Frailty, screened
FRAIL scale frailty questionnaire
Frailty means having less reserve to cope with illness or stress, so that everyday tasks get harder. The FRAIL scale is a 5-question checklist: Fatigue, Resistance (climbing stairs), Ambulation (walking), Illnesses and Loss of weight. Each scores 1 point, for a total from 0 to 5. It is a screening questionnaire, not a diagnosis.
Your answers
5 questions about how you are now. Nothing you enter leaves this page.
What you will see
Your FRAIL score out of 5, whether it falls in the robust (0), pre-frail (1 to 2) or frail (3 to 5) band as the developers define them, and the point for each item.
Educational only, not medical advice. A screening questionnaire, not a diagnosis of frailty.
Source
Morley JE, Malmstrom TK and Miller DK, Journal of Nutrition, Health and Aging 2012. The questions, the scoring of each item and the 0 / 1 to 2 / 3 to 5 bands are as printed in that paper's Methods and Appendix 1.
Validated in
998 African Americans from two areas of St. Louis (inner city and nearby suburbs) who were 49 to 65 years old when the African American Health study began in 2000 to 2001, followed for 9 years.
Limits
A self-report screen, not a diagnosis. Validated in one late middle-aged African American cohort; the authors say the results may not apply to other groups and call for studies in other populations. Few people were frail at the start, which limited the analysis of that group.
How the FRAIL scale is scored
The FRAIL scale has 5 components, 1 point each, so scores run from 0 (best) to 5 (worst). A score of 0 is called robust, 1 to 2 pre-frail and 3 to 5 frail (Morley 2012).
| Item | Question | Scores 1 point when |
|---|---|---|
| Fatigue | How much of the time during the past 4 weeks did you feel tired? | All of the time or most of the time |
| Resistance | By yourself and without aids, any difficulty walking up 10 steps without resting? | Yes |
| Ambulation | By yourself and without aids, any difficulty walking several hundred yards? | Yes |
| Illnesses | Has a doctor ever told you that you have each of 11 illnesses? | 5 or more of the 11 |
| Loss of weight | Your weight now and one year ago | A loss of more than 5% in the past year |
The 11 illnesses are high blood pressure, diabetes, cancer (other than a minor skin cancer), chronic lung disease, heart attack, congestive heart failure, angina, asthma, arthritis, stroke and kidney disease (Morley 2012). Weight loss is worked out as (weight a year ago minus weight now) divided by weight a year ago, times 100 (Morley 2012). Items and scoring are as printed in the paper's Appendix 1; the question wording above follows it closely.
What the bands went with
Among study members with no difficulty with basic daily tasks at the start, 2.7% scored as frail and 37.4% as pre-frail (Morley 2012). After allowing for age, sex and starting values, being pre-frail at the start went with more difficulty with daily tasks, worse balance on a one-leg stand and a higher chance of dying over 9 years. Being frail went with more difficulty with daily tasks, including tasks such as shopping and housework, and a higher chance of dying (Morley 2012). These are links seen in a group, not a forecast for one person.
The authors suggest the FRAIL scale as a quick screening test for clinicians to find people at risk of disability, so that help can start early (Morley 2012).
Limits
The study cohort was late middle-aged at the start, so frailty was less common than it would be in an older group, and the authors note that results in an African American population may not generalize to other populations (Morley 2012). About a quarter of the cohort was left out of some analyses because they already had difficulty with daily tasks (Morley 2012). The answers are self-reported, and some people do not know their weight from a year ago exactly.
FRAIL, SARC-F and falls
The same research group built SARC-F, a 5-question screen for loss of muscle strength (sarcopenia) that scores 0 to 10 (Malmstrom 2016). FRAIL looks wider, at tiredness, long-term illness and weight loss as well as stairs and walking. For adults 65 and older living in the community who are at increased risk for falls, the USPSTF recommends exercise to prevent falls (USPSTF 2024); see the fall risk check. If your score is 1 or more, or you are getting weaker, more tired or losing weight without trying, tell your doctor.
Sources
- Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012;16(7):601-608. doi:10.1007/s12603-012-0084-2. PMID 22836700. PMC4515112. (Developers' validation paper; prints the 5 FRAIL items, the scoring of each and the robust, pre-frail and frail bands in its Methods and Appendix 1.) pmc.ncbi.nlm.nih.gov/articles/PMC4515112/
- Malmstrom TK, Miller DK, Simonsick EM, Ferrucci L, Morley JE. SARC-F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes. J Cachexia Sarcopenia Muscle. 2016;7(1):28-36. doi:10.1002/jcsm.12048. PMC4799853. (Developers' validation paper; prints the 5 items, 0 to 2 points each and the 4+ cut point in its Methods.) pmc.ncbi.nlm.nih.gov/articles/PMC4799853/
- US Preventive Services Task Force. Interventions to Prevent Falls in Community-Dwelling Older Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2024;332(1):51-57. www.uspreventiveservicestaskforce.org/uspstf/recommendation/falls-prevention-community-dwelling-older-adults-interventions
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