Welcome to the Frailty Assessment Instruments Database, which catalogs instruments that have been used to assess frailty status in the research literature. This website stems from a review project that was initiated in 2013 and published in 2016: "Frailty assessment instruments: systematic characterization of the uses and contexts of highly-cited instruments." Ageing Research Reviews (2016). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4806795/ . We continue to update this database to provide a resource for researchers and clinicians who seek guidance on which frailty assessment instrument to use. Please contact us at frailtyresearch@jhu.edu with any questions or comments. Thank you.

Keyword Search:
Frailty InstrumentSeed PublicationNumber of citing articles, through Dec 2013 (from Web of Science)ItemsScoring
Physical Frailty Phenotype (commonly called the frailty phenotype, Fried phenotype, or CHS frailty phenotype)
  
Fried LP, et al, J. Gerontol. A. Biol. Sci. Med. Sci, 2001 Link
1891
 
Walking Speed (measured walking tests)
Activity (physical activity questionnaire)
Weight Loss (unintentional weight loss)
Exhaustion (questions on energy expenditure)
Grip Strength (measured grip strengths tests)
Score range: 0 to 5. Frail = =3 criteria present; Intermediate/pre-frail = 1-2 criteria present Robust = 0 criteria present
Deficit Accumulation Index (commonly called the Frailty index)
  
Mitnitski AB, et al, ScientificWorldJournal, 2001 Link
Mitnitski AB, et al, J Gerontol A Biol Sci Med Sci, 2004 Link
Rockwood K, et al, J Am Geriatr Soc, 2006 Link
Rockwood K et al, J Gerontol A Biol Sci Med Sci, 2007 Link
Rockwood K & Mitnitski A, J Gerontol A Biol Sci Med Sci, 2007 Link
401
 
Diseases, ADLs, health attitudes and values, signs
Symptoms from clinical and neurological exams
For a full list:
http://myweb.dal.ca/amitnits/
CSHAclinical-variables.jpg
Number of deficits present and divided by the number of deficits taken into consideration. Higher proportion equates to a higher level of frailty.
Gill Frailty Measure
  
Gill TM, et al, N Engl J Med, 2002 Link
254
 
Gait speed
Chair stand
Moderately frail if rapid gait speed back and forth over 10ft course is >10s; or could not stand from the chair. Severely frail if meet both criteria. Non frail if can complete both tasks.
Frailty / Vigor assessment
  
Speechley M & Tinetti M, J Am Geriatr Soc, 1991 Link
246
 
Frail:
age (over 80)
decreased / abnormal physical function
infrequent physical activity
psychological function (depressed)
medications (taking sedatives)
lower extremity disability
sensory function (near vision loss)
Vigorous:
age (under 80)
frequent physical activity
cognitively intact
sensory function (good near vision)
Score ranges: Frail 0-9 Vigorous 0-4 Frail: =4 frail values and =1 vigor value Vigorous: =3 vigor values and =2 frail values Transitional: having median values for either or both frail (3) and vigor
Clinical Frailty Scale
  
Rockwood K, et al, CMAJ, 2005 Link
239
 
Please see the scoring column.
1 = Very fit
2 = Well
3 = Well, with treated comorbid disease
4 = Apparently vulnerable
5 = Mildly frail
6 = Moderately frail
7 = Severely frail
Physician assigns score of 1 to 7 based on clinical judgment. Physicians making the initial assessment given access to diagnoses and assessments related to these variables and other measures of comorbidity, function and associated features that inform clinical judgments about the severity of frailty. A secondary review and scoring performed by a multidisciplinary team. Access is available to health variables measured for patient to inform judgment.
Brief Frailty Instrument
  
Rockwood K, et al, Lancet, 1999 Link
226
 
4 levels of classification, fitness to frailty:
See scoring column.
0 = walk without help, perform basic ADL, are continent of bowel and bladder, and are not cognitively -impaired; 1 = bladder incontinence only; 2 = one (two if incontinent) or more of needing assistance with mobility or activities of daily living, has CIND, or has bowel or bladder incontinence; 3 = two (three if incontinent) or more if totally dependent for transfers or 1+ activities of daily life, incontinent, and dementia. Higher classification means higher grade of frailty.
Vulnerable Elders Survey (VES-13)
  
