Clinical Frailty Scale
- Fysiobasen
- Sep 16
- 3 min read
The Clinical Frailty Scale (CFS) is a simple, quick, and reliable tool for assessing frailty in older adults. The scale provides healthcare professionals with a structured way to classify frailty from 1 (very fit) to 9 (terminally ill), based on daily function, mobility, use of aids, and ability to perform activities of daily living¹.
Its strengths include rapid administration, ease of use, and solid validity and reliability for adults aged 65 and older. Limitations include the need for clinical judgment and potential variability between raters². The scale is not validated for younger individuals with congenital conditions or lifelong disabilities.
CFS was developed to provide a quick and holistic measure of frailty, helping clinicians detect vulnerable patients early, optimize treatment, and implement preventive strategies to improve quality of life. It is widely used in emergency departments, primary care, geriatric evaluations, and multidisciplinary treatment planning³. A score of 5 or higher usually indicates the need for a comprehensive geriatric assessment¹.
Method and Administration
The clinician gathers information by observing mobility and function, and by asking questions about daily activities such as:
Bathing and dressing
Household chores
Stair climbing
Going outdoors alone
Shopping
Handling medications
Managing finances
Scoring is based on the patient’s functional ability over the past two weeks, not only on the descriptive images provided for each level.
A typical introduction is: “I’d like to understand how you manage your daily activities.” Key points include activity level, independence in self-care, outdoor mobility, need for support, and current medications⁴.
Levels of the Clinical Frailty Scale
Level 1 – Very Fit: Robust, active, energetic, exercises regularly, among the fittest for their age.
Level 2 – Well: No active disease but less fit than level 1; may engage in seasonal or light activity.
Level 3 – Managing Well: Medical problems are well controlled, but not regularly active beyond normal walking.
Level 4 – Vulnerable: Independent, but slowed down or limited by symptoms such as fatigue. Still autonomous in basic activities.
Level 5 – Mildly Frail: Beginning to need help with complex activities (e.g., shopping, transportation, managing medications). Independent in basic self-care.
Level 6 – Moderately Frail: Needs help with most outdoor activities and household tasks. May require support for bathing, dressing, or stairs.
Level 7 – Severely Frail: Completely dependent for personal care, but may still move around indoors with assistance. Often progressive decline toward bed- or chair-bound state.
Level 8 – Very Severely Frail: Completely dependent, approaching end of life. Unable to get out of bed or chair without assistance.
Level 9 – Terminally Ill: Life expectancy less than 6 months, but not necessarily frail otherwise.
Scoring and Interpretation
Assign a score from 1 to 9 based on the description that best fits the patient.
If the patient seems to fit two categories, choose the higher (more dependent) level².
A score of ≥ 5 indicates clinically relevant frailty, warranting geriatric assessment and often specialist referral.
Clinical Significance
The CFS is widely recognized as a predictor of key outcomes in older adults:
Hospital admission
Institutionalization
Mortality risk
It is frequently used in geriatrics, cardiology, surgery, intensive care, and was adopted internationally for treatment prioritization during the COVID-19 pandemic³.
Validity and Reliability
Well-validated and reliable for older adults (65+)
Interrater variability may occur, especially among inexperienced users¹
Considered highly valuable for both routine clinical assessments and acute care decision-making
Sources:
Mendiratta P, Latif R. Clinical Frailty Scale. StatPearls [Internett]. 2020; sist oppdatert 22. juni.
Introduction to Frailty.
Church S, Rogers E, Rockwood K, Theou O. En scoping review av Clinical Frailty Scale. BMC Geriatrics. 2020;20(1):1–8.
Rockwood K, Theou O. Bruk av Clinical Frailty Scale ved tildeling av begrensede helseressurser. Canadian Geriatrics Journal. 2020;23(3):210.
Kaeppeli T, Rueegg M, Dreher-Hummel T, mfl. Validering av Clinical Frailty Scale for prediksjon av 30-dagers mortalitet på akuttmottak. Annals of Emergency Medicine. 2020;76(3):291–300.
Frailty Scale Classification Tree. Physiospot [Internett]; tilgjengelig fra: https://www.physiospot.com/research/frailty-scale-classification-tree/ [sitert 05.07.2025].
Stille K, Temmel N, Hepp J, Herget-Rosenthal S. Validering av Clinical Frailty Scale for retrospektiv bruk i akuttmottak. European Geriatric Medicine. 2020;11(6):1009–15.
Ko RE, Moon SM, Kang D, mfl. Oversettelse og validering av koreansk versjon av Clinical Frailty Scale. BMC Geriatrics. 2021;21(1):1–8.
