What is Frailty?
A clinical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors — distinct from disability or chronic disease.
A definition
Frailty is a state of increased vulnerability resulting from age-associated decline in reserve and function across multiple physiological systems. The frail individual has a reduced ability to cope with everyday or acute stressors. Even minor events — a urinary tract infection, a new medication, an unfamiliar environment — can trigger disproportionate functional decline.
Frailty is not synonymous with ageing. Many older adults remain robust into their ninth decade. Equally, frailty can affect people in their sixties. The defining feature is loss of resilience.
The Clinical Frailty Scale
The Clinical Frailty Scale (CFS) is a 9-point judgment-based instrument used across the NHS to identify and stratify frailty. Scores from 1 (Very Fit) to 9 (Terminally Ill) stratify clinical risk and guide intervention.
Patients scoring CFS ≥5 benefit most from Comprehensive Geriatric Assessment. The mean CFS in our acute frailty cohort was 6 — moderately frail.
Why it matters clinically
Frailty independently predicts mortality, length of stay, readmission and functional decline. Identifying frailty at the front door allows pathways to be tailored — prioritising senior decision-making, multidisciplinary input, medication review and goals-of-care discussions.