1/9 Was asked good questions re: the Clinical Frailty Scale, so this Tweetorial. Case 1: 84 year old woman; hypertensive, hypothyroid (meds for each) IADLs OK. Walks 5-7 km/day + 15km/week to visit her sister. "Would you still classify her as CFS =3 due to her chronic diseases?"
2/9 She is well with treated co-morbid disease, is physically active daily, and has no function-limiting symptoms; CFS=1, given daily exercise. Few patients aged 75+ are free of any illness: the issue is how much those illnesses bother (symptoms) or limit (function) their lives.
3/9 Case 2: 93 yo, septic, being evaluated for nursing home after 10-day admission for infected ulcer 5 weeks ago. Baseline then was ++ chronic diseases, walked slowly; daughter did finances, housekeeping. Dependent since in all basic ADLs. "CFS=5 (when last well)? or CFS=7? 8?"
4/9 Case 2: Baseline is 2 weeks ago, not when last well, therefore CFS=7 (if bedfast, CFS=8). As the degree of frailty increases, less energy is needed for further damage, and the energy needed to repair increases. [Details in Rutenberg AD et al. Exp Gerontol. 2018;107:126–129.]
5/9 Case 3: 72 yo with bladder cancer 2 years ago, treated hypertension. Takes long walks, strength trains 3x/week, iADL independant. Admitted with pulmonary embolism; for 2+ weeks has massive hematuria. Respiratory distress if anticoagulants stopped. "Is his CFS score 3 or 9?"
6/9 Case 3: His CFS at admission was 3. Now, it is 9. But why do you need to rescore? People can die rapidly, even having just been well -that's why the Level 9 icon is a person in a chair. If you are admitting him elsewhere and he is terminally ill, that trumps the prior state.
7/9 Case 4: 67 yo with a severe hip arthritis, awaits an operation. Usually walks 3-4 km slowly and trains regularly, Fell 4 weeks ago, severe hip pain since; daughter now helps clean house, shop. Now he is admitted with an NSTEMI. "Would you say that the CFS score is 3 or 5?"
8/9 Case 4: Code him as two weeks ago: CFS=5. We first used CFS to summarize a Comprehensive Geriatric Assessment. Used as a screening tool, the data suggest that it is helpful in stratifying risk. For screening, we use whatever information is readily at hand, recognizing/9
9/9 that it won't be the same as an assessment. The CFS works at scale, so 3 sometimes being scored as 5, or 5 as 3 is much less a worry than treating all old people as though they are either a 1 or a 7. As always, for each individual, what to do must be determined individually.
