This Toolkit is a central hub for Frailty and Dementia resources for practitioners.

This Toolkit brings together resources, tools, advice and guidance and best practice for practitioners into one location. It is a work-in progress that will be added to over time.We welcome all feedback to the Toolkit and suggestions for content you would like to see in the future.

If you are aware of any changes in guidance or new updates that are missing from the Toolkit then please let us know. Please contact glicb.ageingwell@nhs.net to get in touch.

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This toolkit is designed to support people by helping professionals across health, social care, and community settings identify, assess, and manage frailty in a consistent and compassionate way

Important Note for Practitioners
This toolkit is for informational purposes only and does not constitute clinical or medical advice.  It does not replace professional judgement or individualised patient care. Practitioners should always apply their own clinical expertise and consider the specific needs and circumstances of each patient when using the information provided.

People living with frailty often experience changes that affect their independence, resilience, and overall wellbeing.

The British Geriatric Society defines frailty as ‘a distinctive health state related to the ageing process in which multiple body systems gradually lose their in-built reserves’. (British Geriatric Society)

It is also defined as a state of health which is more common among older adults. People with frailty lose their in-built reserves and their health becomes increasingly vulnerable to events such as an infection or change in medication or environment. This group of older people is at risk of adverse outcomes such as disability, falls, hospital admission, and the need for long-term care (NIHR)

Frailty is not a disease but is a set of symptoms.

Frailty

People living with dementia may experience gradual changes that affect how they think, communicate, and interact with the world around them.

Dementia is an umbrella term for a range of progressive conditions that affect the brain. Each type of dementia stops a person’s brain cells (neurones) working properly in specific areas, affecting their ability to remember, think and speak. Doctors typically use the word ‘‘dementia’’ to describe common symptoms – such as memory loss, confusion, and problems with speech and understanding – that get worse over time. Dementia can affect a person at any age but it’s more common in people over the age of 65.

There are many different types, subtypes and causes of dementia. The most common are Alzheimer’s disease, vascular dementia, Lewy body dementia, frontotemporal dementia and mixed dementia. (Dementia UK)

Dementia

Personalised care means people have choice and control over the way their care is planned and delivered. It is based on ‘what matters’ to them and their individual strengths and needs.

This happens within a system that makes the most of the expertise, capacity and potential of people, families and communities in delivering better outcomes and experiences.

Personalised care represents a new relationship between people, professionals and the health and care system. It provides a positive shift in power and decision making that enables people to have a voice, to be heard and be connected to each other and their communities. (NHS England » What is personalised care?)

Personalised Care

Proactive care helps people to remain living independently and well for as long as possible in the place they call home. It aims to improve health outcomes and patient experience by delaying the onset of health deterioration where possible, maintaining independent living and reducing avoidable exacerbations of ill health, thereby reducing use of unplanned care.

The national guidance prioritises providing a personalised holistic approach to care and support for people living with moderate or severe frailty. NHSE Proactive Care

Proactive Care