Appendix B: The Clinical Frailty
Scale (CFS)
Clinical Frailty Scale*
1 Very Fit – People who are robust, active, energetic
and motivated. These people commonly exercise
regularly. They are among the fittest for their age.
2 Well – People who have no active disease
symptoms but are less fit than category 1. Often, they
exercise or are very active occasionally, e.g. seasonally.
3 Managing Well – People whose medical problems
are well controlled, but are not regularly active
beyond routine walking.
4 Vulnerable – While not dependent on others for
daily help, often symptoms limit activities. A common
complaint is being “slowed up”, and/or being tired
during the day.
5 Mildly Frail – These people often have more
evident slowing, and need help in high order IADLs
(finances, transportation, heavy housework, medica-
tions). Typically, mild frailty progressively impairs
shopping and walking outside alone, meal preparation
and housework.
6 Moderately Frail – People need help with all
outside activities and with keeping house. Inside, they
often have problems with stairs and need help with
bathing and might need minimal assistance (cuing,
standby) with dressing.
Top Tips to help you use the
Clinical Frailty Scale*
7 Severely Frail – Completely dependent for
1 Very Fit – People who are robust, active, energetic personal care, from whatever cause (physical or
and motivated. These people commonly exercise cognitive). Even so, they seem stable and not at
regularly. They are among the fittest for their age. high risk of dying (within ~ 6 months).
2 Well – People who have no active disease 8 Very Severely Frail – Completely dependent,
symptoms but are less fit than category 1. Often, they approaching the end of life. Typically, they could
exercise or are very active occasionally, e.g. seasonally. not recover even from a minor illness.
3 Managing Well – People whose medical problems
are well controlled, but are not regularly active
beyond routine walking. 9. Terminally Ill - Approaching the end of life. This
Participating Sites:
Clinical Frailty Scale
category applies to people with a life expectancy
4 Vulnerable – While not dependent on others for <6 months, who are not otherwise evidently frail.
daily help, often symptoms limit activities. A common
complaint is being “slowed up”, and/or being tired Scoring frailty in people with dementia
during the day. The degree of frailty corresponds to the degree of dementia.
Common symptoms in mild dementia include forgetting the
5 Mildly Frail – These people often have more details of a recent event, though still remembering the event itself,
evident slowing, and need help in high order IADLs repeating the same question/story and social withdrawal.
(finances, transportation, heavy housework, medica-
tions). Typically, mild frailty progressively impairs In moderate dementia, recent memory is very impaired, even
shopping and walking outside alone, meal preparation though they seemingly can remember their past life events well.
Cape Breton District
and housework. They can do personal care with prompting. HEALTH AUTHORITY
M a k i n g H e a l t h i e r C h o i c e s To g e t h e r
In severe dementia, they cannot do personal care without help.
6 Moderately Frail – People need help with all
* 1. Canadian Study on Health & Aging, Revised 2008.
Sponsors:
outside activities and with keeping house. Inside, they 2. K. Rockwood et al. A global clinical measure of fitness and
often have problems with stairs and need help with frailty in elderly people. CMAJ 2005;173:489-495.
bathing and might need minimal assistance (cuing,
© 2007-2009. Version 1.2. All rights reserved. Geriatric Medicine
standby) with dressing. Research, Dalhousie University, Halifax, Canada. Permission granted
to copy for research and educational purposes only.
7 Severely Frail – Completely dependent for
personal care, from whatever cause (physical or
The Clinical Frailty Scale (CFS) was designed to summarise the results of
cognitive). Even so, they seem stable and not at
high risk of dying (within ~ 6 months).
8 Very Severely Frail – Completely dependent,
approaching the end of life. Typically, they could
not recover
© 2007-2009. even1.2.
Version from
Allarights
minorreserved.
illness. Geriatric Medicine Research, Dalhousie University, Halifax, Canada.
Permission granted to copy for research and educational purposes only.
a Comprehensive Geriatric Assessment. It’s now commonly being used as a triage
9. Terminally Ill - Approaching the end of life. This
category applies to people with a life expectancy
<6 months, who are not otherwise evidently frail.
Scoring frailty in people with dementia
The degree of frailty corresponds to the degree of dementia.
Common symptoms in mild dementia include forgetting the
details of a recent event, though still remembering the event itself,
repeating the same question/story and social withdrawal.
tool to make important clinical decisions, so it is imperative that it is used correctly.
In moderate dementia, recent memory is very impaired, even
though they seemingly can remember their past life events well.
They can do personal care with prompting.
In severe dementia, they cannot do personal care without help.
