A Community-Based Model for Detecting and Managing Frailty

Frailty is common in the older population. It represents an increased vulnerability to adverse health outcomes and consumes substantial health and social care resources. Given its negative effects on both individuals and the care system, identification and management of frailty should be incorporated in routine practice. Community-based frailty prevention programmes should include multiple elements, for instance, frailty screening; comprehensive geriatric assessments; personalized care plans and evidence-based interventions; and other forms of coordinated care. In addition, programmes should be integrated into the existing health and social care systems in order to be effective and sustainable. To this end, empowering care providers as well as motivating and regularizing the participation of older people are of utmost importance. In this chapter, we examine in detail the essence of such community programmes, as well as the prerequisites of sustainable implementation and development, using Hong Kong as an example.