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Keywords: Frailty; long-term care; nursing homes; prevalence. Published by Elsevier Inc. All rights reserved. Abstract Background: Nursing home patients are expected to be very frail. The cultural adaptation was performed in line with the theoretical reference framewok by Guillemin, Bombardier and Beaton 6. The order of phases was modified as proposed by Ferrer 7 , modifications that have been used in Brazilian research : translation fo the scale to Portuguese; achievement of the first consensus version in Portuguese; assessment by an expert committee; back translation; achievement of consensus version in English and comparison with the original version; semantic assessment of the instrument and pretest of the Portuguese version.
The translators assessed and discussed differences between both translations together with the researcher and her advisor, choosing the most appropriate option that would not modify the meaning expressed in the original instrument. The Portuguese consensus version was submitted to a committee of seven experts, composed according to the following criteria: knowledge on the research theme aging and frailty , mastery of Portuguese and English and knowledge of the cross-cultural adaptation methodology.
Before participating in this committee, each member signed a free and informed consent term, agreeing with participation in the research and with the use of the discussed data.
At that moment, the final version in Portuguese was created. After the translation to Portuguese, the back translation was started.
For this purposes, two American translators who have lived in Brazil for several years received the consensus version in Portuguese. They were not informed about the study objectives and did not know the original version of the scale. After the translations were done, two back-translated versions were obtained. To solve some differences between these, a meeting was held between the researcher, her advisor and the two translators.
At that moment, the study goals and the two versions original and back translation were presented for analysis, resulting in a consensus version in Portuguese and in English. Semantic analysis was performed by applying the scale to six elderly living in the community, with similar characteristics and age ranges but different genders three women and three men , randomly selected, complying with strict ethical guidelines. Later, for the pretest, the scale was applied to 40 elderly living in the community.
These were selected in accordance with the criterion established for this research and specified further ahead, but were not included in the validity assessment of the scale. Like in semantic analysis, no scale items needed alterations and the interviewees understood the scale well, resulting in the final translated version. After performing the pretest and determining the final version of the scale, it was applied to a sample of elderly for validity analysis.
For this project, a probabilistic double-stage sampling process was used. In the first stage, the census sector was considered as the Primary Sampling Unit PSU , randomly selecting 30 census sectors, with probability proportional to the number of residences, among the sectors in the city.
The second stage was to visit a fixed number of residences in each sector, with a view to guaranteeing self-weighted sampling, randomly selecting the streets and blocks where this search process was started. As a form of prevention in case of refusals or no answers, people were randomly selected. Data were collected between September and June The researchers interviewed elderly but, for the psychometric analysis of the EFS, a subsample of elderly people was selected, using simple random sampling SRS.
The size of this sample was determined at elderly. In the end, the sampling criterion of reliability was used, as that was the largest sample size demanded in this research.
Data were collected by interviewers whom the project advisor and researcher had trained, wearing a uniform and properly identified with a badge. Data were inserted in EXCEL, and a database was elaborated, using the double-entry typing validation technique.
After typing and verifying data consistency, data were imported and analyzed in SPSS Known-groups validation was also carried out, using Mann-Whitney's non-parametric test of the frailty diagnosis between gender, age and cognitive deficit. In this study, the sensitivity and specificity of the clock test cognitive dimension of the EFS were calculated as a criterion validity measure for a specific item. During the analysis of the EFS' translation to Portuguese and the consensus by the expert committee, face and content validation could be verified, that is, the scale measures what it intends to measure face validation and its items are relevant for the construct under analysis content validation.
Most participants, i. In known-groups validation and comparative analysis of the frailty diagnosis between gender, age and cognitive deficit, three missing data or no answers were observed. The survey indices subtract the percentage of companies saying conditions are improving from that of companies saying conditions are worsening. A positive number means optimists outnumber pessimists. Abe raised the sales tax to 8 percent from 5 percent in April in a bid to curb Japan's runaway government debt, knocking the economy hard in the process.
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