CLINICAL

GUIDE TO SCORING
CFS CATEGORIES
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.

FRAILTY SCALE
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
The Clinical Frailty Scale (CFS) is a 9-point clinical assessment common complaint is being “slowed up”,
tool designed to assist healthcare professionals in evaluating and/or being tired during the day.
5 Mildly Frail – These people often have more
a person’s frailty status across various clinical settings. evident slowing, and need help in high order
iADLs (finances, transportation, heavy
It serves to assist clinicians in identifying frailty, risk housework, medications). Typically, mild frailty
stratification, and guide clinical management. progressively impairs shopping and walking
outside alone, meal preparation and
housework.

IDENTIFYING PREMORBID FRAILTY STATUS 6 Moderately Frail – People need help with all
outside activities and with keeping house.
Inside, they often have problems with stairs
1. When hospitalized, it is important to identify a patient’s premorbid frailty status. and need help with bathing and might need
2. Premorbid frailty status should be a reflection of the patient’s overall health at minimal assistance (cuing, standby) with
least 2 weeks prior to their acute illness and/or functional decline. dressing.
7 Severely Frail – Completely dependent
for personal care, from whatever cause
(physical or cognitive). Even so, they seem

ANSWER THIS CFS SCORE

stable and not at high risk of dying (within
~6 months).
8 Very Severely Frail – Completely
dependent, approaching end of life.
Terminal cancer with <6 YES Typically, they could not recover even from
9) Terminally Ill
months prognosis? a minor illness.
9 Terminally Ill – Approaching the end of life.
NO This category applies to people with a life
Would you be NO 8) Very Severely Frail expectancy <6 months, who are not otherwise
YES surprised* if the evidently frail.
Dependent in ALL bADLs?
patient passes on in

Basic ADL (DE2ATH)

<6 months? YES 7) Severely Frail
NO

YES Dressing
Assisted in 1-5 bADLs? 6) Moderately Frail
NO
Eating (feeding self)
Independent in all bADLs YES
5) Mildly Frail
Evacuation (bladder/bowel)
BUT Assisted in ≥1 iADL?
Ambulation (walking/transfer)
NO
4) Vulnerable
Toileting
YES (Pre-Frail) Hygiene (bathing)
Symptoms limit usual
Chronic medical condition YES
activity OR feels
that requires medications?
“slowed down”?ǂ

NO
NO 3) Managing Well
Instrumental ADL
NO 2) Well
(SHAFT2)
Exercises regularly AND/OR
appears fitter compared to
Shopping
someone their own age?
YES 1) Very Fit Housekeeping
*If you are unsure of this question, consider the following: (i) repeated unplanned hospital admissions, (ii) any unstable or Accounting
rapidly worsening symptoms of chronic disease, and (iii) deteriorating activity and increasing need for support e.g. spending
more time in bed or chair compared to before. Food preparation
ǂDefined as constantly feeling tired during the day and/or having a decrease in usual pace of walking - self-reported or based

on assessor's evaluation. Transportation

REFERENCES: Takes own medications
1. Canadian Study on Health & Aging, Revised 2008.
2. Rockwood K. et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005; 173:489-495.
Guide to Scoring Clinical Frailty Scale. Version 2.0 (13th April 2018) Produced by the Department of Geriatric Medicine, Tan Tock Seng Hospital