Clinical Frailty Scoring

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The Trust is adopting Clinical Frailty Scoring (CFS) for our elderly patients. CFS is a global clinical measure of a person’s level of vulnerability to poor outcomes. Identification of frailty helps to improve both long and short term health management.

Frailty is a medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual's vulnerability for developing increased dependency and/or death (Morley JE, 2013).

Older people living with frailty make up between 9% and 25% of the population. They are the highest users of services across health and social care and have the highest levels of unplanned admissions to hospital. Yet we know that between 20% and 30% of the admissions in this group could be prevented by proactive case finding, assessment, care planning and use of services outside of hospital (Mytton OT, 2012)

The COVID outbreak has identified the importance of identifying and grading frailty using a Clinical Frailty Scale. The purpose is to identify patients who are at increased risk of poor outcomes and who may not benefit from critical care interventions. CFS also allows for identification of patients that may require an uplift in care provision within the community/liaising with primary care providers/access to step up bed’s/further assessment within a frailty unit.

It can be assessed quickly and simply using a Clinical Frailty Scale (Appendix 1). Frailty identification should take no more the one minute and should formulate part of your assessment in older patients. CFS (including the Rockwood system) are used widely and understood by community and acute trust staff. Clinicians should include a frailty score within their handover/documentation where appropriate to aid the transition and continuity of care.

Like any decision support tool, is not perfect and should not be used in isolation to direct clinical decision making. It will sensitise you to the likely outcomes in groups of patients, but clinical decision making with individual patients should be undertaken through a more holistic assessment, using the principles of shared decision making.

Appendix 1.

Download the Rockwood Clinical Frailty Scale using the link below

CFS has not been widely validated in younger populations (below 65 year of age), or in those with learning disability. It may not perform as well in people with stable long-term disability such as cerebral palsy, whose outcomes might be very different compared to older people with progressive disability. We would advise that the CFS is not used in these groups.

The Rockwood Scoring for Clinical Frailty Scoring will be included onto the Trusts Clinical App and in the new version of the ePCR. Please consider the use CFS as part of your patient assessment for patients >65 whom would fit the criteria.

Also consider further reading links such as https://stpsupport.nice.org.uk/frailty/index.html https://www.bgs.org.uk/resources/resource-series/fit-for-frailty

For any further information please contact Clinical.Leads@eastamb.nhs.uk

References
Morley JE, Vellas B, van Kan GA, et al. Frailty consensus: a call to action. J Am Med Dir Assoc 2013;14:392-7. 

Mytton OT, Oliver D, Mirza N, Lippett J, Chatterjee A, Ramcharitar K, Maxwell J. Avoidable acute hospital admission in older people. Brit J of Healthcare Management 2012;18 (11) 597-603

 

 Published 27th October 2020

 

2 Comments
There is also now an App that asks a series of questions and will generate a score.
Cheryl Dempsey
29 October 2020


I'm really glad the trust are doing this. Having worked with the frailty team in two different hospitals last year, I was extremely surprised to learn that the first thing any doctor does when assessing frailty on the specialist units is to read the ambulance paperwork. This is before all other notes.

They explained that we were the ones who see the patient in their home environment and on average spent well over an hour with the patient. This makes us their best source of information. They find it extremely helpful when there is a lot of detail in a crews PRF.

Knowing this made me change how and what I write on my paperwork!

Ben
29 October 2020


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