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Maximising independence: A guide to avoiding frailty

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Maximising independence: A guide to avoiding frailty

Frailty in context:

People living with frailty are often less resilient to health changes in their body, leaving them vulnerable to deterioration. It means they are at increased risk of potentially large changes in their physical and mental wellbeing after even minor events; such as an infection, a fall or a change to medications.

Not all older people are frail and frailty is not an inevitable part of ageing however, around 10% of people aged over 65 years have frailty, rising to approximately half of over 85’s.

Frailty develops slowly over years and signs often begin subtly; due to this frailty often goes unrecognised until much later when symptoms are more obvious.

People now live longer, so frailty is becoming more common. It is therefore even more important to recognise how it affects peoples lives, and what can be done to help.

Frailty is not always a one way deterioration; it is often possible to reduce or reverse frailty symptoms with the right guidance and motivation.

We work with people who are identified as living with frailty to maximise independence, and empower them to manage symptoms of frailty themselves.

A guide to frailty

  1. Very fit
    -Fittest for their age
  2. Well
    -No active disease
    -Less fit
    -Active occasionally,e.g. seasonally
  3. Managing
    -Medical issues well-managed
    -Not regularly active beyond walking
  4. Coping
    -Symptoms limit activity
    -Not dependent for daily help but…
    -Sometimes ‘slowed up’ or ‘tired’
  5. Mildly frail
    -More evident slowing
    -Need help with domestic tasks
    -Need support with outdoor activity e.g. shopping and meal
    – preparation with bathing
  6. Moderately frail
    -Need help with outside activity
    -Help with domestic tasks
    -Stairs are harder
    -May need support with bathing
  7. Severely frail
    -Needs support for all personal care
    -Medically stable but requires monitoring
    -Not mobile beyond short distances

Reference: Rockwood K, Song X, MacKnight C, et al.  A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005.

Using this booklet

This booklet outlines some of of the most common frailty risk factors in chapters. Its aim is to provide guidance on ways in which you can maintain your quality of life, and your physical and mental wellbeing whilst living with frailty.


  1. Falls risk: staying steady
  2. Keeping mobile
  3. Environment, function and independence
  4. Pain that affects function
  5. Continence management
  6. Skin care
  7. Diet and nutrition (including weight loss)
  8. Memory and mental

Falls are more likely if we have frailty. They are a leading cause of admission to hospital in older adults and can result in serious injury and long-term health problems, as well as a loss of confidence and independence. See our checklist to establish if you may be at risk of falls…

Am I at risk of falls?

How many of the below apply to you?

  • My slippers have that ‘lived-In’ look
  • Taking care of my feet is quite difficult these days
  • I have a long-term condition such as Parkinson’s, heart disease/stroke, arthritis, COPD, diabetes, dementia
  • I save electricity by turning off unnecessary lights
  • My alcohol intake is probably more than GPs’ recommended limits (2-3 units a day for women, 3-4 for men)
  • I don’t get out as much as l’d like because I worry about tripping, I feel unsteady
  • If I had a fall I would probably be too embarrassed to tell anyone
  • l often get my feet tangled up in things that could trip me. my pets or grandchildren running around worry me sometimes: they make me feel wobbly!
  • I am not always that warm at home
  • I have had a fall but not seen anyonecabout it
  • My GP hasn’t reviewed my medication in the past year
  • I often need to get up in the night to go to the loo
  • I am probably not as active as doctors recommend (30 minutes moderate activity five times a week).
  • I sometimes feel dizzy or light-headed on standing or walking
  • I struggle with basic maintenance on my home
  • I wear bi-focals or vari-focals
  • I haven’t had an eye test in the past 12 months
  • I sometimes feel weak when I get up from a chair or the bed
  • A bit of clutter has built up at home over the years
  • I probably don’t drink enough fluids (1.6 litres/3 pints a day for women: 2 = litres/3.5 pints for men).