Saliba D, et al, J Am Geriatr Soc, 2001 Link
225
 
Age
Self-rated health
Physical function
ADL / IADL disability
Score range: 0 to 10. Frail = score 3+
FRAIL Scale
  
Abellan van Kan G, et al, J Am Med Dir Assoc, 2008 Link
Abellan van Kan G, et al, J Nutr Health Aging, 2008 Link
211
 
Fatigue
Resistance (ability to climb 1 flight of stairs)
Ambulation (ability to walk 1 block)
Illnesses (greater than 5)
Weight Loss (>5%)
Score range 0 to 5. No frailty = 0 deficits. Intermediate frailty = 1 or 2 deficits. Frailty = 3 or more deficits.
Winograd Screening Instrument
  
Winograd CH, et al, J Am Geriatr Soc, 1991 Link
198
 
Cerebrovascular accident
Chronic and disabling illness
Confusion
Dependence in ADLs
Depression
Falls
Impaired Mobility
Incontinence
Malnutrition
Polypharmacy
Pressure sore
Prolonged bedrest
Restraints
Sensory Impairment
Socioeconomic / family problems
Frail = presence of any one of the 15 screening criteria. Participants could instead be categorized as “Severely impaired” if they had severe dementia and ADL dependence, or terminal illness
Physical Frailty Criteria
  
Binder EF, et al , J Am Geriatr Soc, 2002 Link
185
 
Self-reported difficulty with IADLs or ADL.
Modified PPT
V02 peak
Two or more criteria met = mild to moderate physical frailty
FI-CGA (Frailty Index based on Comprehensive Geriatric Assessment)
  
Jones DM et al, J Am Geriatr Soc, 2004 Link
Jones D et al, Aging Clin Exp Res, 2005 Link
154
 
mood and motivation
communication
mobility
balance
bowel function
bladder function
IADLs and ADLs
nutrition
social resources
cognitive status
FI-CGA score = addition of the count of CGA-identified problems from the 10 domains, plus the comorbidity count of active diagnoses.
1994 Frailty Measure
  
Strawbridge WJ, et al, J Gerontol, 1998 Link
154
 
16 items to represent the following 4 domains:
physical functioning
nutritive functioning
cognitive functioning
sensory problems
A score of "3" or higher on at least one item in any domain was considered as a problem or difficulty in that particular domain. Participants were classified as frail in 1994 if they reported having problems or experiencing difficulty in two or more domains.
Gait speed as a single frailty measure
  
Abellan Van Kan G, et al, J Nutr Health Aging, 2009 Link
152
 
Gait speed (walking speed)
Gait speed < .2 m/s is cut point for extreme frailty. Gait speed < .8 m/s is cut point for increased risk of adverse health outcomes.
Study of Osteoporotic Fractures (SOF) index
  
Ensrud KE, et al, Arch Intern Med, 2008 Link
133
 
Weight loss
Self-report energy
Chair rise
Out of 3 criteria for frailty: =2 = frail. 1 = intermediate or pre-frail. 0 = robust.
Chin A Paw instrument
  
Chin A Paw MJ, et al, J Clin Epidemiol, 1999 Link
111
 
Physical activity
Food and beverage intake
Weight loss
BMI
Functional status
Health characteristics
Physical inactivity combined with: (1) an energy intake less than 7.6 (lowest quartile) MJ per day; (2) a 5-year weight loss more than 4kg (lowest quartile of weight change); or (3) a BMI less than 23.5 kg/m2 (lowest quartile). Physical inactivity was defined as less than 210 minutes (lowest quartile) of physical activity per week.
Survey of Health, Aging and Retirement in Europe (SHARE) Frailty Index (FI) - SHARE-FI
  
