Rockwood Clinical Frailty Scale
Clinical Frailty Scale (CFS) v2.0 - a judgement-based assessment of frailty for patients aged 65 years and over.
When to use the Clinical Frailty Scale
Use the CFS for patients aged 65 and over on hospital admission, in emergency departments, and during outpatient assessments. NICE recommends frailty assessment for all older adults presenting to acute care. It should reflect the patient's baseline status (2 weeks before the current illness) rather than their current acute presentation.
How to interpret
- 1-3 (Very Fit to Managing Well): Not frail - standard clinical pathways
- 4 (Vulnerable): Pre-frail - may benefit from comprehensive geriatric assessment
- 5-6 (Mildly to Moderately Frail): Frail - CGA recommended, function-preserving interventions
- 7-8 (Severely to Very Severely Frail): Discuss goals of care, advance care planning, ceiling of treatment
- 9 (Terminally Ill): Focus on comfort care and symptom management
Clinical context
The CFS was developed by Kenneth Rockwood and colleagues. It is a global clinical measure based on judgement rather than a checklist. The assessor should consider mobility, function, cognition, and comorbidities. It has been validated as a predictor of mortality, length of stay, and institutionalisation. During the COVID-19 pandemic, NICE recommended CFS to inform decisions about critical care escalation in older adults.
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