Retrospective Use of the Pictorial Fit-Frail Scale for Determination of Frailty Level in Hospitalized Older Adults with a Hip Fracture


  • Alanna Bohnsack Horizon Health Network
  • Karla Faig Horizon Health Network
  • Allyson Cook Dalhousie Medicine New Brunswick
  • Sherry Gionet Horizon Health Network
  • Josh Shanks Dalhousie Medicine New Brunswick
  • Susan Benjamin Trauma New Brunswick
  • Aidan Steeves Horizon Health Network
  • Cameron MacLellan Horizon Health Network, Dalhousie University
  • Andrew J. Flewelling Horizon Health Network
  • Chris McGibbon University of New Brunswick
  • Pamela Jarrett Horizon Health Network, Dalhousie Medicine New Brunswick



Pictorial Fit-Frail Scale, frailty, older adults, hip fractures, electronic health records, retrospective review


The Pictorial Fit-Frail Scale (PFFS) is a frailty tool consisting of visual images to comprehensively assess frailty across 14 domains that can be completed by health professionals, patients, or caregivers. The objective of this study was to explore the feasibility of using the PFFS retrospectively to determine a patient’s frailty level using data from the hospital electronic health records (EHRs) of older adults admitted with an isolated hip fracture.

A random sample of 200 hip fracture patients admitted to a Level 1 Trauma Center hospital in New Brunswick was selected for review using the PFFS. The majority (94.5%) of hospital EHRs contained the clinical information needed to populate most of the 14 PFFS domains, allowing for determination of a frailty score. The mean raw PFFS frailty score was 9.7 (SD 6.6), consistent with moderate frailty. For all patients, a Frailty Index (FI) score was calculated, with the mean being 0.27 (SD 0.18), again consistent with moderate frailty. Comparing the PFFS score to the FI score, the percentage categorized as not frail or very mildly frail fell from 33.3% to 20.1%, and those considered severely frail rose from 30.7% to 34.9%.

The PFFS can be successfully used retrospectively with hospital EHRs to determine the frailty level of older patients. When converted to the FI score, there was an increase in the frequency and severity of frailty. This tool may provide a useful way to stratify older adults by frailty that can be helpful in evaluating health outcomes based on frailty levels.


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How to Cite

Bohnsack A, Faig K, Cook A, Gionet S, Shanks J, Benjamin S, Steeves A, MacLellan C, Flewelling A, McGibbon C, Jarrett P. Retrospective Use of the Pictorial Fit-Frail Scale for Determination of Frailty Level in Hospitalized Older Adults with a Hip Fracture. Can Geriatr J [Internet]. 2023 Sep. 1 [cited 2023 Sep. 29];26(3):400-4. Available from:



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