Measurement Properties of Chinese-Language Frailty Assessment Instruments for Older Adults: A Systematic Review Following COSMIN Guidelines

This study aims to conduct a systematic quality assessment of frailty assessment tools for elderly Chinese speakers in order to screen and recommend high-quality assessment tools and provide theoretical support for healthcare professionals. We searched multiple databases, including PubMed, Embase, Web of Science, CINAHL, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal(VIP), and WanFang Data, for contents related to the psychometric properties, scale localization, and cross-cultural studies of Chinese frailty assessment instruments for the elderly. The search period was from the establishment of the databases to April 1, 2025. Two researchers independently screened the literature and extracted data. The risk of bias for the instruments was assessed using the bias risk assessment form of Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN). The measurement properties were evaluated using the assessment form of COSMIN, and the modified Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system were used to determine the recommendation level. A total of 35 studies involving 25 Chinese frailty assessment scales were included, none of which reported cross-cultural validity or responsiveness. Based on evidence of low quality or above, the C-RGA and GFI-C frailty assessment scales for hospitalized elderly patients were deemed to possess "adequate" content validity and internal consistency. These 3 assessment tools were recommended as Grade A, with 12 others classified as Grade B, 7 as Grade C, and 3 as Grade D. There are various Chinese frailty assessment instruments for the elderly, but their quality varies greatly. The Frailty Assessment Scale for Elderly Hospitalized Patients, C-RGA, and GFI-C are suitable for the assessment needs of most elderly populations are provisionally recommended for use in clinical and institutional settings pending further validation. Therefore, none of the tools can yet be considered fully validated for broad clinical or research use without further rigorous psychometric evaluation.<b>Trial registration:</b> PROSPERO registration number withheld for anonymous review.