* 1. Canadian Study on Health & Aging, Revised 2008.
2. K. Rockwood et al. A global clinical measure of fitness and
frailty in elderly people. CMAJ 2005;173:489-495.
#1
© 2007-2009. Version 1.2. All rights reserved. Geriatric Medicine Research, Dalhousie University, Halifax, Canada.
It's all about the baseline #6 Having medical problems does not
If the person you are assessing is acutely automatically increase the score to CFS 3
Permission granted to copy for research and educational purposes only.
unwell, score how they were 2 weeks ago, A person who isn't bothered by symptoms and
not how they are today. whose condition(s) doesn't limit their lives can
be CFS 1 or 2 if they’re active and independent.
#2 You must take a proper history
The CFS is an objective clinical assessment #7 Don’t forget “vulnerable” (CFS 4)
tool. Frailty must be sensed, described, and People in this category are not dependent
measured - not guessed. (though they may need assistance with heavy
housework), but often complain of "slowing
down”. They’re becoming sedentary, with
#3 Trust, but verify
poor symptom control.
What the person you are assessing says is
important, but should be cross-referenced
with family/carers. The CFS is a judgement- #8 Dementia doesn’t limit use of the CFS
based tool, so you must integrate what Decline in function in people living with
you are told, what you observe, and what dementia follows a pattern similar to frailty:
your professional clinical experience tells mild, moderate and severe dementia
you from dealing with older adults generally map to CFS 5, 6 and 7 respectively.
If you don’t know the stage of dementia,
follow the standard CFS scoring.
#4 Over-65s only
The CFS is not validated in people under
65 years of age, or those with stable single- #9 Drill down into changes in function
system disabilities. However, documenting When considering more complex activities of
how the person moves, functions, and has daily living (such as cooking, managing
felt about their health may help to create an finances, and running the home) the focus is
individualised frailty assessment. on change in function. A person who has
always relied on someone else to perform a
particular activity should not be considered
#5 Terminally ill (CFS 9) dependent for that activity if they’ve never
For people who appear very close to had to do it before and may not know how.
death, the current state (i.e. that they are
dying) trumps the baseline state.
Kenneth Rockwood, Sherri Fay, Olga Theou & Linda Dykes
v2.0 5 June 2020
700 J. N. Darvall et al.
Table 2 Secondary outcomes according to frailty, Edmonton Frail and Clinical Frailty Scales
Variable Edmonton Frail Scale Clinical Frailty Scale Univariate regression model Multivariate regression model
Estimate (95% CI) Estimate (95% CI)
Frail Not frail Frail Not frail Edmonton Frail Clinical Frailty Edmonton Frail Clinical Frailty
n = 52 n = 166 n = 61 n = 157 Scale Scale Scale Scale
Mortality within 30 days 5 (9.6%) 3 (1.8%) 5 (8.2%) 3 (1.9%)
5.41 (1.36 to 4.30 (1.09 to 5.26 (1.28 to 4.01 (0.91 to
21.47) 16.98) 21.62) 17.73)
Mortality at six-month 16 17 17 16 3.76 (1.75 to 3.28 (1.54 to 2.86 (1.25 to 2.16 (0.94to
follow-up (30.8%) (10.5%) (27.9%) (10.5%) 8.07) 6.96) 6.51) 4.97)
Any complication* 29 39 28 40 4.05 (2.18 to 2.47 (1.34 to 3.67 (1.84 to 2.33 (1.18 to
(55.8%) (23.5%) (45.9%) (25.5%) 7.75) 4.56) 7.30) 4.61)
Acute myocardial 2 (3.8%) 2 (1.2%) 2 (3.3%) 2 (1.3%) 3.26 (0.55 to 2.61 (0.44 to 1.95 (0.27 to 0.94 (0.13 to
infarction 19.34) 15.47) 14.10) 6.54)
Reintubation 5 (9.6%) 1 (0.6%) 4 (6.6%) 2 (1.3%) 12.78 (2.04 to 4.87 (1.01 to 8.25 (1.22 to 3.54 (0.62 to
