*2.8.2 Physical performance test*

Originally described in 1990, the Physical Performance Test (PPT) was developed by Reuben and co-workers [228] as an assessment tool to monitor and describe the multiple domains of physical function in frail and non-frail community dwelling elderly people through several performance tasks. These tasks simulate activities of daily living using various degrees of difficulty. The two versions presented [228] encompass a nine-item scale that includes writing a sentence, simulated eating, turning 360o , putting on and removing a jacket, lifting a book and putting it on a shelf, picking up a penny from the floor, a 50 ft. (15.24 m) walk test, and climbing stairs (scored as two items), and a seven-item scale that does not include stairs. Both versions demonstrate concurrent validity where high correlation is shown in comparison with basic daily activities and Performance Oriented Mobility Assessment [228] and the 7-item version showed high correlation with lower extremity muscle force and lower extremity joint range of motion as well [229]. The majority of PPT items are scored based on the time taken to finish the task. Scores vary from 0 to 28 and from 0 to 36 for the 7-item and 9-item PPTs, respectively, with higher scores showing better performance. The PPT involves few instruments and minimal instructions and takes about 10 minutes to complete [228].

#### *2.8.3 Senior fitness test*

Rikli and Jones [106] developed the Senior Fitness Test (SFT) which may be used to assess six underlying functional fitness parameters for older adults. These parameters include lower and upper body strength, aerobic endurance, lower and upper body flexibility, and agility/dynamic balance. The test components of the SFT have been singled out for their high content validity, criterion validity, construct validity, and reliability [230, 231]. The SFT is usually performed in a fitness facility or large community facility. However, Rikli and Jones [232] intentionally selected testing procedures that require very little equipment, and therefore could theoretically be easily adapted to other locations (even at home).

## **3. Discussion**

Frailty is difficult to diagnose, particularly within primary care settings, due to its coexistence with other age-related conditions and lack of a universally accepted clinical definition [233, 234]. There is also a debate about frailty screening, especially in relation to screening eligibility as well as the place and time of its administration [235].

All single screening performance based instruments are less time-consuming than the two reference standard, most frequently used frailty indicators. Selfassessment questionnaires seem to be even faster to implement, they are simple and inexpensive. However, their weakness resides in lower rates of completion compared to instruments administered by health workers [236].

#### **Figure 2.**

*The proposed screening scheme for frailty in the elderly in Slovenia. The two tests which proved to be most efficacious as regards the consumption of time for its performance, their good metric properties and costs are the handgrip isometric dynamometry and especially the five-time sit to stand test. The older adults can voluntarily commit to frailty testing or are referred for screening by their personal physician. Within the health centres, they can be advised to participate in frailty screening by their personal physician and can receive it within community nursing services, centres for health promotion, reference outpatient clinics or physiotherapy clinics. If participation in testing is voluntary, there are several possibilities. Numerous non-profit organizations (patients' associations, red cross, older people's associations, etc.) can organize the screening for frailty of the elderly once or several times a year either autonomously or in collaboration with sports associations, private physiotherapy outpatient clinics or fitness centres. It is of great importance to inform the participants' personal physician about the screening results on the basis of which they can perform a complete geriatric assessment. The elderly can be advised to undertake one of the available programmes within a health Centre or their community (e.g. ABC of physical activity for health monitored by certified sports clubs).*

#### *Performance-Based Screening Tools for Physical Frailty in Community Settings DOI: http://dx.doi.org/10.5772/intechopen.94149*

Individual performance tests can be conducted in all environments (**Figure 2**), including the subjects' home. Test batteries, however, require more organization, professional staff, and space. Such test batteries may be conducted in gyms or outdoors in collaboration with public health organizations, sports associations, fitness centres, and other interested non-profit organizations (**Figure 2**). Due to their simplicity, the tests can also be performed by non-medical professionals. The only requirement is strict observance of the test protocols and providing data to a personal physician.

For most performance tests, there are normative values for individual age groups and for each country or geographical area. Therefore, the evaluation of deviations from the expected results makes it difficult to classify the subjects into individual frailty stages. For that reason, the researchers frequently opt for the Z-score system which expresses the value as a number of standard deviations or Z-scores below or above the reference mean or median value. For population-based uses, a major advantage is that a group of Z-scores can be subjected to summary statistics, such as the mean and standard deviation [237]. For population-based assessment, the Z-score is widely recognized as the best system for analysis and presentation of health-related data because of its advantages compared to the other methods [237].

Physical fitness declines early in frailty and manifests differentially in both genders [205]. Prefrail/frail individuals have significantly poorer performance in upper limb dexterity, lower limb power, tandem and dynamic balance and endurance [205]. Except for balance and flexibility, all fitness measures usually differentiate prefrail/frail from robust women. In men, only lower body strength is significantly associated with frailty [205].
