Unifying Concepts

Clinical Frailty Scale (CFS)

The general notion of frailty is widely understood to be a state of increased vulnerability to stressors, following age-related declines in function and reserves across multiple physiological systems. Frailty is clinically characterised by slower and/or incomplete recovery from stressors such as infection, injury, surgery or psychosocial distress.

Rockwood Clinical Frailty Scale

  1.  Very Fit: People who are robust, active, energetic and motivated. These people commonly exercise regularly. They are among the fittest for their age.
  2. Well: People who have no active disease symptoms but are less fit than category 1. Often, they exercise or are very active occasionally, e.g. seasonally.
  3. Managing Well: People whose medical problems are well controlled, but are not regularly active beyond routine walking.
  4. Vulnerable: While not dependent on others for daily help, often symptoms limit activities. A common complaint is being “slowed up”, and/or being tired during the day.
  5. Mildly Frail: These people often have more evident slowing, and need help in high order Instrumental Activity of Daily Living (IADLs) (finances, transportation, heavy housework, medications). Typically, mild frailty progressively impairs shopping and walking outside alone, meal preparation and housework.
  6. Moderately Frail: People need help with all outside activities and with keeping house. Inside, they often have problems with stairs and need help with bathing and might need minimal assistance (cuing, standby) with dressing.
  7. Severely Frail: Completely dependent for personal care, from whatever cause (physical or cognitive). Even so, they seem stable and not at high risk of dying (within ~ 6 months).
  8. Very Severely Frail: Completely dependent, approaching the end of life. Typically, they could not recover even from a minor illness.
  9. Terminally Ill: Approaching the end of life. This category applies to people with a life expectancy <6 months, who are not otherwise evidently frail.

Scoring frailty in people with dementia

The degree of frailty corresponds to the degree of dementia.

  • Common symptoms in mild dementia include forgetting the details of a recent event, though still remembering the event itself, repeating the same question/story and social withdrawal.
  • In moderate dementia, recent memory is very impaired, even though they seemingly can remember their past life events well. They can do personal care with prompting.
  • In severe dementia, they cannot do personal care without help.



  1. Church S, Rogers E, Rockwood K, Theou O. A scoping review of the Clinical Frailty Scale. BMC Geriatr. 2020 Oct 7;20(1):393. [Medline]
  2. Martin FC, O’Halloran AM. Tools for Assessing Frailty in Older People: General Concepts. Adv Exp Med Biol. 2020;1216:9-19. [Medline]


Created Jul 20, 2022.

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