Selected frailty measures for the primary care setting
Tool | Type | Components examined | Frailty scoring system | Psychometric properties | Time to complete, min | Tool administered by |
---|---|---|---|---|---|---|
Clinical Frailty Scale | Judgment based | Visual 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 | < 5 | Physicians or practice nurses |
Gait Speed | Performance based | Patient 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 | < 5 | Physicians or practice nurses |
Timed-up-and-go test | Performance based | The 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 | < 5 | Physicians or practice nurses |
FRAIL | Questionnaire | Five items with yes/no answers:
| Frailty: three or more components present Prefrailty: one to two components present Robust: zero components present | Convergent and predictive validity38 | < 5 | Physicians, practice nurses, or patients or their family members |
Groningen Frailty Indicator | Questionnaire | Fifteen-item clinician-administered questionnaire concerning four domains: physical, social, psychological and cognitive. | Frailty: scores > 4 | Construct validity39 | 15 | Physicians or practice nurses |
PRISMA-7 | Questionnaire | Seven-item self-completed questionnaire with yes or no answers that covers ADL limitations, age (> 85 yr) and sex | Frailty: three or more components present | Diagnostic test accuracy34 | < 5 | Self-administered |
Tilburg Frailty Indicator | Questionnaire | Contains 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 | < 15 | Self-administered |
Frailty phenotype | Mixed (questionnaire and performance based) | Five items with yes or no answers:
| Frailty: three or more components present Prefrailty: one or two components present Robust: no components present | Concurrent and predictive validity10 | 15–20 | Physicians 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 activity | Web-based calculator distinguishes three categories: nonfrail, prefrail and frail | Construct and predictive validity41 | < 10 | Nonphysicians (e.g., nurses, allied health professionals) |
Study of Osteoporotic Fractures | Mixed (Questionnaire and performance based) | Three items with yes or no answers:
| Frailty: one or more components present Prefrailty: one component present Robust: No components present | Predictive validity42 | < 5 | Physicians or practice nurses |
Electronic Frailty Index | Data set | As per the Frailty Index below, with variables obtained from primary care electronic medical records | Severe 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 Index | Data set | Any 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.44 | Criterion and construct validity45 | 20–30 | Mostly administered by researchers; further use in clinical practice needs to be explored |
Edmonton Frail Scale | Multidimensional | Nine items: cognition, health (two items), admission to hospital, social support, nutrition, mood, function and continence | Frailty: score > 7 | Construct validity and reliability46 | < 10 | Physicians 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.