Older Adults with Frailty Rehab Guidelines

Older Adults with Frailty Rehab Guidelines

The RCA’s rehabilitative care best practice frameworks and post-fall pathways support improved outcomes for community-dwelling older adults.

The Direct Access Priority Process (DAPP) supports early identification of individuals with restorative potential who require inpatient rehabilitative care and facilitates referrals directly from the community.

Older Adults with Frailty Rehabilitative Care Best Practice Framework
Rehabilitative Care for Older Adults Living With/At Risk of Frailty: From Frailty to Resilience (May 2024)

Gap Analysis Tool


What to do next:

Sets out core elements and processes of care required when providing rehabilitative care to older adults living with/at risk of frailty, recommended best practices and how to implement them within specific domains of care.

See February 23, 2022 webinar here.

Please note: This new document replaces the earlier Frail Seniors Rehabilitative Care Best Practice Framework: Bedded Levels of Care (June 2020) and the Frail Senior/Medically Complex Compendium (2015).

Frail Seniors: Guidance on Best Practice Rehabilitative Care in the Context of COVID-19 Provides best practice recommendations to guide provision of rehabilitative care services to frail seniors in the pandemic context.
The Alternate Level of Care (ALC) Leading Practices Guide: Preventing Hospitalization and Extended Stays for Older Adults Identifies evidence-based care strategies for proactive management of hospitalized older adults at risk of delayed transition to an appropriate setting. Developed by the Ontario Health ALC Leading Practices Working Group.
Pathways to Post-Fall Rehabilitative Care
Quick Reference to Post-Falls Pathways for Older Adults (November 2021) Overview of support available from RCA to help organizations implement pathways.
Pathways to rehabilitative care for frail older adults in the community presenting to primary care or ED post-fall: Pilot Report (July 2020) Initial findings from the pilot, including implementation strategies and tools.
Post-Fall Pathway: Emergency Department (August 2021) Clinical pathway for ED assessment and referrals.
Post-Fall Pathway: Primary Care (August 2021) Clinical pathway for primary care assessment and referrals.
Paramedic Post-Fall Pathway (Updated May 2024) Clinical pathway for community paramedicine assessment and referrals.
Paramedic Post-Fall Pathway Toolkit (Updated May 2024) Assessment and screening tools to be used with the Paramedic Post-Fall Pathway.
Hip Fracture Rehabilitative Care Best Practices
Rehabilitative Care for Older Adults Living With/At Risk of Frailty: From Frailty to Resilience (December 2021)

Hip Fracture: Addendum to Rehabilitative Care for Older Adults Living With/At Risk of Frailty: From Frailty to Resilience (June 2022)

Both documents should be consulted when providing best practice care to older adults with hip fracture. Together, they provide rehabilitative care best practices for all older adults with frailty, including those with hip fracture, and additional recommendations specific to hip fracture.

Please note: These two documents replace the earlier Hip Fracture Framework (March 2017/Rev Sept 2018).

Rehabilitative Care Best Practices for Hip Fracture in the Context of COVID-19 (October 2020) Additional evidence-based recommendations that align with current COVID-19 restrictions.