{"id":15544,"date":"2023-05-30T15:13:42","date_gmt":"2023-05-30T14:13:42","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=15544"},"modified":"2026-10-26T15:22:22","modified_gmt":"2026-10-26T15:22:22","slug":"frailty","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/medicineoftheelderlygeriatrics\/frailty\/","title":{"rendered":"Frailty"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">When the clinical state of Frailty is present a person has decreased physiological reserve across multiple systems, with an increased vulnerability to stressors such as illness or injury. Those living with Frailty are vulnerable to significant changes in their health and function, often suddenly, in response to stressors. For those living with Frailty there is an increased risk of falls, hospitalisation, and loss of independence. Those living with Frailty are at increased risk of adverse effects from medication.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Frailty is not the same as aging, and many older people are active and resilient. However, the risk of developing Frailty increases significantly with age, and with demographic shifts seeing a rising proportion of older adults, it is an increasingly important focus of Healthcare. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It is important to identify Frailty when it is present. Early identification of Frailty leads to improved outcomes. Identification of Frailty allows HCPs to undertake evidence-based interventions such as Polypharmacy reviews to help reduce and mitigate harm from medication, and to engage in Future Care Planning (FCP). Identification of Frailty allows clinicians to provide care that is patient centred, for example by contextualising Chronic Disease Management in a way that takes into account an individual\u2019s Frailty.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Identifying Frailty<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">There are different approaches to identifying Frailty, some of which have been outlined in Local and National Enhanced Services.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Age based assessment<\/strong><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Ageing does not equal Frailty; however, the prevalence of Frailty significantly increases with longevity. It is however important to be aware that Deprivation has a significant effect on an individual\u2019s likelihood of developing Frailty. Those who are in the most deprived SIMD categories are more likely to have an <strong>earlier onset of frailty and faster progression of Frailty<\/strong>.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Frailty Phenotype<\/strong> &#8211; Usually those living with Frailty have three or more of these five symptoms:<ul><li>Muscle weakness<\/li><\/ul><ul><li>Fatigue<\/li><\/ul><ul><li>Unintentional weight loss (10lbs or more in the past year)<\/li><\/ul><ul><li>Low levels of physical activity<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>Slow walking speed<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Frailty Syndromes<\/strong> &#8211; the following presentations can be an indicator of Frailty:<ul><li>Falls<\/li><\/ul><ul><li>Immobility (e.g. sudden change in mobility)<\/li><\/ul><ul><li>Delirium<\/li><\/ul><ul><li>Incontinence (e.g. change in continence)<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>Susceptibility to side effects of medication<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Associated Health Conditions and Social Indicators<\/strong> \u2013 Frailty is more common in those with pre-existing multimorbidity, with specific associations with the following:<ul><li>2 or more long term conditions<\/li><\/ul><ul><li>Visual impairment<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>Cognitive impairment \/ diagnosis of Dementia<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Other Indicators that Frailty should be assessed for:<\/strong><ul><li>Polypharmacy of ten or more medications<\/li><\/ul><ul><li>Increasing Care Needs including moving into a Care Home<\/li><\/ul><ul><li>Information recorded on Secondary Care clinic or discharge letters<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>Needing Home Visits for Primary Care<\/li>\n\n\n\n<li>Referral to MOE and\/or Hospital at Home services<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Frailty Assessment<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">In NHS Lothian the agreed tool for assessing and coding frailty is the <a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/MoE-HatH-Rockwood-Clinical-Frailty-Scale-April-2020.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Rockwood Clinical Frailty Scale<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This is a link to a training module on the CFS: <a href=\"https:\/\/www.scfn.org.uk\/clinical-frailty-scale-training\" target=\"_blank\" rel=\"noreferrer noopener\">CFS Training \u2014 Specialised Clinical Frailty Network<\/a> When an assessment has been made, it is important that this is coded on the Primary Care Clinical System.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Frailty Interventions<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Future Care Planning<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The following may be helpful when Future Care Planning for those identified as living with Frailty:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/services.nhslothian.scot\/futurecareplanning\/gp-practice-teams\/\" target=\"_blank\" rel=\"noreferrer noopener\">NHS Lothian Website: GP Practice Teams \u2013 Future Care Planning \/ Anticipatory Care Planning<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/services.nhslothian.scot\/futurecareplanning\/care-homes\/\" target=\"_blank\" rel=\"noreferrer noopener\">NHS Lothian Website: Care Homes \u2013 Future Care Planning \/ Anticipatory Care Planning<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/services.nhslothian.scot\/futurecareplanning\/\" target=\"_blank\" rel=\"noreferrer noopener\">NHS Lothian Website: Future Care Planning \/ Anticipatory Care Planning \u2013 can be shared with patients<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.spict.org.uk\/wp-content\/uploads\/sites\/74\/2026\/06\/SPICT-2026.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Supportive and Palliative Care Indicators Tool (SPICT)<\/a><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Polpharmacy<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The following may be helpful when assessing Polypharmacy in those identified as living with Frailty:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.gov.scot\/binaries\/content\/documents\/govscot\/publications\/advice-and-guidance\/2026\/03\/polypharmacy-guidance-appropriate-prescribing-making-medicines-safe-effective-sustainable-2026-2029\/documents\/polypharmacy-guidance-appropriate-prescribing\/polypharmacy-guidance-appropriate-prescribing\/govscot%3Adocument\/polypharmacy-guidance-appropriate-prescribing.