Tools and resources to assist health care providers with routinely identifying, documenting and communicating frailty in patient care settings.

What is Frailty?

Frailty is a stage of life. It is the result of the cumulative effects of health issues that occur over the life course. When accumulation of these issues depletes the physiologic reserve to the point that day-to-day activity is affected, a person is said to be "frail".

Picture a Jar of Marbles...

  • The empty space in the jar represents your ability to bounce back and recover from illness
  • The marbles represent the health and/or social stressors that occur over your life span
  • Each health or social stressor encountered is like adding a marble to the jar
  • The more marbles in your jar, the lower your capacity to bounce back and recover from illness
  • As the jar fills with marbles, we become more frail. What was sustainable five years ago may not be sustainable today
  • Eating well, exercising and having social connections may help to slow down the accumulation of health stressors (i.e. marbles)

Frailty has been shown to be associated with poor outcomes such as:

  • Increased emergency room visits and hospital admissions1
  • Incomplete recovery following acute illness2
  • Increased length of stay2
  • Falls3
  • Adverse drug events4
  • Need for long term care2
  • Mortality5

Why is Frailty Important?

Frailty is becoming more prevalent. 

It is estimated that about a third of Nova Scotians over the age of 65 are frail. Younger people (under 65) can also be frail.6 The impact of frailty extends across age groups, as well as to family-and-friend caregivers.

Frail patients have complex needs that take time to address. Given that a focus on a single diagnosis can distract from all the other things that frail patients need, health care must develop more organized approaches to improving outcomes in this patient population.

Online Learning for Staff

This course is available on the Provincial Learning Management System (LMS):

  • Using Frailty to Inform Care

1. Rockwood, K., Song, X., MacKnight, C., Bergman, H., Hogan, D. B., McDowell, I., & Mitnitski, A. (2005). A global clinical measure of fitness and frailty in elderly people. Canadian Medical Association Journal, 173(5), 489-495.

2. Ekerstad, N., Swahn, E., Janzon, M., Alfredsson, J., Löfmark, R., Lindenberger, M., & Carlsson, P. (2011). Frailty is independently associated with short-term outcomes for elderly patients with non–ST-segment elevation myocardial infarction. Circulation, 124(22), 2397-2404.

3. Theou, O., & Rockwood, K. (2012). Should frailty status always be considered when treating the elderly patient?. Aging Health, 8(3), 261-271.

4. Makary, M. A., Segev, D. L., Pronovost, P. J., Syin, D., Bandeen-Roche, K., Patel, P., ... & Fried, L. P. (2010). Frailty as a predictor of surgical outcomes in older patients. Journal of the American College of Surgeons, 210(6), 901-908.

5. Searle, S. D., Mitnitski, A., Gahbauer, E. A., Gill, T. M., & Rockwood, K. (2008). A standard procedure for creating a frailty index. BioMed Central Geriatrics, 8(1), 24.

6. Statistics Canada. (2015). Table 2 Percentage distribution of frail seniors, based on Frailty Index (FI) cut-point of >0.21, by age group, sex and province/territory, household population, Canada, 2009/2010. Retrieved from