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Printed on 7/20/2026
For informational purposes only. This is not medical advice.
PRISMA-7 is a rapid frailty screening questionnaire designed for use in older adults across primary care, community, and acute settings. It includes seven yes/no questions covering advanced age, male sex, activity limitation, dependence on help, homebound status, social support, and mobility aid use. A score of 3 or more is commonly used as a positive frailty screen and should prompt more comprehensive geriatric assessment.
Formula: PRISMA-7 score = sum of 7 yes/no items, range 0-7; >=3 suggests frailty risk.
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PRISMA-7 is a 7-item self-administered or interviewer-administered frailty screening questionnaire. Each item is answered Yes or No; positive responses score 1 point (except item 6, where 'No' = 1 point — reversed scoring). The seven items are: (1) 'Are you more than 85 years old?' — Yes=1, No=0. (2) 'Are you male?' — Yes=1, No=0 (males have higher frailty risk at older ages in this instrument). (3) 'In general, do you have any health problems that require you to limit your activities?' — Yes=1, No=0. (4) 'Do you need someone to help you on a regular basis?' — Yes=1, No=0 (captures any regular caregiver dependency). (5) 'In general, do any health problems require you to stay at home?' — Yes=1, No=0 (homebound status is a marker of severe functional limitation). (6) 'In case of need, can you count on someone close to you?' — Yes=0, No=1 (NOTE: 'No' scores 1 point — reversed scoring; social isolation is a frailty risk factor). (7) 'Do you regularly use a cane, walker, or wheelchair to get around?' — Yes=1, No=0 (mobility aid use indicates mobility impairment). PRISMA-7 can be self-completed by literate patients in approximately 2 minutes or interviewer-administered in under 2 minutes, making it extremely practical for population-level screening.
Add all seven item scores (each 0 or 1; note item 6 is reversed: No=1, Yes=0) to produce the total PRISMA-7 score. Range 0–7; higher score indicates greater frailty risk. Score 0–1: Very low frailty risk — most items negative; patient is unlikely to have clinically significant frailty (though advanced age alone, item 1, could account for a score of 1). Score 2: Borderline — some risk factors present; annual reassessment and clinical monitoring recommended. Score 3–7: Positive screen for frailty risk — warrants comprehensive geriatric assessment (CGA). Score 3 is the commonly used positive threshold, endorsed by the original Raîche/Bergman development papers. Higher scores within the positive range (4–7) indicate greater frailty burden, though PRISMA-7 is a screening instrument rather than a frailty severity scale — clinical detail comes from the subsequent CGA rather than from the raw PRISMA-7 score.
PRISMA-7 score 0–2 = Negative screen: low probability of clinically significant frailty. Routine preventive care, annual reassessment, attention to any positive items. If score 2 with concerning clinical context, consider a more sensitive frailty tool (FRAIL Scale, Clinical Frailty Scale) for supplementary assessment. PRISMA-7 score 3–7 = Positive screen: probable frailty risk warranting comprehensive geriatric assessment. Refer to geriatrician or geriatric assessment program. CGA components: functional status (Katz ADL + Lawton IADL), cognitive screening (Mini-Cog), nutritional assessment (MNA-SF), medication review (polypharmacy and Beers criteria medications), falls risk ([Morse Fall Scale](/tools/morse-fall-scale) or TUG), social support assessment, psychological screening. From CGA findings, develop a multidisciplinary care plan addressing identified deficits. PRISMA-7 was specifically designed for triggering CGA referrals — its clinical value lies in the accuracy and appropriateness of the CGA that follows a positive screen.
Public health departments, primary care networks, community health workers, ACO programs
PRISMA-7 was specifically designed for population-level frailty identification in community and primary care settings. Its brevity (7 yes/no items, <2 minutes) and simple response format enable deployment across a broad population without trained clinical administrators. In Quebec, Canada (where PRISMA-7 was developed), the tool is used for regional frailty prevalence surveys and systematic community screening programs targeting adults aged 65+. UK NHS Community Frailty Programs use population-level frailty identification to trigger CGA referrals — PRISMA-7's simplicity makes it suitable for completion by non-clinical community workers and sent by mail. Positive screens (≥3) are referred to a geriatric care coordinator for CGA scheduling.
Emergency physicians, emergency nurses, geriatric emergency specialists
Frailty screening in the emergency department identifies older adults who need comprehensive geriatric assessment during or after their ED visit, rather than standard discharge without follow-up. PRISMA-7's brevity is particularly valuable in the ED triage environment — it can be administered by nursing staff at triage or during initial assessment. PRISMA-7 ≥3 in the ED predicts higher risk of adverse outcomes including 30-day readmission, functional decline, and nursing home placement, prompting consideration of geriatric emergency consultation, social work referral, and close post-discharge follow-up. ACEP's Geriatric Emergency Department Guidelines recommend frailty assessment for all patients ≥65.
Primary care physicians, geriatricians, practice nurses, health visitors
PRISMA-7 can be mailed to patients aged 65+ before their annual wellness visit for pre-completion, or completed in the waiting room, allowing clinical consultation time to focus on positive results and care planning rather than screening administration. Self-completed PRISMA-7 in primary care has been shown to have good agreement with interviewer-administered versions, supporting its use as a waiting-room or pre-visit questionnaire. Primary care practices with large older adult populations can use PRISMA-7 as an initial filter: patients scoring ≥3 are booked for an extended appointment with CGA components or referred to a geriatric frailty clinic.
