Frailty Assessment · Geriatric · Rockwood 2005 · ICU · Emergency Medicine

Clinical Frailty Scale (CFS) Calculator

Rockwood Clinical Frailty Scale with complete descriptors for all 9 levels — Very Fit (1) through Terminally Ill (9). Select the single best-fit description for the patient's pre-illness baseline. Frailty confirmed at CFS ≥ 5. Includes management guidance and EMR documentation.

NMClinically reviewed byDr. Nikhil Mahajan, PT, MPT · Jan 15, 2026

1 – 3RobustNo frailty

4VulnerablePre-frailty

5 – 6Mild–Mod FrailFrailty confirmed ≥ 5

7 – 9Severe / TerminalComplete dependence

BaselineRate Pre-IllnessNot current state

Selected Level—

Frailty StatusSelect below

Frail (≥5)?—

Scale1 – 9

Select the level that best describes the patient's status — rate pre-illness baseline, not current acute state

1 Very Fit People who are robust, active, energetic and motivated. These people commonly exercise regularly. They are among the fittest for their age.

2 Well People who have no active disease symptoms but are less fit than category 1. Often, they exercise or are very active occasionally, e.g. seasonally.

3 Managing Well People whose medical problems are well controlled, but are not regularly active beyond routine walking.

4 Vulnerable While not dependent on others for daily help, often symptoms limit activities. A common complaint is being 'slowed up' and/or being tired during the day.

5 Mildly Frail FRAIL These people often have more evident slowing, and need help in high order IADLs (finances, transportation, heavy housework, medications). Typically, mild frailty progressively impairs shopping and walking outside alone, meal preparation and housework.

6 Moderately Frail FRAIL People who need help with all outside activities and with keeping house. Inside, they often have problems with stairs and need help with bathing and might need minimal assistance (cuing, standby) with dressing.

7 Severely Frail FRAIL Completely dependent for personal care, from whatever cause (physical or cognitive). Even so, they seem stable and not at high risk of dying (within ~ 6 months).

8 Very Severely Frail FRAIL Completely dependent, approaching the end of life. Typically, they could not recover even from a minor illness.

9 Terminally Ill FRAIL Approaching the end of life. This category applies to people with a life expectancy <6 months who are not otherwise evidently frail.

Clinical Frailty Scale — All 9 Levels Reference

CFS	Level	Description	Management Implication
1	Very Fit	People who are robust, active, energetic and motivated. These people commonly exercise regularly. They are among the fittest for their age.	No frailty interventions needed.
2	Well	People who have no active disease symptoms but are less fit than category 1. Often, they exercise or are very active occasionally, e.g. seasonally.	Preventive care focus.
3	Managing Well	People whose medical problems are well controlled, but are not regularly active beyond routine walking.	Pre-frailty — monitor closely.
4	Vulnerable	While not dependent on others for daily help, often symptoms limit activities. A common complaint is being 'slowed up' and/or being tired during the day.	Pre-frailty — increased risk.
5 ⚠️	Mildly Frail	These people often have more evident slowing, and need help in high order IADLs (finances, transportation, heavy housework, medications). Typically, mild frailty progressively impairs shopping and walking outside alone, meal preparation and housework.	FRAILTY CONFIRMED.
6 ⚠️	Moderately Frail	People who need help with all outside activities and with keeping house. Inside, they often have problems with stairs and need help with bathing and might need minimal assistance (cuing, standby) with dressing.	MODERATE FRAILTY.
7 ⚠️	Severely Frail	Completely dependent for personal care, from whatever cause (physical or cognitive). Even so, they seem stable and not at high risk of dying (within ~ 6 months).	SEVERE FRAILTY.
8 ⚠️	Very Severely Frail	Completely dependent, approaching the end of life. Typically, they could not recover even from a minor illness.	VERY SEVERE FRAILTY.
9 ⚠️	Terminally Ill	Approaching the end of life. This category applies to people with a life expectancy <6 months who are not otherwise evidently frail.	TERMINAL ILLNESS.

What Is the Clinical Frailty Scale?

The Clinical Frailty Scale (CFS) was developed by Dr. Kenneth Rockwood and colleagues at Dalhousie University, Canada, originally published in the New England Journal of Medicine in 2005 as part of the Canadian Study of Health and Aging. It was updated in 2019 and is now one of the most widely used frailty assessment tools worldwide. Unlike multi-item frailty indices, the CFS requires only a brief clinical assessment of the patient's pre-illness baseline functional status and activity level.

Critical Instruction: Rate Pre-Illness Baseline, Not Acute State

The most important principle of CFS administration is that the score reflects the patient's functional status in the 2 weeks before acute illness or hospitalisation, not their current acute presentation. A patient admitted with pneumonia who was previously walking independently at home should be rated based on their pre-pneumonia function — not their current bed-bound acute state. This baseline rating predicts prognosis and guides care planning more accurately than acute-state assessment.

CFS in Critical Care and Emergency Medicine

The CFS has been validated as a predictor of mortality, ICU outcomes, and discharge destination in emergency department and ICU populations. During COVID-19, multiple health systems used CFS ≥ 5 as part of critical care triage frameworks. A CFS of 5 or above is associated with significantly increased 30-day mortality in medical admissions, and CFS ≥ 7 is associated with poor ICU survival. This makes CFS a key tool in goals-of-care discussions and critical care planning.

Dr. Nikhil Mahajan, PT, MPTReviewed January 15, 2026 · View full credentials

Frequently Asked Questions

What CFS score indicates frailty?

A Clinical Frailty Scale score of 5 (Mildly Frail) or above indicates frailty. CFS 1–3 = robust/well; CFS 4 = vulnerable (pre-frail); CFS 5 = mildly frail (IADL dependence); CFS 6 = moderately frail (ADL dependence with some independence inside); CFS 7 = severely frail (complete ADL dependence, not imminently dying); CFS 8 = very severely frail (complete dependence, approaching end of life); CFS 9 = terminally ill (life expectancy <6 months).

Should I rate the CFS based on current state or pre-illness baseline?

Always rate the pre-illness baseline — the patient's functional status in the 2–4 weeks before the acute illness or admission. Rating the acute state significantly overestimates frailty for acutely unwell patients who were previously independent. Ask: "Before this illness, what was your typical day like? Were you able to walk independently? Did you need help with any activities?" Use collateral history from family if the patient cannot self-report reliably.

Can the CFS be used in patients with dementia?

Yes — the CFS applies to all older adults including those with dementia. Patients with early dementia who are still independent in basic ADLs would typically score CFS 5 (mildly frail — IADL dependence). Patients with moderate dementia with ADL dependence score CFS 6–7. The key is rating the overall functional picture including both cognitive and physical function in the pre-illness state. For patients with dementia who cannot self-report, collateral history from caregivers is essential.