Synopsis
Recognise frailty as reduced physiological reserve, select and interpret an appropriate validated tool, protect the distinction between stable baseline and acute illness, and use results to trigger proportionate CGA rather than ration care.
- Frailty is a dynamic state of vulnerability after a stressor caused by reduced reserve across multiple systems; it is distinct from chronological age, comorbidity and disability.
- First-line recognition in routine care may use gait speed, Timed Up and Go, self-reported health or an electronic frailty index; an abnormal screen should trigger assessment, not become the diagnosis alone.
- The Clinical Frailty Scale is a global clinical judgement anchored to mobility, function and cognition in the stable baseline state, usually about two weeks before acute illness.
Key red flags
New immobility, falls, confusion, incontinence or poor intake requires an acute cause search before it is attributed to frailty progression.
Usual mobility, cognition, exercise and ADL or IADL help before illness anchor the grade; current ward performance does not.
Investigation priorities
Anchor stable function before the stressor.
Management branches
Falls, slow gait, weight loss, recurrent admission or increasing dependency raises frailty concern.
- Treat acute instability and establish whether the observed limitation predates the current illness.
- Use an appropriate screening or scoring tool and verify its output with concrete function and collateral evidence.
A baseline CFS is clinically useful in an adult aged at least 65 years.