Table 1:

Selected frailty measures for the primary care setting

ToolTypeComponents examinedFrailty scoring systemPsychometric propertiesTime to complete, minTool administered by
Clinical Frailty ScaleJudgment basedVisual chart of nine pictures covering the frailty spectrum, with corresponding explanation text.Nine grades of frailty from 1 (very fit) to 9 (terminally ill). A score of 5 or more indicates frailty.Predictive validity and reliability36< 5Physicians or practice nurses
Gait SpeedPerformance basedPatient is asked to walk from one place to another at usual speed. Distance considered ranges from 2.4 to 6 m.A walking speed of < 0.8 m/s identifies patients at high risk of frailty.Diagnostic test accuracy34< 5Physicians or practice nurses
Timed-up-and-go testPerformance basedThe test measures the time taken to stand up from a chair, walk a distance of 3 m, turn, walk back and sit down.A time of > 10 s identifies patients at risk of frailty.Diagnostic test accuracy37< 5Physicians or practice nurses
FRAILQuestionnaireFive items with yes/no answers:
  • Fatigue

  • Resistance (ability to climb up one flight of stairs)

  • Ambulation (ability to walk one block)

  • Illness (> 5 comorbidities)

  • Loss of weight (> 5%)

Frailty: three or more components present Prefrailty: one to two components present Robust: zero components presentConvergent and predictive validity38< 5Physicians, practice nurses, or patients or their family members
Groningen Frailty IndicatorQuestionnaireFifteen-item clinician-administered questionnaire concerning four domains: physical, social, psychological and cognitive.Frailty: scores > 4Construct validity3915Physicians or practice nurses
PRISMA-7QuestionnaireSeven-item self-completed questionnaire with yes or no answers that covers ADL limitations, age (> 85 yr) and sexFrailty: three or more components presentDiagnostic test accuracy34< 5Self-administered
Tilburg Frailty IndicatorQuestionnaireContains two parts: 10 questions on determinants of frailty and diseases (Part A) and 15 questions on components of frailty in three domains (i.e., physical, psychologic and social frailty) (Part B)A score of 5 or more indicates frailty.Reliability, construct, predictive and concurrent types of validity40< 15Self-administered
Frailty phenotypeMixed (questionnaire and performance based)Five items with yes or no answers:
  • Weight loss over the past year (≥4.5 kg unintentionally)

  • Slow walking speed

  • Low grip strength

  • Exhaustion (two self-reported questions)

  • Low physical activity

Frailty: three or more components present Prefrailty: one or two components present Robust: no components presentConcurrent and predictive validity1015–20Physicians or practice nurses
SHARE Frailty Instrument (SHARE-FI)Mixed (questionnaire and performance based)Includes five variables: exhaustion, weight loss, weakness (as assessed by handgrip strength using a dynamometer), slowness and low activityWeb-based calculator distinguishes three categories: nonfrail, prefrail and frailConstruct and predictive validity41< 10Nonphysicians (e.g., nurses, allied health professionals)
Study of Osteoporotic FracturesMixed (Questionnaire and performance based)Three items with yes or no answers:
  • Weight loss (> 5% intentional/unintentional)

  • Exhaustion (Do you feel full of energy?)

  • Inability to rise from a chair five times without using arms

Frailty: one or more components present
Prefrailty: one component present
Robust: No components present
Predictive validity42< 5Physicians or practice nurses
Electronic Frailty IndexData setAs per the Frailty Index below, with variables obtained from primary care electronic medical recordsSevere frailty: a score of > 0.36
Frailty: a score of 0.24–0.36
Mild frailty: a score of 0.12–0.24
Fit: a score of ≤ 0.12
Predictive validity43< 5 (if automated)Automatically computed from the electronic medical records*
Frailty IndexData setAny 30 or more health deficits (variables) that increase in prevalence with age but do not plateau with age. Variables should be multidimensional, including ADLs/IADLs, comorbidities, mood, cognition and nutritional status.Frailty is measured on a continuum, although > 0.25 is often selected to define frailty.44Criterion and construct validity4520–30Mostly administered by researchers; further use in clinical practice needs to be explored
Edmonton Frail ScaleMultidimensionalNine items: cognition, health (two items), admission to hospital, social support, nutrition, mood, function and continenceFrailty: score > 7Construct validity and reliability46< 10Physicians or practice nurses
  • Note: ADL = activities of daily living, IADL = instrumental activities of daily living, PRISMA-7 = Program of Research to Integrate the Services for the Maintenance of Autonomy, SHARE = Survey of Health, Aging and Retirement in Europe.

  • * The Electronic Frailty Index is easy to use once it is automated in the electronic medical records; however, if done manually, it requires time and training.