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Covid-19 Primary Care Resources

The Clinical Frailty Scale

NICE outlines the importance of the CFS in the context of the Covid outbreak


This information is sourced from the NHS Specialised Clinical Frailty Network and NICE:

Rapid NICE guidance produced in response to the Covid outbreak outlines the importance of identifying and grading frailty using the Clinical Frailty Scale (CFS):

  • On admission to hospital NICE now recommends assessment of all adults for frailty irrespective of COVID‑19 status
  • The purpose is to identify patients who are at increased risk of poor outcomes and who may not benefit from critical care interventions
  • If there is uncertainty regarding the likely benefit of critical care support ( ie CFS score >4 ), critical care advice is needed to help the decision about critical care treatment

The Clinical Frailty Scale categorises Frailty on a 9 point scale

  • 1 = very fit, 2 = well, 3 = managing well, 4 = vulnerable, 5 = mildly frail, 6 =  moderately frail, 7 = severely frail, 8 = very severely frail, 9 = terminally ill

When to use the CFS

  • The CFS) should be assessed at emergency triage, or any first point of contact with acute care
  • It should be reassessed after two weeks if clinically relevant

Cautionary notes

  • The CFS has ONLY been validated in older people (>65 years)
  • The CFS has not been widely validated in younger populations (below 65 years of age), or in those with learning disability
  • It may not perform as well in people with stable long term disability such as cerebral palsy, whose outcomes might be very different compared to older people with progressive disability
  • The scale should not be used in these groups
  • For terminally ill people, their current state trumps the baseline state

How to use the CFS (please see top tips to help you use the CFS)

  • Ask the patient/their carer what the patient’s capability was TWO weeks ago NOT how the patient appears before you today
  • Decision makers using the CFS to inform clinical management MUST check the score to ensure that it is accurate
  • Having medical problems doesn’t automatically increase the score (a person who’s condition doesn’t limit their lives can be CFS1)

Prompting Questions

  • Do you have any trouble with your daily activities? i.e. cooking, cleaning, shopping?
  • If yes: Are you able to shower and get dressed in the morning?
  • Do you walk?
  • If yes: How often? How far?
  • If no:  Do you often feel slowed up or tired during the day?
  • If you have a cane or walking aid, how often do you use it?
  • Do you have any chronic pain/mobility issues (e.g., back pain, sciatica, arthritis in knees or hips)?
  • Do you participate in any other types of activities (i.e. fitness classes, weights at the gym, dance)?
  • If yes: What types, how often? How long are the activities?