| Objective:To cross-culturally adapt and validate the Comprehensive Frailty Assessment Instrument(CFAI)among Chinese community-dwelling older adults.To explore the association between frailty and medication adherence among community-dwelling older patients with chronic diseases,and to investigate the mediate effects of medication beliefs(concerns and necessity)between frailty and medication adherence.Methods:A total of 1235 community-dwelling older adults,including 780 older patients with chronic diseases,were recruited from Jinan City,China.The Chinese CFAI was developed through forward-backward translations.The validity(construct validity and criterion validity)and the reliability(internal consistency and test-retest reliability)were examined in a sample of 1235 older adults.Among the 780 older patients,frailty,medication adherence and medication beliefs were assessed using the Chinese CFAI,the 8-item Morisky Medication Adherence Scale(MMAS-8),and the Beliefs about Medicines Questionnaire-Specific(BMQ-Specific),respectively.The multivariate liner regression was used to test the relationship between frailty,medication beliefs and medication adherence.The bias-corrected non-pararametric percentile Bootstrap method was used to examine the mediate effects of medication beliefs between frailty and medication adherence.Data were analyzed using SPSS 22.0,AMOS 17.0 and STATA 12.0.Results:1.The Chinese CFAI achieved semantic and idiomatic equivalence,and showed acceptable reliability and an expected factor structure except the social support domain.The exploratory factor analysis extracted five factors explaining 53.8%of the total variance of frailty.The confirmatory factor analysis showed that the data well fit to the second-order factor theoretical model,with a RMSEA of 0.05,TLI of 0.93 and CFI of 0.95.Using the Rockwood Frailty Index as an external criterion,the optimal frailty cut-point of the Chinese CFAI was 39,with balanced sensitivity(65.31%)and specificity(81.19%).The composite reliability was 0.70 for the total scale.The Cronbach’s alpha coefficients of the Chinese CFAI were 0.77 for the physical,0.83 for the mood,0.60 for the emotion,0.86 for the social loneliness,and 0.81 for the environmental domain,respectively.The test-retest reliability(ICC)within the 7-15-day interval was 0.90 for the total scale,0.91 for the physical,0.88 for the mood,0.79 for the emotion,0.71 for the social loneliness,and 0.82 for the environment domain,respectively.2.The prevalence of frailty and low medication adherence among the 780 older patients were 32.1%and 32.3%,respectively.Compared with non-frail older patients,frail subjects had a higher proportion of low medication adherence(42.0%vs.27.7%,P<0.001).Frail older patients had higher scores of both medication concerns and medication necessity than their counterparts.3.Multivariate regression models demonstrated that frail older patients had higher medication concerns(β=1.867,P<0.001)and higher medication necessity(β=0.426,P=0.049)and lower medication adherence(β=-0.524,P<0.001)after adjusting socio-demographic characteristics,cognitive function,comorbidity and the number of medicine.With further adjustment for the medication concerns and medication necessity,frailty was not statistically associated with medication adherence(β=-0.235,P=0.097),but medication adherence was negatively associated with medication concerns and positively with medication necessity.4.Bootstrap test showed that the relationship between frailty and medication adherence was totally mediated by medication concerns and necessity beliefs.And the mediate effect of medication concerns overweighed that of medication necessity.Conclusions:1.The Chinese CFAI has satisfied validity and reliability as a practical frailty measure in Chinese community-dwelling older adults.2.Frail older patients have low medication adherence.Higher medication concerns among the frail inhibits their medication adherence,which cannot be offset by the positive effect of their higher medication necessity.Therefore,interventions should target medication beliefs among frail patients,particularly concerns about medications,to most efficiently improve their medication adherence. |
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