Falls are more likely if we have frailty. They are a leading cause of admission to hospital in older adults and can result in serious injury and long-term health problems, as well as a loss of confidence and independence. See our checklist to establish if you may be at risk of falls…

Home safety checklist

  • Declutter: clear furniture from walkways, tidy wires, remove rugs/ tape edges to avoid tripping
  • Ensure there is sufficient lighting and handrails on stairs, and keep free of clutter
  • Move heavy or difficult items in the kitchen to a height that does not require you bending low or reaching high
  • Consider grab rails and non-slip mats in the bathroom – this is a slippery area!
  • Put a lamp in reach of the bed. If the area between your bedroom and bathroom is dark, consider a hallway night light.
  • Keep emergency numbers that are easy to read next to phones
  • Carry a phone in the house, or have a pendant or wrist alarm so help can be called at all times
  • Get a fire safety check from the fire service. They can install a fire alarm if needed, free of charge.
  • Raise or change chairs that are too low or difficult to get up from
  • Place stools around the house to use as a rest, especially if you become breathless/experience pain when walking.
  • Keep outdoor paths tidy from weeds/shrubs and keep paving in good condition
  • Ensure heating is in good working order (over 18 °C). Cold houses can cause chest problems or contribute to flu.
  • Consider organising access to the property in an emergency, e.g. key safe
  • Consider creating access to a toilet on each level of your home
  • Think through the trip hazard a pet may cause. Consider shutting them in living room whilst answering the front door.

Keeping mobile

Walking aids

Some people may benefit from a walking aid to maintain safe walking and independence. Ask a healthcare professional about an assessment for this if it is relevant.

Keep moving!

Inactivity causes deconditioning. Daily exercise is so important in avoiding frailty symptoms. Exercise is shown to…
Increase strength, flexibility, balance & functional independence. It is also proven to decrease depression, body fat, arthritic pain, blood pressure problems and risk of falling.

Impact of medications:

Taking multiple medications can affect safe mobility and impact on your general health. If you notice dizziness or are not feeling yourself after a medication change (or weight loss) you may benefit from a medications review. This can be done via your GP or pharmacist.

Foot care:

Long toe nails & ill fitting footwear significantly impacts mobility & increases falls risk. Ensure shoes fit well, provide ankle support, have adequate grip and have a flat heel. Those with foot care issues may benefit from input from a Healthcare Professional.

People with diabetes should be particularly aware of the importance of good foot care.

Chair based exercises for maintaining strength and functional independence.

Muscles, bones and joints like to be moved, lack of movement causes your muscles to waste away quickly and this affects your strength and your balance.

The exercises below will help you to stay strong and steady. Aim to do these exercises two to three times throughout the week. You can spilt them up and do them a few at a time throughout the day, at a time that works for you. Remember to start small and build up
gradually. As the exercises begin to feel easier you can increase the repetitions to 8-10. If you want to make it harder still, you can build up to three rounds of 8-10 repetitions for each exercise.

Strength exercises can be done sitting or standing. If you can’t stand comfortably or safely, then choose the seated option. Please use a stable and secure surface for balance when standing.

Always warm up before you start

Sit up straight in a supportive chair, take two or three deep breaths in and out to calm the mind and body in preparation for the exercises.

Heel lifts: 
-Lift heels off the floor, then place them back down.
-Lift toes off floor then place down.
-Do these slowly and fully.
30 seconds

Chair marching
-Lift one leg at a time, as if marching.
-You can add your arms in too, if comfortable.
30 seconds


Arm raises

Raise your arms out to the side and above your head, then slowly lower back down. Start with three then build up.

Make this harder by going very slowly and hold for one second at the top before you lower your arms down.

Alternate leg extensions

Straighten out one leg in front of you, then lower slowly back down. Start with three each leg then build up.

Make this harder by lifting the leg slightly off the chair as you straighten it.

By the end of the warm up you should feel warmer and be breathing a little harder.

Arm curls

Keep elbows into your sides, bend one arm up, then slowly lower. Alternate sides. Start with three repetitions on each side.

Make this harder by holding a small weight, bottle of water or tin of food.

Cool down

Let your breathing settle and enjoy the feeling of accomplishment!

Hamstring stretch

Feel gentle stretch at back of thigh. Hold for 20 seconds.

Chest opening

Feel gentle stretch across your chest. Hold for 20 seconds.

Breathe. Three deep breaths in and out

Standing Exercises

Always warm up before you start.

Remember to have something sturdy, like a work surface, next to you. Use it to stay steady and safe.


Slow march on the spot, gradually lifting the knees slightly higher, or by marching a little faster and adding arms in.
30 seconds

Shoulder rolls

Three each way. You should feel warmer and be breathing a little harder now.

Mini squats

Stand tall, slowly bend your knees keeping your body upright. Push up and return to standing Start with three repetitions then build up.

Make this harder by going a further into the squat, and holding for longer.

