What is frailty?
Frailty is a common syndrome in older adults. It involves a decline in strength, energy, and overall resilience. This makes individuals more vulnerable to health issues that can quickly become serious. [1-3] Frailty is not just about physical weakness; it can also include cognitive and social challenges that affect a person’s independence and quality of life. [4,5]
Frailty impacts multiple systems in the body, not just muscles. It often involves chronic inflammation, which can make frailty worse and lower physical function over time. [1,6-8] Due to ageing, people with frailty will also often have multiple chronic conditions (multimorbidity) and cognitive impairment. [9] These additional issues can have a major impact on daily activities and healthcare use, making managing frailty challenging. [10,11]
Gender and social factors also influence frailty. Women, who tend to live longer, may face higher risks due to added social and psychological challenges, such as loneliness. [4,12]
Why frailty matters in aged care
Frailty is associated with range of problems for older people. These include an increased risk of falls, delirium, harm from medications and poor recovery after surgery, as well as increased hospitalisations and health care use generally. [13,14]
The Aged Care Quality Standards, especially Standard 3, focus on the need for keeping track of changes in physical and mental health to guide best care. [15] Recognising frailty and understanding its combined physical, mental, and social effects allows aged care staff to develop personalised care plans that support residents’ overall wellbeing. Identifying frailty early helps set up preventive measures to avoid complications and risks associated with the syndrome. [16]
What the evidence tells us
Frailty can be assessed routinely using a validated measurement tool such as the Clinical Frailty Scale or Edmonton Frail Scale. [16,17] Finding signs of frailty or increasing frailty helps staff take proactive actions, lowering risks of falls and hospital visits. [18] Signs of frailty include:
- Unintentional weight loss
- Exhaustion
- Reduced grip strength
- Slow gait speed
- Low physical activity. [19]
If irreversible frailty is identified, this should prompt discussions about end-of-life goals and the careful reduction of medications that may no longer benefit the resident or could be harmful. [17]
Staff training is key to recognising and managing frailty and deterioration. Training should cover safe ways to help residents move and how to communicate well within the care team. [20] Research supports that when staff are well-trained, the quality of care improves, and residents are safer. [3]
Coordinated care that aligns with the older person’s personal goals can help achieve better outcomes as the end of life approaches. [21] Working as a team to create personalised care plans is an important part of managing frailty. Plans should include input from GPs, allied health staff, and care workers, and cover all aspects of the person’s health. This approach fits with Standard 2 of the Aged Care Quality Standards, which highlights the importance of working together on care planning. [15,18,20]
Nutritional supplementation and multicomponent physical activity programs that include resistance for maintaining muscle strength may help in managing frailty. [16] Early involvement of dietitians, nutritionists, speech pathologists, and physiotherapists may therefore be helpful. Studies show that combining good nutrition with exercise can slow down frailty and improve quality of life. [22] Screening all new residents for malnutrition may identify people who should be referred to a dietitian. [16] There are simple tools available for this purpose, including the Malnutrition Screening Tool (MST) [23] and the Mini Nutritional Assessment-Short Form. [24] Speech pathologists can consult on swallowing difficulties [16] while people with advanced frailty may benefit from referral to a geriatrician. [17]
Caring for frail residents can be difficult, especially in areas with limited resources. Telehealth can make specialist care accessible in remote locations. [25] Balancing resident independence with safety measures can also be complex. Many residents want to stay as independent as possible, which may not always align with risk management practices. Regular feedback from residents and staff can help find the right balance between respecting independence and ensuring safety. [5,18] Other challenges include managing multiple medications [16] and dealing with the emotional effects of frailty on residents and their families. [26]
Care of people with dementia
Frailty and dementia often occur at the same time in older adults, which can make their care needs more complex. It is helpful for staff to be aware of how frailty and cognitive impairment might influence each other, as the combination of physical weakness and dementia increases dependency and vulnerability to adverse health events. [27] People with both conditions may experience not only physical frailty, but also behavioural changes and cognitive challenges, which will require adaptations in their care plans to address their needs. [28] Simple, clear communication methods, such as using straightforward language and visual aids, can support residents’ understanding and engagement in their care, particularly as cognitive abilities decline over time. [29] Involving specialist clinicians, including occupational therapists and geriatricians, may also help create personalised interventions that aim to improve comfort and quality of life for frail residents living with dementia, with a focus on addressing both physical and cognitive needs. [27-29]
Cultural considerations
Culturally appropriate care is essential in managing frailty, especially for residents from diverse backgrounds. Standard 1 of the Aged Care Quality Standards requires care that respects each resident’s identity, beliefs, and traditions. Using culturally relevant communication, like language support and familiar practices, helps build trust and encourages residents to take part in their care. [20] Understanding cultural preferences - such as specific dietary needs, family roles in care, and spiritual practices - can make frailty care more effective and improve health outcomes. [11,22] Connecting with community leaders or cultural liaisons can strengthen relationships between care providers and residents, promoting a supportive environment. [30]
Considerations for families
Involving families in care discussions and providing them with information can improve their sense of preparedness and support. [11,21]
Considerations for home care
For home care, managing frailty means supporting older adults to stay safe and independent in their own homes. Regular checks by clinical staff using tools like the Clinical Frailty Scale can help spot early signs of frailty and guide actions to prevent issues like falls. [31] Personalised care plans that involve GPs, allied health professionals, and family carers make sure the care matches the person's needs and goals. [32] Training for home care workers is important so they know how to help frail older people move safely and communicate well. Good nutrition and light exercise may also help slow down frailty, making a big difference in the quality of life for those receiving care at home. [33]
Page updated 07 April 2025