COSMIN database

Measures of frailty in population-based studies: an overview

Bouillon, K., Kivimaki, M., Hamer, M., Sabia, S., Fransson, E. I., Singh-Manoux, A., Gale, C. R., and Batty, G. D.
BACKGROUND: Although research productivity in the field of frailty has risen exponentially in recent years, there remains a lack of consensus regarding the measurement of this syndrome. This overview offers three services: first, we provide a comprehensive catalogue of current frailty measures; second, we evaluate their reliability and validity; third, we report on their popularity of use.

METHODS: In order to identify relevant publications, we searched MEDLINE (from its inception in 1948 to May 2011); scrutinized the reference sections of the retrieved articles; and consulted our own files. An indicator of the frequency of use of each frailty instrument was based on the number of times it had been utilized by investigators other than the originators.

RESULTS: Of the initially retrieved 2,166 papers, 27 original articles described separate frailty scales. The number (range: 1 to 38) and type of items (range of domains: physical functioning, disability, disease, sensory impairment, cognition, nutrition, mood, and social support) included in the frailty instruments varied widely. Reliability and validity had been examined in only 26% (7/27) of the instruments. The predictive validity of these scales for mortality varied: for instance, hazard ratios/odds ratios (95% confidence interval) for mortality risk for frail relative to non-frail people ranged from 1.21 (0.78; 1.87) to 6.03 (3.00; 12.08) for the Phenotype of Frailty and 1.57 (1.41; 1.74) to 10.53 (7.06; 15.70) for the Frailty Index. Among the 150 papers which we found to have used at least one of the 27 frailty instruments, 69% (n = 104) reported on the Phenotype of Frailty, 12% (n = 18) on the Frailty Index, and 19% (n = 28) on one of the remaining 25 instruments.

CONCLUSIONS: Although there are numerous frailty scales currently in use, reliability and validity have rarely been examined. The most evaluated and frequently used measure is the Phenotype of Frailty.
BMC Geriatr
1471-2318 (Electronic)
Publication year:
Biological and physiological variables:
Biological and physiological variables
Symptom status:
Cognitive/mental state
Emotional state
Physical state
Functional status:
Cognitive/mental functioning
Physical functioning
Social functioning
General health perceptions / HRQoL:
Self-rated health
Seniors (65+)
Certain infections and parasitic diseases and related symptoms
Codes for special purposes
Congenital malformations, deformations and chromosomal abnormalities and related symptoms
Diseases of and symptoms related to the blood and blood-forming organs and certain disorders involving the immune mechanism
Diseases of and symptoms related to the circulatory system
Diseases of and symptoms related to the digestive system
Diseases of and symptoms related to the ear and mastoid process
Diseases of and symptoms related to the eye and adnexa
Diseases of and symptoms related to the genitourinary system
Diseases of and symptoms related to the musculoskeletal system and connective tissue
Diseases of and symptoms related to the nervous system
Diseases of and symptoms related to the respiratory system
Diseases of and symptoms related to the skin and subcutaneous tissue
Endocrine, nutritional and metabolic diseases and related symptoms
External causes of morbidity and mortality
Injury, poisoning and certain other consequences of external causes
Mental and behavioural disorders and related symptoms
Neoplasms and related symptoms
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
4 - Performance-based tests
6 - Clinical rating scales
7 - Observations
9 - Laboratory tests
1994 Frailty Measure Strawbridge
Brief Frailty Index
CFAI - Comprehensive Assessment of Frailty
CGA - Comprehensive Geriatric Assessment (versions: FI-CGA; CP-FI-CGA)
CGIC-PF - Clinical Global Impression of Change in Physical Frailty
CSHA Clinical Frailty Scale - Canadian study of health and aging Clinical Frailty Scale
CSHA rules based definition - Canadian study of health and aging rules based definition
EFS - Edmonton Frailty Scale
FI - Frailty Index (accumulation of deficits) (versions: mFI; mFI-5; mFI-11; mFI-19)
FP - Frailty Phenotype (alias: Phenotype of Frailty) (versions: mFP)
FRAIL Scale - Fatigue Resistance Ambulation Illness Loss of Weight Scale
Fried’s frailty scale
FSS - Frailty Staging System
GFI - Groninger Frailty Indicator
Klein’s frailty index
Marigliano-Cacciafesta Polypathological Scale
Mitnitski’s Frailty Index
Modified Physical Performance Test
Opasich’s frailty scale
Physical frailty
Physical Frailty Score
Score-Risk Correspondence for dependency
SOF - Study of Osteoporotic Fractures
SPPB - Short Physical Performance Battery   
Static/Dynamic frailty index
Subjective Frailty Score
TFI - Tilburg Frailty Indicator
Vulnerable Elderly Survey-13