The Clinical Frailty Scale grades an older person’s overall fitness or frailty from 1, very fit, to 9, terminally ill. It’s a clinical judgment of how they moved, managed daily life, thought, and felt in the two weeks before an illness, not a questionnaire. See how the level is judged, what each band means for care, and record it with the free template. Get the official version 2.0 from Dalhousie University.
CFS result template
FreeCLINICAL FRAILTY SCALE Date: [Date] Patient: [Name or ID, age] Setting: [Emergency department, admission, preoperative clinic, geriatric clinic, or home visit] Scored by: [Name, credentials] Form: [Official CFS version 2.0] BASELINE Reference point: [Usual state about 2 weeks before the acute illness began, or current usual state if not unwell] Information from: [Patient, family member, carer, care home staff, or records; name and relationship] LEVEL CFS level: [1 to 9, with its name on the official scale] Group: [Not frail, very mild frailty, mild to moderate frailty, or severe frailty to terminally ill] How the person appears today: [Same as baseline, or worse because of the acute illness, and how] REASONS FOR THE LEVEL Daily activities: [Household tasks, shopping, money, medicines, transport; bathing, dressing, toileting; what is done alone, with help, or by others] Mobility: [Walking aid, distance, stairs, rising from a chair, falls in the past year, time in bed or chair] Cognition: [Memory concerns, dementia diagnosis and stage, delirium now] Health conditions: [Main conditions, how well symptoms are controlled, number of regular medicines] Activity and self-rated health: [Exercise or daily activity, and how the person rates their health against others their age] USE IN THE PLAN Purpose: [Prognosis, goals-of-care conversation, surgical risk, discharge planning, or referral] What it informed: [Decisions made, alongside the acute illness, treatment options, and the wishes of the person] Discussed with: [Patient, family or named decision-maker, team members] Rescore: [After recovery, before discharge, or at the next review] Clinician: [Name, credentials]
Use it for
Score the person as they were about two weeks before they became unwell. Acute illness makes fit people look frail, and few people recover beyond where they were then.
Avoid: Scoring the person in the bed. A confused, bedbound patient with pneumonia may have been walking to the shops two weeks ago.
The developers’ guidance asks how the person moved, managed daily activities, thought, and felt about their health over those two weeks.
Avoid: Counting a task the person never did as a loss. Someone whose spouse has always done the banking isn’t dependent for it now.
Match what you’ve learned to the official descriptions and pick the one level that fits best. It takes judgment, not arithmetic.
Avoid: Writing down whatever the patient says. The level combines what you hear, what you see, and what people who know the person tell you.
The CFS measures the frailty that builds up with age. It was developed and validated in people 65 and older.
Avoid: Turning a lifelong disability into a high frailty level. It doesn’t carry the prognosis that frailty from aging does.
The level informs prognosis, goals of care, and planning, together with how sick the person is now and what they want.
Avoid: Using the level as the only reason to withhold treatment, intensive care, or resuscitation. It’s one input to a decision made with the person, never the decision.
Each one follows the recording template. Use them to judge how much to write.
Medical ward, first day of admission from the emergency department
Her usual state two weeks before the cough began. Information from her daughter, who visits most days, and the home care agency’s care plan. The patient is drowsy and confused today and couldn’t give a history.
CFS 6, living with moderate frailty, on version 2.0. Group: mild to moderate frailty. Today she looks like an 8: in bed, needing help to turn and to drink, with delirium. That is the pneumonia, not her baseline.
84-year-old woman living alone in a ground-floor apartment. Daily activities: her daughter does the shopping and banking, meals are delivered, and an aide helps her shower twice a week; she dresses and uses the toilet on her own. Mobility: walker indoors, no longer goes out alone, one fall in the summer. Cognition: mild Alzheimer’s disease for 2 years, on donepezil. Conditions: heart failure with preserved ejection fraction, atrial fibrillation on apixaban, and knee osteoarthritis; 9 regular medicines.
Talked through with her daughter, her named decision-maker, alongside a CURB-65 of 3 and what she told her family doctor last year about not wanting life support. Agreed: IV antibiotics, oxygen, and fluids on the ward; no intensive care, intubation, or CPR. Delirium care started. Physical and occupational therapy from day 2. Rescore before discharge; more home support likely.
Preoperative assessment clinic, 3 weeks before a laparoscopic right hemicolectomy
Current usual state; no recent illness. Information from the patient, his wife, who came with him, and his family doctor’s referral letter.
CFS 3, managing well, on version 2.0. Group: not frail.
