Recognising Frailty

Recognising Frailty

Any interaction between and older person and a health or social care professional should include an assessment which helps identify if the individual has frailty. The type of assessment will differ with every individual and will be dependent on their circumstances. The presence of one or more of the five frailty syndromes should raise suspicions that the individual has frailty:

1. Falls
2. Immobility
3. Delirium
4. Incontinence
5. Susceptibility to side effects of medication

How is frailty identified?

Timely identification of frailty can help reduce the likelihood of progression of frailty and associated outcomes. Several factors are taken into consideration when identifying frailty and simple tests can be carried out:

• Walking/Gait Speed: taking more than five seconds to cover four metres.
• Has there been unintentional weight loss (4.5kg in the last year)
• Grip strength: weakened grip strength
• Timed up-and-go test (TUGT): taking more than ten seconds to get up from a chair, walk three meters, turn and sit down.
• PRIMSA 7 Questionnaire: a seven item questionnaire to identify disability. A score of >3 is considered to identify frailty.
• GP Assessment: GP’s assess individuals as frail or not frail on the basis of clinical assessment

Comprehensive Geriatric Assessment:

A Comprehensive Geriatric Assessment (CGA) is a vital part in the assessment, planning and intervention for older people suspected of having frailty. It uses an organised approach to assess an older person’s physical health, mental health, functional capacity and social circumstances. The main purpose of a CGA is to identify areas for improvement and support to reduce the impact of frailty; this is done by developing and implementing a plan for treatment, rehabilitation, support and long-term follow-up.

Rockwood Clinical Frailty Scale

The Clinical Frailty Scale (CFS), developed by Professor Kenneth Rockwood, is the agreed standard frailty screening tool. It is designed not only to identify frailty but to measure the severity of frailty after an assessment has been carried out. The CFS is a nine-point global frailty scale based on clinical evaluation:

1. Very Fit
2. Fit
3. Managing well
4. Living with very mild frailty
5. Living with mild frailty
6. Living with moderate frailty
7. Living with severe frailty
8. Living with very severe frailty
9. Terminally ill

To view a more detailed version of the Rockwood Clinical Frailty Scale please follow the link below:

There are a number of key factors involved in determining a person’s CFS score:

• Level of physical activity and mobility
• The presence or absence of any active diseases
• Level of dependency on other people for everyday activities
• Cognitive status and function

The Rockwood Clinical Frailty Scale is a very effective and efficient way to assess a person’s level of frailty and it is also less time-consuming compared to other, more complex tools while providing similar predictive information.