Table 2.

Simplified workflow for frailty assessment in primary care beyond chronological age

Step	Actions	Tools/details
Step 1: Identify older adults at risk	Screen older adults aged ≥ 65 years with multiple comorbidities, recent weight loss, functional decline, or falls	Quick screening questions: “Have you experienced unintended weight loss in the past 6 months” “Do you feel fatigued or lack energy most days?” “Do you have difficulty walking a short distance (e.g., 400 m)?”
Step 2: Select an appropriate frailty assessment tool	Use validated tools to assess frailty. Select based on time availability and resources	Clinical Frailty Scale (CFS): < 5 min, no equipment, scores ≥ 5/8 indicate frailty
		Full Fried Frailty Phenotype: 5–10 min, includes grip strength (dynamometer required) and walk speed
		Simplified Fried Frailty Scale: < 5 min, no equipment, evaluates weight loss, exhaustion, physical activity, walking speed
		Frailty Index (FI): Comprehensive tool based on accumulation of health deficits (e.g., symptoms, comorbidities, disabilities)
		Electronic Frailty Index (eFI): Calculated using routine electronic health record data, providing an objective measure of frailty based on accumulated deficits. The eFI calculates a frailty score by dividing the number of deficits present by the total possible: uses 36 validated deficits. The eFI score ranges from 0 to 1, with higher scores indicating greater frailty
Step 3: Stratify frailty severity	Categorize patients based on frailty assessment results	Non-frail (Fit): Robust health, no frailty markers
		Pre-frail: 1–2 frailty markers
		Frail: ≥ 3 markers or CFS score ≥ 5
Step 4: Conduct Comprehensive Geriatric Assessment (CGA)	Evaluate medical, functional, and psychosocial aspects for frail or pre-frail individuals	Physical function: i.e., gait speed, grip strength. Nutritional status: i.e., Mini Nutritional Assessment. Cognitive function: i.e., Mini Mental State Examination. Polypharmacy review: i.e., deprescribe unnecessary medications. Psychosocial needs: i.e., caregiver support, living conditions
Step 5: Develop an individualized management plan	Create a personalized care plan based on frailty status and functional needs	Functional goals: Maintain independence, mobility, and quality of life. Interventions: Prescribe physical therapy, resistance training, and nutritional support. Glycaemic targets: Adjust based on frailty severity (e.g., HbA1c: 7.5–8.5% for frail individuals). Monitoring: Schedule regular follow-ups to reassess functional and clinical status