NICE outlines the importance of the CFS in the context of the Covid outbreak
- 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
- 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
- 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)
- 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?