The Clinical Frailty Scale (CFS), developed by Dr Kenneth Rockwood at Dalhousie University, is a 9-point scale used widely in the NHS to assess frailty in older adults. It ranges from 1 (Very Fit — robust, active, energetic) through to 9 (Terminally ill — less than 6 months to live). Scores of 4 indicate vulnerability, 5-6 indicate mild to moderate frailty, and 7-9 indicate severe to very severe frailty. The CFS is now recommended by NICE and is used routinely in UK hospitals, especially for patients aged 65 and over admitted acutely.

The Electronic Frailty Index (eFI) is a tool developed by the University of Exeter and adopted by NHS England in 2017. It uses routinely collected GP data to calculate a frailty score as the ratio of health deficits present to total deficits considered (typically 36 deficits). A score below 0.12 indicates fitness, 0.12–0.24 indicates mild frailty, 0.24–0.36 indicates moderate frailty, and above 0.36 indicates severe frailty. The eFI is automatically calculated for patients aged 65 and over registered with a GP in England.

The Edmonton Frail Scale assesses 9 domains: cognition, general health, functional independence, social support, medications, nutrition, continence, functional performance, and mood. Each domain is scored individually, with a total possible score of 0 to 17. A score of 0–5 indicates the patient is not frail, 6–7 indicates apparently vulnerable, 8–9 indicates mild frailty, 10–11 indicates moderate frailty, and 12–17 indicates severe frailty. It takes approximately 10 minutes to administer and is widely used in UK hospitals and primary care.

The FRAIL scale is a simple 5-item screening tool for frailty that can be self-administered or clinician-administered in under 2 minutes. The five items are: Fatigue, Resistance (inability to climb stairs), Ambulation (inability to walk a block), Illnesses (more than 5 illnesses), and Loss of weight (more than 5% in the past year). Each item scores 1 point if present, giving a total score of 0–5. A score of 0 indicates robust, 1–2 indicates pre-frail, and 3–5 indicates frail. It is widely used in UK primary care as a quick screening tool.

The PRISMA-7 is a 7-question screening questionnaire for frailty developed in Canada and validated in the UK. It asks about age (85+), sex (male), health problems limiting activities, need for regular help, need for help shopping, need for help managing money, and need for help preparing meals. Each ‘yes’ scores 1 point, giving a total score of 0–14. A score of 0–2 indicates no frailty, 3–5 indicates moderate frailty, and 6–14 indicates severe frailty. It is quick to administer and useful in primary care and community settings.

The choice of frailty scale depends on the clinical context. The Clinical Frailty Scale (CFS) is recommended by NICE for use in acute hospital settings and is the most widely used in UK hospitals. The Electronic Frailty Index (eFI) is used for population-level identification in primary care in England. The Edmonton Frail Scale provides a more detailed multidimensional assessment. The FRAIL scale is ideal for quick screening in primary care or community settings. The PRISMA-7 is useful for identifying those who may benefit from comprehensive geriatric assessment.

Yes, frailty is not necessarily permanent. Evidence shows that targeted interventions can improve frailty status, particularly in those with mild to moderate frailty. Interventions include: structured exercise programmes (especially resistance training), nutritional optimisation (protein supplementation), medication review (reducing polypharmacy), treatment of underlying conditions, and social support. Comprehensive Geriatric Assessment (CGA) is the gold standard approach in the NHS for managing frailty. Early identification and intervention are key to preventing progression to severe frailty.

Comprehensive Geriatric Assessment (CGA) is a multidimensional, interdisciplinary diagnostic process used to identify the medical, psychological, and functional capabilities of a frail older person. It is the gold standard approach recommended by NICE for managing frailty in the NHS. CGA is typically delivered by a multidisciplinary team including geriatricians, nurses, occupational therapists, physiotherapists, pharmacists, and social workers. The aim is to develop a coordinated care plan to optimise health, function, and quality of life.