Does the FRAIL scale predict disability and death?
Answered November 2, 202610 sources
EvidenceBModerateGood evidence in people with one real weakness. New studies could change the answer.
Yes. Older adults scoring as frail on the FRAIL scale had several times the risk of later disability and death, though it sorts groups better than it predicts one person's fate.
Who it's for
Middle-aged and older adults, including before surgery; not tested as a stand-alone verdict for individuals.
What to expect
Frail scores go with much higher risk; the scale ranks risk roughly.
Watch out for
Predictions are imperfect for any one person; many studies are observational.
Frail and prefrail people face higher risk of death
Each dot is the pooled risk of death compared with robust people, with a line for its likely range.
← BetterWorse →
No difference
Frail3.53 (1.66 to 7.49)Clear worsening
Prefrail1.75 (1.14 to 2.7)Clear worsening
11.5235
risk of death vs. robust, 1 = same
Frail and prefrail people face higher risk of death
A review that pooled 3 studies of community-dwelling middle-aged and older adults found frailty on the FRAIL scale linked to about 3.5 times the risk of death compared with robust people. Prefrailty was linked to about 1.75 times the risk1Meta-analysis · 2018Frailty Defined by FRAIL Scale as a Predictor of Mortality: A Systematic Review and Meta-analysis.This study demonstrated that FRAIL scale is a tool that can effectively identify frailty/prefrailty status, as well as quantify frailty status in a graded manner in relation to mortality risk. Although its feasibility is of note, not many studies are yet using this relatively new tool. More studies are warranted…J Am Med Dir Assoc. These figures compare groups, so one person's gain or loss depends on their starting risk.
A review that pooled 7 studies found frailty linked to far higher odds of new trouble with daily self-care (about 10 times the odds) and with household tasks (about 2.5 times). Prefrailty roughly doubled the odds of self-care disability2Meta-analysis · 2018Quick and Simple FRAIL Scale Predicts Incident Activities of Daily Living (ADL) and Instrumental ADL (IADL) Disabilities: A Systematic Review and Meta-analysis.The current study demonstrated that frailty status defined by the FRAIL scale was a significant predictor of disability among community-dwelling middle-aged and older individuals. In light of feasibility of the FRAIL scale, especially in a clinical setting, it may be a promising tool to facilitate the translation of…J Am Med Dir Assoc.
Accuracy for individuals was modest. In four studies, the scale's ability to separate those who died from those who didn't ranged from 0.54 to 0.70, where 0.5 is a coin flip and 1.0 is perfect1Meta-analysis · 2018Frailty Defined by FRAIL Scale as a Predictor of Mortality: A Systematic Review and Meta-analysis.This study demonstrated that FRAIL scale is a tool that can effectively identify frailty/prefrailty status, as well as quantify frailty status in a graded manner in relation to mortality risk. Although its feasibility is of note, not many studies are yet using this relatively new tool. More studies are warranted…J Am Med Dir Assoc.
A study of 1,152 Finnish older adults followed for up to 18 years found frailty on the FRAIL scale linked to about 6 times the risk of death. Results held after adjustment, and were similar to a longer, more detailed frailty index8Observational study · 2020 · 1,152 peopleFrailty and mortality: an 18-year follow-up study among Finnish community-dwelling older people.FS and PRISMA-7 are applicable frailty screening instruments in clinical setting among community-dwelling Finnish older people.Aging Clin Exp Res.
Before surgery, a review of 18 studies (4,479 patients) linked frailty to higher odds of death at 30 days and 6 months, and to complications and delirium. The link to death at 1 year could be due to chance3Meta-analysis · 2023 · 4,479 peopleAssociation Between the FRAIL Scale and Postoperative Complications in Older Surgical Patients: A Systematic Review and Meta-Analysis.As measured by the FRAIL scale, frailty was associated with 30-day mortality, 6-month mortality, postoperative complications, and postoperative delirium.Anesth Analg.
Related simple tools show similar patterns. Studies of older women (6,701) and men (3,132) found frail people had higher risks of disability and death6Observational study · 2008 · 6,701 peopleComparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women.The simple SOF index predicts risk of falls, disability, fracture, and death as well as the more complex CHS index and may provide a useful definition of frailty to identify older women at risk of adverse health outcomes in clinical practice.Arch Intern Med,10Observational study · 2009A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men.The simple SOF index predicts risk of falls, disability, fracture, and mortality in men as well as the more-complex CHS index.J Am Geriatr Soc. These did not use the FRAIL scale itself.
Key studies
Study
Who
What it found
Review of 3 studies, 20181Meta-analysis · 2018Frailty Defined by FRAIL Scale as a Predictor of Mortality: A Systematic Review and Meta-analysis.This study demonstrated that FRAIL scale is a tool that can effectively identify frailty/prefrailty status, as well as quantify frailty status in a graded manner in relation to mortality risk. Although its feasibility is of note, not many studies are yet using this relatively new tool. More studies are warranted…J Am Med Dir Assoc
Community adults, middle-aged and older
Frailty linked to about 3.5 times the death risk
Review of 7 studies, 20182Meta-analysis · 2018Quick and Simple FRAIL Scale Predicts Incident Activities of Daily Living (ADL) and Instrumental ADL (IADL) Disabilities: A Systematic Review and Meta-analysis.The current study demonstrated that frailty status defined by the FRAIL scale was a significant predictor of disability among community-dwelling middle-aged and older individuals. In light of feasibility of the FRAIL scale, especially in a clinical setting, it may be a promising tool to facilitate the translation of…J Am Med Dir Assoc
Community adults, middle-aged and older
Frailty linked to much higher odds of disability
Study following 1,152 people, 20208Observational study · 2020 · 1,152 peopleFrailty and mortality: an 18-year follow-up study among Finnish community-dwelling older people.FS and PRISMA-7 are applicable frailty screening instruments in clinical setting among community-dwelling Finnish older people.Aging Clin Exp Res
Finnish older adults
Frailty linked to about 6 times the death risk over 18 years
Review of 18 studies, 20233Meta-analysis · 2023 · 4,479 peopleAssociation Between the FRAIL Scale and Postoperative Complications in Older Surgical Patients: A Systematic Review and Meta-Analysis.As measured by the FRAIL scale, frailty was associated with 30-day mortality, 6-month mortality, postoperative complications, and postoperative delirium.Anesth Analg
4,479 older surgical patients
Higher death at 30 days and 6 months; more complications
Study following 883 people, 20124Observational study · 2012 · 883 peopleA simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans.This study has validated the FRAIL scale in a late middle-aged African American population. This simple 5-question scale is an excellent screening test for clinicians to identify frail persons at risk of developing disability as well as decline in health functioning and mortality.J Nutr Health Aging
African Americans aged 49 to 65
Frailty predicted disability and death over 9 years
What we don't know
Few studies have used the FRAIL scale itself, and the death review pooled only three.
Whether acting on a frailty score improves outcomes is not answered by these studies.
Written by AI from the studies listed, without review by a clinician, and graded with the GRADE method. It can be wrong, so check the studies it cites. Education, not medical advice.