Frailty in the Elderly
Frailty is a state of increased vulnerability to adverse outcomes after physiological, medical or psychosocial stressors. It reflects cumulative decline across multiple organ systems (sarcopenia, impaired homeostasis, reduced reserve) and raises the risk of falls, delirium, hospitalisation, functional loss and death.
Frailty is associated with-but is not synonymous with-older age; many people aged ≥65 remain robust while about a third show frailty features in population studies.
In the Emergency Department (ED) frailty should be identified early because it changes thresholds for investigation and intervention, focuses attention on reversible precipitants (especially delirium and falls), demands a targeted medication review, and prompts explicit goals‑of‑care and safe disposition planning (RCEM SDEC Toolkit; NICE NG56).
Screening and initial assessment
Principles
- Use brief, validated tools suitable for the ED and document baseline (pre‑illness) function wherever possible. Where guidance asks for baseline assessment, score against the patient’s function about two weeks before the acute illness (RCEM SDEC Toolkit; NICE NG56).
- Screening informs further assessment and disposition; do not let a frailty score alone determine care.
Key tools and approaches
Clinical Frailty Scale (CFS; Rockwood)
- A 9‑point global scale (1 = very fit to 9 = terminally ill).
- Record baseline CFS (approximately 2 weeks prior to acute illness).