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Frailty in older people

Life expectancy is increasing and as a result of this a higher number of older people are living with frailty

On this page you will find advice and resources on identifying frailty in older patients and choosing the right interventions to help manage their condition.

Frailty is not an illness, but a syndrome that combines the effects of natural ageing with the outcomes of multiple long-term conditions, a loss of fitness and reserves (Lyndon 2014).

Research suggests that changes in the immune system, longstanding inflammation, and decline of the musculoskeletal and endocrine systems all contribute to the onset of fraility.

Frailty occurs more often as people become older. Of people over 85 years of age about one in four is living with frailty and increasingly it is suggested that frailty needs to be thought of as a long-term condition.

What it is like for an older person living with frailty

Older people who are living with frailty often say they have fatigue, unintended weight loss, diminished strength and their ability to recover from illness, even minor ones, or injury is greatly reduced. This can have a marked impact on the quality and length of their lives.

Age UK spoke with older people to help discover what is like to live with frailty, and produced films and content to explore what the term frailty means to older people. You can view these on the Age UK website.

How to identify and treat frailty

The British Geriatric Society recommends that "Any interaction between an older person and a health or social care professional should include an assessment which helps to identify if the individual has frailty".

One method of identifying frailty in the first instance is based on the presence of indicators (Fried et al 2001). If on assessment of an older patient you are able to identify three out of the five following indicators as being present, then you can identify the patient as being frail: unintentional weight loss; feelings of exhaustion; weakness; slow walking speed and low levels of physical activity.

Frailty is a slowly progressing complex clinical syndrome that can be identified at an early stage. There are interventions that can slow decline and prevent crises.

Nurses should identify frail older people in their area of practice using validated screening and assessment tools and direct patients and carers to supportive services and interventions.

The interventions that people living with frailty can benefit from vary considerably and often need to be individually tailored. They should also be supported by a mutually created care plan.

You can find further guidance on the recognition and management of older patients with frailty in community and outpatient settings on the British Geriatrics Society website.

As a nurse working with older people it is also useful to familiarise yourself with the Comprehensive old age assessment, which is sometimes referred to as comprehensive geriatric assessment. You can view the assessment on the British Geriatrics Society website

Frailty resources

RCN initial response to HSJ Frailty Commission Consultation 2014
The RCN's response to the Health Service Journal's Frailty Commission Consultation.  

British Geriatrics Society, Scotland (2014) Think frailty and delirium - the Scottish approach
Includes an assessment tool which encourages the targeting of the Comprehensive Geriatric Assessment (CGA) at patients likely to benefit from it.

Frailsafe aims to improve measured quality of care for frail older patients admitted to NHS hospitals with medical emergencies.

Safe, compassionate care for frail older people using an integrated care pathway
NHS England published examples of good practice and the wider issues relating to how care for people living with frailty should be delivered. 

Supporting older people with frailty and achieving the requirements of the unplanned admissions enhanced service
NHS England toolkit aims to provide GPs and practice nurses with a suite of tools to support the case finding, assessment and case management of frail older patients.