Management of frail older people with acute illness

Frailty status is intrinsically related to every aspect of older patients' hospital journeys: the way in which they present to hospital, their health status at admission, vulnerability to complications in hospital and rate of recovery after an acute insult. In younger people, hospitalisation is usually the result of a serious illness or injury, such as sepsis or major trauma. Management can be underpinned by evidence-based algorithms relating to the precipitating insult and recovery usually follows a predictable trajectory. In older people who are frail, on the other hand, admission to hospital may be triggered by an illness that may seem minor, such as a viral infection, which causes a geriatric syndrome. A fall or delirium with no major precipitant should be considered an indicator of frailty. Promptly recognising the acute illness and the increased risk for hospital-associated complications is essential for providing safe systems of care for frail older people. Early consideration of health assets and engagement of families and community services can have an important role in successful recovery during and beyond the hospital stay. Effective decision-making about clinical interventions can benefit from explicit assessment of frailty status and consideration of patient priorities.