Small lunges

Take a small step forward and bend both knees. Push back into standing. Start with three repetitions each leg and build up.

Make this harder by stepping further forward, ensuring you return from the lunge position in one steady step backwards.

Wall press up

Slowly bend both arms so that your nose moves closer to the wall. Slowly push back into standing.

Start with three repetitions then build up.

Make this harder by moving very slowly and smoothly.


Heel/toe raises

Push up onto your toes,keeping bottom in, thenslowly lower back down. Do these slowly whilst maintaining good posture. Start with three repetitions and build up. Make this harder by lowering down very slowly.

Sideways leg lift

Lift one leg slowly out to the side, to where it is comfortable and keep your upper body straight. Slowly lower back down. Start with
three repetitions each leg then build up. Make this harder by moving the leg very slowly.

Cool down

Let your breathing settle and enjoy the feeling of accomplishment!

Hamstring stretch: Hold for 20 seconds

Chest opening Hold for 20 seconds

Breathe three deep breaths.

Ways to build activity into your day

As well as doing these exercises two to three times a week, try to avoid any long periods of inactivity and find ways to build movement into your day, every day. Any movement is good, particularly if it makes you feel a little bit warm and makes you breathe a little faster.
Cleaning Dancing Gardening Going up and down stairs Stretching regularly

Information above is adapted from the Public Health England Active at Home booklet:

3. Environment, function and independence

Safe home: Ensure hazards are removed to reduce risk of falls, skin grazes etc. Take a look at our home safety checklist.

Local amenities: Staying connected to your local community is important for quality of life and mental wellbeing. There are often accessible transport services, activity centres and support with shopping.

Carer support: There is assistance available for people who provide regular support to someone; these people are recognised as carers or care givers.

Maintaining independence: If you are struggling in the short-term with functional tasks such as bathing, dressing, going to the toilet or preparing meals, a short period of rehab could benefit you; request a referral for therapy from your GP. If you have been
finding functional tasks difficult for a longer period of time, a social services assessment may benefit you. They can look at your longer-term needs and provide support if deemed appropriate.

Physio and Occupational Therapy: People experiencing mobility or functional issues could benefit from a therapy assessment to look at their needs. Therapists could provide valuable advice, exercise, equipment or education.

Assistive Technology can provides
equipment aimed to help remain independent in your own home. Products are able to help 24 hours a day, 7 days a week, from 52p per a day.Options includes: Fall Detectors, Memory aids, Pager linked equipment, Epilepsy Sensors, GPS Trackers and so much more!
Please contact the team to find out about products to best suit your needs: 0300 125 6899.

4. Pain that affects function

Ask for help: As we age, our body endures more wear and tear through activity, but pain is not a natural part of ageing. Evidence shows that people who experience pain often don’t ask for help.

Take regular pain control: In some long-term conditions it is not always possible to completely stop pain, but it may be possible to minimise symptoms. Taking regular pain control, as prescribed, should help.

Pace Yourself: Regular pain can cause people to become inactive, which causes deconditioning. Tackling pain symptoms and pacing your activity can make it easier to maintain activity and in turn, quality of life. Close to 50% of community based adults over 65 report pain that affects their function on a regular basis. You are not alone!

5. Continence management

Drink more water: Dehydration causes urine to be concentrated, this irritates the bladder creating urge even if the bladder is empty. Drinking more early in the day will reduce the chance of needing to urinate at night.

Avoid Irritants: Minimise food & fluids that irritate or stimulate the bladder & bowel. Fluids: Caffeinated drinks, fizzy drinks, citrus juices, alcohol and blackcurrant squash. Foods: Spicy food, tomato based products & chocolate.

Investigate symptoms: New incontinence, pain while urinating, urgency to pass urine/stools, increased frequency, or blood in your urine or stools can all be signs of ill health and need to be investigated. Report any of these symptoms to your GP immediately. Changes to bladder or bowel habits (e.g. rushing to get to the toilet) coul increase your risk of falling. Talk to a healthcare professional if this applies.

Avoid Constipation: Stay hydrated, eat 5 portions of fruit, veg & brown bread/pasta/rice. Do not ignore a “call to stool”, lean forward with elbows on knees when opening bowels (as long as you are not at risk of falls whilst doing this). Incontinence is very common, yet
people often find it embarrassing to talk about so don’t seek help.

