Using the Clinical Frailty Scale in Allocating Scarce Health Care Resources

Kenneth Rockwood, Olga Theou, Kenneth Rockwood, Olga Theou

Abstract

The key idea behind the Clinical Frailty Scale (CFS) is that, as people age, they are more likely to have things wrong with them. Those things they have wrong (health deficits) can, as they accumulate, erode their ability to do the high order functions which define their overall health. These high order functions include being able to: think and do as they please; look after themselves; interact with other people; and move about without falling. The Clinical Frailty Scale brings that information together in one place. This paper is a guide for people new to the Clinical Frailty Scale. It also introduces an updated version (CFS version 2.0), with revised level names (e.g., "vulnerable" becomes "living with very mild frailty") and minor edits to level descriptions. The key points discussed are that the Clinical Frailty Scale assays the baseline state, it is not widely validated in younger people or those with stable single-system disabilities, and it requires clinical judgement. The Clinical Frailty Scale is now commonly used as a triage tool to make important clinical decisions such as allocating scarce health care resources for COVID-19 management; therefore, it is important that the scale is used appropriately.

Keywords: Clinical Frailty Scale; ageing; frailty.

Conflict of interest statement

Olga Theou declares that no conflicts of interest exist. CONFLICT OF INTEREST DISCLOSURES Kenneth Rockwood has asserted copyright of the Clinical Frailty Scale through Dalhousie University. Use is free for research, education, or not-for-profit care. (Users are asked not to change it or charge for its use.) In addition to academic and hospital appointments, he is President and Chief Science Officer of DGI Clinical, which in the last five years has contracts with pharma and device manufacturers (Baxter, Baxalta, Biogen, Shire, Hollister, Nutricia, Roche, Otsuka) on individualized outcome measurement. In 2017 he attended an advisory board meeting with Lundbeck. He is Associate Director of the Canadian Consortium on Neurodegeneration in Aging, which is funded by the Canadian Institutes of Health Research (CAN-137794), with additional funding from the Alzheimer Society of Canada and several other charities. He receives research support through grants from the Canadian Institutes of Health Research, the Canadian Frailty Network, the Nova Scotia Health Research Foundation, the Nova Scotia Health Authority Research Fund, the Dalhousie Medical Research Fund as the Kathryn Allen Weldon Professor of Alzheimer Research, and the Fountain Family Innovation Fund of the QEII Health Science Centre Foundation.

© 2020 Author(s). Published by the Canadian Geriatrics Society.

Figures

FIGURE 1
FIGURE 1
The Clinical Frailty Scale (CFS) version 2.0

References

    1. World Health Organization. Ethical considerations in developing a public health response to pandemic influenza. Geneva, Switzerland: WHO; 2007. [Accessed May 3 2020]. .
    1. Rockwood K. Medical management of frailty: confessions of a gnostic. CMAJ. 1997;157(8):1081–84.
    1. Rockwood K, Howlett SE. Age-related deficit accumulation and the diseases of ageing. Mech Ageing Dev. 2019;180:107–16. doi: 10.1016/j.mad.2019.04.005.
    1. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95. doi: 10.1503/cmaj.050051.
    1. Theou O, Squires E, Mallery K, et al. What do we know about frailty in the acute care setting? A scoping review. BMC Geriatr. 2018;18(1):139. doi: 10.1186/s12877-018-0823-2.
    1. Hatheway OL, Mitnitski A, Rockwood K. Frailty affects the initial treatment response and time to recovery of mobility in acutely ill older adults admitted to hospital. Age Ageing. 2017;46(6):920–25.
    1. Boccardi V, Ruggiero C, Mecocci P. COVID-19: a geriatric emergency. Geriatrics (Basel) 2020;5(2):E24. doi: 10.3390/geriatrics5020024.
    1. Romero-Ortuno R, Wallis S, Biram R, et al. Clinical frailty adds to acute illness severity in predicting mortality in hospitalized older adults: an observational study. Eur J Intern Med. 2016;35:24–34. doi: 10.1016/j.ejim.2016.08.033.
    1. Pulok M, Theou O, van der valk A, et al. The role of illness acuity on the association between frailty and mortality in Emergency Department patients referred to internal medicine. Age Ageing. 2020 May 11;:afaa089. doi: 10.1093/ageing/afaa089. Published online ahead of print. Correction in Age Ageing 2020 Jul 24:afaa153. Published online ahead of print.
    1. Bhatraju PK, Ghassemieh BJ, Nichols M, et al. Covid-19 in critically ill patients in the Seattle region—case series. N Engl J Med. 2020 doi: 10.1056/NEJMoa2004500. NEJMoa2004500. Published online ahead of print, 2020 Mar 30.
    1. National Institute for Health and Care Excellence. COVID-19 rapid guidelines: critical acre in adults (update 27 March 2020) London, UK: NICE; 2020. .
    1. The Swiss Society of Emergency and Rescue Medicine. COVID-19: Prehospital triage and care under resource scarcity in the hospital sector. Geneva, Switzerland: SSERM; 2020. V2.0-EN / 06.04.2020. .
    1. Perez-Zepeda MU, Godin J, Armstrong JJ, et al. Frailty among middle-aged and older Canadians: Population norms for the Frailty Index using the Canadian Longitudinal Study on Aging. and Ageing. (in press)
    1. Golding-Day M, Whitehead P, Radford K, et al. Interventions to reduce dependency in bathing in community dwelling older adults: a systematic review. Syst Rev. 2017;6(1):198. doi: 10.1186/s13643-017-0586-4.
    1. Hill AD, Stukel TA, Fu L, et al. Trends in site of death and health care utilization at the end of life: a population-based cohort study. CMAJ Open. 2019;7(2):E306–E315. doi: 10.9778/cmajo.20180097.
    1. Varshney N. COVID-19 and ethical critical care triage—utilizing this period to further knowledge translation of frailty and ICU evidence during a pandemic and beyond. Can Geriatr Soc CME J. 2020;10(1) Available from: .
    1. Rockwood K, Dykes L. Communicating an ethical basis for decision-making in relation to frailty and allocation of scarce resources in the COVID-19 pandemic. Can Geriatr Soc CME J. 2020;10(1) .
    1. Theou O, Andrew M, Ahip SS, et al. The Pictorial Fit-Frail Scale: developing a visual scale to assess frailty. Can Geriatr J. 2019;22(2):64–74. doi: 10.5770/cgj.22.357.
    1. Rockwood K, Theou O, Fay S, et al. Top Tips to help you use the Clinical Frailty Scale. [Accessed on July 28, 2020]. Available from: .
    1. Acute Frailty Network. Clinical Frailty Scale App. [Accessed on July 28, 2020]. Available from: .
    1. AIMS Research Group. Clinical Frailty Scale Training Module. [Accessed on July 28, 2020]. Available from:
    1. Moloney E, Ahern E, O’Caoimh R. Clinical Frailty Scale Education Tool. [Accessed on July 28, 2020]. Available from: .
    1. Hubbard RE, Maier AB, Hilmer SN, et al. Frailty in the face of COVID-19. Age Ageing. 2020 Jul 1;49(4):499–500. doi: 10.1093/ageing/afaa095.
    1. Montero-Odasso, Hogan DB, Lam R, et al. Age alone is not adequate to determine health-care resource allocation during the COVID-19 pandemic. Can Geriatr J. 2020;23:152–54. doi: 10.5770/cgj.23.452.

Source: PubMed

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