Sir, the challenges that the ageing population will present to the dental profession have long been forecasted and the word 'frail' is often bandied about. But what does this word mean? The British Geriatrics Society define frailty as 'a distinctive health state related to the ageing process in which multiple body systems gradually lose their in-built reserves'.1 Do we eyeball a person and say they are frail? Is it a binary decision: frail/not frail?

In my search for answers, I came across the Rockwood Clinical Frailty Scale2 (Fig. 1) which is widely used in geriatric medicine on a global level. Clinical descriptors and pictographs allow clinicians to recognise and quantify frailty.

Fig. 1
figure 1

The Rockwood Clinical Frailty Scale.2 Reprinted with the permission of The Geriatric Medicine Research, Dalhousie University, Halifax, Nova Scotia

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The Clinical Frailty Scale is validated, quick to apply and avoids bias. The tool can particularly help newly-qualified clinicians to evaluate the risk/benefits of treatment options and justify their clinical decision-making. Recording a frailty score in patient notes could also be used in defence of 'supervised neglect'.

Dental treatment planning for the ageing population can be complex and sometimes the decision between radical anticipatory care or the carefully-considered option of not treating disease is a grey area. The Clinical Frailty Scale provides a reminder of the heterogeneity of ageing. It's not a panacea to treatment planning for the ageing population - but it's another tool to have in the toolkit when dealing with complexity.