Managing frailty: from identification to intervention

Frailty is not a single disease with a single prescription. Management combines treatment of acute and chronic illness with rehabilitation, medicines optimisation, nutrition, falls prevention, sensory support, social intervention and goal-based care. The balance depends on the person’s priorities and the drivers of vulnerability.

During acute illness, prevent avoidable secondary decline: unnecessary bed rest, poorly controlled pain, sleep disruption, constipation, dehydration, missed hearing aids, sedating medicines and fragmented handover can all worsen function. Early mobilisation and rehabilitation should be tailored to safety and baseline ability.

Recent systematic reviews support multicomponent exercise for improving frailty-related and physical-function outcomes in selected older adults. The evidence does not justify one universal dose or programme. Assessment, contraindications, preferences, setting and professional input matter. The teaching message is that physical function can improve and should be actively considered rather than assumed irreversible.

Medication review should ask not only whether each medicine has an indication but whether the overall regimen remains proportionate to goals, renal function, falls risk, cognition, adherence and treatment burden. Deprescribing is not simply reducing tablet count; it is structured optimisation with monitoring.

Weight loss, swallowing difficulty, poor dentition, depression, social isolation and acute illness can all reduce intake. Nutrition assessment belongs alongside function and goals. Supplements may be appropriate in selected circumstances, but the course should avoid implying that supplements alone reverse frailty.

For complex frailty, CGA provides the structure to connect medical, psychological, functional, social, environmental and future-wishes domains into one prioritised plan. The companion CGA course teaches this in depth. Here the key principle is that intervention follows the person’s problems and goals, not the frailty score itself.

A plan needs a review question: what are we trying to improve, preserve or clarify, and by when? Function, symptom burden, falls, medication burden, carer strain and achievement of personal goals can all be meaningful outcomes.

What will you do differently when you next assess an older person whose current function differs from their usual baseline? Record one specific change in history-taking, documentation, tool use or multidisciplinary communication.