Frailty

Assessing the frailty of patients following a fall is important in identifying states of vulnerability preceding the episode and circumventing avoidable adverse events in the future, and can be performed as early as from point of triage. Establishing whether or not patients have a baseline state of significant frailty can help determine the beneficence of support services (eg. review by clinical frailty teams) and critical care interventions (establishing an appropriate (ceiling of care).

Below is a depiction of the Clinical Frailty Scale (CFS), known colloquially as the ‘Rockwood score’;

Figure 1: Clinical Frailty Scale (Copyright: Dalhousie University)

Higher CFS scores are associated with longer stays in hospital, greater need for discharge support and in-patient mortality; this relationship is illustrated in the following infographic presented by the NHS Specialised Clinical Frailty Network (2020);

Figure 2: Outcomes in Acute Care (Not Covid Specific) associated with frailty (NHS Specialised Clinical Frailty Network)

The NHS Specialised Clinical Frailty Network has also highlighted the following important aspects of the CFS to be aware of;

• It has only been validated in older patients (65 years and above), and not in younger patients and those with learning disabilities.
• Sometimes it can be difficult to assign a patient to one category as opposed to another in these cases the ability to define the patients level of vulnerability based on their baseline function (not just how theyve presented today), and focussing on the specific changes in their function in recent history, is key.
• Collateral histories from family, friends and carers can be of great value

Further tips to aid the correct assessment of frailty in a patient are included in the infographic below;

Figure 3: Top Tips to help you use the Clinical Frailty Scale (NHS Specialised Clinical Frailty Network)

Learning Bite

Assessing older patients for frailty is essential in establishing safety of discharge and an appropriate ceiling of care, and can be achieved using clinical frailty scores.