Clinical Frailty Scale (CFS)
The Clinical Frailty Scale (CFS) is a nine-point tool to assess frailty in older adults, developed by Dr. Kenneth Rockwood and colleagues at Dalhousie University in Canada in 2005. It is widely used in clinical and community settings to support decision-making, care planning, and risk stratification.
The Clinical Frailty Scale is the agreed tool across Nottingham and Nottinghamshire to stratify risk. It provides a shared language between all areas of our health and social care system, helping everyone to support older people to live well.
The nine points in the scale are as follows:
1. Very Fit
People who are robust, active, energetic, and motivated. They tend to exercise regularly and are among the fittest for their age.
2. Fit
People who have no active disease symptoms but are less fit than category 1. Often, they exercise or are very active occasionally, e.g., seasonally.
3. Managing Well
People whose medical problems are well controlled, even if occasionally symptomatic, but often are not regularly active beyond routine walking.
4. Living with Very Mild Frailty
Previously “vulnerable”; this category marks early transition from complete independence. While not dependent on others for daily help, often symptoms limit activities. A common complaint is being “slowed up” and/or being tired during the day.
5. Living with Mild Frailty
People who often have more evident slowing and need help with high-order instrumental activities of daily living (finances, transportation, heavy housework). Typically, mild frailty progressively impairs shopping and walking outside alone, meal preparation, medications, and begins to restrict light housework.
6. Living with Moderate Frailty
People who need help with all outside activities and with keeping house. Inside, they often have problems with stairs and need help with bathing and might need minimal assistance (cueing, standby) with dressing.
7. Living with Severe Frailty
Completely dependent for personal care, from whatever cause (physical or cognitive). Even so, they seem stable and not at high risk of dying (within ~6 months).
8. Living with Very Severe Frailty
Completely dependent for personal care and approaching end of life. Typically, they could not recover even from a minor illness.
9. Terminally Ill
Approaching the end of life. This category applies to people with a life expectancy < 6 months, who are not otherwise living with severe frailty. (Many terminally ill people can still exercise until very close to death.)
Training on how to use the Clinical Frailty Scale to identify different levels of frailty is available through React to Frailty: [link to React to Frailty Training tile].
Guidance on recording Clinical Frailty Scale scores in a person’s record on health and social care systems, including SystmOne, is available here.