Pre-operative assessment nurses, surgical teams, anesthesiologists
PRISMA-7 provides a rapid frailty screen at surgical pre-operative assessment that can be administered alongside other routine pre-operative assessments (consent, blood tests, ECG) without adding significant time burden. PRISMA-7 ≥3 in the pre-operative assessment clinic identifies patients who warrant escalation to formal CGA or geriatric surgery program consultation before proceeding with elective surgery. In centres without embedded geriatrician input, a positive PRISMA-7 prompts the surgeon and anesthesiologist to consider frailty-related surgical risk in their informed consent process and post-operative planning (discharge destination, rehabilitation needs, family involvement).
Social workers, case managers, home care coordinators, community support program staff
PRISMA-7 was designed partly to identify older community-dwelling adults who need home care and community support services — people who are functionally vulnerable but may not be accessing available services. Items 4 (needs regular help) and 5 (health keeps them home) directly identify patients with care needs, while items 3, 6, and 7 capture additional functional and social vulnerabilities. PRISMA-7 ≥3 in a home care eligibility assessment supports allocation of community services (home care hours, day programs, Meals on Wheels, transportation assistance) and prioritization for CGA. The tool's social isolation item (item 6) is particularly valuable for identifying older adults at risk of self-neglect who lack the social support to access services independently.
PRISMA-7 item 6 ('In case of need, can you count on someone close to you?') uses reversed scoring compared to all other items: No=1 point; Yes=0 points. Social isolation (no reliable social support) is a frailty risk factor — hence the positive score for 'No'. This reversed scoring is the most common error in PRISMA-7 administration. Verify before scoring that item 6 has been correctly applied: a patient who says 'No, I don't have anyone to count on' should score 1 point, not 0. In electronic implementations, this reversal should be built into the scoring algorithm to prevent manual errors.
PRISMA-7 was deliberately designed to have high sensitivity (catch most frail individuals) with moderate specificity (some false positives). This is appropriate for a community screening tool whose purpose is to identify people who need CGA — false negatives (frail people missed) cause greater harm than false positives (robust people receiving an unnecessary CGA assessment). Published sensitivity is approximately 73–86% and specificity approximately 57–65% against comprehensive frailty definitions. A PRISMA-7-positive patient who has a normal CGA has not been harmed — they have received a potentially beneficial assessment. Do not use PRISMA-7 as a definitive frailty diagnostic; use it as a trigger for the CGA that provides clinical detail.
PRISMA-7 item 2 (male sex = 1 point) reflects the epidemiological observation that older men in the original Quebec development population had higher frailty rates than older women at the same age — possibly related to lower baseline social support, later healthcare seeking, and faster decline after critical illness threshold. In individual clinical decision-making, a man scoring 1 point solely due to sex and age (score 1) is at lower absolute risk than a woman with multiple functional and social risk factors scoring 3. Consider the clinical context: a score of 3 driven mainly by age, sex, and mild activity limitation differs in its intervention urgency from a score of 3 driven by homebound status, regular care dependency, and mobility aid use.
PRISMA-7's clinical value is not in the score itself but in the CGA it triggers. A score of 3+ identifies people who need systematic multi-domain geriatric assessment — but the PRISMA-7 score alone does not tell you which interventions are needed. The CGA fills in the clinical detail: is the frailty driven by physical decline (exercise referral), malnutrition (dietitian), polypharmacy (deprescribing), cognitive impairment (memory clinic), depression (psychological support), or social isolation (social prescribing)? Ensure that PRISMA-7 positive screening in your setting is linked to a functioning CGA pathway — screening without assessment follow-through has minimal clinical benefit.
In community-based frailty programs, PRISMA-7 can be re-administered annually (or more frequently in higher-risk populations) to detect frailty progression or improvement. A score improvement from 3 to 1 after a structured community frailty intervention (exercise program, medication review, social prescribing) documents intervention benefit. Score worsening from 2 to 4 between annual assessments signals frailty progression requiring CGA escalation. Document PRISMA-7 scores with dates at each administration to enable trend analysis. Frailty trajectory is often as clinically important as the absolute score.
PRISMA-7 was developed in French-speaking Quebec, Canada, primarily from a community-dwelling older adult population in the late 1990s–early 2000s. Item 2 (male sex) may not perform equivalently in populations with different sex-stratified frailty epidemiology. Cultural interpretations of 'counting on someone close to you' (item 6) may vary across cultures with different social support norms (collectivist cultures with strong family support structures may score differently than individualistic cultures). When using PRISMA-7 in culturally or linguistically diverse populations, ensure translated validated versions are used and be attentive to cultural interpretation differences for items 4 and 6.
PRISMA-7 developed within the PRISMA (Program of Research to Integrate Services for the Maintenance of Autonomy) program by Raîche M, Hébert R, Dubois MF (Can J Aging 2008). Original development validation n=749 community-dwelling adults; sensitivity 76%, specificity 72% vs. Case Management Assessment. PRISMA integrated services RCT: Hébert R et al. (Age Ageing 2010) — systematic identification + coordinated services reduced disability progression. ED validation: Sirois MJ et al. (J Am Med Dir Assoc 2017). Comparative review: Pialoux T et al. (Curr Gerontol Geriatr Res 2012).
Higher PRISMA-7 totals indicate greater frailty risk and support escalation to comprehensive multidomain geriatric evaluation.
Use for rapid initial frailty triage in older adults, especially when time is limited and a simple yes/no tool is needed for referral prioritization.
PRISMA-7 favors sensitivity over detailed phenotyping, and some items (for example sex and age) may influence score independently of reversible functional factors.
Disclaimer: This tool is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about your health.
April 21, 2026 · trust-baseline
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