CFS

 

🩺 Clinical Frailty Scale (CFS)

The Clinical Frailty Scale (CFS) was developed by Kenneth Rockwood and colleagues as part of the Canadian Study of Health and Aging.

It is a 9-point clinical judgment tool used to assess baseline frailty, especially in older adults and increasingly in ICU and acute care settings.

📊 CFS Scoring System (1–9)

Score	Category	Description
1	Very Fit	Robust, active, energetic
2	Well	No active disease symptoms
3	Managing Well	Medical problems well controlled
4	Vulnerable	Not dependent but symptoms limit activities
5	Mildly Frail	Needs help with higher-order IADLs (finances, transport)
6	Moderately Frail	Needs help with all outside activities and housework
7	Severely Frail	Completely dependent for personal care (stable)
8	Very Severely Frail	Completely dependent and approaching end of life
9	Terminally Ill	Life expectancy < 6 months (not otherwise evidently frail)

🔎 Key Features

• Based on baseline function 2 weeks before acute illness
• Quick to apply (usually <1 minute once familiar)
• Relies on clinical judgment rather than lab tests
• Validated for predicting:
  
• Mortality (including 1-year survival)
• ICU outcomes
• Hospital length of stay
• Institutionalization risk
• 
  

🧠 Why It Matters in ICU

In critical care:

• CFS independently predicts 30-day and 1-year mortality
• Adds prognostic value beyond severity scores (e.g., APACHE, SOFA)
• Supports goals-of-care discussions
• Helps frame realistic recovery expectations

This links directly to the concept in “The Long Shadow of Frailty” — long-term survival often reflects pre-ICU physiological reserve.

⚠️ Important Considerations

• Designed primarily for older adults (≥65 years)
• Should assess baseline state, not current acute illness
• Not a stand-alone triage tool
• Requires appropriate training for reliability

If you’d like, I can:

• Provide a visual memory aid for the 1–9 scale
• Explain differences between CFS and Fried frailty phenotype
• Discuss ethical considerations in ICU triage
• Provide example case scenarios using CFS