CFS case laboratory: applying judgement under uncertainty

Real CFS scoring is rarely as tidy as a poster. The purpose of this module is to make uncertainty visible. Each case therefore withholds at least one important piece of information, introduces conflicting accounts, or includes an acute change. Learners are rewarded for asking the right next question as well as for selecting a defensible category.

An 86-year-old normally walks with a stick, manages medicines and finances, cooks simple meals and shops with her daughter because she no longer drives. During pneumonia she requires assistance to transfer. The first task is not to score the transfer dependency; it is to reconstruct usual function and determine whether shopping support reflects frailty, transport choice or another factor.

An 82-year-old walks independently but needs prompting for medication and repeated reminders for appointments. A relative reports increasing difficulty with finances. Learners must describe the functional impact of cognition rather than equate the diagnostic label with a fixed CFS level.

A 70-year-old with a long-standing spinal cord injury is dependent for several activities but has stable health, active work and no age-related decline. The case tests whether learners remember that the CFS is not designed for stable single-system disability.

A 74-year-old with advanced progressive malignancy remains mobile around the house and manages personal care but is thought to be in the final months of life. Learners explore why end-of-life status is not identical to severe functional frailty and why prognosis remains uncertain.

A person reports full independence; a daughter says 'Dad does nothing now'; therapy notes show independent transfers but recent withdrawal from community activities. Learners must ask for specifics, avoid taking either account literally, and identify what evidence would discriminate between very mild and more established frailty.

An older person was independent before hip fracture, dependent at discharge and improving during rehabilitation. Learners record baseline frailty separately from current function and use direct mobility measures to track recovery rather than repeatedly changing baseline CFS with every therapy session.

If evidence is incomplete, say so. A provisional score with a stated range or competing interpretation is safer than false precision. Record the missing information and who will obtain it. The score should become more certain as the history becomes better, not because time has passed.

What will you do differently when you next assess an older person whose current function differs from their usual baseline? Record one specific change in history-taking, documentation, tool use or multidisciplinary communication.