Clinical Frailty Scale Score 6: Moderately Frail
A CFS score of 6 indicates "moderately frail" status, characterized by patients who need help with both instrumental and basic activities of daily living, are not fully dependent but require assistance with tasks like shopping, meal preparation, medications, finances, and typically need help with bathing and dressing. 1, 2
Clinical Significance and Risk Profile
Patients with CFS 6 face substantially elevated risks across multiple outcomes:
Mortality risk increases dramatically - CFS 6 patients have an adjusted hazard ratio of 3.60 (95% CI 2.39-5.44) for long-term mortality compared to non-frail patients (CFS 1-4), representing more than triple the death risk 3
Hospital length of stay is significantly prolonged - mean 11.2 ± 10.8 days for CFS 5-6 patients versus 4.1 ± 2.1 days for non-frail patients 4
Adverse discharge disposition becomes highly likely - CFS 6-7 patients have an odds ratio of 5.1 (95% CI 2.0-13.2) for unfavorable discharge destinations 2
30-day mortality risk doubles with each point increase in CFS score, with adjusted OR of 2.07 (95% CI 1.64-2.62) per point 3
Mandatory Clinical Actions at CFS 6
The American Geriatrics Society mandates routine SALT (Speech and Language Therapy) assessment for all patients with CFS ≥6 due to significantly elevated dysphagia risk, with observational data showing up to 100% of severely frail patients experiencing swallowing impairment 2
Key assessment triggers at CFS 6:
Initiate SALT evaluation immediately upon identification - delayed assessment impedes nutritional therapy success 2
Screen for polypharmacy effects on swallowing function as medications can worsen dysphagia 2
Coordinate swallowing assessment with rehabilitative exercise programs to maintain muscle mass 2
Implement early discharge planning given the 5-fold increased risk of adverse placement 2
Predictive Validity Across Outcomes
CFS 6 independently predicts multiple adverse outcomes even after adjusting for age, sex, and comorbidities:
- Mortality: CFS predicts death 87% of the time across studies 5
- Complications: 100% predictive accuracy 5
- Cognitive decline: 94% predictive 5
- Functional deterioration: 91% predictive 5
- Falls: 71% predictive 5
Common Clinical Pitfalls
Do not underestimate CFS 6 as "mild" frailty - this represents moderate frailty with substantial functional dependence requiring assistance with both instrumental ADLs (shopping, finances, medications) and basic ADLs (bathing, dressing) 1, 2
Avoid using age alone for risk stratification - CFS 6 patients have markedly worse outcomes than robust patients of the same chronological age, as frailty captures biological rather than chronological aging 6, 7
Do not delay intervention planning - frailty states are dynamic and bidirectional, meaning early targeted interventions addressing physical activity, nutrition, and deficit accumulation can potentially reverse frailty progression 7
Recognize that CFS 6-7 patients who died in trauma cohorts were universally classified as frail by validated indices, emphasizing the critical importance of early risk identification 2
Documentation Requirements
Chart the following elements for CFS 6 patients: 1
- Numeric CFS score (6)
- Frailty category (moderately frail)
- Date of assessment
- Specific functional deficits identified (which IADLs and ADLs require assistance)
- SALT assessment completion or scheduling