Frailty in the face of COVID-19

Date of Review: July, 2021

Hubbard RE, Maier AB, Hilmer SN, Naganathan V, Etherton-Beer C, Rockwood K. Frailty in the face of COVID-19. Age Ageing. 2020 Jul 1;49(4):499-500. doi: 10.1093/ageing/afaa095. PMID: 32374368; PMCID: PMC7239250.

Frailty has become a cornerstone of geriatric medicine and geriatricians have long advocated for screening of frailty whenever older people access health care. On this basis, geriatricians have promoted development and broad uptake of convenient screening and assessment tools to assist in the identification of people who live with varying degrees of frailty. The Clinical Frailty Scale (CFS) is a quick and reliable screening tool for frailty, which performs better than measures of cognition, function or comorbidity in assessing medium-term risk of death. While we agree that a multidimensional measure of frailty such as the CFS has value in allocation of scarce health resources, it is important for clinicians and administrators to understand its limitations when used in the acute hospital setting. Frailty is not synonymous with end-of-life. In summary, we recommend against the use of screening tools (including the CFS when used as such) as the sole component to ration access of older people to health care. Instead we recommend that frailty screening tools are implemented as a rapid component of a person-centred approach to assessment that takes account of three key biomedical factors: severity of the presenting acute illness, the likelihood of medical interventions being successful and the degree of frailty. —Ashley Darcy Mahoney, PhD