Frailty is not a disease, but it profoundly influences disease expression.
Frailty is a "geriatric syndrome [that is] a state of increased vulnerability across multiple health domains that leads to adverse outcomes" (Allison, Assadzandi & Adelman, 2021).
Nova Scotia’s population is aging and people are living longer; however, increased longevity does not always mean more years of good health and quality of life. Older adults living with frailty face a higher risk of adverse health outcomes such as falls, hospitalizations, institutionalization, disability, and death.
Current health care systems are not designed to handle the complex needs of patients with multiple chronic conditions.
Understanding frailty is critical for healthcare providers to improve care pathway planning and patient outcomes.
– Canadian Institute for Health Information. A profile of hospitalized seniors at risk of frailty in Canada — Infographic. Accessed February 29, 2024.
Older adults living with frailty:
Canadian Institute for Health Information. A profile of hospitalized seniors at risk of frailty in Canada — Infographic. Accessed February 29, 2024.
Is frailty an unavoidable consequence of aging?
The answer is NO.
Frailty is often preventable and can even be modified.
Functional decline is one of the leading complications of hospitalized older adults living with frailty. A higher frailty score at the time of hospital admission is a strong predictor of adverse outcomes, including loss of independence and functional abilities.
Research shows, on discharge, approximately:
Unintentional hospital harm and functional decline occurs in as little as 48 to 72 hours of admission and is often driven by factors such as:
To prevent unintentional hospital harm, including functional loss, it is essential for healthcare providers to know a patient's baseline functional status from two weeks before they became ill or hospitalized to assess frailty upon admission.
The Clinical Frailty Scale (CFS) is a 9-point risk stratification tool that assists clinicians assess the overall level of frailty in older adults. Developed in Halifax, Nova Scotia in the 1990s by Dr. Ken Rockwood, the CFS scores range from 1 (Very fit) to 9 (Terminally ill), with higher scores indicating greater frailty and risk for adverse health outcomes.
The CFS is the most widely used frailty tool, extensively cross-validated, and applied internationally across a range of clinical settings and research. It serves as a practical frailty measurement tool, enabling healthcare professionals to identify older adults at increased risk and to guide care planning and resource allocation.
The CFS score is based on a patient’s baseline functional status — what a patient was able to do two weeks prior to the onset of illness or hospitalization. The baseline does not reflect the patient’s current state or appearance; rather, it offers clinicians a clear picture of the patient’s functional abilities before illness, which is crucial for establishing appropriate recovery or management goals.
The patient’s baseline is determined by asking about the patient’s mobility, and ability to complete activities of daily living (ADLs), such as dressing and feeding, and instrumental activities of daily living (IADLs) such as meal preparation, banking, driving, managing medications, two weeks prior to illness. Understanding a patient’s functional baseline is essential for individualized care planning and for discussions about prognosis and goals of care with patients and their families.
The Clinical Frailty Scale:
CFS is not a questionnaire; rather, it uses judgement based on information gathered from a clinical encounter and verified by speaking with the patient’s essential care partners to determine a patient’s functional baseline what they were able to do two weeks prior to illness or hospitalization.
Nova Scotia Health Learning Management System Course:
NOTE Microsoft Edge is the optimal browser for LMS. More information: The Compass: Learning Management System
Early identification allows for the development and implementation of individualized, proactive care plans that prioritize mobility, nutrition, cognitive support, and the minimization of unnecessary medical interventions. This approach can help maintain independence and quality of life for older adults during and after hospitalization.
Recognizing and managing frailty in older adults guides: