In primary care settings, the recommended approach to evaluating frailty in older adults involves using comprehensive, multidimensional assessment tools that capture physical, cognitive, and psychosocial domains. UK guidelines emphasize identifying frailty through clinical judgment supported by structured assessments, often integrated within broader falls risk and multimorbidity evaluations. Specifically, the NICE guideline on falls and multimorbidity recommends assessing gait, balance, mobility, muscle strength, cognitive function, and psychosocial factors as part of a multifactorial assessment to identify frailty and related risks NICE CG161,NICE NG249.
Validated frailty screening tools suitable for primary care include the Clinical Frailty Scale (CFS), which provides a rapid clinical judgment-based frailty categorization, and the electronic Frailty Index (eFI), which utilises routine primary care data to stratify frailty severity. These tools align with NICE’s emphasis on identifying frailty to guide comprehensive falls assessment and management NICE CG161,NICE NG249.
Recent literature further supports a biopsychosocial approach to frailty assessment, recommending tools that evaluate physical performance (e.g., gait speed, grip strength), cognitive status, nutritional status, and psychosocial dimensions such as mood and social support De Luca et al. 2022. Sarcopenia assessment tools, including muscle mass and function measures, are also integral to frailty evaluation, as muscle weakness is a core component of frailty Beaudart et al. 2016. This comprehensive approach complements the UK guidelines’ multifactorial assessment framework NICE CG161,NICE NG249[De Luca et al. 2022][Beaudart et al. 2016].
In summary, primary care practitioners should use validated frailty screening tools like the CFS or eFI combined with targeted assessments of physical function, cognition, and psychosocial factors to evaluate frailty in older adults. This approach enables identification of those at risk who may benefit from tailored interventions to prevent falls and functional decline, consistent with NICE recommendations and supported by recent evidence Beaudart et al. 2016De Luca et al. 2022 NICE CG161,NICE NG249[Beaudart et al. 2016][De Luca et al. 2022].
Key References
- CG161 - Falls in older people: assessing risk and prevention
- NG249 - Falls: assessment and prevention in older people and in people 50 and over at higher risk
- CG103 - Delirium: prevention, diagnosis and management in hospital and long-term care
- (Beaudart et al., 2016): Sarcopenia in daily practice: assessment and management.
- (De Biasio et al., 2020): Frailty in Critical Care Medicine: A Review.
- (De Luca et al., 2022): Assessment Tools of Biopsychosocial Frailty Dimensions in Community-Dwelling Older Adults: A Narrative Review.