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Integrating Frailty into Chronic Disease Management: Enhancing Care for Older Adults living with Complexity

Unrecognized or unmanaged frailty can impact the achievement of desired outcomes for individuals living with chronic conditions such as Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure (CHF), Diabetes Mellitus (DM), etc. The Guidance Document details a practical, 4-step approach for integrating frailty-informed care into Chronic Disease Management for older adults. Frailty is a dynamic condition that influences clinical outcomes, self-management capacity, and risk of harm. Identifying and addressing frailty early allows primary care providers and specialty care teams to tailor care plans, mobilize appropriate supports, and improve quality of life.


Related Resources:

Related Resources

Related Resources

SfCare Framework

Designing Integrated Care for Older Adults 

Position Statement on The Need for Expert Clinical Geriatric Care in Ontario Health Teams 

Central East Region Intra-COVID Hybrid Adult Day Program Model Guidelines

Specialized and Focused Geriatric Services Asset Inventory 

A Measurement Primer

Central East Adult Day Program Guidelines 2020

Population Health Planning

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