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?