The Electronic Frailty Index (eFI) is based on the cumulative deficit model of frailty and constructs the diagnosis and severity of an individual on the basis of a range of deficits (36 in total), comprising of about 2000 Read codes which are gathered from primary care based electronic patient records.


The Read codes used in the eFI cover areas from clinical signs to symptoms to diseases and even abnormal test values (eg haemoglobin levels).

The eFI offers a unique opportunity to adopt a proactive and population based approach to the identification and management of frailty in primary care:

  • It can help in identifying and predicting adverse outcomes.
  • It can be used at an individual or whole population level for identifying/screening for frailty.

It categorises frailty at 4 levels, from ‘Fit’ to ‘severe frailty’ to enable better targeting of evidence-based interventions:

  1. Fit (eFI score 0-0.12 or 0-4 deficits) – People who have no or few long-term conditions that are usually well controlled. This group would mainly be independent in day to day living activities.  Estimated to be 50% of population aged 65+.
  2. Mild frailty (eFI score 0.13–0.24 or 5-8 deficits) –People who are slowing up in older age and may need help with personal activities of daily living such as finances, shopping, transportation. Estimated to be 35% of population aged 65+.
  3. Moderate frailty (eFI score 0.25–0.36 or 9-13 deficits) – People who have difficulties with outdoor activities and may have mobility problems or require help with activites such as washing and dressing. Estimated to be 12% of population aged 65+.
  4. Severe frailty (eFI score > 0.36 or more than 13 deficits) – People who are often dependent for personal cares and have a range of long-term conditions/multimorbidity.  Estimated to be 3% of population aged 65+.

The eFI has been developed in collaboration between the University of Leeds, TPP, the University of Bradford, the University of Birmingham and Bradford Teaching Hospitals NHS Foundation Trust and funding from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, Yorkshire and Humber (NIHR CLAHRC YH).   It has undergone internal and external validation in a retrospective cohort study using data from around 1 million patients in the ResearchOne and THIN databases.

A Healthy Ageing collaborative has been established as part of the Yorkshire & Humber  AHSN Improvement Academy to implement and evaluate the eFI.  The collaborative has engaged locally, regionally and nationally with 55 CCGs to develop new models of frailty care using the widespread availability of the eFI to enable delivery of evidence-based interventions to potentially modify frailty trajectories and improve outcomes for older people.

The eFI can be found on both the main GP electronic clinical patient systems (SystemOne and EMIS).  The guidance note below provides further information about implementation.

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Further information about the eFI project can be found here.