Selection of an Appropriate Tool for Assessing Geriatric Frailty in Clinical Practice: A Narrative Review

Frailty is a clinically significant geriatric syndrome characterized by reduced physiological reserve and increased vulnerability to stressors, resulting in a higher risk of adverse health outcomes such as functional decline, hospitalization, institutionalization, and mortality. Its early identification is essential for risk stratification, care planning, and individualized intervention. As no universal biomarker of frailty exists, its assessment relies on standardized clinical assessment instruments. However, the available tools are not interchangeable, and their optimal use depends on the clinical setting, the purpose of assessment, and organizational capacity.

A narrative review was conducted using PubMed/MEDLINE, Scopus, and Web of Science, supplemented by manual screening of reference lists of key articles, methodological papers, and international recommendations. The literature search was current to March 2026. Ten frailty assessment instruments were included based on predefined eligibility criteria, including external validation in large cohorts, demonstrated prognostic performance in more than one independent study, or endorsement in international geriatric guidelines: the FRAIL scale (Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight), the Study of Osteoporotic Fractures (SOF) index, the Clinical Frailty Scale (CFS), the Program of Research to Integrate Services for the Maintenance of Autonomy 7-item questionnaire (PRISMA-7), the Vulnerable Elders Survey-13 (VES-13), the Fried frailty phenotype, the Tilburg Frailty Indicator (TFI), the Groningen Frailty Indicator (GFI), the Edmonton Frail Scale (EFS), and the Frailty Index derived from Comprehensive Geriatric Assessment (FI-CGA).

The reviewed instruments differ in their conceptual background, including phenotypic, deficit-based, and multidomain approaches, as well as in assessed domains, time requirements, and staffing demands. They are therefore not directly interchangeable. Based on this synthesis, a stepwise, context-oriented pathway for instrument selection is proposed. Brief screening tools such as PRISMA-7 or the FRAIL scale may be suitable at first contact in outpatient and community care; the CFS may support rapid clinical stratification in acute hospital and emergency settings; multidomain instruments such as the EFS may be appropriate when a broader clinical overview is required but full comprehensive geriatric assessment (CGA) is not feasible; and CGA supplemented by a deficit accumulation index such as the FI-CGA may be most appropriate in specialized geriatric care and individualized management planning.

The stepwise pathway proposed in this review represents a conceptual framework synthesized from the available literature rather than a prospectively validated clinical protocol. Its purpose is to support clinicians in selecting an appropriate frailty assessment instrument for a defined clinical situation. Prospective evaluation across different healthcare settings is needed before the pathway can be regarded as an evidence-based protocol for routine practice.