Frailty assessment

For frailty assessment, the Fried Frailty Phenotype (FFP), the Clinical Frailty Scale (CFS), and the Edmonton Frailty Scale (EFS) were performed.

The FFP is a commonly used tool for detecting physical frailty, and it includes five criteria: unintentional weight loss; weakness or poor handgrip strength; self-reported exhaustion; slow walking speed; and low physical activity. A total score of 0 means that a person is robust or not frail; 1–2 prefrail; and 3 and above means frail [2, 25]. The CFS is a judgment-based tool to screen for frailty. An individual’s frailty status is scored from 0 to 9 with the aid of a visual chart by an experienced clinician. Level 1 indicates very fit; level 2 fit; level 3 managing well; level 4 living with very mild frailty; level 5 living with mild frailty; level 6 living with moderate frailty; level 7 living with severe frailty; level 8 living with very severe frailty; and level 9 terminally ill [26, 27]. The EFS is a valid and reliable frailty detection tool consisting of 9 items (cognition, general health status, functional independence, social support, medication use, nutrition, mood, continuity, and functional performance). Total score from 0 to 5 points indicates robust; 6–7 points, apparently vulnerable; 8–9 points, mildly frail; 10–11 points, moderately frail; 12–17 points indicate severe frailty [28, 29].