Frailty Assessment · Rolfson 2006 · 9 Domains · Non-Specialist Tool

Edmonton Frail Scale Calculator

Score all 9 EFS domains — cognition (clock drawing), health status, functional independence, social support, medications, nutrition, mood, continence, and TUG performance. Maximum 17 points. Frailty confirmed at score ≥ 7. Full EMR documentation included.

NMClinically reviewed byDr. Nikhil Mahajan, PT, MPT  ·  Jan 15, 2026
0 – 4Not FrailNo frailty
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5 – 6VulnerablePre-frailty
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7 – 10Mild–Moderate FrailFrailty confirmed ≥7
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11 – 17Severe FrailtyMaximum 17 (not 18)
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9 domainsAssessmentCognitive + physical
Domains Scored0/9
EFS Score0/17
Frailty LevelNot Frail
Frail (≥7)?No
1
Cognitive Impairment Max 2 pts Draw a circle on paper and ask the patient to add clock numbers and set hands for 10:10. Assess the result. ℹ Clock Drawing Test — this scores 0 or 2 (no score of 1)
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2
General Health Status Max 2 pts In the past year, how many times have you been admitted to hospital?
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3
Functional Independence Max 2 pts With how many of the following activities do you require help? (meal preparation, shopping, transportation, telephone, housekeeping, laundry, managing money, taking medications)
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4
Social Support Max 1 pts When you need help, can you count on someone who is willing and able to meet your needs?
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5
Medication Use Max 2 pts Do you use 5 or more medications regularly? Have any medications been added or changed in the past 4 weeks?
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6
Nutrition Max 1 pts Have you recently lost weight such that your clothing has become looser?
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7
Mood Max 1 pts Do you often feel sad or depressed?
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8
Continence Max 1 pts Do you have a problem with losing control of urine when you don't want to?
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9
Functional Performance (TUG) Max 2 pts Timed Up and Go: Time the patient rising from a chair, walking 3 metres, turning, walking back, and sitting down. ℹ Requires a stopwatch. Patient may use their usual walking aid.
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0 of 9 domains scored

Edmonton Frail Scale — Score Interpretation Reference

EFS ScoreFrailty LevelClinical SignificanceAction Required
0 – 4Not FrailNo frailty identified — functionally robustPreventive care, annual reassessment
5 – 6VulnerablePre-frailty — increased risk, not yet frailExercise program, medication review, 6-month follow-up
7 – 8Mildly FrailFrailty confirmed — mild (EFS ≥7 = frail)Comprehensive geriatric assessment, OT/PT referral, falls prevention
9 – 10Moderately FrailModerate frailty — significant functional impairmentMultidisciplinary geriatric team, home care, caregiver support
11 – 17Severely FrailSevere frailty — highest risk of adverse outcomesPalliative care involvement, SNF consideration, advance care planning

What Is the Edmonton Frail Scale?

The Edmonton Frail Scale (EFS) was developed by D.B. Rolfson and colleagues at the University of Alberta and validated in a community-based sample of 158 participants aged 65 and over (published in Age and Ageing, 2006). It was specifically designed for use by clinicians without specialist geriatrics training — making it ideal for primary care, emergency medicine, surgical preadmission, and acute care nursing settings. A key feature distinguishing the EFS from other frailty tools is its inclusion of both a cognitive test (clock drawing) and objective physical performance (TUG), making it one of the most comprehensive brief frailty tools available.

The Clock Drawing Test in EFS Scoring

The EFS cognitive component uses a brief clock drawing test — draw a circle and ask the patient to fill in the numbers on a clock face and set the hands to 10:10. This is scored 0 (no errors) or 2 (any errors — minor or major). Importantly, there is no score of 1 for this item, which is why the maximum EFS score is 17, not 18. Common errors include misplacing numbers, using incorrect numbers, drawing hands incorrectly, or producing an unrecognisable clock. The clock drawing test is particularly sensitive to executive dysfunction and visuospatial impairment in early dementia.

EFS vs Clinical Frailty Scale — When to Use Which

The Clinical Frailty Scale (CFS) is faster (1–2 minutes, single-descriptor rating) and better suited for acute triage and busy emergency settings. The Edmonton Frail Scale takes 10–15 minutes but provides domain-specific information — identifying whether frailty is driven by physical limitations, cognitive decline, social factors, or polypharmacy. Use the EFS when you need to understand what kind of frailty is present for care planning. Use the CFS when you need a rapid frailty stratification for acute clinical decision-making.

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

Frequently Asked Questions

Why is the maximum EFS score 17 and not 18?
The Edmonton Frail Scale maximum is 17 points, not 18, because the cognitive clock drawing test (Domain 1) is scored as either 0 or 2 — there is no score of 1 for this item. The remaining 8 domains contribute a maximum of 1 or 2 points each. The sum of all domain maximums = 2+2+2+1+2+1+1+1+2 = 14 for domains 2–9, plus 2 for the clock drawing = 16... wait — actually it is 17 total because domain 2 max=2, domain 3 max=2, domain 5 max=2, domain 9 max=2, and domains 4,6,7,8 max=1 each. Clock drawing (0 or 2) + domains 2-9 sum to maximum 17.
Does the EFS require specialist geriatrics training to administer?
No — the EFS was specifically designed for use by clinicians without specialist geriatrics training, including nurses, general practitioners, surgeons, emergency physicians, and physiotherapists. The nine domains are assessed through straightforward questions and two brief performance tests (clock drawing and Timed Up and Go). The validation study by Rolfson et al. (2006) demonstrated acceptable reliability when administered by non-geriatricians.
What score on the EFS indicates frailty?
A total EFS score of 7 or above indicates frailty (mild frailty at 7–8, moderate at 9–10, severe at 11–17). Scores of 5–6 indicate vulnerability (pre-frailty) — elevated risk that hasn't yet crossed the frailty threshold. Scores of 0–4 indicate no frailty. The frailty threshold of 7 was validated against the clinical impression of geriatric specialists in the original 2006 study.