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Polypharmacy Guidance: Appropriate Prescribing<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.acbcalc.com\/\" target=\"_blank\" rel=\"noreferrer noopener\">Anticholinergic Burden Calculator<\/a><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>MOE Referral<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Please follow the link to see the available <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/medicine-of-the-elderly-local-services\/\" target=\"_blank\" rel=\"noreferrer noopener\">Medicine of the Elderly Services<\/a> in your locality<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Specialty Specific Guidance for those living with Frailty<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/diabetes-frailty\/\" target=\"_blank\" rel=\"noreferrer noopener\">Diabetes &amp; Frailty \u2013 RefHelp<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/lipids#tab-group-tab-2#Elderly\" target=\"_blank\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/lipids#tab-group-tab-2#Elderly\" rel=\"noreferrer noopener\">Lipid-lowering medication in specific patient groups: Prescribing in older patients<\/a><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>J.B. &amp; A.C. &#8211; 17-9-26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\"><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\"><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/MoE-HatH-Rockwood-Clinical-Frailty-Scale-April-2020.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Rockwood Clinical Frailty Scale Summary<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/frailty-questionnaire-self-CFS-july-27.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Frailty self-assessment questionnaire<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Frailty_Information_Resource.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Ageing Well: Information on Frailty PDF Leaflet<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/FRAILTY-POSTER.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Ageing Well: Information on Frailty Summary PDF Poster<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/services.nhslothian.scot\/futurecareplanning\/gp-practice-teams\/\" target=\"_blank\" rel=\"noreferrer noopener\">NHS Lothian Website: GP Practice Teams \u2013 Future Care Planning \/ Anticipatory Care Planning<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/services.nhslothian.scot\/futurecareplanning\/care-homes\/\" target=\"_blank\" rel=\"noreferrer noopener\">NHS Lothian Website: Care Homes \u2013 Future Care Planning \/ Anticipatory Care Planning<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/services.nhslothian.scot\/futurecareplanning\/\" target=\"_blank\" rel=\"noreferrer noopener\">NHS Lothian Website: Future Care Planning \/ Anticipatory Care Planning \u2013 can be shared with patients<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.spict.org.uk\/wp-content\/uploads\/sites\/74\/2026\/06\/SPICT-2026.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Supportive and Palliative Care Indicators Tool (SPICT)<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.gov.scot\/binaries\/content\/documents\/govscot\/publications\/advice-and-guidance\/2026\/03\/polypharmacy-guidance-appropriate-prescribing-making-medicines-safe-effective-sustainable-2026-2029\/documents\/polypharmacy-guidance-appropriate-prescribing\/polypharmacy-guidance-appropriate-prescribing\/govscot%3Adocument\/polypharmacy-guidance-appropriate-prescribing.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Polypharmacy Guidance: Appropriate Prescribing<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.acbcalc.com\/\" target=\"_blank\" rel=\"noreferrer noopener\">Anticholinergic Burden Calculator<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.bgs.org.uk\/sites\/default\/files\/content\/attachment\/2025-11-10\/BGS%20Pragmatic%20Prescribing%20-%20portrait_0.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">BGS Pragmatic Prescribing one page summary<\/a> \u2013 but please note that some specific targets vary local guidance such as that for <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/diabetes-frailty\/\" target=\"_blank\" rel=\"noreferrer noopener\">Diabetes &amp; Frailty &#8211; RefHelp<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.bgs.org.uk\/bgs-key-messages-frailty\" target=\"_blank\" rel=\"noreferrer noopener\">British Geriatric Society: Key Messages re Frailty<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.bgs.org.uk\/recognising-frailty\" target=\"_blank\" rel=\"noreferrer noopener\">British Geriatric Society: Recognising Frailty<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/academic.oup.com\/biomedgerontology\/article\/56\/3\/M146\/545770\" target=\"_blank\" rel=\"noreferrer noopener\">Journal Article: Frailty in Older Adults: Evidence for a Phenotype<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/academic.oup.com\/ageing\/article\/52\/5\/afad058\/7147101\" target=\"_blank\" rel=\"noreferrer noopener\">Journal Article: Frailty transitions and prevalence in an ageing population<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.thelancet.com\/journals\/lanpub\/article\/PIIS2468-2667(18)30091-4\/fulltext\" target=\"_blank\" rel=\"noreferrer noopener\">Journal Article: Frailty and pre-frailty in middle-aged and older adults and its association with multimorbidity and mortality<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>When the clinical state of Frailty is present a person has decreased physiological reserve across multiple systems, with an increased vulnerability to stressors such as illness or injury. Those living with Frailty are vulnerable to significant changes in their health and function, often suddenly, in response to stressors. For those living with Frailty there is<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":4118,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[939],"class_list":["post-15544","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-frailty"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/medicineofelderlygeriatrics\/https-apps-nhslothian-scot-refhelp-frailty\/\" rel=\"tag\">Frailty<\/a>","rttpg_excerpt":"When the clinical state of Frailty is present a person has decreased physiological reserve across multiple systems, with an increased vulnerability to stressors such as illness or injury. Those living with Frailty are vulnerable to significant changes in their health and function, often suddenly, in response to stressors. For those living with Frailty there is","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/15544","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=15544"}],"version-history":[{"count":6,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/15544\/revisions"}],"predecessor-version":[{"id":30567,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/15544\/revisions\/30567"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4118"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=15544"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=15544"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}