The Clinical Frailty Scale (CFS) is a judgement-based frailty tool that assesses the person's illnesses, function and cognition (thinking and understanding)  to generate a frailty score ranging from 1 (very fit) to 9 (terminally ill).

Appropriate use 

• Recognition of frailty should be part of a holistic assessment.
• The CFS can be undertaken by any appropriately trained healthcare professional with training and support. A free 15 minute eLearning resource from Ottawa Hospital is available here.
• The CFS is only validated for people aged ≥ 65. It should not be used in younger people, people with stable long-term disabilities (for example, cerebral palsy), learning disability or autism and an individualised assessment is recommended.
• Be mindful of your prejudices. Just because a person is old doesn’t mean they are frail.
• Complete the screening based on how the person’s function was two weeks prior to deterioration. This requires understanding their global function and cognition which means talking to the patient, their family members and their carers as appropriate.

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 diseasesymptoms 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 (cuing, 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.)

Scoring frailty in people with dementia

The degree of frailty generally corresponds to the degree of dementia. Common symptoms in mild dementia include forgetting the details of a recent event, though still remembering the event itself, repeating the same question/story and social withdrawal.

In moderate dementia, recent memory is very impaired, even though they seemingly can remember their past life events well. They can do personal care with prompting.

In severe dementia, they cannot do personal care without help.

In very severe dementia they are often bedfast. Many are virtually mute.

Copyright and further information

Copied with permission from Dalhousie University.

Rockwood, K and Theou, O. Using the Clinical Frailty Scale in Allocating Scarce Health Care Resources. Canadian Geriatrics Journal, Volume 23, Issue 3, pages 254-259, September 2020.