Frailty assessment tools for preoperative evaluation of older adults: scoping review

Optimal frailty assessment in surgery remains unclear due to insufficient tool performance evaluations. This scoping review summarizes evidence on frailty tools in the preoperative setting, focusing on key performance metrics.

Following JBI and PRISMA-ScR recommendations, the MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature databases were systematically searched (2005-May 2026), for studies evaluating performance metrics of frailty tools in adults aged ≥ 65 years undergoing major intracavitary surgery. Two reviewers conducted screening and data charting. Data were analysed on settings, surgical types, and six performance metrics across measurement properties, clinical impact, and pragmatic factors.

From 12 272 records, 160 unique studies on 35 frailty tools were included. Some tools were extensively investigated (up to 41 studies and 11 287 participants), whereas 40% of tools had been investigated in only one study. Predictive validity was commonly studied, whereas reliability, clinical impact, and pragmatic factors were less explored. The Clinical Frailty Scale was extensively studied, covering four of six performance metrics across diverse settings and surgical types. The Edmonton Frail Scale was the only tool investigated across all six metrics, although reliance on performance and cognitive testing may hinder implementation. The FRAIL scale, Geriatric 8, and Vulnerable Elders Survey-13 are simple questionnaires, with the FRAIL scale being the most extensively investigated (five of six metrics).

Several frailty assessment tools show promise based on investigation extent and features. This review aids clinical teams in identifying tools that meet specific local needs. Further research should focus on clinical impact and pragmatic factors, as well as tool-specific meta-analyses of performance metrics to enhance tool selection and implementation.