Santos-Eggimann et al, J Gerontol, 2009 Link
Romero-Ortuno R, BMC Geriatr, 2010 Link
106
 
Frailty Phenotype approach with major modification
Exhaustion: 1 self-report question
Shrinking: reported diminution in desire for food
Weakness: grip strength
Walking speed: mobility questions
Low activity: self-report
One point for each fulfilled criterion; individuals with 0 points were classified as nonfrail; with 1-2 points as prefrail; and with 3-5 points as frail.
Modified Physical Performance Test (PPT)
  
Brown M, et al, J Gerontol, et al, 200 Link
102
 
Book lift
Put on and take off coat
Pick up penny
Chair rise
Turn 360 degrees
50 ft. walk
Climb one flight of stairs
Climb four flights of stairs
Progressive Romberg test
Score range on the PPT: 0-36 points Not frail: 32–36. Mildly frail: 25–31. Moderately frail: 17–24.
MDS-CHESS
  
Hirdes JP et al, J Am Geriatr Soc. 2003 Link
96
Groningen Frailty Indicator (GFI)
  
Steverink N, Gerontologist, 2001 Link
Schuurmans H, et al, J Gerontol, 2004 Link
96
 
Physical (mobility functions, multiple health prob
Cognitive (cognitive functioning)
Social (emotional isolation)
Range from zero to fifteen that assesses the physical, cognitive, social, and psychological domains. A GFI score of four or greater is considered the cut-off point for frailty (“moderately frail”)
Clinical Global Impression of Change in Physical Frailty (CGIC-PF) instrument
  
Studenski S, et al, J Am Geriatr Soc, 2004 Link
95
Grip Strength as single measure
  
Syddall H, et al, Age Ageing, 2003 Link
93
 
Grip Strength
Modified Frailty Phenotype, with Cognition
  
Rothman MD, J Am Geriatr Soc, 2008 Link
92
 
Slow gait speed
Low physical activity
Weight loss
Exhaustion
Weakness
Cognitive Impairment
Depressive symptoms
Static / Dynamic Frailty instrument
  
Puts MT, et al, J Am Geriatr Soc, 2005 Link
87
Edmonton Frail Scale
  
Rolfson DB, et al, Age Ageing, 2006 Link
81
Modified Frailty Phenotype
  
Avila-Funes, et al, J Am Geriatr Soc, 2009 Link
66
 
Weight Loss
Slowness
Exhaustion
Physical Activity
3+ out of 5 = frail 1-2 out of 5 = prefrail 0 out of 5 = nonfrail
Health Status Questionnaire empirical method
  
Brody KK, et al, Gerontologist, 1997 Link
55
Frailty is dependent dichotomous variable determined by whether or not the subject has been placed in nursing home; received long-term care; and/or been eligible to receive these services within 365 days of the receipt of the HSF
Sherbrooke Postal Questionnaire
  
Hébert R et al, Age Ageing, 1996 (Hebert) Link
54
 
Health problems that limit activities
Age / Sex
Live alone
Hospitalized in last year
Easy Prognostic Score for Frailty Outcomes in the Aged
  
Ravaglia G, Age Ageing, 2008 Link
51
Modified version of the Functional Independence Measure (FIM) instrument
  
Carlson JE, et al, Am J Phys Med Rehabil, 1998 Link
51
 
Feeding
Hygiene
Bathing
Toileting
Dressing
Communication
Mobility
Classification of subjects by functional homeostasis was defined dichotomously as no decline in FIM™ score versus a decline of one point or greater. Frail = having a decline in FIM score.
Balducci Criteria
  
Pal SK, CA Cancer J Clin, 2010 Link
49
Tilburg Frailty Indicator (TFI)
  
Gobbens RJ, et al, J Am Med Dir Assoc, 2010 Link
45
 
Weight loss
Walking
Hand strength
Tiredness
Physical health
Balance
Vision
Hearing
Cognition
Depressive symptoms
Anxiety
Coping
Living alone
Social relations
Social support
Scoring range 0-15, with a score of 0 or 1 per item. 15 equates to highest level of frailty.
Frailty Staging System
  
