A total of 933 individuals were surveyed in this study, including 472 (50.6%) females. The median age of all participants was 71.0 years. A total of 408 subjects were assessed as multidimensional frailty. The prevalence of multidimensional frailty was 43.7%. The centrality indices revealed that ‘difficulty in walking’, ‘difficulty in maintaining balance’, and ‘feeling down’ were the symptoms with the largest strength and expected influence values. Conclusion: This study primarily utilised network analysis to construct a symptom network of multidimensional frailty among community‐dwelling older adults. The findings revealed that difficulty in walking, difficulty in maintaining balance, and feeling down were the most central symptoms. Implications: This study identified the central symptoms of multidimensional frailty in older adults, which may serve as primary intervention targets. Nursing staff could incorporate targeted physical and psychological interventions into person‐centred care plans. Reporting Methods: This study was reported in accordance with the STROBE guidelines. Patient or Public Contribution: No patient or public contribution was involved in this study.

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