Transforming Acute Frailty Care at the Hospital Front Door
Evidence-based frailty pathways, AI-supported decision tools, and front-door Comprehensive Geriatric Assessment designed to reduce admissions, improve outcomes, and standardise care across the NHS.
Why Current Systems Struggle
Acute pathways were designed for single-organ disease — not for older adults with multimorbidity, frailty and complex social context.
Fragmented assessment
Patients reviewed in isolation by multiple teams without a unified frailty lens.
Delayed CGA
Geriatric assessment often arrives 24–72 hours after admission, after deconditioning starts.
Polypharmacy burden
Older adults arrive on 8+ medications; structured review is rarely embedded at the front door.
Delirium risk
Hyperactive and hypoactive delirium are missed in up to 50% of acute presentations.
Discharge delays
Lack of community wrap-around prolongs stays and accelerates functional loss.
Specialty silos
Frailty crosses every specialty but is owned by none in many acute trusts.
Reactive, not proactive
Crisis-led care displaces anticipatory planning and goals-of-care discussions.
A clinical syndrome — not simply old age
Frailty is a state of increased vulnerability resulting from age-related decline in reserve and function across multiple physiological systems.
Frailty changes everything about how patients should be assessed
A frail 80-year-old presenting with a urinary tract infection is not the same clinical problem as a fit 80-year-old. Standard pathways miss polypharmacy, cognition, falls risk, social context and goals of care — all of which determine outcome.
- Frail patients have longer hospital stays and higher readmission rates
- Hospital-associated deconditioning can be irreversible after 7 days of bed-rest
- Polypharmacy reviews can prevent up to 30% of admissions
- Early CGA reduces functional decline and improves 12-month survival
“Frailty is not simply ageing — it is a measurable clinical syndrome associated with vulnerability, deconditioning and poorer outcomes.”
Front-Door Comprehensive Geriatric Assessment
Multidisciplinary geriatric expertise placed at the hospital front door — assessing, treating and safely discharging frail older adults within hours, not days.
Identify
Screen every patient over 65 with the Clinical Frailty Scale at the front door.
Assess
Multidisciplinary CGA covering medical, functional, cognitive and social domains.
Treat
Targeted intervention, medication review, rehabilitation and goals-of-care planning.
Discharge
Safe same-day discharge with community support and follow-up.
- Frailty score (CFS / Rockwood)
- Observations & bloods
- Medication list
- Cognition (4AT)
- Mobility & function
- Social context
- Admission risk stratification
- Delirium screening prompts
- Polypharmacy alerts
- Discharge optimisation
- One-Click Frailty Profile
- Standardised CGA record
- Safer clinical decisions
- Improved discharge planning
Operational intelligence designed to support — not replace — senior clinical decision-making.
Real-World Acute Frailty Outcomes
Outcomes observed through frontline NHS acute frailty practice — a live, multidisciplinary, front-door geriatric service.
Developed through frontline NHS acute frailty practice.
One-Click Comprehensive Geriatric Assessment
A unified frailty profile, generated at the point of contact — designed for pressured acute teams.
- Initiate delirium prevention bundle
- STOPP review — consider deprescribing
- Refer to community frailty team
Reduce duplication. Accelerate assessment. Standardise frailty care.
- A single frailty profile generated from existing clinical data
- Visual cognition, mobility and medication risk indicators
- Discharge recommendations aligned to community capacity
- Decision support that augments — never overrides — clinicians
- Designed to reduce cognitive load on pressured acute teams
Frailty Knowledge Hub
An evolving educational resource for clinicians training and practising in geriatric and acute medicine.
Landmark Studies
CGA evidence (Ellis et al.)Cochrane meta-analysis: CGA increases the likelihood of being alive and at home at 12 months.
Cochrane meta-analysis: CGA increases the likelihood of being alive and at home at 12 months.
Acute Care for Elders (ACE)ACE units reduce functional decline and length of stay through environment, team, and process redesign.
ACE units reduce functional decline and length of stay through environment, team, and process redesign.
BGS Silver Book IIStandards for the urgent care of older people, embedding frailty identification at every entry point.
Standards for the urgent care of older people, embedding frailty identification at every entry point.
Delirium prevention (HELP)Hospital Elder Life Program demonstrates 40% reduction in delirium incidence with non-pharmacological bundles.
Hospital Elder Life Program demonstrates 40% reduction in delirium incidence with non-pharmacological bundles.
STOPP/START polypharmacyStructured medication review reduces adverse drug events and inappropriate prescribing in older adults.
Structured medication review reduces adverse drug events and inappropriate prescribing in older adults.
OrthogeriatricsCo-managed hip fracture care reduces 30-day mortality and improves return-to-residence rates.
Co-managed hip fracture care reduces 30-day mortality and improves return-to-residence rates.
Hospital-associated deconditioningEach day of bed-rest in older adults reduces muscle strength by 1–5% — often irreversible.
Each day of bed-rest in older adults reduces muscle strength by 1–5% — often irreversible.
Core Topics in Geriatric Medicine
Practical resources for the front door
Tools designed by frontline practitioners — for the registrar at 2am, the consultant on a post-take ward round, and the MDT planning safe discharge.
A 2-year prospective NHS service evaluation
The Future of Frailty Intelligence
The next decade of NHS frailty care will be defined by integrated digital infrastructure that augments — never replaces — expert clinical judgement.
AI-assisted clinical workflows
Decision-support that reduces cognitive load and surfaces overlooked risks.
Scalable NHS frailty systems
A reproducible operational model for trusts of every size.
Safer discharge infrastructure
Community-integrated wrap-around to prevent readmission.
Digital CGA
A standardised, structured CGA record across the acute pathway.
Predictive operational support
Forecasting demand, occupancy and frailty acuity in real time.
Multidisciplinary integration
A shared frailty record across medical, nursing, AHP and social teams.
Front-door frailty care is now NHS policy
NHS FRAIL Strategy
National framework setting standards for acute frailty care across all NHS Trusts.
GIRFT Geriatric Medicine
Getting It Right First Time recommends front-door CGA in every acute hospital.
CQUIN Indicator
NHS England commissioning incentive linked to early identification of frailty.
BGS Position Statement
British Geriatrics Society endorses 7-day acute frailty services as standard of care.
A clinically-led frailty initiative
Frailty Solutions is a clinically-led, frontline-informed initiative dedicated to transforming acute frailty care across the NHS. Our work is grounded in multidisciplinary geriatric practice and shaped by direct experience at the hospital front door.
We focus on practical, evidence-based interventions — front-door CGA, structured medication review, delirium prevention and supported discharge — delivered through operational models that scale across trusts.
Supported through NHS Clinical Entrepreneur Programme learning and innovation networks.
Designed by practising geriatricians and acute physicians.
Built around real ward and front-door experience.
Refined through live NHS service delivery.
Resources to develop the next generation of frailty clinicians.
Three pathways to drive change
Champion CGA in your department, audit your frailty pathway, and connect with the wider community of practice.
Learn moreUse the NHS FRAIL Strategy and the evidence base to fund 7-day acute frailty services in your ICB.
Learn moreContribute to the growing evidence on front-door CGA — service design, outcomes, and health economics.
Learn moreHave a question or want to collaborate?
Reach out — we'd be glad to hear from clinicians, commissioners, researchers and patients.
Contact us