Getting Started with the Edmonton Frail Scale
Darryl Rolfson is a Professor and Specialist in Geriatric Medicine at the University of Alberta in Edmonton, Alberta, Canada. His research interest is in the use of frailty measures to enhance the care experience of older adults at risk for the condition. In particular, there is an opportunity to define the role of multidimensional frailty measures to improve care by accounting for both the severity and the component nature of frailty in particular individuals. He tweets @darryl_rolfson
Clinicians and researchers who want to do something about frailty can be daunted by the number of frailty models and even larger number of frailty measures in circulation. The Edmonton Frail Scale website is designed to help navigate this, and to offer a value proposition for use of the EFS itself.
The EFS was developed at the University of Alberta by Dr. Darryl Rolfson and presented to the Canadian Geriatric Society in 2000. Its validity and reliability were first published in 2006 in Age and Ageing1. Since then, the EFS has been adopted for use in countries throughout the world, primarily in research settings.
The EFS website offers clinicians a description of the instrument itself, guidance on when it might be used, and how it should be administered and interpreted. It also offers patients and family members a description of frailty in plain language, and explains why clinicians and researchers may want to measure it. The new imperative in frailty research is the implementation of frailty measures in ways that offer clinical value to patients, their families, clinicians, and researchers. The EFS website also addresses this new challenge.
Frailty is viewed by many as a stigmatizing condition. The website argues that appropriate use of the term ‘frailty’ and respectful dialogue about what it means, can actually help counter ageism. If the construct of frailty is real, and if it is the predominant pattern in the last years of life2, then surely it deserves the best efforts of clinicians and researchers to prevent and address it, as has been done in the past with other single-organ conditions.
Researchers may find it useful to review the different categories of frailty measures, before deciding what makes sense for them. Responses to common questions about the EFS in research are also provided. These comparisons are available on the EFS website.
Finally, the website provides a mechanism to obtain a license to use the EFS. It briefly describes the new design of the EFS, and how to access training materials. A licensing fee is required for larger organizations and research enterprises. However, the license will be free for front-line use by single providers and for smaller scale research.
We ask that all who use the EFS ensure that there is an appropriate license in place. We also invite those who have been using EFS for clinical or researcher purposes to ensure that they have the official version of the scale. This version was redesigned based on the experience of clinicians and researchers representing hundreds of front-line administrations. A large number of common questions about administration and scoring helped inform the new design and the accompanying training materials, including a training manual (EFS Toolkit), a training video, and an online training course.
1. Rolfson DB, Majumdar SR, Tsuyuki RT, Tahir A, Rockwood K. Validity and reliability of the Edmonton Frail Scale. Age and Ageing. 2006;35(5):526-9.
2. Gill TM, Gahbauer EA, Han L, Allore HG. Trajectories of disability in the last year of life. The New England journal of medicine. 2010;362(13):1173-80.