This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
What is frailty?
Frailty is a state of reduced physiological reserve in which an older person becomes vulnerable to stresses such as an infection, a fall or a hospital stay. It is not the same as old age or disability: many people in their nineties are robust, and frailty can be prevented or partly reversed. In 2001, Linda Fried and colleagues defined a frailty phenotype with five measurable criteria, based on the Cardiovascular Health Study of more than 5,000 adults aged 65 and over.
The five criteria
- Unintentional weight loss: 10 lb (4.5 kg) or more, or 5% of body weight, in the past year.
- Exhaustion: answering “a moderate amount of the time” or “most of the time” to either of two questions: “I felt that everything I did was an effort” or “I could not get going”, in the past week.
- Weakness: grip strength in the lowest 20%, adjusted for sex and BMI, for example 29 kg or less for a man with a BMI of 24 or less, and 17 kg or less for a woman with a BMI of 23 or less.
- Slowness: time to walk 15 feet in the slowest 20%, 7 seconds or more for shorter people and 6 seconds or more for taller ones.
- Low physical activity: energy spent on leisure activity in the lowest 20%, under 383 kcal a week in men and 270 kcal in women.
Interpreting the score
| Criteria | Category |
|---|---|
| 0 | Robust |
| 1 – 2 | Prefrail |
| 3 – 5 | Frail |
In the original study, frail participants were two to three times more likely to fall, become disabled, be hospitalized or die over the following years.
Example
An 82-year-old who often feels that everything is an effort and has a weak grip, but walks at a normal pace, has not lost weight and gardens regularly meets 2 criteria: prefrail. This is the right time to act.
What helps
- Exercise, especially resistance and balance training two to three times a week, is the most effective intervention.
- Nutrition: enough energy and about 1 to 1.2 g of protein per kg of body weight a day, with vitamin D if levels are low.
- Medication review, to reduce drugs that cause drowsiness, falls or weight loss.
- Treating the causes: heart failure, depression, anemia, thyroid disease, poor vision or hearing.
Other tools
The Clinical Frailty Scale, a 9-point visual scale, is quicker in hospitals. Simple tests such as gait speed, under 0.8 m/s, or the Timed Up and Go are also strong predictors.