Background:
Australia’s ageing population is growing, with 1-in-6 people currently over 65—a figure projected to reach nearly 25% by 2066. Older adults are frequent healthcare users and increasingly predisposed to frailty, a syndrome involving decline across multiple physiological systems. Frailty increases vulnerability to stressors and is linked to adverse outcomes.

In occupational therapy (OT), frailty is often under-recognised, resulting in limited evidence-based practice and reduced clinician capacity. This leads to deprioritisation of frail patients, suboptimal service delivery, and challenges in progressing discharge. Frailty’s complexity contributes to reduced clinician confidence and satisfaction. Despite existing assessments and strategies, uptake is low due to limited knowledge and the perception that frailty is inevitable and irreversible.

Aim:
To improve OT service provision for frail older adults by delivering optimal frequency and modality of intervention.
To design, implement, and evaluate a Model of Care (MoC) that standardises evidence-based OT with consideration of frailty status.
To enhance clinician confidence and capability in managing frailty.

Intervention:
An OT Frailty MoC was developed through literature review, documentation audit, staff survey, and benchmarking. It includes a best-practice workflow, intervention matrix, clinician handbook, and communication supports such as team huddles and a Microsoft Teams chat.

Evaluation:
Effectiveness is measured via outcome, process, and balancing metrics including:
Days to first occupations-based input
Occasions of service (OT and AHA)
Length of stay
Workload impact

Clinical Implications/Recommendations:
The pilot is underway on a Geriatric Evaluation and Management ward. Anticipated outcomes include increased clinician capability, prioritisation of frail patients, and improved patient flow.