Frailty assessment in people with hemophilia

In the general population, aging is associated with frailty. Screening is recommended because targeted interventions improve health outcomes. In 2014, frailty screening was incorporated within routine clinic appointments for persons with hemophilia aged ≥50 years at our large UK Haemophilia Comprehensive Care Centre.

To determine the prevalence of frailty in persons with hemophilia aged ≥50 years.

Electronic health records of persons with hemophilia ≥50 years were reviewed (2024-2025) to collect data on prospective Clinical Frailty Scale (CFS) scores, comorbidities, and regular medications.

Of 116 persons with hemophilia aged ≥50 years, 111 had a documented CFS score. Frailty (CFS ≥4) occurred in 24%. Among those aged 50 to 64 years (n = 66), 18% were frail (11 severe and 1 moderate hemophilia); of those aged ≥65 years (n=45), 33% were frail (4 severe, 2 moderate, 9 mild hemophilia). Frailty was associated with high rates of multimorbidity (100%) and polypharmacy (78%). Hemophilic arthropathy appeared to be a significant contributory factor in some patients. Of those with CFS ≥4, falls were reported in 26%, with immobility identified in 11%, cognitive impairment in 4%, and no incontinence documented. Specific clinical actions by the hemophilia team included hemophilia physiotherapy assessment and highlighting CFS to the primary care practitioner.

Persons with hemophilia have higher rates of frailty than reported for the general UK population (33% for those aged ≥65 years vs 10%), and a high incidence in younger persons with hemophilia. Hemophilic arthropathy appears to be a major contributing factor in some patients. Further studies are needed to clarify the impact of identification of frailty in persons with hemophilia.