Research focus

The management of frailty in practice

Frailty is a recognised state of increased vulnerability to adverse outcomes resulting from an interaction of physical, psychological, socio-economic and co-morbidity factors. As a diagnosis it is independently associated with falls, decreased quality of life, hospital admissions, premature entry into long-term care and death.

Frailty is a recognised state of increased vulnerability to adverse outcomes resulting from an interaction of physical, psychological, socio-economic and co-morbidity factors. As a diagnosis it is independently associated with falls, decreased quality of life, hospital admissions, premature entry into long-term care and death.


Physical activity interventions can significantly reduce the number of frailty markers. Picture: Alamy

Recognising frailty and offering personalised interventions can help support individuals to live well with the condition, to maintain independence and to remain in their own homes for as long as possible.

The three studies summarised below specifically describe the interventions that support the management of recognised frailty in practice.

Interventions to prevent disability in frail community-dwelling older persons: an overview

This narrative literature review provides an overview of interventions aimed at disability prevention in older community-dwelling adults living with frailty.

The search strategy and selection process identified 48 studies to be included in the review. The studies were combined in a narrative synthesis, grouped by the type of intervention assessed. The 49 interventions were categorised into: comprehensive geriatric assessment (CGA), physical exercise, nutrition, technology and other interventions. Data were extracted on the statistical significance of disability outcomes at the reported follow-up points.

The findings identified that 18 of the 49 interventions had a significantly positive effect for disability in the experimental group. The significantly relevant interventions included: CGA, specifically transmural care and community-based assessments incorporating treatments, referrals and recommendations; physical exercises, specifically focused on a multicomponent programme; and technological interventions including the use of assistive devices and home modifications.    

Promising aspects of the interventions included multidisciplinary and multifactorial features, individualised assessment and intervention, case management, long-term follow up, incorporation of a physical component in older people living with moderate frailty, and the use of technology. 

Daniels R, Metzelthin S, van Rossum E et al (2010) European Journal of Ageing. 7, 1, 37-55.  


Do the elderly have a voice? Advance care planning discussions with frail and older individuals: a systematic literature review and narrative synthesis

This systematic review and narrative synthesis explores the literature concerning the attitudes of the public and healthcare professionals about end of life care discussions with older and frail adults who have no main diagnosis.

The systematic literature review identified 26 studies to be included. Each study was critically analysed to answer the proposed research questions relating to advance care planning (ACP) discussions.

The review identified important themes, which included:

  • A minority of individuals living with frailty and older adults had end of life care discussions with a healthcare professional. 
  • Older adults and those living with frailty would welcome the opportunity to discuss their end of life care, although a significant minority would find this unwelcome.
  • Most studies identified that older adults wanted discussions sooner rather than later, perceiving the risk of leaving it too late.
  • Doctors see initiating end of life care discussions as their responsibility.

From a practice perspective the review identified important barriers for practitioners to be aware of from the perspective of individuals and their family members, which have not been identified in previous reviews, including:

  • Reluctance of family members to discuss end of life care.   
  • The passive expectation from the individual that family members, god or others would decide on their behalf.  
  • Significant uncertainty concerning future illness and decline.

From a healthcare perspective time pressures and the absence of a clear diagnosis to trigger ACP discussions are seen as the major obstacles. 

Sharp T, Moran E, Kuhn I et al (2013) British Journal of General Practice. 63, 615, e657-668.


Interventions to prevent or reduce the level of frailty in community-dwelling older adults: a scoping review of the literature and international policies

The study provides a comprehensive review of the interventions and policies that can prevent or reduce the level of frailty in community-dwelling older adults. A scoping review methodology was applied to identify qualitative and quantitative studies, grey literature and to facilitate a stakeholder consultation.

The systematic literature review identified 14 qualitative studies to be included: 12 randomised controlled trials and 2 cohort studies. The interventions identified in the studies included physical activity, physical activity combined with nutrition; physical activity plus nutrition plus cognitive training; home modifications; prehabilitation and comprehensive geriatric assessments. 

The scoping review highlighted that nine of the 14 studies were effective in preventing or reducing the level of frailty as a result of the intervention. All studies that incorporated exercise as a component showed a significant reduction in frailty makers and in the prevalence of frailty.

The exercise interventions ranged in duration, frequency and type, but all were significantly effective in reducing the level of frailty. More importantly, these findings were significant 12 months after completion of the intervention.

Puts M, Toubasi S, Andrew M et al (2017) Age and Ageing. 46, 3, 383-392.


Compiled by Claire Nelson, consultant practitioner trainee specialising in frailty, Berkshire Healthcare NHS Foundation Trust

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