Measuring Frailty in Older Adults Using Multiple Surveys: Insights from the Italian Case for Health and Social Policy

Tommaso Aicardi , Bocconi University
Elisabetta Listorti, SDA Bocconi School of Management
Benedetta Pongiglione, UNIVERSITA Di PAVIA

Detection and measurement of frailty are essential for providing targeted care to older adults and informing health policy. Numerous frailty tools exist, differing in conceptual frameworks, data requirements, and application settings, resulting in substantial variation in estimated prevalence across populations. Focusing on Italy, this study adopts a policymaker’s perspective to identify practical, nationally applicable tools for frailty assessment using representative survey data. We evaluated three bio-psycho-social indicators—the Tilburg Frailty Indicator (TFI), Groningen Frailty Indicator (GFI), and Edmonton Frail Scale (EFS)—across four datasets: the international SHARE survey (benchmark) and three Italian surveys (EU-SILC, EHIS, and AVQ). The study proceeded in three steps: (1) reconstruction of each indicator within each dataset to test variable availability; (2) validation of reproducible indicators through internal consistency and criterion validity; and (3) comparison of prevalence estimates and predictive validity for health outcomes to assess their applicability. Results showed that the GFI was most replicable across surveys, while the EFS demonstrated superior predictive ability. Among datasets, EHIS emerged as the most suitable platform for frailty assessment, providing broad item coverage and strong predictive accuracy. Regional analyses revealed a clear North–South gradient, with higher frailty prevalence in Southern regions. Multivariable models confirmed that frailty adds explanatory power for outcomes such as activity limitations, beyond biological age, gender, and education. By providing a comparative framework for operationalizing frailty indicators across data sources, this study offers practical guidance for policymakers and researchers to monitor frailty in aging populations and evaluate health vulnerabilities.

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 Presented in Session 33. Aging, Frailty and the Dynamics of Later-Life Health