The Clinical Frailty Scale: Do Staff Agree?

Rebekah L Young,David G Smithard

doi:10.3390/geriatrics5020040

Abstract

The term frailty is being increasingly used by clinicians, however there is no strict consensus on the best screening method. The expectation in England is that all older patients should have the Clinical Frailty Scale (CFS) completed on admission. This will frequently rely on junior medical staff and nurses, raising the question as to whether there is consistency. We asked 124 members of a multidisciplinary team (consultants, junior doctors, nurses, and allied health professionals; physiotherapists, occupational therapists, dietitians, speech and language therapists) to complete the CFS for seven case scenarios. The majority of the participants, 91/124 (72%), were trainee medical staff, 16 were senior medical staff, 12 were allied health professions, and 6 were nurses. There was broad agreement both between the professions and within the professions, with median CFS scores varying by a maximum of only one point, except in case scenario G, where there was a two-point difference between the most junior trainees (FY1) and the nursing staff. No difference (using the Mann–Whitney U test) was found between the different staff groups, with the median scores and range of scores being similar. This study has confirmed there is agreement between different staff members when calculating the CFS with no specific preceding training.

Highlights

Frailty can be described as a clinical state in which the ability of older people to cope with every-day or acute stressors is compromised by increased vulnerability due to age-associated declines in physiological reserve and function across multiple organ systems [1]
All older people admitted to hospital should undergo a comprehensive geriatric assessment (CGA)
The expectation in England is that all older patients should have the Clinical Frailty Scale completed at the time of admission or soon after [6]

Summary

Introduction

Frailty can be described as a clinical state in which the ability of older people to cope with every-day or acute stressors is compromised by increased vulnerability due to age-associated declines in physiological reserve and function across multiple organ systems [1]. Frailty can be used to describe certain physical changes, such as muscle wasting and weakness, leading to reduced walking ability. The identification of these patients allows us to start a care pathway to address the issues contributing to frailty and avoid adverse outcomes. All older people admitted to hospital should undergo a comprehensive geriatric assessment (CGA). An assessment of frailty is one component of the CGA, and should be completed at the earliest opportunity

Methods

Results

Conclusion