79.96) 23.52) 55.53) 20.32)
Acute pulmonary edema 9 (17.3%) 8 (4.8%) 7 (11.5%) 10 (6.4%) 4.07 (1.52 to 1.93 (0.72 to 4.44 (1.55 to 1.90 (0.63 to
10.90) 5.19) 12.68) 5.69)
Pulmonary embolus 0 (0.0%) 2 (1.2%) 0 (0.0%) 2 (1.3%) 0.63 (0.03 to 0.51 (0.02 to 0.36 (0.01 to 0.22 (0.00 to
13.26) 10.69) 20.18) 13.81)
Stroke/Transient ischemic 0 (0.0%) 4 (2.4%) 0 (0.0%) 4 (2.5%) 0.34 (0.02 to 0.28 (0.01 to 0.31 (0.02 to 0.28 (0.02 to
attack 6.49) 5.23) 5.11) 4.98)
Wound infection 10 8 (4.8%) 10 8 (5.1%) 4.61 (1.75 to 3.59 (1.38 to 1.52 (0.52 to 1.41 (0.38 to
(19.2%) (16.4%) 12.10) 9.35) 2.52) 2.45)
Acute kidney injury 8 (15.4%) 20 10 18 1.37 (0.57 to 1.54 (0.68 to 1.26 (0.50 to 1.59 (0.64 to
(12.0%) (16.4%) (11.5%) 3.25) 3.50) 3.14) 3.93)
Unplanned reoperation 11 7 (4.2%) 10 8 (5.1%) 5.89 (2.21 to 3.59 (1.38 to 6.20 (2.09 to 4.37 (1.47 to
(21.2%) (16.4%) 15.72) 9.35) 18.38) 13.02)
Unplanned admission to 13 12 (7.2%) 13 12 (7.6%) 4.22 (1.81 to 3.24 (1.41 to 4.54 (1.83 to 3.70 (1.46 to
ICU (25.0%) (21.3%) 9.83) 7.47) 11.26) 9.41)
Hospital length of stay 9.0 [5.0– 3.0 [1.0– 8.0 [5.0– 3.0 [1.0– 6.00 (3.15 to 5.00 (2.88 to 2.97 (-0.35 to 2.52 (-0.66 to
(days) 14.6] 9.0] 14.0] 9.0] 8.85) 7.12) 6.29) 5.69)
Other major complications 13 21 13 21 2.31 (1.08 to 1.77 (0.83 to 1.95 (0.86 to 1.69 (0.73 to
(25.0%) (12.7%) (21.3%) (13.4%) 4.98) 3.76) 4.43) 3.93)
Discharge location
Home 25 122 29 118 Ref. Ref. Ref. Ref.
(48.1%) (73.5%) (47.5%) (75.2%)
Assisted living facility/ 17 29 23 23 2.86 (1.37 to 4.07 (2.01 to 1.92 (0.81 to 2.66 (1.15 to
Rehabilitation (32.7%) (17.5%) (37.7%) (14.7%) 5.98) 8.25) 4.55) 6.13)
Other acute hospital 6 (11.5%) 12 (7.2%) 5 (8.2%) 13 (8.3%) 2.44 (0.84 to 1.56 (0.52 to 2.20 (0.68 to 1.10 (0.31 to
7.12) 4.74) 7.15) 3.91)
Died in hospital 4 (7.7%) 3 (1.8%) 4 (6.6%) 3 (1.9%) 6.51 (1.37 to 5.43 (1.15 to 6.49 (1.25 to 5.02 (0.92 to
30.89) 25.59) 33.79) 27.51)
* Defined as at least one of the following: acute myocardial infarction, cardiac arrest, tracheal reintubation, acute pulmonary edema, deep venous
thrombosis, pulmonary embolus, stroke, wound infection, acute kidney injury, unplanned need for reoperation, unplanned admission to intensive
care unit (ICU).
Values are expressed as median [interquartile range], n (%). Estimates are odds ratio (95% confidence interval [CI]), with the exception of the
estimates for hospital length of stay (median difference [95% CI]) and the estimates for discharge location (relative risk ratio [95% CI]).
older patients.10 Nevertheless, there remains a major gap in been applied in a variety of surgical cohorts, where it has
perioperative frailty screening. The Association of been found predictive of postoperative complications,
Anaesthetists of Great Britain and Ireland, the American increased length of stay, and inability to be discharged
College of Surgeons, and the American Geriatrics Society home after surgery.27 It also has good inter-rater reliability,
all similarly emphasize the importance of perioperative and correlates well with a comprehensive geriatric
frailty measurement.25,26 The Edmonton Frail Scale has assessment.11 There are significant challenges, however,
123
Section C: The Percentage of
Glottic Opening Score (POGO)
1. As per the title, the POGO is self-explainatory. A score of 100 represents full visualization from
the anterior commissure of the vocal cords to the interarytenoid notch between the posterior
cartilages
2. In general, a CL 1 view will correspond with a 100% POGO score, CL2A with a 50 % POGO
score, and CL3-4 collectively with a 0% POGO score
