A healthcare provider checks a patient’s blood pressure at their home.

Addressing Frailty in the Community: Connecting to Community-Based Services

The ‘Addressing Frailty in the Community: Connecting to Community-Based Services’ report highlights the ways that 17 teams participating in the Advancing Frailty Care in the Community collaborative connected frail older adults to community-based services.

Participating teams chose from a menu of evidence-informed frailty models (or adapted others as appropriate) and they all followed the same basic care pathway.  Approaches included:

  • Using dedicated staff such as a system navigator or community connector to refer to supports and services.
  • Connecting to in-house services.
  • Connecting to both in-house and external services.

This resource was informed by final team reports and interviews with implementation team members.

Download the report