Try to remember incontinence is a bodily function just like anything else & there is lots that can be done to help. You can request a particular staff gender to assess you if this makes you feel more comfortable. The NHS will make every effort for such requests to be met.

6. Skin care

Keep moving and change position regularly. This could be a short walk between rooms or marching on the spot for a few seconds. This will reduce pressure on the skin by improving circulation to the area and aiding muscle/skin health. It also eases joint stiffness.
There is a direct link between reduced mobility and maintaining healthy skin. This is because reduced movement places more pressure on the skin in areas that are in contact with surfaces. Incontinence or sweat can damage skin. Keep skin clean, dry and moisturised.

Report any issues: Older people are at higher risk as they often have more fragile skin, and are sometimes seated/ lying for long periods, which increases pressure to vulnerable areas. Report any breaks to skin or sore areas to a GP or nurse immediately, as if not treated they can lead to serious health issues such as infection or poor healing wounds. Check skin daily for marks, especially
your buttocks and bony bits.

Pressure sore hot spots
Tail bone
Back of knees

7. Diet and nutrition

Balanced diet: Eating a balanced diet including proteins, carbohydrates and some fats is important to maintain a heathy weight. Protein is particularly important as we age as it maintains muscle mass and strength. See our ‘tips for increasing protein intake’.

Weight loss: Losing weight is not a normal part of ageing. Weight loss can be due to poor appetite, inability to eat adequate meal sizes and chewing or swallow issues. If losing weight, (a sign may clothing becoming loose) then consult a health care professional
to explore ways to gain adequate nutritional intake. A self-screening tool is available at

Supplements: Vitamin D and calcium are important for general wellbeing and bone health. Vitamin D can be sourced from the sun and food, but we often don’t get enough. Supplements for these may be useful, especially for those who spend lots of time indoors.

Stay hydrated: Good hydration is essential for kidney function and avoiding illness. Recommended intake is 1.5-2 litres per day (6-8 glasses). In heart conditions this may alter for safe management; consult a doctor in this instance for advice.

Tips for a poor apetite
• Eat ‘little and often’. Small meals with added snacks are easier to manage & eating regularly can improve appetite.
• Eat more when feeling hungry e.g. if more hungry in mornings, have a cooked breakfast.
• Eat first, drink after. Drinking with meals can make you feel fuller sooner.
• Difficulty cooking? Choose ready meals or tinned foods such as chilli, bolognaise, curry.
• Have a pudding, snack, creamy soup, or a nourishing drink if you don’t fancy a full meal.
• If you are feeling tired choose soft, moist foods which are easier to eat.
• Take your time and rest during eating if you need to, have the best bits first!
• Avoid foods and drinks labelled ‘low fat’, ’low sugar’. Fat & sugar products are more nourishing
• A small glass of alcohol may stimulate appetite – try one 30 minutes before a meal (ask a doctor first to ensure suitable with your medication).
• Fresh air can stimulate appetite. Try a stroll before meals or simply sit outside for a while.
• Make mealtimes sociable if possible. Eating with others helps improve the eating experience.
• If food shopping is hard, consider alternatives i.e., online shop or community meal delivery services (such as Wiltshire Farm Foods, Meals on Wheels, Parsley Box, Oakhouse or others).
• Smoking can reduce appetite. Try not to smoke in the half an hour before a meal. Tips for increasing your protein intake
• Try to have a portion of poultry, meat, fish, eggs, beans, pulses or cheese at each meal.
• If you are vegetarian/vegan, there are more ideas on plant-based protein foods you can
include at each meal.
• Try to have a milky dessert such as yogurt, custard or rice pudding after or between your meals.
• Use fortified milk for drinks and on cereals – to make fortified milk: take 4 heaped
tablespoons of skimmed milk powder, mix to paste with a small amount of milk then whisk into a pint of milk.
• Choose drinks such as milk hot chocolate or malted drinks made with milk (these all count as fluid but are more nourishing than other fluids such as water, squash and tea).
• Some products, for example yogurts, ice cream, plant-based milks (eg, nut and oat milks), bread, pasta and cereals, have extra protein added to their ingredients – look out for the words “high protein” on the label.
• If you are struggling with your appetite or are worried you aren’t getting enough protein from your food, speak to your doctor, nurse or a dietitian who will be able to give you more advice.
• In some cases your healthcare professional may prescribe oral nutritional supplements to help. For more information about getting the most from your food and oral nutritional supplements, visit

