The selection of the tool for identifying and assessing frailty depends on both the approach and the setting. Set out below is a summary of commonly used and/or recommended tools within primary, community and hospital settings.
Further details about the individuals tools can be found in the Enabling Zone.
Identifying and assessing frailty in primary care, community care and hospital outpatient settings
NICE Guidance NG56 on multimorbidity recommends the following tools when identifying and assessing frailty in primary care, community care and hospital outpatient settings.
Validated tools including the eFI are recommended to identify proactively adults with multimorbidity who are at risk of adverse events such as unplanned hospital admission or admission to care homes.
Identifying and assessing frailty in acute settings
NICE guidance recommends that physical performance tools (e.g., Gait speed test, Timed up and Go test, measures of grip strength) are NOT used to identify or assess frailty in a person who is acutely unwell.
Identifying and assessing frailty in acute settings, such as the Emergency Department usually involves criteria such as:
- Age (75 and over)
- Presenting with a frailty syndrome:
- Care home residence
The Clinical Frailty Scale (Rockwood) is also used in some Emergency Departments in combination with these, or similar criteria, to stream patients to Frailty Units or Older People Assessment and Liaison (OPAL) Teams.
Whilst there is a lack of consensus on which tool should be used to identify and assess frailty in surgical settings, evidence is emerging for the use of the Edmonton Frail Scale. The strengths of this tool include brevity, clinical feasibility and identification of aspects of frailty amenable to preoperative optimisation (e.g. cognition, nutrition).