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.

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. 

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".

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, see: Silver Book II. Quality care for older people with urgent care needs.

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.

• Acute Frailty Network Newsletter Feb 2017

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

• NHS Specialised Clinical Frailty Network. Clinical Frailty Scale. Frailty & COVID-19: why, what, how, where & when?

• NIHR (2018) Comprehensve care. Older people living with frailty in hospitals. This review looks at the concept of ‘frailty’ in older people and what can be done to raise awareness amongst hospital staff, so that they identify and manage the needs of this group of people and avoid known potential problems.

• Royal College of General Practitioners. Joining up care for older people with frailty. This report shows how GPs and geriatricians are collaborating to design and lead innovative schemes to improve the provision of integrated care for older people with frailty.

• 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.

• SIGN (2020). Management of osteoporosis and the prevention of fragility fractures. This guideline provides recommendations based on current evidence for best practice in the management of osteoporosis and prevention of fractures.

• Skills for Health. Frailty Core Capabilities Framework. Health Education England and NHS England have commissioned the development of a Frailty Core Capabilities Framework. The framework will aim to identify and describe the skills, knowledge and behaviours required to deliver high quality, compassionate care and support. 

• Toolkit for general practice in supporting older people living with frailty. 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.