Geriatric assessment

Frailty

Overview and approach

Frailty is reduced physiological reserve with vulnerability to stressors; it is not synonymous with age or disability.

  • Frailty is a syndrome of physiological decline in later life with vulnerability to adverse outcomes: falls, institutionalisation, disability, complications of procedures and death. Old age alone does not define it and it is not inevitable (1).
  • Sarcopenia (loss of muscle mass and strength) is a key component; dysregulated immune, endocrine and stress-response systems (raised IL-6, CRP) contribute (1).
  • Frailty is best assessed annually with a validated tool (1).
Assessment and clinical features

Establish baseline mobility, ADLs, cognition, nutrition, comorbidity, medications and social support before the acute illness.

  • Associated factors: older age, smoking, lower education, depression, intellectual disability, Aboriginal and Torres Strait Islander descent, sedentary lifestyle, undernutrition, chronic disease, multimorbidity, obesity (1).
  • Screen for undernutrition (weight loss, fluid retention can mask it); consider comorbid depression and cognitive impairment (1).
Differentials and investigations

Use a validated frailty tool appropriately, supported by comprehensive geriatric assessment; screen for reversible decline, falls and delirium.

  • Tools: Fried phenotype (≥3 of: unintentional weight loss ≥4 kg/year, exhaustion, weak grip, slow gait, low activity = frail; 1-2 = pre-frail); frailty index (>20 deficits); Clinical Frailty Scale (quick); Edmonton Frail Scale; simple tests: 4 m walk >5 seconds, Timed Up and Go >10 seconds (1).
  • Malnutrition screening tools: MST, MUST, MNA-SF, SGA; screen every RACF admission and refer at-risk residents to a dietitian (1).
Management and follow-up

Treat the acute problem while maintaining mobility, nutrition and orientation. Involve multidisciplinary rehabilitation and align interventions with the person’s goals.

  • Prescribe physical activity with a resistance component (physiotherapist early); caloric and protein support; vitamin D if deficient; reduce polypharmacy; involve dietitian, dentist and speech pathologist as needed (1).
  • Nutrition support to consider if unintentional weight loss >10% in 3-6 months, or BMI <20 with >5% loss; or little intake for more than 5 days (1).
  • Have early discussions about end-of-life goals and limits on invasive therapy; watch for delirium, pressure injuries and falls (1).
Red flags and clinical pearls

Do not score frailty solely from acute illness or use a score as the only basis for limiting treatment.

  • Frailty is a prognostic aid, not a reason in itself to withhold treatment; decisions rest on goals of care and the whole clinical picture.
References
  1. RACGP Silver Book Part A: Frailty

Last updated from Sen’s notes on 9 October 2026.