Frailty

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

Identifying Frailty Contributors

Frailty can be the result of problems with cognition (memory and thinking), mobility, and/or day-to-day function. For example, one person could be severely frail due to severe stage dementia, while another may be severely frail due to physical limitations from arthritis. Often it’s a combination of problems in two or more of these domains. Social circumstances also impact how a person copes with frailty. Identifying contributors to frailty (physical and/or cognitive deficits) allows health care providers to plan targeted interventions and supports that can optimize the patient and caregiver experience.

Dementia

Dementia is a key driver of frailty. In fact, the dementia stage can determine the overall frailty stage. For example, a person with mild dementia is at least mildly frail. They could be even more frail if they also have limitations related to physical or social problems. 

Social Function

People living with frailty are at increased risk of social vulnerability. Social function is important for two reasons:

  1. Social vulnerability is a risk factor for adverse health outcomes
  2. Effective discharge planning relies on the health care team to understand and identify social circumstances. For example:
    • What supports are available or lacking in the patient’s home environment?
    • Is the home accessible and conducive to recovery?
    • Will the patient be able to afford medications and nutritious foods?

Frailty Level Descriptions

Levels

Frailty Level

(Clinical Frailty Scale* Value)

Descriptors

Well (1-3) Minor subjective complaints
Cognitively intact (recall 2-3/3, normal clock)
 
Vulnerable (4) Starting to slow down/more tired during the day
Symptoms (e.g. SOB, pain) limit activities but do not require assistance
Mild Cognitive Impairment (MCI): recall on cognitive screen of 0-1/3, gives details TV/what brings them to hospital), or Delirious (confused today compared to their usual self), or Prior episode of delirium
 
Mild Frailty (5) Walking slowly, regularly uses/needs a gait aid
Needs helps with Instrumental Activities of Daily Living (IADLs)
Mild stage dementia (i.e., can't recall current events at baseline)
 
Moderate Frailty (6) Needs hands-on help using stairs or getting into the tub
Needs reminders to change clothes and/or choose season-appropriate clothes
Needs reminder to bathe and/or someone to prepare a bath or shower
Moderate stage dementia (e.g. can't name grandchildren at baseline)
 
Severe Frailty (7) Needs hands-on assistance for walking
Needs daily hands-on help to carry out the steps of grooming, bathing, dressing, toileting (ADLs)
Severe stage dementia (e.g. can't remember first degree relatives at baseline)
 
Very Severe Frailty (8) Bed-bound, does not mobilize
Dependent on others for all aspects of day-to-day life
Very severe stage dementia (e.g. speaks less than 10 words at baseline)