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Older Person, Frailty & Community Care Centre

Older Person, Frailty & Community Care Centre

A practical, multidisciplinary knowledge centre for recognising frailty, understanding acute change, undertaking comprehensive assessment, supporting recovery, designing community pathways and providing palliative care when goals change.

ClinicalEdu › Older Person Centre

Flagship ClinicalEdu centre

One place for knowledge, assessment and practice

This centre is designed as an evolving online handbook and practical learning environment rather than a collection of isolated calculators. It follows the older person's journey across home, community, urgent care, hospital, rehabilitation, care homes and palliative care.

The organising idea

Start with the person's usual state and what matters to them. Identify acute change. Use multidimensional assessment. Treat reversible problems. Protect function. Rehabilitate where possible. Coordinate care across settings. Introduce palliative approaches when burden, reserve and goals indicate they are needed — often alongside rehabilitation rather than instead of it.

Explore

Core areas

Phase 1 live

Frailty & CFS

Understand frailty as a dynamic state of reduced reserve and learn to use the Clinical Frailty Scale as a judgement-supported tool.

Open frailty section →

Phase 1 live

Comprehensive Geriatric Assessment

Move from a score to a multidimensional, coordinated plan spanning medical, functional, psychological and social domains.

Open CGA →

Phase 1 live

Rehabilitation & recovery

Protect mobility, function and participation; recognise deconditioning; measure recovery and support a realistic new baseline.

Open rehabilitation →

Phase 1 live

Community & neighbourhood care

Proactive care, urgent community response, community hospitals, care homes and continuity around the person.

Open community care →

Phase 1 live

Palliative frailty

Recognise transition, hold uncertainty, align treatment with goals and integrate comfort-focused care with ongoing active treatment where appropriate.

Open palliative frailty →

Phase 2 interactive

Assessment tools

CFS, HABAM, PFFS/PFFS Acute and a guided CGA workspace, with original authorised reference materials available now.

Open tools hub →

The older-person journey

Living well / resilience
Emerging frailty
Acute change
Recovery / new baseline
Advanced / palliative frailty

The pathway is not linear. People may improve, deteriorate, stabilise or move between rehabilitation and palliative priorities over time.

Current authoritative context

NHS England · Best practice guide for NHS frailty pathways (2026)Open current guidance ↗
Welsh Government · Proactive care for adults with complex needs and older people living with frailty in the communityOpen Welsh guidance ↗
NICE NG56 · Multimorbidity: clinical assessment and managementOpen NICE guidance ↗

About this content

Source-led learning

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For time-sensitive decisions, always check the current operative guidance and local pathway.

Reviewed and updated

Clinical content is version-controlled and reviewed as source guidance changes.

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