72-year-old retired electrician, lives with his wife in a house with stairs. Daily activities: independent in all of them, including driving, money, his own medicines, and gardening. Mobility: no aid, climbs a flight of stairs without stopping, walks the dog about 20 minutes a day but does no other exercise. Cognition: no concerns from him or his wife; Mini-Cog 5. Conditions: type 2 diabetes with an A1c of 7.2%, blood pressure controlled on two medicines, and knee pain after long walks; 5 regular medicines. Rates his health as good for his age.
Not frail: standard enhanced recovery pathway, with no geriatric co-management needed. Anesthesia review for his diabetes only. Discharge home expected on day 2 or 3. Level recorded as his baseline to compare against if complications slow his recovery. Advised to keep walking daily before surgery.
An acute illness can make a level 3 look like a level 7. Score how the person was two weeks before it began, and say where that information came from.
A confused or very ill patient can’t give a reliable baseline. Ask family, carers, or care home staff, and check the records.
In younger adults and in people with one stable disability, a high level doesn’t carry the prognosis it does in age-related frailty. Describe their function instead.
The CFS informs prognosis and goals of care. Decisions about intensive care, surgery, or resuscitation also need the acute illness, the options, and what the person wants.
A bare “CFS 6” can’t be checked or compared later. Note the baseline date, the source, and the function, mobility, and cognition behind the level.
Vero Scribe records the CFS result in your template from the visit, with the patient’s consent, or from your dictation: the baseline, who told you, the level and the reasons for it, and how it shaped the plan. You review and edit every line, then copy it into your record. Vero works in 60+ languages.
It’s a 9-level scale that sums up an older person’s overall fitness or frailty, from 1, very fit, to 9, terminally ill. A clinician chooses the level after assessing the person, using judgment and what the person and their family report. Dr. Kenneth Rockwood and colleagues at Dalhousie University published it in 2005; the current version, 2.0, came out in 2020.
There’s nothing to add up. Find out how the person moved, managed daily activities, thought, and felt about their health about two weeks before any acute illness, from them and from someone who knows them. Then pick the level on the official scale that fits best; if two fit equally well, choose the higher one. Level 9 is the only level scored on the person’s current state.
Levels 1 to 3 are not frail, level 4 is living with very mild frailty, and 5 or more is the usual cutoff for frailty: 5 mild, 6 moderate, 7 severe, 8 very severe, and 9 terminally ill. Some studies and services count 4 or more as frail, so record the level itself, not only “frail” or “not frail.”
It was developed and validated in people 65 and older, and it’s largely unvalidated in younger adults, so use it there with caution and never on its own. It shouldn’t be used for disability from one stable condition, such as a spinal cord injury, cerebral palsy, or a learning disability, because a high level wouldn’t mean the same thing for prognosis.
The level usually follows the stage of dementia: mild dementia fits level 5, moderate level 6, and severe level 7. Use the stage at baseline, not the confusion of a delirium from a new illness, and still check function and mobility, which can place the person higher.
A frailty index counts health problems from a long list and divides by the number checked, for a score from 0 to 1. The frailty phenotype measures five things: weight loss, exhaustion, low activity, slow walking, and weak grip. The CFS is quicker than both: one clinical judgment with no equipment, which is why emergency and hospital teams use it.
The developers’ guidance says any licensed or registered health care professional who has assessed the person, such as a physician, nurse, occupational or physical therapist, social worker, or psychologist. New raters can check their scores with the classification tree on the official site, and with an experienced colleague when unsure.
The CFS is copyrighted by Dr. Rockwood and Geriatric Medicine Research at Dalhousie University. Clinical care, teaching, and research that isn’t for profit are usually free once you send a permission request on their site; commercial use needs a license. Get the official version 2.0, its guidance, and translations from the Dalhousie CFS page. The recording template here is free to copy or download.
Ten-year probability of a major osteoporotic fracture and of a hip fracture, from 12 inputs, with or without bone density.
Six nursing items that predict a patient’s risk of falling in hospital, scored 0 to 125: the higher the total, the higher the risk.
Stand, walk 3 meters, turn, walk back, and sit: a timed test of mobility and fall risk, with 12 seconds as the usual flag.
Fourteen balance tasks, from sitting to standing on one leg, scored 0 to 56: the higher the total, the better the balance.
A scored frailty test across nine domains, with a clock drawing and a timed up and go, totaled 0 to 17 from not frail to severe frailty.
History, risk assessment, and the plan before surgery, with frailty alongside.
Notes for frailty, falls, memory, and goals-of-care visits.
Admission notes, daily progress, and discharge planning on the ward.
Every tool, by area, with what its scores mean.
Vero records scores, findings, and plans in the templates you choose, so you review instead of type.
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