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NHS Frailty Management UK 2026 — Elderly Care & Comprehensive Geriatric Assessment
Complete guide to NHS frailty management in the UK — Comprehensive Geriatric Assessment (CGA), frailty scoring, elderly care pathways, virtual wards for frail patients, and frailty software.
3.8 million older people in the UK have frailty. They account for 40% of NHS bed days and 50% of NHS spending. Effective frailty management through CGA and virtual wards can reduce admissions by 30%.
Clinical Frailty Scale (CFS)
| Score | Category | Description |
|---|---|---|
| 1 | Very fit | Robust, active, energetic, regularly exercise |
| 2 | Well | No active disease symptoms, less fit than category 1 |
| 3 | Managing well | Medical problems well controlled, not regularly active |
| 4 | Vulnerable | Not dependent on others but symptoms limit activities |
| 5 | Mildly frail | Evident slowing, needs help with high-order IADLs |
| 6 | Moderately frail | Needs help with outside activities and housekeeping |
| 7 | Severely frail | Needs help with all personal care, stable |
| 8 | Very severely frail | Completely dependent, not recovering from illness |
| 9 | Terminally ill | Near end of life, otherwise fit-frail |
Frailty Care Pathway
- Identification: Screen all 65+ patients using eFI or CFS at GP registration and hospital admission
- Assessment: Comprehensive Geriatric Assessment for moderate-severe frailty (CFS 5+)
- Care planning: Personalised care and support plan based on CGA findings
- Intervention: Tailored interventions: medication review, exercise, nutrition, falls prevention
- Coordination: Care coordinator for severe frailty, regular reviews
- Crisis prevention: Urgent community response, virtual ward, SDEC for frail
- End of life: Advance care planning for terminal frailty
CGA Components
| Domain | Assessment | Tools |
|---|---|---|
| Medical | Comorbidities, polypharmacy | Medication review, diagnoses |
| Functional | ADLs, IADLs, mobility | Barthel Index, Timed Up and Go |
| Cognitive | Cognition, delirium screening | MMSE, MoCA, 4AT |
| Psychological | Mood, depression | PHQ-9, GDS-15 |
| Social | Social support, finances | Social worker assessment |
| Environmental | Home safety, falls hazards | Home assessment, OT |
| Nutritional | Nutrition status | MUST screening, BMI |
Frequently Asked Questions
- What is Comprehensive Geriatric Assessment (CGA)?
- CGA is a multi-dimensional, interdisciplinary assessment of an older person's medical, psychological, and functional capabilities. It includes: medical, functional, cognitive, social, environmental, and medication review. CGA reduces mortality by 25%, reduces institutionalisation by 30%, and reduces readmissions by 20%.
- How is frailty scored in the NHS?
- Frailty is scored using the Clinical Frailty Scale (CFS) — a 9-point scale from 1 (very fit) to 9 (terminally ill). Other tools: eFI (Electronic Frailty Index) using GP records, PRISMA-7, and Edmonton Frail Scale. NHS England recommends routine frailty screening for all 65+ patients.
- How many frail older people are in the UK?
- There are 3.8 million people aged 65+ in the UK with some degree of frailty. 1.3 million have moderate to severe frailty. Frail older people account for 40% of NHS hospital bed days and 50% of NHS spending. Effective frailty management can reduce admissions by 30%.