Cacciatore F, et al, Eur J Clin Invest, 2005 Link
44
 
Disability
Mobility
Cognition
Visual
Hearing
Continence
Social Support
Score of 0 or 1 in each domain. Class 1 frailty = 0-1 Class 2 frailty = 2-3 Class 3 frailty = 4-7
Comprehensive Assessment of Frailty (CAF)
  
Sündermann S, et al, Eur J Cardiothorac Surg, 2011 (Sundermann) Link
44
Macarthur Study of Successful Aging (MSSA) Extended Phenotype
  
Sarkisian CA, J Am Geriatr Soc, 2008 Link
35
Multi-dimensional frailty score (combined and modified Fried and Rockwood items)
  
Hubbard RE et al, Age Ageing, 2009 Link
29
 
Weight loss
Grip strength
MMSE
Timed get-up-and-go
FEV
Dayhoff instrument
  
Dayhoff NE, et al, J Gerontol Nurs, 1998 Link
24
 
ADL/IADLs (WHO Assessment of Functional Capacity)
Self-reported perceived health
Score range: 14 (self-sufficiency) to 70 (total dependency) Non-frail if score =20 & excellent/good health. Frail if score =21 & fair/poor health.
Frail Elderly Functional Assessment (FEFA) questionnaire
  
Gloth FM, et al, Am J Phys Med Rehabil, 1995 Link
21
 
Mobility
Toileting
Meals
Dressing
Bathing
Basic Mechanical Skills
Finances
Communication
Medications
Scores range from 0-55. Low score infers better function.
Klein Frailty Index
  
Klein BE, et al, Trans Am Ophthalmol Soc, 2003 Link
20
G8, as a frailty assessment instrument
  
Bellera CA, et al, Ann Oncol, 2012 Link
17
Short Physical Performance Battery (SPPB) as frailty instrument
  
Bandinelli S, et al, Aging Clin Exp Res, 2006 Link
16
Score range on the Short Physical Performance Battery (SPPB) is 0-12 (0-4 on each of 3 tests) Frailty defined as score =9.
Hebrew Rehabilitation Center for Aged (HRCA) vulnerability index, as a frailty assessment instrument
  
Kanauchi M et al, Int J Clin Pract, 2008 Link
15
COOP-WONCA (COOP functional health assessment charts – World Organization of Family Doctors) screener
  
Van Hout et al, J Gerontol, 2010 Link
14
Score-risk scale for dependency
  
Carrière I, et al, J Clin Epidemiol, 2005 Link
14
 
Mobility (gait speed, chair stand)
Balance (tandem position test)
Nutrition (BMI)
Muscle strength (grip test)
Physical Activity
Perceived health
Education level
Age
Time since last evaluation
Score, between 25-165, corresponds to risk for dependency coefficient
PRISMA-7
  
Hébert R, et al, Can Fam Physician, 2003 Link
13
British Frailty Index
  
Kamaruzzaman S et al, Health Qual Life Outcomes, 2010 Link
12
Frailty as subjective immediate impression of general health appearance
  
Gerdhem P, et al, Gerontology, 2003 Link
11
 
General health appearance
General assessment of health and appearance within 15 seconds from first sight, transferred this into an arbitrary scale, from 1–100, where ‘1’ represented an individual not frail at all and ‘100’ a very frail or aged individual. 2 raters per individual overall.
Frailty Cluster Analysis Method
  
Passarino G, Biogerontology, 2007 Link
11
Clinical judgment criteria for dependence on another person for daily care
  
Brody KK, et al, J Am Geriatr Soc, 2002 Link
11
Brief frailty index (for clinical use with coronary artery disease patients)
  
Freiheit EA, et al, J Am Geriatr Soc 2010 Link
11
 
Body composition
Balance
Cognition
Mood
Social Isolation
Domains dichotomized as abnormal (=1) or normal (=0). Score range 0-5, with higher score = higher risk of frailty.
Guilley instrument
  
