Understanding Frailty in Older Adults

Reviewed by: Dr Jackie Gray, Public Health Expert and Retired GP
(Carents Trusted Reviewer Programme – Last reviewed January 2026)

Frailty is often confused with ageing itself, but the two are not the same. Many people live into very old age without becoming frail. Frailty develops when multiple systems in the body lose resilience at the same time.

This matters because if frailty is seen as “just ageing”, problems can be dismissed and support delayed. Understanding that frailty is a condition helps families push for assessment and appropriate care rather than being told to accept decline as inevitable.

People living with frailty are unusually vulnerable to sudden and significant declines in their physical or mental health. These changes can be triggered by things that might seem minor, such as an infection, a fall, or even a change in routine.

Frailty increases the likelihood of needing health or social care and increases the risk of poor outcomes. People may experience more falls, increasing disability, or a need for long-term care.

Research into frailty has grown rapidly over the last decade, but there are still many gaps. We do not fully understand why some people develop frailty while others do not, or how best to prevent or reverse it. Current evidence suggests frailty develops due to age-related changes across multiple systems in the body, including muscles, bones, hormones, the immune system, and the brain.

Many families spot the signs of frailty long before anyone uses the word. These early changes are often subtle and easy to explain away. A parent stops going out as much, struggles to recover after a minor illness, or seems more exhausted by everyday life.

You may notice more falls, slower walking, or increasing reliance on furniture for balance. Memory lapses, missed medications, or reduced appetite can also be early signs of frailty in older adults. These changes often appear gradually, which makes them harder to recognise as part of a bigger picture.

Carers often blame themselves for not acting sooner, but frailty does not announce itself clearly. Trusting your instincts matters. If something feels different, it usually is.

Identifying frailty early can make a real difference. It helps families and professionals plan care and put safeguards in place before a crisis hits.

A proper diagnosis usually requires a comprehensive assessment. People who may benefit from assessment include those who are:

• Over 85 years old

• Living in a care home

• Living with dementia

• Taking 10 or more medications

• Housebound

• Living with neurological conditions such as stroke, MS, or Parkinson’s disease

Another important group are people over 65 experiencing issues commonly linked with frailty, including:

• Falls, legs giving way, or unexplained collapses

• Fluctuating ability, good days followed by sudden drops in mobility

• Delirium, sudden confusion or worsening confusion in dementia

• New or worsening incontinence

• Strong or unusual reactions to medication

Frailty exists on a spectrum. Some people live with mild frailty and manage largely independently. Others live with severe frailty and need round-the-clock support.

There is ongoing debate among professionals about how best to measure frailty, but most systems group it into mild, moderate, or severe. These levels often, but not always, reflect how much support someone needs.

• Mild Frailty - needing help with tasks outside the home eg shopping, medical appointments, travel and transport

• Moderate frailty - needing help and support with everyday tasks in and outside the home eg  laundry, housework, financial affairs

• Severe frailty - needing help with everyday personal care tasks such as bathing, dressing, toilet hygiene

As frailty progresses, people often feel more tired and find it harder to manage the background tasks of daily life, such as:

• Managing finances

• Transport and technology

• Housework and laundry

• Taking medication correctly

• Shopping

• Preparing meals

These are the everyday tasks that keep life running. Professionals often call them “instrumental activities of daily living”.

People with more severe frailty may struggle with more basic needs such as washing, dressing, eating, or using the toilet.

Treatment for frailty focuses on reducing risks and limiting further decline. This usually includes addressing:

• Medication review, stopping or changing medicines where needed

• Falls risk assessment and reduction

• Mobility problems and muscle strength

• Incontinence

• Memory or thinking difficulties

• Low mood

• Smoking or alcohol use

• Loneliness and isolation

• Weight loss or poor nutrition

• Physical inactivity

• Vision problems

A GP may involve other professionals such as physiotherapists, occupational therapists, social workers, pharmacists, or community nurses. The NHS recommends that people with frailty have a personalised care and support plan.

Caring for a parent with frailty often means constant adjustment. Needs change quickly. What worked last month may not work now. This uncertainty is exhausting.

Many carers find themselves balancing safety with respect for independence, often without clear guidance. It is common to feel guilt, frustration, and grief alongside love. None of this means you are doing a bad job.

Practical support, honest conversations, and early planning can reduce pressure, but caring for frailty is rarely straightforward.

Many older people dislike the term frailty. Research from Age UK shows it often feels like a judgement rather than a medical condition. Because of this, the language used can become a real barrier to accepting help.

Attempts to reduce risk or increase support may be met with resistance. Care packages can feel imposed, threatening independence and control. For families, this can be incredibly frustrating and emotionally draining.

Many older people recognise frailty as a series of losses. They often cope by adapting their lives quietly, rather than openly asking for help.

Frailty is still a relatively new focus for health and social care services. Many professionals are learning as they go.

Although the NHS is developing initiatives to improve care for frailty, much of the focus remains on hospitals and care homes. Support for families caring for someone at home often feels limited or unclear and both the NHS Confederation and the National Audit Office have found that care for frailty is inadequate in many parts of the country.

Medically reviewed by Dr Jackie Gray, January 2026