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It is estimated that more than a quarter of older adults are frail, making them more likely to have poor health outcomes. With an ageing population, itimely recognition of frailty followed by an evidence-based intervention can improve health outcomes. 

We partnered with five health services to introduce an approach to frailty screening and management - recognising and providing timely intervention to patients presenting with frailty and pre-frailty.


We tested a frailty screening process and bundle of care to address frailty in five community settings, with a targeted response addressing strength, nutrition and polypharmacy.

Health services reported an 18 per cent increase in screening, and older people reported improvements in function, social interaction, independence and enjoyment.


  • The percentage of older people screened for frailty increased from 70 to 88%
  • No significant improvement was observed in percentage referred to the bundle of care
  • There was a trend towards slight improvement in frailty status (note: limited data) 
  • Consumer reported benefits including improvement in function, social interaction, increased independence, enjoyment and being pushed out of comfort zone
  • Increased clinician knowledge and understanding of improvement science.

Project summary

Get in touch

Clinical Guidance Team
Safer Care Victoria
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