Guilley E, et al, Research on Aging, 2008 Link
10
 
Mobility
Memory
Energy
Physical pains
Sensory capacities
Frail = deficiencies in two or more domains; Robust = one or zero affected domains.
Gérontopôle Frailty Screening Tool (Gerontopole)
  
Subra J, et al, J Nutr Health Aging, 2012 Link
10
Simple prognostic frailty risk score
  
Pijpers E, et al, Postgrad Med J, 2009 Link
8
Physical Performance Frailty Tests
  
Lee JS, et al, J Nutr Health Aging, 2011 Link
7
Schoenenberger index
  
Schoenenberger AW, Eur Heart J, 2013 Link
6
Gealey instrument
  
Gealey SG, et al, J Am Acad Nurse Pract, 1997 Link
5
 
ADLs
IADLs
ADL: 0–10; IADL: 0–14; combination of ADL/IADL: 0–24. Dichotomous: frail–not frail. Frail/non-frail determination made by gerontological nurse practitioners, then compared to ADL, IADL and combined scores.
Geriatric Functional Evaluation (GFE) questionnaire
  
Scarcella P, et al, Arch Gerontol Geriatr, 2005 Link
5
Marigliano-Cacciafesta polypathological scale (MCPS)
  
Amici A, et al, Arch Gerontol Geriatr. 2008 Link
5
Polypathology (as measure of fragility or frailty or comorbidity): Score range: 0 to 245 Slight: <15 Medium: 15–24 Medium-severe: 25-49 Severe: 50-74 Very severe: =75
Opasich assessment
  
Opasich C, et al, Eur J Cardiovasc Prev Rehabil, 2010 Link
4
Self-Report Frailty Screening Instrument
  
De Souto Barreto, et al, Arch Gerontol Geriatr, 2012 Link
3
 
Low BMI
Low level of physical activity
Dissatisfaction with muscle strength
Dissatisfaction with energy endurance
Score range 0-4. Frail: =3 Pre-frail: 1-2 Robust: 0
Physical, Mental and Social Frailty Indices
  
Garre-Olmo J, et al, Age Ageing, 2013 Link
2
 
see: http://ageing.oxfordjournals.org/content/
suppl/2012/03/06/afs047.DC1
Deficit accumulation model, excluding disability.
Barber Questionnaire, as frailty screening test
  
Molina-Garrido MJ and Guillen-Ponce C, Crit Rev Oncol Hematol, 2011 Link
2
Subscale of SF-20 as frailty assessment
  
Haken et al, Scand J Caring Sci, 2002 Link
1
 
Very demanding physical activities
Less demanding activities
Walking stairs or a hill
Bending or kneeling
Walking
Eating or dressing
Physical frailty was measured using a six item functioning scale, which was a subscale of the MOS Short-form General Health Survey, SF-20. Physical frailty was determined if participants had restraints in at least three of the six physical activities.
Simple assessments: clinical judgment; polypharmacy; self-rated health
  
Hoogendijk EO et al, Age Ageing, 2013 Link
1
Evaluative Frailty Index for Physical Activity (EFIP)
  
de Vries NM, et al, Phys Ther, 2013 Link
1
 
Physical functioning
Psychological functioning
Social functioning
General health
Score range 0-50. Score calculated by total points divided by 50. Higher score indicates higher level of frailty.
Comprehensive Frailty Assessment Instrument
  
De Witte N, et al, Geriatr Nurs, 2013 Link
0
 
Physical (4 indicators)
Psychological (5 mood and 3 emotional indicators)
Social (3 social and 3 social support indicators)
Environmental (5 home/neighborhood indicators)
Score range 0-23. Higher score indicates higher level of frailty.
Accelerometry-based frailty assessment
  
Fontecha J, et al, J Med Internet Res, 2013 Link
0
 
Accelerometer data
Easycare Two-step Older persons Screening (TOS)
  
van Kempen JA, et al, Br J Gen Pract, 2013 Link
0