Overview of Clinical Frailty Scale
Around the world, the number of older adults is growing. This has put a spotlight on frailty, a condition that becomes more common with age and can lead to poor health. Frailty means the body’s resilience and performance decrease, making it hard to handle physical stressors.
Essentially, frailty happens when damage builds up inside our cells over the course of our lives. This damage affects the body’s systems that help keep us stable and healthy. While it’s true that these systems weaken as we age, many older adults are still able to function well. However, stress or injury can tip the balance, leading to more frailty. We can group older adults into three categories based on how much their bodies have declined: robust, pre-frail, or frail.
Many factors contribute to frailty. These include demographic and social factors, like poverty, living alone or having a lower level of education. Other contributors include mental health issues, like depression, not getting enough nutrition, taking multiple medications, and being physically inactive. In addition, certain diseases can also add to frailty such as inflammation, cancer, hormonal disorders, dementia, and malnutrition.
Despite the critical impact of frailty, there’s no worldwide accepted definition for it. This is due to its complex nature, and the difficulty in separating it from the normal aging process or disability. Regardless of how it’s defined, frailty remains an important health concern for older adults that can fluctuate over time, and often involves problems in multiple body systems. To help manage this, healthcare professionals have been using frailty scores since the mid-1990s. These scores help measure how much a person’s frail condition has affected their ability to function.
Why do People Need Clinical Frailty Scale
Assessing the strength and health levels of older adults, or “frailty,” is vital for doctors and healthcare providers to come up with targeted treatments. Over time, we’ve come up with many ways to evaluate frailty, which helps us predict health risks and make necessary healthcare plans.
One popular tool that we often use is the Clinical Frailty Scale (CFS). This scale helps healthcare providers judge the fitness and frailty of a patient, as it was originally developed by the Canadian Study of Health and Aging. The scale ranges from 1 (meaning a very fit person) to 7 (meaning a severely frail person). However, in 2007 the scale was expanded to include 9 points, adding very severely frail and terminally ill as separate categories. In 2020, the descriptions and labels in the CFS were fine-tuned to be more clear. The chart uses levels to show increasing frailty from 1 to 9 and has a handy visual chart to help classify a person’s frailty.
Although applying the CFS to patients requires the healthcare provider to make a clinical judgment, which may differ among different observers, it’s still considered a valuable tool. The CFS doesn’t just require a quick glance; it relies heavily on assessing a patient’s functional abilities such as their capacity to do normal tasks like bathing, housework, going shopping, taking care of finances, and preparing meals among other things. However, the CFS’s main strength is that it’s easy and quick to use in a clinical setting.
The CFS helps us foresee the health outcomes of older people admitted to hospitals due to sudden sickness. It’s also been used to predict the risk of dying in the hospital, and it may help direct special resources for older adults within the hospital.
How is Clinical Frailty Scale performed
The Clinical Frailty Scale is a tool doctors use to measure a person’s overall health and fitness levels. The scale ranges from very fit to terminally ill. Here’s what each category means:
1. “Very Fit”: If you fall into this category, it means you’re very strong and active. You likely exercise regularly and you’re some of the healthiest and fittest people of your age group.
2. “Well”: You might not be as active or fit as those in the first category, but you don’t have any serious health problems. You likely stay active or exercise once in a while.
3. “Managing Well”: If you’re in this group, it means you have some health issues, but you’re handling them well. However, you are not overly active beyond regular walking.
4. “Living With Very Mild Frailty”: This used to be labeled as “Vulnerable”. In this group, people can take care of their daily needs by themselves. But, they often feel “slowed-up” and tired throughout the day, which restricts what they can do.
“Living with Mild Frailty”: This category includes those people who need a bit of help in tasks like managing their money, transportation, medications, and heavy housework. They might have difficulty going grocery shopping, preparing meals, and keeping their homes tidy due to their health condition.
“Living With Moderate Frailty”: People in this category need assistance with all activities outside of their homes and often struggle with housework. They may need help with tasks like bathing and may need some help with getting dressed.
“Living With Severe Frailty”: If you fall into this category, it means you completely depend on others for both physical and cognitive personal care. But, you’re pretty much stable and not at high risk of dying within six months.
“Living with Very Severe Frailty”: These individuals are completely dependent for their personal care and are nearing the end of their lives. They often struggle to recover, even from minor illnesses.
“Terminally Ill”: If you’re in this category, you’re nearing the end of life, with a life expectancy of fewer than six months. This classification does not apply to those who are living with severe frailty. Many people in this group, however, may still be able to exercise until close to death.
For patients with dementia, the level of frailty goes hand in hand with the degree of dementia. Mild dementia might include symptoms like forgetting some details of recent events, repeatedly asking the same questions, or withdrawing socially. With moderate dementia, memory problems are more severe, even though past events can be well remembered. Personal care may require prompting. Severe dementia patients cannot perform personal care without assistance. In cases of very severe dementia, they may be bedridden and often not able to communicate verbally.
What Else Should I Know About Clinical Frailty Scale?
Frailty, a state of increased vulnerability to poor health or higher dependency due to age or disease, can be hard to diagnose. There’s currently no agreed-upon international standard definition for frailty, possibly because of its complex nature, its overlap with aging and disability, and differences in how researchers define it. In fact, there are several scoring systems designed to measure frailty, like the Frailty Phenotype (FP), the 5-Item Frailty Trait Scale (FTS-5), and the Survey of Health, Aging, and Retirement Frailty Index (SHARE-FI). However, these scales don’t always agree with each other, likely because they look at different aspects or types of frailty. Some focus on daily functions, such as the ability to get dressed, shower, or cook for oneself. Others consider physical measures such as unexpected weight loss or personal experiences such as feeling exceptionally tired.
One widely-used and tested scoring system is the Clinical Frailty Scale (CFS). This score gives a lot of weight to a person’s ability to do everyday activities and move around. It’s useful because it can help identify patients who, due to their frailty, may be at risk of worse health outcomes. This information can then guide healthcare providers towards preventive strategies that can improve patients’ health outcomes. The CFS has proven to be accurate and practical in a clinical setting. For example, recent studies have found that higher CFS scores are associated with higher death rates in patients with COVID-19. The CFS can also help in deciding the urgency of care, as higher scores can predict worse outcomes in patients seen in the emergency department. The CFS is used in many care settings, including nursing homes, intensive care units, emergency rooms, hospital admissions, and pre-surgery assessments.
It’s important to point out that the CFS does have its critics, mainly because it highly focuses on patients’ functionality. This could lead to an unintentional “ableism” bias. For instance, a patient born with an amputation might need the same level of in-hospital care as a patient who had an amputation due to diabetes. The patient born with the amputation might be in better overall health than the diabetes patient, yet the CFS might rank them similarly. This could potentially lead to unfair allocation of limited medical resources, like ICUs, negatively influenced by this “ability” bias.
