Comprehensive Geriatric Assessment (CGA): Frailty status
Frailty status is essential in CGA as it identifies individuals at increased risk of adverse outcomes like falls, hospitalisation, disability, and mortality.
Frailty reflects decreased physiological reserve, making people more vulnerable to even minor stressors (e.g., infection, medication changes). Including frailty status in CGA helps guide personalised care, predict prognosis, and plan proactive interventions to maintain function and independence.
The presence of frailty leads to higher risk of delirium, polypharmacy-related harm, prolonged hospital stays, and dependency. Evidence shows that frailty increases the likelihood of care home admission and readmission after discharge from hospital. Targeted interventions (like exercise, nutrition, and medication review) can slow progression and reduce hospital admissions.
Methods to assess frailty include:
- Physical performance (e.g. gait speed, grip strength)
- Weight loss (unintentional)
- Exhaustion and low energy
- Comorbidities and medication burden
- Cognition and mood
- Social support and environment
Common tools include the Clinical Frailty Scale (CFS), Fried Frailty Phenotype, and Edmonton Frail Scale.
The Clinical Frailty Scale is easy to use in everyday clinical practice across most clinical settings. In an individual who is acutely unwell their frailty state must be assessed based on how they were at least two weeks prior; to understand their usual level of function and frailty.
Assessment is essential to determine the severity of frailty, not just whether or not frailty is present. It is also useful to know the trajectory of their frailty as this will help guide decision-making around health and care decisions.
Early identification and intervention are key and research supports multidomain approaches, such as combining strength training, nutritional support, and medication optimisation to reduce frailty-related decline.
Understanding frailty ensures care focuses on what matters most to the person - quality of life, independence, and minimising avoidable harm.
For further information about frailty and its assessments, please see our Frailty Hub.
References
References
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1. National Institute for Health and Care Research (NIHR).Frailty: Research shows how to improve care https://evidence.nihr.ac.uk/collection/frailty-research-shows-how-to-improve-care.
