Frailty Index Calculator

Assess frailty status using the Fried Frailty Phenotype, a validated tool for identifying vulnerable older adults at risk for adverse health outcomes.

Fried Frailty Phenotype Assessment

Unintentional Weight Loss (>10 lbs in past year)

Self-Reported Exhaustion

Based on CES-D questions: "I felt that everything I did was an effort" or "I could not get going"

Weakness (Grip Strength)

Men: <29 kg (BMI ≤24), <30 kg (BMI 24.1-28), <32 kg (BMI >28)
Women: <17 kg (BMI ≤23), <17.3 kg (BMI 23.1-26), <18 kg (BMI 26.1-29), <21 kg (BMI >29)

Slow Walking Speed

Based on time to walk 15 feet. Men: ≥7 sec (height ≤173 cm) or ≥6 sec (>173 cm)
Women: ≥7 sec (height ≤159 cm) or ≥6 sec (>159 cm)

Low Physical Activity Level

Men: <383 kcal/week; Women: <270 kcal/week of physical activity

Frailty Score

0 / 5

Frailty Status

Classification:

0 points: Robust - No frailty criteria present
1-2 points: Pre-frail - Intermediate/transitional state
3-5 points: Frail - High vulnerability to stressors

Clinical Implications:

•Low risk for adverse outcomes
•Encourage continued physical activity
•Maintain healthy lifestyle habits
•Routine age-appropriate preventive care
•Reassess annually or with significant health changes

Understanding the Frailty Index

The Fried Frailty Phenotype, developed by Dr. Linda Fried and colleagues from the Cardiovascular Health Study, is one of the most widely used and validated tools for assessing frailty in older adults. This phenotype identifies frailty as a distinct biological syndrome characterized by decreased physiologic reserve and resistance to stressors.

The Five Components

Each of the five criteria represents a key dimension of the frailty phenotype. Weight loss reflects nutritional decline and sarcopenia. Exhaustion indicates reduced energy and endurance. Weakness (low grip strength) correlates with overall muscle strength. Slowness reflects mobility impairment. Low physical activity demonstrates reduced energy expenditure and deconditioning.

Clinical Significance

Frailty is associated with a 2-3 fold increased risk of falls, disability, hospitalization, and mortality. Pre-frailty represents a critical window for intervention, as progression to frailty can often be prevented or delayed with appropriate interventions. Studies show that multicomponent exercise programs and nutritional interventions can reverse or improve frailty status.

Evidence-Based Interventions

Multicomponent exercise programs combining resistance training, aerobic exercise, and balance training show the strongest evidence for frailty prevention and reversal. Protein supplementation (1.0-1.2 g/kg/day), vitamin D optimization, and comprehensive geriatric assessment with targeted interventions also demonstrate benefit. Medication review and deprescribing can reduce polypharmacy-related risks.

Frequently Asked Questions

What is the difference between frailty and disability?

Frailty is a biological syndrome of decreased reserve and resistance to stressors, while disability refers to difficulty or dependence in performing activities of daily living. Frailty often precedes and predicts disability, but the two conditions are distinct and can occur independently.

Can frailty be reversed?

Yes, particularly in the pre-frail stage. Studies show that approximately 25-50% of pre-frail individuals can transition back to robust status with targeted interventions. Even in frail individuals, improvements in frailty status are possible with comprehensive, multifaceted interventions including exercise, nutrition, and medication optimization.

How often should frailty be assessed?

Annual screening is recommended for community-dwelling adults aged 65 and older. More frequent assessment (every 3-6 months) is appropriate for pre-frail individuals receiving interventions, after major illness or hospitalization, or when there are noticeable changes in functional status.

What grip strength indicates weakness?

Weakness thresholds are stratified by gender and BMI. For men: <29 kg (BMI ≤24), <30 kg (BMI 24.1-28), or <32 kg (BMI >28). For women: <17 kg (BMI ≤23), <17.3 kg (BMI 23.1-26), <18 kg (BMI 26.1-29), or <21 kg (BMI >29). These represent the lowest 20th percentile for each category.

What exercises are best for frail older adults?

Multicomponent programs work best, combining resistance training (2-3 times/week), aerobic exercise (moderate intensity, 20-30 min, 3-5 times/week), and balance training. Start with low intensity and progress gradually. Chair exercises, resistance bands, and walking programs are safe starting points. Physical therapy guidance is recommended for frail individuals.

How much protein do frail older adults need?

Current evidence supports 1.0-1.2 g/kg body weight/day for older adults, with higher amounts (1.2-1.5 g/kg/day) for those who are frail or malnourished. Protein should be distributed throughout the day, with 25-30 grams per meal to optimize muscle protein synthesis. Leucine-rich sources (dairy, meat, soy) are particularly beneficial.

Is frailty the same as sarcopenia?

No, though they overlap significantly. Sarcopenia refers specifically to age-related loss of muscle mass and strength, while frailty is a broader syndrome encompassing multiple systems. Sarcopenia can contribute to frailty, and many frail individuals have sarcopenia, but frailty includes additional factors like exhaustion, low activity, and weight loss beyond muscle loss.

Should surgical decisions be based on frailty status?

Frailty is a strong independent predictor of post-operative complications, increased length of stay, and mortality. However, frailty should inform but not solely determine surgical candidacy. Frailty assessment helps with shared decision-making, allows for prehabilitation interventions, and guides post-operative care planning rather than serving as an absolute contraindication.