Acceptability and feasibility of the Zulfiqar Frailty Scale (ZFS) in primary care: a cross-sectional survey

Frailty in older adults is a major public health concern in primary care. Although numerous frailty screening tools have been developed, their implementation in routine outpatient practice remains limited, mainly due to time constraints and perceived complexity. The Zulfiqar Frailty Scale (ZFS) was specifically designed for use in primary care. Beyond its psychometric properties, its acceptability and feasibility among healthcare professionals require evaluation. We conducted a cross-sectional descriptive survey using an anonymous questionnaire distributed to general practitioners and advanced practice nurses working in outpatient settings. Participants were asked to use the ZFS during routine renewal consultations in patients aged 65 years and older and to compare it with the Clinical Frailty Scale (CFS). Perceived feasibility, relevance, ease of use, reproducibility, and time required for completion were assessed. Fourteen practitioners provided usable responses, evaluating 126 older patients. The majority of participants reported that the ZFS could be completed in less than 5 minutes and considered it easy to use and reproducible. Most practitioners perceived the ZFS as relevant for routine clinical practice and feasible based on information available in medical records. A large proportion of respondents indicated their intention to integrate the ZFS into daily practice. Overall perceptions of feasibility and ease of use were comparable between the ZFS and the CFS. This study suggests that the Zulfiqar Frailty Scale is a feasible and well-accepted tool for frailty screening in primary care settings. Its simplicity and short administration time may facilitate the integration of frailty screening into routine outpatient practice. Larger studies are warranted to further assess its implementation and impact across diverse primary care contexts.