Lightning Learning: Clinical Frailty Score in the ED
STOP!
At the Leicester Royal Infirmary, 2/3rds of the patient population presenting to the ED are older and frail. They are our everyday “bread and butter” and can present with any of the following geriatric syndromes: delirium, falls, polypharmacy, mobility and continence problems.
Identification of frailty helps to improve both long and short term healthcare provisions for these patients. As such, they will require a more in-depth comprehensive geriatric assessment where possible.
NOTE: Early recognition of frailty is important in planning and tailoring any intervention(s).
LOOK
The Clinical Frailty Score (CFS)
This can be undertaken by any appropriately trained healthcare professional. This score directly correlates with adverse outcomes: the higher the CFS, the higher the associated morbidity and mortality of the patient.
The Clinical Frailty Scale app can be downloaded for iPhone or Android smartphones via the Acute Frailty Network website.
NOTE: The CFS should reflect the patient’s capabilities TWO WEEKS AGO, not right now.
Don’t let the pictures on the typical Rockwood Clinical Frailty Scale misguide you, use the app to accurately score your patients!
LEARN
Take a stepwise approach…
- Is the patient frail?
- If YES, what is the CFS?
- Have we involved the patient, family, NOK?
- What is the outcome that matters to the patient?
Aim to discuss these cases with seniors, family members and carers. To learn more about frailty as a concept, watch the following video by Dr Jay Banerjee and links below…
References
Linda P. Fried, Catherine M. Tangen, Jeremy Walston, Anne B. Newman, Calvin Hirsch, John Gottdiener, Teresa Seeman, Russell Tracy, Willem J. Kop, Gregory Burke, Mary Ann McBurnie, Frailty in Older Adults: Evidence for a Phenotype, The Journals of Gerontology: Series A, Volume 56, Issue 3, 1 March 2001, Pages M146–M157, https://doi.org/10.1093/gerona/56.3.M146
Kenneth Rockwood, Arnold Mitnitski, Frailty in Relation to the Accumulation of Deficits, The Journals of Gerontology: Series A, Volume 62, Issue 7, July 2007, Pages 722–727, https://doi.org/10.1093/gerona/62.7.722
Acute Frailty Network Webpage with Clinical Frailty Score Information: https://www.acutefrailtynetwork.org.uk/Clinical-Frailty-Scale
Simon Paul Conroy, Kharwar Ansari, Mark Williams, Emily Laithwaite, Ben Teasdale, Jeremy Dawson, Suzanne Mason, Jay Banerjee, A controlled evaluation of comprehensive geriatric assessment in the emergency department: the ‘Emergency Frailty Unit’, Age and Ageing, Volume 43, Issue 1, January 2014, Pages 109–114, https://doi.org/10.1093/ageing/aft087
British Geriatrics Society: Improving Healthcare for Older People website available at: https://www.bgs.org.uk
