• 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
• 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)
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)
• 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
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Author & Educational Disclaimer
Author:
Dr Phillip Cockrell BM FRCP DipClinEd
Dr Phillip Cockrell is a UK Consultant Physician in Internal Medicine, currently working at Queen Alexandra Hospital, Portsmouth University Hospitals NHS Trust. He has previously worked as a registrar across Intensive Care Medicine, Gastroenterology, Cardiology, Stroke Medicine, Acute Medicine, and Respiratory Medicine.
He has held senior leadership roles including Associate Clinical Director of the Acute Medical Unit, Clinical Director of Internal Medicine, and Chief of Medicine. Dr Cockrell has over 15 years’ experience in postgraduate medical education, having lectured extensively across the MRCP syllabus and contributed to MRCP revision teaching and course development.
Dr Cockrell holds a Bachelor of Medicine (BM), Fellowship of the Royal College of Physicians (FRCP), and a Diploma in Clinical Education (DipClinEd). His teaching approach is based on structured consolidation of complex medical topics to support efficient and effective revision for postgraduate examinations.
Purpose of this content:
The material on this page is intended solely for educational purposes to support revision for the MRCP (UK) Part 1 examination. It reflects examination-relevant principles of internal medicine and is designed to aid learning and pattern recognition.
Medical disclaimer:
This content is designed for postgraduate medical examination revision and does not constitute medical advice, diagnosis, or treatment guidance and must not be used as a substitute for professional clinical judgement, local guidelines, or specialist consultation. Clinical decisions should always be made in the context of individual patient circumstances and current national guidance.