8. Memory and mental health

Memory: Sometimes as people get older they can have problems with their memory, causing issues with thinking, problem solving and communication. If you are worried about your memory, or that of a family member, seek advice from a healthcare professional or the
Alzheimer’s Society

Loneliness: People can become isolated/lonely for a variety of reasons such as:

– Getting older, leading to difficulty getting out
– No longer being the hub of the family
– Leaving the workplace
– Deaths of spouses and friends
– Disability/illness

Delirium: Delirium is an uncommon but serious condition that causes temporary changes in behaviour and memory,
including confusion and sometimes hallucinations. It often develops soon after infection, surgery, hospital admission, changes
to medication, poor nutrition or dehydration. It can last for days, weeks or occasionally months – if you have any concerns, you
should contact a healthcare professional.

Stay active: Regular exercise, such as walking, has been proven to prevent mental illnesses in later life and raise your mood. Even doing exercises in a chair can help regulate sleep, improve your sense of wellbeing and reduce stress. Group exercise is thought to be most beneficial in older people due its social nature.

No one has perfect memory Our memories can be affected by many things; Poor hearing, multi-tasking, feeling sad, anxious and physical illness. Be aware of these factors and tackle them if they occur. Follow these helpful day-to-day tips to assist your memory!

1. Regular routines: Have a daily routine, which includes time to relax and some stimulation.
2. One place: Put keys, glasses and purse in the same place. i.e., a brightly coloured bowl.
3. Do one thing at a time: multi-tasking taxes memory i.e. don’t try to make a hot drink whilst on a phone call.
4. Reduce distractions: Noisy or busy places increases pressure on memory. Try turning the TV off when cooking.
5. Timing: Are you a morning person, or a night owl? Use ‘good’ times of the day for you, to do things that require most concentration.
6. Pacing: Do jobs at your own pace to allow time to process things; don’t let others hurry you.
7. Relax: If you forget something, keep calm and reset. Getting anxious makes memory worse.
8. Support: Ask your GP to see an appropriate health professional if you feel you need support and advice.

Sleep well tips

10 tips for a more restful night:
1. Make sure the bed and bedroom are a comfortable environment, i.e. supportive mattress, comfortable temperature.
2. Ensure good air circulation – fresh air can help you sleep. Try a fan/open window.
3. Allow time to relax before bed; reduce screen time (due to blue light effect), relax with music or practice mindfulness or meditative breathing.
4. Keep active during the day – not expending much energy can lead to a restless night.
5. If something is on your mind keep a pad of paper by the bed, write it down and deal with it in the morning. Try not to dwell on it at night.
6. Avoid caffeine after 4pm, decaffeinated tea/coffee is a useful switch.
7. Try not to nap during the day – it can lead to wakeful nights and a mixed up pattern.
8. If you go to the toilet a lot during the evening, try changing the pattern of your fluid intake – drink more during the day and reduce fluid intake after 6pm. It is important that you stay hydrated so that your kidneys don’t have to work too hard.
9. Hunger: if you eat tea early and wake not knowing why, it may be because you are hungry. Try eating some snacks in the evening before bed (or keep some by your bed) to stave off hunger.
10. If you are a light sleeper try ear plugs and black out curtains for a less disturbed sleep. If you have tried the above and seen no improvement, contact your GP for assessment/ advice.


Sometimes as people age (or even when younger, if due to long-term health conditions) bodies struggle to maintain their natural fitness.

Don’t worry – it is never too late to improve. It may just take a little more effort or support from others to keep as fit and healthy as you can. It is important to remember:
– Everybody’s journey is different. Set small, achievable goals daily; weekly or monthly to maintain motivation.
– Being sedentary/inactive can cause many additional health problems. Try to keep as active as possible.
– Maintain a good diet.
– Adjustments could mean slight adaptations to lifestyle, or getting assistance from a healthcare professional to help along the way.
– Small details matter. Do not underestimate the difference a few changes can make in helping to maintain quality of life. It all adds up!
– Asking for help shows strength not weakness – everyone needs a helping hand sometimes.
– Healthcare professionals can provide support when needed to maintain independence and quality of life, but it is also up to the individual to help maintain themselves. Being proactive in taking steps to avoid your own frailty symptoms will provide better long-term outcomes!

Date of creation: 08/2022
Date for review: 08/2024
URN: 0420
@ SironaCIC

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Lead Author: Louise Whiting (in conjunction with various specialist Sirona care & health colleagues).