Australian Consensus Statement on the Prevention and Management of Frailty Among Community-Dwelling Older Adults: A Modified Delphi Study

Adrienne Young, Caroline Gibson, Donna M. Reidlinger, Elissa Burton, Emily H. Gordon, James Baker, Leila Shafiee Hanjani, Sakshi Chopra, Ida Tornvall, Natasha Reid, Elizabeth Whiting, Sarah N. Hilmer, Jenny Job, Anthony Villani, Andrew J. Maiorana, Mark Morgan, Sarah Fox,

doi:10.5694/mja2.70182

Topics

Abstract

Introduction

This consensus statement from multidisciplinary experts and consumers across Australia provides comprehensive recommendations on the prevention and management of frailty in community-dwelling older adults.

Methods

The study uses a modified Delphi design. Phase I involved iterative discussion among six frailty care working groups, based on current evidence and expert opinion, to draft the statements. Phase II involved validation of each statement across two Delphi rounds conducted to determine level of agreement.

Main Recommendations

A lifelong approach to health promotion for frailty prevention should focus on raising awareness, annual screening (65+ years) and personalised counselling around accessible health behaviours to manage chronic comorbidities.
An individualised, balanced, protein-rich diet is likely to be effective in delaying the onset of frailty. Protein–energy malnutrition and nutritional deficiencies should be identified and treated. A nutrition care plan that considers the relaxation of dietary restrictions aligned with goals of care should be planned for older adults with severe frailty.
Progressive, individualised and ongoing exercise should be a combination of aerobic and resistance exercise, and balance and functional training tailored to frailty level and supervised by professionals.
Social prescribing for older adults should be co-designed with a link worker to support meaningful, accessible and culturally appropriate activities that foster social engagement, with plans customised to the individual's frailty level.
A comprehensive, multidisciplinary medication review tailored to the older adult's health status, preferences and frailty degree helps optimise medication use, minimise harm and support functional independence across all stages of frailty.
Older adults with severe frailty need a regularly reviewed, personalised care plan, which involves carers in decision-making, supports advance care planning and ensures high-quality end-of-life care.

Changes in Management Informed by This Statement

The consensus statements introduce an integrated, evidence-informed and consumer-focused framework to guide healthcare professionals in delivering personalised and effective care for community-dwelling older adults living with or at risk of frailty.

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Sakshi Chopra, Ida Tornvall, Natasha Reid, Elizabeth Whiting, Sarah N. Hilmer, Jenny Job, Anthony Villani, Andrew J. Maiorana, Mark Morgan, Sarah Fox, Adrienne Young, Caroline Gibson, Donna M. Reidlinger, Elissa Burton, Emily H. Gordon, James Baker, Leila Shafiee Hanjani
Lisa Kouladjian O’Donnell, Marc Sim, Michelle Miller, Peta Dampney, Pazit Levinger, Shannon King, Ruth E. Hubbard, on behalf of the Australian Frailty Network Working Group

Correspondence: r.hubbard1@uq.edu.au

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