Frailty and Comprehensive Geriatric Assessment (CGA)

Frailty Phenotype (Fried Criteria)

•    Defines frailty as a clinical syndrome of decreased reserve and resistance to stressors

•    ≥3/5 criteria = frail; 1–2 = prefrail

Criteria

1.    Unintentional weight loss

o    5% of body weight over 1 year

o    Reflects sarcopenia and nutritional decline

2.    Weakness

o    Reduced grip strength (measured with dynamometer)

o    Sex- and BMI-adjusted cut-offs used

3.    Exhaustion

o    Self-reported low energy or fatigue

4.    Slow walking speed

o    Typically gait speed <0.8 m/s (over 4 m)

5.    Low physical activity

o    Decreased energy expenditure; assessed via questionnaires

Rockwood Clinical Frailty Scale

•    Practical global measure of frailty based on clinical judgement

•    Scores from 1 (very fit) to 9 (terminally ill)

•    Key grades:

o    1: Very fit (robust, active)

o    4: Vulnerable (not dependent but slowing down)

o    5: Mildly frail (need help with higher-order IADLs: finances, heavy housework)

o    6: Moderately frail (need help with all outside activities and some inside activities)

o    7: Severely frail (completely dependent for personal care)

o    8: Very severely frail (completely dependent, approaching end of life)

o    9: Terminally ill (life expectancy <6 months)

Comprehensive Geriatric Assessment (CGA)

Definition

•    Multidisciplinary diagnostic and therapeutic process to determine an older person's medical, psychosocial, and functional capabilities to develop a coordinated plan

Domains

1️⃣ Medical

•    Review of comorbidities

•    Polypharmacy → STOPP/START criteria

•    Falls, sensory impairment

•    Pain assessment

2️⃣ Functional

•    Basic activities of daily living (ADLs): bathing, dressing, feeding, toileting, transferring

•    Instrumental activities of daily living (IADLs): shopping, cooking, managing finances, medications

3️⃣ Psychological

•    Cognitive assessment: MMSE, MoCA, AMTS

•    Depression screening: GDS (Geriatric Depression Scale)

4️⃣ Social

•    Home environment, support networks

•    Carer stress

•    Risk of abuse or neglect

5️⃣ Nutritional

•    BMI

•    Recent unintentional weight loss

•    Nutritional screening tools (e.g., MUST)

Clinical Implications

•    Identifies reversible factors contributing to decline

•    Reduces risk of hospitalisation, institutionalisation, and mortality

•    Improves functional outcomes and quality of life

•    Helps inform advance care planning and goal-setting

Extra Revision Pearls

•    Frailty ≠ age alone — reflects reduced physiological reserve, not just chronological age

•    CGA should be iterative — not a one-time event

•    Sarcopenia is both a cause and consequence of frailty

•    Functional decline often precedes clinical decompensation — early detection crucial