Consensus statement on frailty in the community

Frailty is a common and complex clinical syndrome characterised by reduced physiological reserve and increased vulnerability to adverse health outcomes. In Australia, frailty represents a growing public health challenge, with more than 20% of older adults estimated to be living with frailty.

The new consensus statement, published in the Medical Journal of Australia, provides comprehensive recommendations from multidisciplinary experts and consumers across Australia on the prevention and management of frailty in community-dwelling older adults.

Methods

The study uses a modified Delphi design. Phase I involved iterative discussion among six frailty care working groups, based on current evidence and expert opinion, to draft the statements. Phase II involved validation of each statement across two Delphi rounds conducted to determine level of agreement.

Main Recommendations

• A lifelong approach to health promotion for frailty prevention should focus on raising awareness, annual screening (65+ years) and personalised counselling around accessible health behaviours to manage chronic comorbidities.
• An individualised, balanced, protein-rich diet is likely to be effective in delaying the onset of frailty. Protein–energy malnutrition and nutritional deficiencies should be identified and treated. A nutrition care plan that considers the relaxation of dietary restrictions aligned with goals of care should be planned for older adults with severe frailty.
• Progressive, individualised and ongoing exercise should be a combination of aerobic and resistance exercise, and balance and functional training tailored to frailty level and supervised by professionals.
• Social prescribing for older adults should be co-designed with a link worker to support meaningful, accessible and culturally appropriate activities that foster social engagement, with plans customised to the individual's frailty level.
• A comprehensive, multidisciplinary medication review tailored to the older adult's health status, preferences and frailty degree helps optimise medication use, minimise harm and support functional independence across all stages of frailty.
• Older adults with severe frailty need a regularly reviewed, personalised care plan, which involves carers in decision-making, supports advance care planning and ensures high-quality end-of-life care.

Changes in management informed by this statement

The consensus statements introduce an integrated, evidence-informed and consumer-focused framework to guide healthcare professionals in delivering personalised and effective care for community-dwelling older adults living with or at risk of frailty.

“The statements reflect a shared commitment to facilitating frailty-informed care and enhancing the quality of life and health outcomes for older adults in community settings,” the authors wrote.

“Clinicians and healthcare professionals should adopt and combine key recommendations such as raising awareness, personalised counselling on health behaviours, optimal protein intake coupled with exercise programmes, encouraging meaningful social engagement and customising care plans to the individual's values and goals of care, with a special focus on optimisation of medicines.”

“Collectively, these recommendations aim to embed integrated, multidisciplinary frailty care delivered in community settings to optimise outcomes for older adults across all stages of frailty.”

Read the consensus statement in the Medical Journal of Australia.