New recommendations lay out a multidisciplinary roadmap for preventing and managing frailty in older adults before it spirals into hospitalisation, disability and loss of independence.
A new Australian consensus framework has outlined 19 recommendations for preventing and managing frailty in older adults, with a focus on earlier intervention, multidisciplinary care and supporting healthy ageing in the community.
Developed by University of Queensland researchers, the Australian Consensus Statement on the Prevention and Management of Frailty Among Community-Dwelling Older Adults: A Modified Delphi Study recommendations were developed through a national collaboration involving 77 healthcare experts and six consumers with lived experience of frailty.
The framework, published in The Medical Journal of Australia, outlines 19 consensus statements spanning six domains including health promotion and screening, nutrition, exercise, social prescribing, medicine optimisation and management of severe frailty.
The researchers said it is the first Australian attempt to provide integrated, multidisciplinary guidance across the full spectrum of frailty severity.
“Importantly, frailty is a dynamic and potentially modifiable condition. With timely identification and appropriate intervention, frailty can often be prevented, delayed or even reversed,” they wrote.
“Evidence supports the effectiveness of multicomponent interventions – such as nutrition, physical activity and medication optimisation – in reducing frailty and improving health outcomes for older adults.
“Despite its significance, there remains considerable variation in how frailty is understood, assessed and managed across health and community care settings in Australia.
“This variation is compounded by systemic challenges, including fragmented care pathways, limited access to multidisciplinary services and inconsistent use of frailty screening tools.”
Dr Sakshi Chopra, from UQ’s Frazer Institute, said the framework was designed to address significant inconsistencies in how frailty is recognised and managed across Australian healthcare settings.
“We have developed 19 consensus statements to guide frailty prevention and management and enhance quality of life for adults over 65 years,” Dr Chopra said.
“Our aim is to reduce long-term complications, take pressure off the health system and offer practical recommendations to support healthcare professionals in delivering consistent and proactive care.”
Frailty affects more than one in five Australians aged over 65 years and is associated with increased risks of falls, hospitalisation, disability, loss of independence and death. The condition is characterised by reduced physiological reserve and vulnerability to stressors such as illness or injury.
The researchers advocated annual frailty screening for adults aged 65 years and older using validated tools linked to clear intervention pathways.
Nutrition and exercise featured prominently throughout the recommendations, with experts supporting higher protein intake for older adults, particularly those with frailty, alongside progressive aerobic, resistance and balance training tailored to functional status.
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The statement also highlights the importance of identifying and treating protein-energy malnutrition and nutritional deficiencies through multidisciplinary care involving accredited practising dietitians.
The recommendations extend beyond physical health, calling for greater use of “social prescribing” to reduce isolation and improve engagement through community-based activities aligned with an individual’s preferences and functional capacity.
The framework proposes the use of “link workers” to help connect older adults with appropriate social and community resources.
Medication optimisation is another key pillar, with the statement warning that polypharmacy and adverse drug reactions can significantly worsen frailty outcomes.
The researchers recommended regular multidisciplinary medication reviews that account for functional status, cognition, nutrition and goals of care.
Geriatrician Professor Ruth Hubbard, director of UQ’s Australian Frailty Network, said the framework recognised the important contribution older people make to society and aimed to support healthy ageing.
“In order to optimise the health and quality of life of older people, it is important for frailty to be prevented and, if it does occur, for it to be managed appropriately,” Professor Hubbard said.
“Evidence supports the effectiveness of multicomponent interventions, and our 19 consensus statements are guided by the six pillars to improve health outcomes for adults across the spectrum of health – from robust to severely frail.”
The recommendations also place greater emphasis on personalised care planning for people with severe frailty, including advance care planning, comprehensive geriatric assessment and support for ageing in place wherever possible.
“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,” the researchers concluded.
“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.”
The framework was commissioned by the Queensland Health Reform Office in partnership with the Australian Frailty Network and developed using a modified Delphi process informed by evidence reviews, expert consultation and consumer feedback.
