What a frailty score means, and what should happen next

Age UK describes frailty as a person's ability to bounce back and recover from events like illness and injury. In somebody living with frailty, a problem that sounds minor, such as a urinary infection, can have a large and lasting effect on how they manage. NHS England says it raises the risk of falls, delirium and loss of independence.

It is more common as people get older, but Age UK is clear that it is not inevitable, and that somebody living with frailty can still lead a full life. It is also not one illness. It builds up from several things at once: weaker muscles, tiredness, long-term conditions, several medicines, poorer eating and less activity. That is why the response to it looks at the whole person rather than one condition. The mobility and falls care guide covers the wider picture of staying steady at home.

The electronic Frailty Index looks for 36 kinds of problem in the GP record, such as conditions, symptoms, disabilities and test results. The more it finds, the more likely it is that somebody is living with frailty. Because it only reads the record, it is a flag for the GP to look more closely rather than a diagnosis. Since 2017, the GP contract has asked practices to identify patients aged 65 and over living with moderate and severe frailty each year, and the eFI is one of the tools they can use.

The Clinical Frailty Scale was developed by Kenneth Rockwood and colleagues at Dalhousie University in Canada. In England, NHS England's guidance for hospital frailty services asks for a score within 30 minutes of arrival for people aged 65 and over. The scale is meant to describe how your parent was two weeks before they became unwell, not how they look in a hospital bed, so the staff will ask you what they could do at home. Your answer matters, so be specific about what they managed alone and what they needed help with.

Hospitals use the level alongside everything else they know about your parent. It helps staff plan the right care on the ward, and it is one of the things doctors weigh up when they talk with you about treatment. The scale's authors say scoring it needs clinical judgement, and NHS England's hospital guidance asks staff to help patients understand the options, risks and benefits of their care. If you are unsure how a score is being used, ask the doctor to explain it. It is a reasonable question, and a good team will welcome it.

If your parent has made an advance decision or advance statement about their care, tell the ward, because what matters to them is part of the plan.

1. 1

   A review of their medicines

   GP or pharmacist

   For patients with severe frailty, GP practices are required to review medicines every year. Some medicines add to dizziness and falls, and the NHS advises speaking to a GP or pharmacist if you think a medicine is affecting balance.
2. 2

   A check on falls

   GP, then a falls service

   The practice should ask whether your parent has fallen in the last year. A fall, or being worried about falling, is a reason to ask for a referral to the local falls service.
3. 3

   A fuller assessment for some

   Older people's team

   NHS England says people with moderate frailty benefit from a comprehensive geriatric assessment, and its hospital guidance asks for one for people who score 6 or more.
4. 4

   A look at eating and weight

   GP or dietitian

   Losing weight without trying is a sign of malnutrition, and the NHS says it is not an inevitable part of getting older. The GP can check it and refer to a dietitian.
5. 5

   A care and support plan

   With your parent

   NHS England describes a plan built around what is important to the person, drawing on the family, carers and community services as well as the NHS.

The medication review and falls question come from the GP contract requirements for severe frailty. For moderate frailty, coding and review are left to the clinician. Cambridge University Hospitals explains what a comprehensive geriatric assessment involves for patients and carers: the team gathers information from your parent and the family and looks at all of their health problems together.

If the council has not yet looked at what help your parent needs day to day, ask for a care needs assessment. It is separate from the NHS reviews and is free to ask for.

The British Geriatrics Society's guidance on managing frailty reports that exercise at home or in groups improves mobility and everyday ability, and North Tees and Hartlepool's frailty advice covers the everyday steps. The NHS activity guidelines for older adults say strength and balance work helps somebody feel steadier and more confident. Physiotherapy at home explains how to get a referral and keep exercises going between visits. If your parent has started doing less because they are afraid of falling, breaking the cycle of fear of falling covers what helps. For food, what happens when older people do not eat enough sets out the signs, and the NHS page on malnutrition explains when to see the GP.

Help at home can support all of this: somebody to walk with, to cook a proper lunch, and to notice if things change. If the score has made you think about what your parent is managing alone, the signs your parent needs help at home are worth reading. When you are ready, you can search for carers near you and compare their rates. Carers on PrimeCarers charge £18 to £25 an hour with our fee included, and agencies charge £28 to £35. Every carer's identity, right to work and enhanced DBS on the Update Service are checked and they are interviewed online, and every visit booked through PrimeCarers is insured. We do not check training or qualifications, so ask a carer about their experience directly.