Selected frailty assessment tool summaries
| CFS | Definition: The CFS is an ordinal, hierarchical nine-item person-assessed scale where patients score more highly if more frail. The scale scores run between 1 (‘very fit’) and 9 (‘terminally ill’) with each score having a picture and succinct written definitions This tool is recommended for use in clinical practice by Healthcare Improvement Scotland (HIS). Personnel: Vascular surgeon, patient and proxy if present will complete. In the unlikely event where the surgeon is unwilling or unable to provide the frailty assessment score for the patient, another investigator will score the patient instead. Where relevant, non-completion of frailty assessment by surgeon/patient/proxy, and the reason why, will be recorded. Training requirement: While not necessary, there is a short online module available to develop understanding in how the CFS is applied. To ensure internal rigour, clinician’s contributing to this study will be requested to complete this training. Duration: It is expected this tool will take <1 min for clinicians once they are familiar with the tool. For patient’s or proxy’s completing the tool, it is expected this will take 5 min. Application: A copy of the CFS chart will be available in the outpatient department. At the end of the clinic, the consultant will be approached by one of the research team and asked to score included patients. For patients/proxy’s a modified CFS chart will be displayed at the end of their clinic appointment. The patient/proxy will be asked to read each the definition for each score (1–8) before selecting the one they feel most accurately describes them. To reduce the risk of bias, the title and image for each score will be hidden from patient/proxy, leaving only the text description. Modifications for study: A CFS score of 9 describes a terminally ill patient, regardless of frailty status. As this is not relevant to this trial, and to reduce the risk of participants becoming upset, this score will not be considered by this trial and therefore not displayed to the participant. |
| mFI-11 | Definition: This frailty index assessment is based on the frailty theory of cumulative deficits.24 Healthcare records are accessed to determine the presence, or absence, of 11 variables across multiple domains (non-independent function status, cognitive impairment and the following co-morbidities: congestive cardiac failure, myocardial infarction, previous percutaneous coronary intervention/cardiac surgery or angina, hypertension, diabetes mellitus, severe chronic obstructive pulmonary disease/active pneumonia, peripheral arterial disease, stroke/transient ischaemic attack without residual neurological deficit or with deficit). Each variable is scored 1 point when present with the end score divided by the total number of variables (11), giving a score between 0 and 1. The greater the value, the greater the risk of frailty. Personnel: A member of the research team will complete this assessment. Where relevant, non-completion of frailty assessment by surgeon/patient/proxy, and the reason why, will be recorded Training requirement: No training required for application. Duration: This tool has been piloted and found to take <5 min per participant to derive from electronic health record. Application: This is a frailty index which is calculated by extracting relevant data through accessing National Health Service (NHS) electronic records. Modifications for study: Nil. |
| FiND | Definition: This is a 5-item self-assessment questionnaire. The first two questions relate to disability while the remaining three relate to frailty. Patients reporting one or more of the three frailty symptoms, in the absence of disability, are defined as frail. The scale’s design reflects principles of the Fried frailty phenotype which defines frailty as the presence of three or more of the following energy-negative components: unintentional weight loss (‘shrinking’), poor grip strength, exhaustion, slowness and low physical activity levels.25 This questionnaire is recommended for use by HIS. The original questionnaire uses metric measurements of distance and weight, an imperial conversion will be added to relevant parts of the questionnaire to assist with patient comprehension. Personnel: The patient, and proxy if present, will be completing the questionnaire themselves. Training requirement: No training required for application. Duration: The questionnaire takes 2 min to complete. Application: A copy of the FiND will be displayed to the patient/proxy at the end of their clinic. They will be asked to read each of the 5 items closely and select the option that most accurately describes their situation (scoring either 0 or 1 per point). Modifications for study: Nil. |
| HIS ‘Think Frailty’ FRAIL assessment | Definition: This is a five-item frailty screening tool which has been developed by HIS and is currently recommended to be used in all unscheduled older adult admissions. The format is based on the theory of cumulative deficits across multiple domains (function, cognition, social). It’s selection, in part, is due to the novel aspect of this tool not considering co-morbidity as part of the assessment. The five questions include: - Functional impairment - Resident in care home - Altered mental state such as delirium or dementia - Immobility/Instability - Living at home with support on a daily basis Personnel: The consultant leading the clinic will be asked to complete the HIS FRAIL assessment. In the unlikely event where the surgeon is unwilling or unable to provide the frailty assessment score for the patient, a member of the research team will score the patient instead. Non-completion of frailty assessment by surgeon will be recorded. Training requirement: No training required for application. Duration: Completion of the HIS tool takes <2 min. Application: A copy of the HIS FRAIL chart will be available in the outpatient department. At the end of clinic, the consultant will be approached by the chief investigators and asked to score included patients. Modifications for study: Nil. |
| ICE | Definition: Also known as the ‘end of bed test’. Clinicians will report a subjective and binary assessment of the patient; ‘frail’ or ‘non-frail’. Personnel: The consultant leading the clinic will be asked to provide an ICE. In the unlikely event where the surgeon is unwilling or unable to provide the frailty assessment score for the patient, a clinical member of the research team will score the patient instead. Non-completion of frailty assessment by surgeon will be recorded. Training requirement: No training required for application. Duration: This assessment takes part as routine practice during a clinical interaction between clinician and patient. No additional time is required. Application: The consultants will be approached at the end of the clinic and asked to provide their subjective opinion (ICE) on patient’s frailty status to the chief investigator. This assessment will be performed first to minimise bias in clinician responses from completing alternate assessments prior. Modifications for study: Nil. |
CFS, Clinical Frailty Scale; FiND, Frailty non-Disabled Questionnaire; HIS, Healthcare Improvement Scotland; ICE, Initial Clinical Evaluation; mFI-11, 11-item Modified Frailty Index.