Actions To Help Provide Effective Acute Care For Older People Living With Frailty

Guidance to support acute teams to deliver optimal care for older people living with frailty has been developed by Getting It Right First Time (GIRFT) in collaboration with the BGS.

The new guidance, Co-ordinated frailty care for better outcomes, offers tools, practical advice and checklists to support a system-wide approach, ensuring older people with frailty receive timely access to care in the right setting.

It also features a set of actions to improve key areas: identifying frailty, preventing deconditioning, delirium, falls and bone health, end of life care and advance care planning, community-based care, and working with care homes.

In addition to optimising hospital care, its overarching principles are:
Early identification of the severity of frailty.
Adopting a ‘home first’ approach to avoid unnecessary emergency department (ED) attendance or hospital admission.
Delivering care outside hospital at an appropriate scale, to meet local demand and avoiding long waits in EDs, which cause delay-related harm.
Early discharge planning using a ‘home first’ principle.
This latest guide builds on our 2023 collaboration with GIRFT and the Royal College of Physicians (RCP), which produced the Hospital Acute Care Frailty Pathway, and the linked Six Steps to Better Care. It should also be used in conjunction with our Joining the dots: A blueprint for preventing and managing frailty in older people resource.

The guide can support the move towards developing neighbourhood teams, as outlined in NHS England’s Neighbourhood health guidelines 2025/26.

Dr Adrian Hopper, GIRFT’s clinical lead for geriatric medicine, said: “The demographic changes we are already seeing mean all healthcare professionals, regardless of their specialty, need the knowledge and skills to deliver effective care to older people.

“Now is the time to tackle variation in care we have seen across the country – issues like older people with frailty being conveyed to hospital disproportionately or deteriorating in hospital – and to adopt system-wide best practice.

We hope that integrated care systems review their existing services against this GIRFT guide and will work with their partners to embed an approach that will help us to deliver optimal care for older people living with frailty, now and into the future.”