Evaluating Patient Self-Assessment of the Clinical Frailty Scale at the Front Door

Background: The Clinical Frailty Scale (CFS) is a validated 9-point tool used to assess frailty in older adults, supporting clinical decision-making and care planning. Current guidance recommends CFS assessment at first contact with acute services; however, locally, completion often occurs after review by geriatric teams. This project explored whether a patient/carer-completed CFS questionnaire could facilitate earlier frailty assessment.

Aim: To develop a self-completed CFS questionnaire for patients and carers and evaluate its accuracy compared with clinician CFS scores in patients aged over 75 years presenting to acute services.

Methods: A self-CFS questionnaire was developed with input from the multidisciplinary frailty team. Emergency Department (ED) staff received education before a one-week pilot in which all patients aged over 75 years presenting to ED were offered the questionnaire, with results compared against staff CFS scores. A second four-week cycle was undertaken within the ED and Acute Medical Unit (AMU), where the frailty team facilitated questionnaire completion in patients over 75. Self-CFS scores were compared with clinician scores, and reasons for non-completion were recorded.

Results: During the initial ED pilot, only 5 of 371 eligible patients completed the questionnaire. Of these, 60% of self-CFS scores matched clinician scores, while 40% rated higher. In the second cycle, 50 patients were screened. Self-CFS agreed with clinician scores in 28% of cases, was higher in 16%, and lower in 8%. Nearly half (48%) were unable to complete the questionnaire. Reasons included confusion (33%), clinically unstable (25%), visual impairment (17%), language barrier (8%), tremor (4%), and other factors (12%).

Conclusions: Patient/carer-completed CFS demonstrated low completion rates and poor agreement with clinician assessment, limiting its utility as a replacement for staff-completed CFS at the front door. Future work should focus on identifying barriers to timely clinician CFS completion and exploring integration of CFS assessment into electronic triage workflows.