A global clinical measure of fitness and frailty in elderly people
Open accessAbstract
BACKGROUND: There is no single generally accepted clinical definition of frailty. Previously developed tools to assess frailty that have been shown to be predictive of death or need for entry into an institutional facility have not gained acceptance among practising clinicians. We aimed to develop a tool that would be both predictive and easy to use. METHODS: We developed the 7-point Clinical Frailty Scale and applied it and other established tools that measure frailty to 2305 elderly patients who participated in the second stage of the Canadian Study of Health and Aging (CSHA). We followed this cohort prospectively; after 5 years, we determined the ability of the Clinical Frailty Scale to predict death or need for institutional care, and correlated the results with those obtained from other established tools. RESULTS: The CSHA Clinical Frailty Scale was highly correlated (r = 0.80) with the Frailty Index. Each 1-category increment of our scale significantly increased the medium-term risks of death (21.2% within about 70 mo, 95% confidence interval [CI] 12.5%-30.6%) and entry into an institution (23.9%, 95% CI 8.8%-41.2%) in multivariable models that adjusted for age, sex and education. Analyses of receiver operating characteristic curves showed that our Clinical Frailty Scale performed better than measures of cognition, function or comorbidity in assessing risk for death (area under the curve 0.77 for 18-month and 0.70 for 70-month mortality). INTERPRETATION: Frailty is a valid and clinically important construct that is recognizable by physicians. Clinical judgments about frailty can yield useful predictive information.
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The Clinical Frailty Score has been validated in the ICU and is useful mainly in elderly patients.
“An additional score, the Clinical Frailty Score (25), ranging from 1 (very fit) to 7 (very frail) has been validated in the ICU and is useful mainly in elderly patients (26. 27).”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [26]
The Frailty Index came from the CSHA, a five-year prospective cohort of 10,263 Canadian older adults (mean age 82) studying dementia epidemiology and burden.
“The Frailty Index (FI) was developed as part of the CSHA (71); a five year prospective cohort study (n=10,263) designed to investigate the epidemiology and burdens of dementia in older people in Canada (mean age: 82 years).”
From Frailty in elderly people (2013) · cites this paper as [71]
Two main emerging frailty models are the phenotype approach and the cumulative deficit approach behind the CSHA Frailty Index.
“The two principal emerging models of frailty are the phenotype model (3) and the cumulative deficit model underpinning the Canadian Study of Health and Aging (CSHA) Frailty Index (71).”
From Frailty in elderly people (2013) · cites this paper as [71]
In two CSHA studies, clinically obtained CGA results were highly correlated with the research standard CSHA frailty index.
“the clinically obtained CGA results were highly correlated with the research standard CSHA FI”
From Frailty in elderly people (2013) · cites this paper as [71]
In two CSHA studies, clinically obtained CGA results were predictive of death and need for institutional care.
“and were predictive of death and need for institutional care.”
From Frailty in elderly people (2013) · cites this paper as [71]
The Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale is short but was validated only after a comprehensive geriatric assessment (CGA) was carried out.
“Another new judgement-based measure, the Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale [4], is short but was validated only after a CGA was carried out.”
From Validity and reliability of the Edmonton Frail Scale (2006) · cites this paper as [4]
Frailty is measured in many ways, including rules-based instruments, summative impairment lists and algorithms derived from clinical judgement.
“Frailty is measured in many ways, including 'rules based' instruments, summative impairment lists and algorithms derived from clinical judgement [4][5][6].”
From Validity and reliability of the Edmonton Frail Scale (2006) · cites this paper as [4]
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“The inclusion criteria for participation in this study are: (1) Caregivers of frail older adults based on a professional’s assessment of Clinical Frailty Scale with a score of 6, indicating a moderate level of frailty or above [51].”
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“Patient age ranges and frailty (assessed by BEW according to the clinical frailty scale [26]) are included for cases in D.”
- Authors
- Rockwood, K.
- Affiliations
- Dalhousie University (CA)
- Corresponding author
- Rockwood, K.
- ORCID
- Rockwood, K.
- Venue
- Canadian Medical Association Journal
- Publisher
- CMA Impact Inc.
- Published
- 2005-08-30
- Volume
- 173
- Issue
- 5
- Pages
- 489-495
- ISSN
- 0820-3946 (ISSN-L)
- 1488-2329
- PMC
- PMC1188185
- OpenAlex
- W2164186760
- Cited by
- 8,968
- References
- 4
- Citations by year
- 2026: 884 · 2025: 935 · 2024: 1046 · 2023: 913 · 2022: 980 · 2021: 961 · 2020: 787 · 2019: 544 · 2018: 423 · 2017: 380 · 2016: 280 · 2015: 251 · 2014: 157 · 2013: 121 · 2012: 75
- FWCI
- 12.31
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Canadian Medical Association Journal (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Pfizer
- Dalhousie Medical Research Foundation
- University of Calgary
- University of Ottawa
- McGill University
- Dalhousie University
- Pfizer Canada
- Health Canada
- Canadian Institutes of Health Research
- Medical Research Council
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Keywords
- frailty, Clinical Frailty Scale, frailty index, older adults, mortality prediction, institutional care, Canadian Study of Health and Aging, frailty assessment tools, clinical judgment
- MeSH terms
- Aged, Aged, 80 and over, Female, Health Status, Humans, Institutionalization, Male, Mortality, Physical Fitness, Predictive Value of Tests, Prognosis, Prospective Studies, Geriatric Assessment, Frail Elderly
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