Cross-cultural adaptation and validation of the Arabic version of the Edmonton Frail Scale among Saudi community-dwelling older adults: A cross-sectional study

Frailty is a clinical condition characterized by increasing vulnerability in older adults, resulting from declines in various physiological systems. The Edmonton Frail Scale (EFS) is a multidimensional tool for assessing frailty aspects including general health, functional independence, social support, medication usage, nutrition, mood, continence, cognition, balance, and mobility. Since the EFS has not been translated and validated among Arabic-speaking populations, the aim of this study was to translate, validate, and culturally adapt the EFS into Arabic for the Saudi geriatric population while examining its reliability and validity among community-dwelling older adults. A cross-sectional study was conducted between February and May 2024 in the Riyadh region of Saudi Arabia among community-dwelling older adults. One hundred eighty-two participants (100 male and 82 female) aged 60 and above from the King Salman Social Center were included. The EFS was translated from English into Arabic following standardized guidelines. Internal consistency using Cronbach alpha was assessed among the full sample (n = 182), while test-retest reliability using the intraclass correlation coefficient was assessed with 20 participants over a 1-week interval. Concurrent validity of the Arabic EFS (A-EFS) using Spearman rank correlation coefficient was tested against other related measures in all participants, including the Arabic (Saudi) version of the Tilburg Frailty Indicator, Arabic version of the Montreal Cognitive Assessment, Arabic version of Activities of Daily Living, and grip strength using a digital dynamometer, to identify correlations. In a sample of 182 community-dwelling older adults (mean age 65.6 ± 5.2 years; 100 males and 82 females), the A-EFS demonstrated good reliability and validity. Internal consistency was acceptable (Cronbach alpha = 0.61), with item correlations ranging from 0.54 to 0.65. For test-retest reliability, the intraclass correlation coefficient was 0.89 (95% confidence interval = 0.79-0.94). Moderate correlations were observed with grip strength (r = -0.508, P < .01) and Tilburg Frailty Indicator (R = 0.503, P < .01), and a weak correlation with Activities of Daily Living and Montreal Cognitive Assessment (r = -0.330, -0.346; P < .01) respectively. The A-EFS is a reliable, valid, and culturally sensitive tool for assessing frailty among Saudi older adults in both research and clinical contexts, with the potential to support informed clinical decision-making in routine practice. Future studies should focus on establishing the validity and reliability of the A-EFS across diverse settings.