Geriatric Medicine Research

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Geriatric Medicine Research · Dalhousie University and Nova Scotia Health

GMR Toolkit

Beta for testing only. The pictures are placeholders, not the official artwork. Not for clinical use.

Pictorial Fit-Frail ScaleBeta

Choose the picture closest to the person's usual state in each of 14 categories to get a frailty score from 0 to 43.

Completed by
You, a family member or a health professional
Questions
14 pictures
Time
About 2–5 minutes

Pictorial Fit-Frail Scale (Beta), version 0.1. Printed .

https://gmrtoolkit.ca/tools/pffs/

GMR Toolkit, Geriatric Medicine Research (Dalhousie University and Nova Scotia Health). This result is not a diagnosis and does not replace clinical judgement.

About this assessment

Who is completing this?

Categories 1 to 7

1. Mood
2. Number of medications
3. Mobility
4. Function
5. Balance
6. Social connections
7. Daytime tiredness

Categories 8 to 14

8. Memory and thinking
9. Vision (with glasses if needed)
10. Hearing (with hearing aid if needed)
11. Pain
12. Unintentional weight-loss
13. Aggression
14. Bladder control

Review your answers

    Turn your phone sideways to see the pictures larger.

    Open a saved result

    About this tool

    The Pictorial Fit-Frail Scale (PFFS) measures frailty with pictures. It covers 14 categories: mood, number of medications, mobility, function, balance, social connections, daytime tiredness, memory and thinking, vision, hearing, pain, unintentional weight-loss, aggression and bladder control. In each category the pictures run from best to worst, and you choose the one closest to the person’s usual state. The usual state is how the person was about 2 weeks before any acute illness.

    The scale can be completed by the older person, by a family member or other care partner, or by a health professional. There are official versions for each: PFFS Version 1.0 for the person or a care partner, and PFFS HCP Version 1.0 for health professionals. Choose who is completing it at the start, and the instructions change to match. For people with marked memory or thinking problems, a rating by a care partner or a health professional may be more reliable than a self-rating.

    This is a beta

    This page is an early version for testing. The pictures are placeholders, not the official PFFS artwork, so the scale cannot yet be used as intended. The instructions for health professionals are interim wording, not the official PFFS HCP Version 1.0 text. Do not use this page for clinical decisions. We have found no published study of whether an on-screen PFFS gives the same results as the paper form.

    How it is scored

    The first (best) picture in each category scores 0, and each picture after it adds 1. The PFFS score is the total of the 14 categories, from 0 to 43. Higher scores mean more frailty. Health professionals see the score under each picture, as on the HCP form.

    The result also shows the score as a frailty index: the total divided by the highest score possible for the categories answered, from 0 to 1. A skipped category is left out of both, so it does not lower the score. No score is calculated when 4 or more categories are unanswered.

    Geriatric Medicine Research recommends using the continuous score. The PFFS has no official categories (such as “fit” or “frail”), so this tool does not show any.

    Permission

    The Pictorial Fit-Frail Scale is © Theou and Rockwood. Permission to use it is managed by Geriatric Medicine Research (www.geriatricmedicineresearch.ca).

    Privacy

    Answers stay in this browser tab until you close it or choose New assessment. Nothing is sent to a server.

    More about the Pictorial Fit-Frail Scale (Geriatric Medicine Research website)

    References

    This reference list is under review.

    1. Theou O, Andrew M, Ahip SS, Squires E, McGarrigle L, Blodgett JM, Goldstein J, Hominick K, Godin J, Hougan G, Armstrong JJ, Wallace L, Sazlina SG, Moorhouse P, Fay S, Visvanathan R, Rockwood K. The Pictorial Fit-Frail Scale: developing a visual scale to assess frailty. Can Geriatr J. 2019;22(2):64–74. doi:10.5770/cgj.22.357
    2. McGarrigle L, Squires E, Wallace LMK, Godin J, Gorman M, Rockwood K, Theou O. Investigating the feasibility and reliability of the Pictorial Fit-Frail Scale. Age Ageing. 2019;48(6):832–837. doi:10.1093/ageing/afz111
    3. Wallace LMK, McGarrigle L, Rockwood K, Andrew MK, Theou O. Validation of the Pictorial Fit-Frail Scale in a memory clinic setting. Int Psychogeriatr. 2020;32(9):1063–1072. doi:10.1017/S1041610219000905
    4. Cooper L, Deeb A, Dezube AR, Mazzola E, Dumontier C, Bader AM, Theou O, Jaklitsch MT, Frain LN. Validation of the Pictorial Fit-Frail Scale in a thoracic surgery clinic. Ann Surg. 2023;277(5):e1150–e1156. doi:10.1097/SLA.0000000000005381
    5. Ahip SS, Ghazali SS, Theou O, Samad AA, Lukas S, Mustapha UK, Thompson MQ, Visvanathan R. The Pictorial Fit-Frail Scale-Malay version (PFFS-M): reliability and validity testing in Malaysian primary care. Fam Pract. 2023;40(2):290–299. doi:10.1093/fampra/cmac089
    6. Theou O, Rockwood K. Pictorial Fit-Frail Scale. In: Ruiz JG, Theou O, eds. Frailty: A Multidisciplinary Approach to Assessment, Management, and Prevention. Cham: Springer; 2024:131–135. doi:10.1007/978-3-031-57361-3_18
    7. Geriatric Medicine Research, Dalhousie University. Pictorial Fit-Frail Scale. https://www.dal.ca/sites/gmr/our-tools/pictorial-fit-frail-scale.html

    How to cite

    This is a beta for testing. Please cite the Pictorial Fit-Frail Scale paper, not this page:

    Pictorial Fit-Frail Scale © Theou and Rockwood. PFFS Version 1.0. For permission: www.geriatricmedicineresearch.ca

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    Version 0.1