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This paper describes a revised Clinical Frailty Scale (CFS-Self) tool designed for self- or caregiver-administered screening, addressing limitations of assessor dependence in the original CFS approach. Four modifications were introduced, including an added physical activity question and updated fatigue wording, supported by improved questionnaire presentation and a Chinese version. A pilot study in primary care evaluated agreement with trained care-coordinator CFS-CC ratings using robust inter-rater statistics and reported score ranges across participants.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/empowering-self-assessment-of-frailty-a-revised-cfs-self-tool-for-primary-and-community-care/434589/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/empowering-self-assessment-of-frailty-a-revised-cfs-self-tool-for-primary-and-community-care/434589.png","ImageObject",300,407,{"name":92,"@type":93},"วิน","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-02","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why is frailty screening important in primary and community care?","Question",{"text":113,"@type":114},"Frailty reflects compromised homeostasis across multiple body systems, increasing vulnerability to adverse outcomes. Early detection and timely interventions are needed as ageing increases frailty prevalence.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How is the revised CFS-Self structured and administered?",{"text":118,"@type":114},"The revised CFS-Self is a 4-item self- or caregiver-administered questionnaire covering basic ADLs, instrumental ADLs, fatigue, and gait slowing. It assigns categories ranging from CFS 1–3 (robust) to CFS 7–8 (severely frail).",{"name":120,"@type":111,"acceptedAnswer":121},"What changes were made when revising the original CFS-Self?",{"text":122,"@type":114},"The revision added a fifth question on physical activity beyond routine walking to distinguish CFS 1–2 from CFS 3, reworded fatigue to align with a CFS guide, and enhanced questionnaire format and pictorial aids based on patient feedback. A Chinese version was also developed alongside the English version.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},434589,1790919844,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":39,"preview_page_count":4},2336475104736,"https://ap-avatar.wpscdn.com/avatar/22000c4c5e0e5b17e70?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786591360781797222","Empowering Self-assessment of Frailty: A Revised CFS-Self Tool for Primary and Community Care  \nSai Zhen Sim1,2, Xinyao Ng1, Wei Chun Gan2, Dexin Zheng2, Shu Yun Tan1,2,3, Wee Shiong Lim3,4, Eng SingLee3,5  \n1Clinical Research Unit, National Healthcare Group Polyclinics, Singapore 2Department of Family Medicine, National Healthcare Group Polyclinics, Singapore 3Lee Kong Chian School of Medicine, Singapore  \n4Institute of Geriatrics and Active Aging, Department of Geriatric Medicine, TanTock Seng Hospital, Singapore 5Future Primary Care, Ministry of Health Office for Healthcare Transformation, Singapore  \nDear Editor,  \nFrailty is a syndrome in which homeostatic compromise across multiple body systems increases one’s vulnerability to adverse outcomes such as morbidity and mortality.1) Its prevalence is expected to rise with an ageing population, necessitating early detection and interventions to mitigate its impact.2) In response, the Healthier Singapore initiative, launched by Singapore Ministry of Health in 2022, aims to promote preventive health through partnerships with primary and community care providers.3) As part of its phased implementation, the initiative will integrate frailty screening with secondary assessments and interventions into its care protocols. To support this, the Singapore National Frailty Policy Workgroup has recommended the Clinical Frailty Scale (CFS) asthe national frailty screening tool.2)  \nThe CFS is a validated, judgement-based tool that categorizes individuals from 1 (very fit) to 9 (terminally ill), based on fitness level, physical activity, functional status, and cognitive ability.4) It is widely used for its simplicity and potential for algorithm-guided scoring to increase the accuracy of CFS rating.5,6) The CFS’s graded structure allows for effective staging of frailty severity, enabling tailored follow-up assessments and efficient allocation of healthcare resources.2) However, a key limitation is its requirement for a trained assessor, which may hinder large-scale screening and population-level monitoring.6,7)  \nTo overcome this, the CFS-Self was developed for self-administration8) and it has been validated against the Frailty Index with good diagnostic accuracy and predictive ability for adverse outcomes in the emergency setting.9) It is a 4-item self-or caregiver-administered questionnaire evaluating basic activities of daily living (bADLs: toileting, dressing, showering, and walking); instrumental activities of daily living (iADLs: going outside, manag-  \ning finances, and medication adherence); fatigue (“feeling constantly tired throughout the day”); and slowing of gait (“walking slower than usual”). Individuals are categorized as: CFS 1–3 (robust), CFS 4 (very mildly frail), CFS 5 (mildly frail), CFS 6 (moderately frail), and CFS 7–8 (severely frail).  \nSubsequently, a team of primary care physicians and geriatricians revised the CFS-Self for use in community and primary care settings. The revised CFS-Self incorporated 4 modifications to the original version. (Supplementary Figs. S1 and S2) Firstly, a fifth question on “physical activity beyond routine walking” was added to distinguish CFS 1–2 from CFS 3. From a primary care perspective, as physical inactivity is a significant modifiable risk factor for frailty,10) individuals at CFS 3 may be amenable to early intervention aimed at increasing physical activity. Secondly, the fatigue question was reworded to “feel tired more easily” to better align with Rockwood and Theou’s 2019 CFS guide.4) Thirdly, the format and pictorial aids ofthe questionnaire were enhanced based on feedback from six patient interviews, with the goal of improving readability and comprehension. Lastly, a Chinese version of the revised CFS-Self was developed alongside the English version, reflecting the two most widely spoken languages in Singapore.11)  \nA pilot study was conducted in the primary care setting to assess the agreement between self-administered ratings","cbCaihJ5WpFbcfEM","https://ap.wps.com/l/cbCaihJ5WpFbcfEM","pdf",129610,"English","# Background and Need\n# CFS and CFS-Self Overview\n# Revisions for Primary and Community Care\n# Pilot Study Design and Methodology\n## Participants and Measures\n## Results Summary\n# Score Grouping Approach","[{\"question\":\"Why is frailty screening important in primary and community care?\",\"answer\":\"Frailty reflects compromised homeostasis across multiple body systems, increasing vulnerability to adverse outcomes. Early detection and timely interventions are needed as ageing increases frailty prevalence.\"},{\"question\":\"How is the revised CFS-Self structured and administered?\",\"answer\":\"The revised CFS-Self is a 4-item self- or caregiver-administered questionnaire covering basic ADLs, instrumental ADLs, fatigue, and gait slowing. It assigns categories ranging from CFS 1–3 (robust) to CFS 7–8 (severely frail).\"},{\"question\":\"What changes were made when revising the original CFS-Self?\",\"answer\":\"The revision added a fifth question on physical activity beyond routine walking to distinguish CFS 1–2 from CFS 3, reworded fatigue to align with a CFS guide, and enhanced questionnaire format and pictorial aids based on patient feedback. A Chinese version was also developed alongside the English version.\"}]","Empowering Self-assessment of Frailty - A Revised CFS-Self Tool for Primary and Community Care | PDF",1790669917]